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1.
R I Med J (2013) ; 103(8): 62-68, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-33003683

RESUMO

STUDY OBJECTIVE: To characterize oral health practices using data from statewide, multi-stakeholder surveys. STUDY DESIGN AND METHODS: We analyzed data from two Rhode Island surveys. Together, the surveys targeted all nursing homes, residents, and resident representatives in Rhode Island, and asked about staff training on mouth care, frequency of dental provider visits, enrollment in nursing home dental programs, and barriers to oral health. Primary Results: Responding nursing home administrators reported high levels of commitment to oral health. Among residents enrolled in a nursing home dental care program, 76.1% had a preventive visit in the prior six months, compared to 31.0% of residents not enrolled. The majority of facilities (71.8%) reported that staff received training on routine mouth care at the time of hire. CONCLUSIONS: Our findings highlight opportunities to better support nursing homes in providing residents with high-quality oral health, including acquiring staff skills to manage care-resistant behaviors, and routinely assessing residents' ability to provide their own mouth care.

2.
R I Med J (2013) ; 103(6): 75-79, 2020 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-32752573

RESUMO

BACKGROUND: To quantify changes to the electronic health record (EHR) market in Rhode Island and to assess the degree of EHR market consolidation between 2009 and 2017. METHODS: The EHR market in Rhode Island is represented by three measures: the proportion of physicians who have adopted an EHR, the number of EHR vendors in use, and EHR market competitiveness, captured by the Herfindahl-Hirschman Index (HHI). RESULTS: The EHR market became more consolidated overall between 2009 and 2017. Among outpatient physicians, the market has remained competitive, despite ongoing consolidation. In contrast, the EHR market among inpatient physicians crossed into the "highly concentrated" zone in 2015. DISCUSSION: While consolidation in the EHR market may facilitate the exchange of data across health systems, potentially reducing duplicative testing and facilitating timely diagnosis, limiting competition may affect vendors' responsiveness to calls for improved usability and innovation.

4.
J Am Med Inform Assoc ; 27(9): 1401-1410, 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32719859

RESUMO

OBJECTIVE: The study sought to examine the association between clinician burnout and measures of electronic health record (EHR) workload and efficiency, using vendor-derived EHR action log data. MATERIALS AND METHODS: We combined data from a statewide clinician survey on burnout with Epic EHR data from the ambulatory sites of 2 large health systems; the combined dataset included 422 clinicians. We examined whether specific EHR workload and efficiency measures were independently associated with burnout symptoms, using multivariable logistic regression and controlling for clinician characteristics. RESULTS: Clinicians with the highest volume of patient call messages had almost 4 times the odds of burnout compared with clinicians with the fewest (adjusted odds ratio, 3.81; 95% confidence interval, 1.44-10.14; P = .007). No other workload measures were significantly associated with burnout. No efficiency variables were significantly associated with burnout in the main analysis; however, in a subset of clinicians for whom note entry data were available, clinicians in the top quartile of copy and paste use were significantly less likely to report burnout, with an adjusted odds ratio of 0.22 (95% confidence interval, 0.05-0.93; P = .039). DISCUSSION: High volumes of patient call messages were significantly associated with clinician burnout, even when accounting for other measures of workload and efficiency. In the EHR, "patient calls" encompass many of the inbox tasks occurring outside of face-to-face visits and likely represent an important target for improving clinician well-being. CONCLUSIONS: Our results suggest that increased workload is associated with burnout and that EHR efficiency tools are not likely to reduce burnout symptoms, with the exception of copy and paste.

6.
R I Med J (2013) ; 103(1): 21-24, 2020 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-32013299

RESUMO

BACKGROUND: The Rhode Island Department of Health (RIDOH) has administered the Health Information Technology (HIT) Survey since 2009 to report clinician-level process measures relating to HIT adoption and use. METHODS: RIDOH administers the Rhode Island HIT Survey to all licensed independent practitioners. Descriptive analyses examined HIT adoption and the clinician experience working with HIT. RESULTS: Most physician and Advanced Practice Provider (APP) respondents report using an EHR (92.5% and 94.3%) and e-prescribing medications (84.1% and 81.6%). Less than half of physicians (40.9% or n=565) and APPs (35.4% or n=195) who prescribe controlled substances currently submit controlled substance prescriptions electronically. A higher percentage of physicians, compared to APPs, reported experiencing HIT-related stress (80.9% and 66.6%). The overall prevalence of physicians reporting symptoms of burnout was 29.7% (n=539) but varied between specialties. DISCUSSION: As of 2019, the majority of Rhode Island physicians have adopted EHRs and e-prescribing. Adoption plateaued after 2012, and challenges persist in integrating existing technology into practice.


Assuntos
Esgotamento Profissional/etiologia , Registros Eletrônicos de Saúde , Informática Médica , Médicos/psicologia , Prescrição Eletrônica/estatística & dados numéricos , Pesquisas sobre Serviços de Saúde , Humanos , Estresse Ocupacional , Rhode Island
7.
J Am Med Dir Assoc ; 21(4): 508-512, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31812334

RESUMO

OBJECTIVE: To determine if implementation of Project Re-Engineered Discharge (RED), designed for hospitals but adapted for skilled nursing facilities (SNFs), reduces hospital readmissions after SNF discharge to the community in residents admitted to the SNF following an index hospitalization. DESIGN: A pragmatic trial. SETTING AND PARTICIPANTS: SNFs in southeastern Massachusetts, and residents discharged to the community. METHODS: We compared SNFs that deployed an adapted RED intervention to a matched control group from the same region. The primary outcome was hospital readmission within 30 days after SNF discharge, among residents who had been admitted to the SNF following an index hospitalization and then discharged home. January 2016 through March 2017 was the baseline period; April 2017 through June 2018 was the follow-up period (after implementation of the intervention). We used a difference-in-differences analysis to compare the intervention SNFs to the control group, using generalized estimating equation regression and controlling for facility characteristics. RESULTS: After implementation of RED, readmission rates were lower across all 4 measures in the intervention group; control facilities' readmission rates remained stable or increased. The relative decrease was 0.9% for the primary outcome of hospital readmission within 30 days after SNF discharge and 1.7% for readmission within 30 days of the index hospitalization discharge date (P ≤ .001 for both comparisons). CONCLUSIONS AND IMPLICATIONS: We found that a systematic discharge process developed for the hospital can be adapted to the SNF environment and can reduce readmissions back to the hospital, perhaps through improved self-management skills and better engagement with community services. This work is particularly timely because of Medicare's new Value-Based Purchasing Program, in which nursing homes can receive incentive payments if their hospital readmission rates are low relative to their peers. To verify its scalability and broad potential, RED should be validated across a broader diversity of SNFs nationally.

8.
J Gen Intern Med ; 34(11): 2542-2548, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31463685

RESUMO

IMPORTANCE: Physician attitudes about websites that publicly report health care quality and experience data have not been recently described. OBJECTIVES: To examine physician attitudes about the accuracy of websites that report information about quality of care and patient experience and to describe physician beliefs about the helpfulness of these data for patients choosing a physician. DESIGN, PARTICIPANTS, AND MEASURES: The Rhode Island Department of Health (RIDOH) and a multi-stakeholder group developed and piloted two questions that were added to RIDOH's biennial physician survey of all 4197 practicing physicians in Rhode Island: (1) "How accurate of a picture do you feel that the following types of online resources give about the quality of care that physicians provide?" (with choices) and (2) "Which types of physician-specific information (i.e., not about the practice overall) would be helpful to include in online resources for patients to help them choose a new physician? (Select all that apply)." Responses were stratified by primary care vs. subspecialty clinicians. Summary statistics and chi-squared tests were used to analyze the results. RESULTS: Among 1792 respondents (response rate 43%), 45% were unaware of RIDOH's site and 54% were unaware of the Centers for Medicare & Medicaid Services (CMS)' quality reporting sites. Only 2% felt that Medicare sites were "very accurate" in depicting physician quality. Most physicians supported public reporting of general information about physicians (e.g., board certification), but just over one-third of physicians felt that performance-based quality measures are "helpful" (and a similar percentage reported that patient reviews felt are "helpful") for patients choosing a physician. CONCLUSIONS: Physician-respondents were either uninformed or skeptical about public reporting websites. In contrast to prior reports that a majority of patients value some forms of publicly reported data, most physicians do not consider quality metrics and patient-generated reviews helpful for patients who are choosing a physician.


Assuntos
Atitude do Pessoal de Saúde , Satisfação do Paciente , Médicos/psicologia , Inquéritos e Questionários/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Internet , Masculino , Pessoa de Meia-Idade , Médicos/normas , Rhode Island
9.
J Gen Intern Med ; 34(5): 684-691, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30993609

RESUMO

BACKGROUND: In varied educational settings, narrative evaluations have revealed systematic and deleterious differences in language describing women and those underrepresented in their fields. In medicine, limited qualitative studies show differences in narrative language by gender and under-represented minority (URM) status. OBJECTIVE: To identify and enumerate text descriptors in a database of medical student evaluations using natural language processing, and identify differences by gender and URM status in descriptions. DESIGN: An observational study of core clerkship evaluations of third-year medical students, including data on student gender, URM status, clerkship grade, and specialty. PARTICIPANTS: A total of 87,922 clerkship evaluations from core clinical rotations at two medical schools in different geographic areas. MAIN MEASURES: We employed natural language processing to identify differences in the text of evaluations for women compared to men and for URM compared to non-URM students. KEY RESULTS: We found that of the ten most common words, such as "energetic" and "dependable," none differed by gender or URM status. Of the 37 words that differed by gender, 62% represented personal attributes, such as "lovely" appearing more frequently in evaluations of women (p < 0.001), while 19% represented competency-related behaviors, such as "scientific" appearing more frequently in evaluations of men (p < 0.001). Of the 53 words that differed by URM status, 30% represented personal attributes, such as "pleasant" appearing more frequently in evaluations of URM students (p < 0.001), and 28% represented competency-related behaviors, such as "knowledgeable" appearing more frequently in evaluations of non-URM students (p < 0.001). CONCLUSIONS: Many words and phrases reflected students' personal attributes rather than competency-related behaviors, suggesting a gap in implementing competency-based evaluation of students. We observed a significant difference in narrative evaluations associated with gender and URM status, even among students receiving the same grade. This finding raises concern for implicit bias in narrative evaluation, consistent with prior studies, and suggests opportunities for improvement.


Assuntos
Educação Médica/métodos , Avaliação Educacional , Estudantes de Medicina/estatística & dados numéricos , Feminino , Humanos , Masculino , Grupos Minoritários/educação , Preconceito , Avaliação de Programas e Projetos de Saúde , Sexismo , Terminologia como Assunto
11.
J Am Med Inform Assoc ; 26(2): 106-114, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30517663

RESUMO

Objective: To quantify how stress related to use of health information technology (HIT) predicts burnout among physicians. Methods: All 4197 practicing physicians in Rhode Island were surveyed in 2017 on their HIT use. Our main outcome was self-reported burnout. The presence of HIT-related stress was defined by report of at least 1 of the following: poor/marginal time for documentation, moderately high/excessive time spent on the electronic health record (EHR) at home, and agreement that using an EHR adds to daily frustration. We used logistic regression to assess the association between each HIT-related stress measure and burnout, adjusting for respondent demographics, practice characteristics, and the other stress measures. Results: Of the 1792 physician respondents (43% response rate), 26% reported burnout. Among EHR users (91%), 70% reported HIT-related stress, with the highest prevalence in primary care-oriented specialties. After adjustment, physicians reporting poor/marginal time for documentation had 2.8 times the odds of burnout (95% CI: 2.0-4.1; P < .0001), compared to those reporting sufficient time. Physicians reporting moderately high/excessive time on EHRs at home had 1.9 times the odds of burnout (95% CI: 1.4-2.8; P < .0001), compared to those with minimal/no EHR use at home. Those who agreed that EHRs add to their daily frustration had 2.4 times the odds of burnout (95% CI: 1.6-3.7; P < .0001), compared to those who disagreed. Conclusion: HIT-related stress is measurable, common (about 70% among respondents), specialty-related, and independently predictive of burnout symptoms. Identifying HIT-specific factors associated with burnout may guide healthcare organizations seeking to measure and remediate burnout among their physicians and staff.


Assuntos
Esgotamento Profissional/etiologia , Registros Eletrônicos de Saúde , Informática Médica , Médicos/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Satisfação no Emprego , Masculino , Medicina , Pessoa de Meia-Idade , Estresse Ocupacional , Rhode Island , Inquéritos e Questionários , Carga de Trabalho
12.
Appl Nurs Res ; 43: 36-41, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30220361

RESUMO

BACKGROUND: Health information technology (HIT), such as electronic health records (EHRs), is a growing part of the clinical landscape. Recent studies among physicians suggest that HIT is associated with a higher prevalence of burnout. Few studies have investigated the workflow and practice-level predictors of burnout among advanced practice registered nurses (APRNs). AIM: Characterize HIT use and measure associations between EHR-related stress and burnout among APRNs. METHODS: An electronic survey was administered to all APRNs licensed in Rhode Island, United States (N = 1197) in May-June 2017. The dependent variable was burnout, measured with the validated Mini z burnout survey. The main independent variables were three EHR-related stress measures: time spent on the EHR at home, daily frustration with the EHR, and time for documentation. Logistic regression was used to measure the association between EHR-related stress and burnout before and after adjusting for demographics, practice-level characteristics, and the other EHR-related stress measures. RESULTS: Of the 371 participants, 73 (19.8%) reported at least one symptom of burnout. Among participants with an EHR (N = 333), 165 (50.3%) agreed or strongly agreed that the EHR added to their daily frustration and 97 (32.8%) reported an insufficient amount of time for documentation. After adjustment, insufficient time for documentation (AOR = 3.72 (1.78-7.80)) and the EHR adding to daily frustration (AOR = 2.17 (1.02-4.65)) remained predictors of burnout. CONCLUSIONS: Results from the present study revealed several EHR-related environmental factors are associated with burnout among APRNs. Future studies may explore the impact of addressing these EHR-related factors to mitigate burnout among this population.


Assuntos
Prática Avançada de Enfermagem , Esgotamento Profissional , Registros Eletrônicos de Saúde , Recursos Humanos de Enfermagem/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
13.
J Gen Intern Med ; 33(11): 1892-1898, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30030734

RESUMO

BACKGROUND: Physicians spend significant time outside of regular office visits caring for complex patients, and this work is often uncompensated. In 2015, the Centers for Medicare & Medicaid Services (CMS) introduced a billing code for care coordination between office visits for beneficiaries with multiple chronic conditions. OBJECTIVE: Characterize use of the Chronic Care Management (CCM) code in New England in 2015. DESIGN: Retrospective observational analysis. PARTICIPANTS: All Medicare fee-for-service beneficiaries in New England continuously enrolled in Parts A and B in 2015. INTERVENTION: None. MAIN MEASURES: The primary outcome was the number of beneficiaries with a CCM claim per 1000 eligible beneficiaries. Secondary outcomes included the total number of CCM claims, total reimbursement, mean number of claims per beneficiary, and beneficiary characteristics independently associated with receiving CCM services. KEY RESULTS: Of the more than two million Medicare fee-for-service beneficiaries in New England, almost 1.7 million were potentially eligible for CCM services. Among eligible beneficiaries, 10,951 (0.65%) had a CCM claim in 2015. Massachusetts had the highest penetration of CCM use (9.40 claims per 1000 eligible beneficiaries); Vermont had the lowest (0.54 claims per 1000 eligible beneficiaries). Mean reimbursement per physician was $1745.98. Age, race/ethnicity, dual-eligible status, income, number of chronic conditions, and state of residence were associated with receiving CCM services in an adjusted model. CONCLUSIONS: The CCM code is likely underutilized in New England; the program may therefore not be achieving its intended goal of encouraging consistent, team-based chronic care management for Medicare's most complex beneficiaries. Or practices may be foregoing reimbursement for care coordination that they are already providing. Recently implemented revisions may improve uptake of CCM services; it will be important to compare our results with future utilization.


Assuntos
Doença Crônica/epidemiologia , Benefícios do Seguro/métodos , Classificação Internacional de Doenças , Medicare , Administração dos Cuidados ao Paciente/métodos , Adolescente , Adulto , Criança , Pré-Escolar , Doença Crônica/tendências , Feminino , Humanos , Lactente , Recém-Nascido , Benefícios do Seguro/tendências , Classificação Internacional de Doenças/tendências , Masculino , Medicare/tendências , Pessoa de Meia-Idade , New England/epidemiologia , Administração dos Cuidados ao Paciente/tendências , Estudos Retrospectivos , Estados Unidos/epidemiologia , Adulto Jovem
14.
R I Med J (2013) ; 100(8): 23-28, 2017 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-28759896

RESUMO

Background: The Hospital Readmission Reduction Program was instituted by the Centers for Medicare & Medicaid Services in 2012 to incentivize hospitals to reduce readmissions. OBJECTIVE: To examine the most common diagnoses driving readmissions among fee-for-service Medicare beneficiaries in the hospitals with the highest and lowest readmission performance in Southern New England from 2014 to 2016. METHODS: This is a retrospective observational study using publicly available Hospital Compare data and Medicare Part A claims data. Hospitals were ranked based on risk-adjusted excess readmission ratios. Patient demographic and hospital characteristics were compared for the two cohorts using t-tests. The percentages of readmissions in each cohort attributable to the top three readmission diagnoses were examined. RESULTS: Highest-performing hospitals readmitted a significantly lower percentage of black patients (p=0.03), were less urban (p<0.01), and had higher Hospital Compare Star ratings (p=0.01). Lowest-performing hospitals readmitted higher percentages of patients for sepsis (9.4% [95%CI: 8.8%-10.0%] vs. 8.1% [95%CI: 7.4%-8.7%]) and complications of device, implant, or graft (3.2% [95%CI: 2.5%-3.9%] vs. 0.2% [95%CI: 0.1%-0.6%]), compared to highest-performing hospitals. CONCLUSIONS: Ongoing efforts to improve care transitions may be strengthened by targeting early infection surveillance, promoting adherence to surgical treatment guidelines, and improving communication between hospitals and post-acute care facilities. [Full article available at http://rimed.org/rimedicaljournal-2017-08.asp].


Assuntos
Benchmarking/estatística & dados numéricos , Hospitais/normas , Readmissão do Paciente/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Planos de Pagamento por Serviço Prestado , Feminino , Hospitais/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Masculino , Medicare , Pessoa de Meia-Idade , New England/epidemiologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/terapia , Estudos Retrospectivos , Risco Ajustado , Sepse/diagnóstico , Sepse/epidemiologia , Sepse/terapia , Estados Unidos , Adulto Jovem
15.
R I Med J (2013) ; 100(7): 18-21, 2017 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-28686235

RESUMO

Chronic obstructive pulmonary disease (COPD) is associated with significant morbidity, decreased quality of life, and burdensome hospital admissions. Therefore, patients with COPD interact with clinicians in a number of healthcare settings. A coalition of healthcare practitioners in Rhode Island, in partnership with the local Quality Improvement Organization, designed and implemented a standardized, COPD education program for use across multiple healthcare settings. More than 60 organizations participated, producing 140 Master Trainers, who trained 634 staff members at their facilities from October 2015 through June 2016. Master Trainers were satisfied with the training, and we observed significant increases in knowledge scores post-training among all participants, which remained significant when stratified by setting. These results demonstrate that implementation of a community-based program to disseminate patient-centered, standardized COPD education in multiple healthcare settings is feasible. We hope this program will ultimately improve patient outcomes and serve as the foundation for expanding standardized education for other chronic conditions. [Full article available at http://rimed.org/rimedicaljournal-2017-07.asp].


Assuntos
Educação de Pacientes como Assunto/normas , Doença Pulmonar Obstrutiva Crônica , Humanos , Projetos Piloto , Desenvolvimento de Programas , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/etiologia , Doença Pulmonar Obstrutiva Crônica/terapia , Rhode Island
16.
J Innov Health Inform ; 24(2): 894, 2017 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-28749316

RESUMO

nBACKGROUND: Electronic health records (EHRs) may reduce medical errors and improve care, but can complicate clinical encounters. OBJECTIVE: To describe hospital-based physicians' perceptions of the impact of EHRs on patient-physician interactions and contrast these findings against office-based physicians' perceptionsMethods: We performed a qualitative analysis of comments submitted in response to the 2014 Rhode Island Health Information Technology Survey. Office- and hospital-based physicians licensed in Rhode Island, in active practice, and located in Rhode Island or neighboring states completed the survey about their Electronic Health Record use. RESULTS: The survey's response rate was 68.3% and 2,236 (87.1%) respondents had EHRs. Among survey respondents, 27.3% of hospital-based and 37.8% of office-based physicians with EHRs responded to the question about patient interaction. Five main themes emerged for hospital-based physicians, with respondents generally perceiving EHRs as negatively altering patient interactions. We noted the same five themes among office-based physicians, but the rank-order of the top two responses differed by setting: hospital-based physicians commented most frequently that they spend less time with patients because they have to spend more time on computers; office-based physicians commented most frequently on EHRs worsening the quality of their interactions and relationships with patients. CONCLUSION: In our analysis of a large sample of physicians, hospital-based physicians generally perceived EHRs as negatively altering patient interactions, although they emphasized different reasons than their office-based counterparts. These findings add to the prior literature, which focuses on outpatient physicians, and can shape interventions to improve how EHRs are used in inpatient settings.


Assuntos
Registros Eletrônicos de Saúde/estatística & dados numéricos , Hospitais , Relações Médico-Paciente , Médicos/psicologia , Adulto , Atitude Frente aos Computadores , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Rhode Island
18.
J Emerg Med ; 50(3): 416-21, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26281813

RESUMO

BACKGROUND: Despite patients' increasing use of urgent care centers (UCC), little is known about how urgent care clinicians communicate with the emergency department (ED). OBJECTIVES: To assess ED clinicians' perceptions of the quality and consistency of communication when patients are referred from UCCs to EDs. METHODS: Emergency medicine department chairs distributed a brief, electronic survey to a statewide sample of ED clinicians via e-mail. The survey included multiple-choice and free-text questions focused on types of communication desired and received from UCCs, types of test results available on transfer, and suggestions for improvement. RESULTS: Of 199 ED clinicians, 102 (51.3%) responded. More than four out of five respondents "somewhat" or "strongly agreed" that each of the following would be helpful: a telephone call, the reason for referral, specific concern, a copy of the chart, and UCC contact information. However, ED clinicians reported not consistently receiving these: only a fifth (21.6%) of clinicians reported receiving the specific concern for their last 5 patients transferred from a UCC, and 34.3% recalled receiving a copy of the chart. Overall, 54.9% reported receiving laboratory test results "often or almost always," 49.0% electrocardiograms, and 44.1% imaging reports. Qualitative analysis revealed several themes: incomplete data when patients are referred; barriers to discussion between ED and urgent care clinicians; and possible solutions to improve communication. CONCLUSIONS: Our findings highlight variation in communication from UCCs to EDs, indicating a need to improve communication standards and practices. We identify several potential ways to improve this clinical information hand-off.


Assuntos
Instituições de Assistência Ambulatorial/organização & administração , Atitude do Pessoal de Saúde , Comunicação , Continuidade da Assistência ao Paciente/organização & administração , Serviço Hospitalar de Emergência/organização & administração , Contrato de Transferência de Pacientes/normas , Comportamento Cooperativo , Humanos , Relações Interprofissionais , Melhoria de Qualidade/organização & administração
19.
R I Med J (2013) ; 98(10): 29-32, 2015 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-26422543

RESUMO

We used data from the mandatory statewide Rhode Island (RI) Health Information Technology (HIT) Survey to characterize office-based PCPs' adoption and use of EHRs from 2009-2014. We found accelerated adoption of EHRs in the five years since state and federal incentive programs began targeting PCPs' adoption of HIT. There was room for improvement, however; for example, when asked to indicate the proportion of patients with whom they used various functionalities, only 13.4% of office-based PCPs said they "almost always" communicated with patients using secure messaging and 22.3% "almost always" used secure clinical messaging with outside providers. Results suggest uneven use of EHR functionalities, with low rates and slower uptake in some areas. These findings highlight opportunities to increase use of functionalities related to improved patient care and quality-based payment models.


Assuntos
Registros Eletrônicos de Saúde/estatística & dados numéricos , Médicos de Atenção Primária/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Registros Eletrônicos de Saúde/normas , Pesquisas sobre Serviços de Saúde , Humanos , Pessoa de Meia-Idade , Rhode Island , Autorrelato
20.
Am J Manag Care ; 20(10): e349-444, 2014 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-25414979

RESUMO

OBJECTIVES: To evaluate the association between family caregiver presence and patient completion of the Care Transitions Intervention (CTI), a patient activation model that provides transitional care coaching for 30 days following hospital discharge. STUDY DESIGN: A convenience sample of 2747 fee-for-service Medicare patients recruited for the CTI during inpatient medical hospitalizations at 6 hospitals in Rhode Island between January 1, 2009 and June 31, 2011. METHODS: As part of an effectiveness trial of the CTI, Transitions Coaches recruited patients prior to hospital discharge. When a family caregiver was present during recruitment, the patient and family caregiver were coached together or the family caregiver was coached independently. RESULTS: We hypothesized that CTI participation would be equivalent for the 2265 coached patients without a family caregiver present at recruitment, versus the 482 patients with a family caregiver. After adjusting for significant covariates, patients with family caregivers were more than 5 times as likely to complete the intervention as patients without family caregivers (AOR = 5.48; 95% CI = 4.22-7.12). Men with family caregivers were nearly 8 times as likely to complete the intervention as men without family caregivers (AOR = 7.94; 95% CI = 5.26-11.98). CONCLUSIONS: The inclusion of a family caregiver is associated with a greater rate of completing the CTI for post discharge coaching, particularly among men; the inclusion of a family caregiver is a feasible modification to the CTI program.


Assuntos
Cuidadores , Cuidado Transicional , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Alta do Paciente , Participação do Paciente/métodos , Avaliação de Programas e Projetos de Saúde , Cuidado Transicional/organização & administração
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