Individual and Systemic Barriers Blocking Community Health Workers from Helping the Seriously Ill.

Background: Palliative care is a valuable component of health care that improves a patient's quality of life, yet its availability to patients with serious chronic illness remains relatively low. Due to their knowledge of community preferences and ability to improve patient education and access to care, community health workers (CHWs) can increase palliative care usage by patients. Notably, barriers to CHWs helping patients with serious chronic illness remain poorly understood. Objective: Explore the perception of barriers CHWs feel they face when attempting to support the health care of patients with serious chronic illness. Design: Qualitative semistructured individual interviews of CHWs and qualitative descriptive analysis. Setting/Subjects: Twelve CHWs who have worked with patients with serious chronic illness were recruited from the Johns Hopkins Healthcare LLC and the Baltimore Alliance for Careers in Healthcare organizations to virtually participate. Results: CHWs perceived both active and passive barriers that obstructed their efforts to work with seriously ill patients. CHWs shared that these barriers were dependent on themselves, their peers, and their work environments. Prevalent themes included interprofessional conflict, poor health care worker understanding of the CHW's role, and lack of access to quality resource organizations. CHWs noted job-specific training, better means to identify needed resources for patients, and inclusive health care teams as solutions to support their professional goals, while helping patients with serious illness. Conclusions: There are multiple perceived barriers to CHWs helping seriously ill patients. CHWs aiding patients with serious illness can be supported through better job training, better resource management tools, and improved communication between health care team members.

Assessing the Impact of a Note-Writing Session and Standardized Note Template on Medical Student Note Length and Quality.

PURPOSE: To determine whether a formal note-writing session and note template for medical students (MS) during the Core Clerkship in Pediatrics (CCP) increase note quality, shortens note length, and decreases time of documentation. METHODS: In this single site, prospective study, MS participating in an 8-week CCP received a didactic session on note-writing in the electronic health record (EHR) and utilized EHR template developed for the study. We assessed note quality (measured by Physician Documentation Quality Instrument-9 [PDQI-9]), note length and note documentation time in this group compared to MS notes on the CCP in the prior academic year. We used descriptive statistics and Kruskal-Wallis tests for analysis. RESULTS: We analyzed 121 notes written by 40 students in the control group and 92 notes writing by 41 students in the intervention group. Notes from the intervention group were more "up to date," "accurate," "organized," and "comprehensible" compared to the control group (P = 0.02, P = 0.04, P = 0.01, and P = 0.02, respectively). Intervention group notes received higher cumulative PDQI-9 scores compared to the control group (median score 38 (IQR 34-42) versus 36 (IQR 32-40) out of 45 total, P = 0.04). Intervention group notes were approximately 35% shorter than the control group notes (median 68.5 lines vs 105 lines, P < 0.0001) and were signed earlier than control group notes (median file time 316 minute vs 352 minute, P = 0.02). CONCLUSIONS: The intervention successfully decreased note length, improved note quality based on standardized metrics, and reduced time to completion of note documentation.

Surgical palliative care disparities.

Surgical palliative care is an interdisciplinary treatment modality that aims to decrease suffering and improve the quality of life of seriously ill surgical patients. Although surgical palliative care is increasingly being found to positively impact patient quality of life, disparities in surgical palliative care remain poorly defined. While the field of medical palliative care has demonstrated certain racial/ethnic, socioeconomic, and geographic groups are at higher risks for receiving worse palliative care, there is no analogous consensus in the field of surgical palliative care. This is largely secondary to a paucity of research focus in this field. Given that the aforementioned disparities experienced by minoritized patient populations has led to significant morbidity, it is important to understand and call attention to disparities existing within the field of surgical palliative care as well. To advance the knowledge of current healthcare shortcomings and progress towards equitable surgical palliative care, this paper reviews the current state of surgical palliative care disparities evidence, details gaps in knowledge, and highlights priorities for future surgical palliative care research. The articles identified in this review noted disparate surgical palliative care access and outcomes across various racial/ethnic groups, age ranges, socioeconomic classes, hospital populations, and regions. However, evidence scarcity necessitates more robust research be performed to adequately identify at risk groups and understand the factors supporting disparity development.