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Publication Record


A technology-based patient and family engagement consult service for the pediatric hospital setting.
Jackson GP, Robinson JR, Ingram E, Masterman M, Ivory C, Holloway D, Anders S, Cronin RM
(2018) J Am Med Inform Assoc 25: 167-174
MeSH Terms: Adolescent, Child, Child, Preschool, Consumer Health Informatics, Consumer Health Information, Family, Female, Hospitals, Pediatric, Humans, Infant, Infant, Newborn, Information Seeking Behavior, Information Technology, Internet, Male, Mobile Applications, Patient-Centered Care, Referral and Consultation, Retrospective Studies, Tennessee
Show Abstract · Added November 8, 2017
Objective - The Vanderbilt Children's Hospital launched an innovative Technology-Based Patient and Family Engagement Consult Service in 2014. This paper describes our initial experience with this service, characterizes health-related needs of families of hospitalized children, and details the technologies recommended to promote engagement and meet needs.
Materials and Methods - We retrospectively reviewed consult service documentation for patient characteristics, health-related needs, and consultation team recommendations. Needs were categorized using a consumer health needs taxonomy. Recommendations were classified by technology type.
Results - Twenty-two consultations were conducted with families of patients ranging in age from newborn to 15 years, most with new diagnoses or chronic illnesses. The consultation team identified 99 health-related needs (4.5 per consultation) and made 166 recommendations (7.5 per consultation, 1.7 per need). Need categories included 38 informational needs, 26 medical needs, 23 logistical needs, and 12 social needs. The most common recommendations were websites (50, 30%) and mobile applications (30, 18%). The most frequent recommendations by need category were websites for informational needs (39, 50%), mobile applications for medical needs (15, 40%), patient portals for logistical needs (12, 44%), and disease-specific support groups for social needs (19, 56%).
Discussion - Families of hospitalized pediatric patients have a variety of health-related needs, many of which could be addressed by technology recommendations from an engagement consult service.
Conclusion - This service is the first of its kind, offering a potentially generalizable and scalable approach to assessing health-related needs, meeting them with technologies, and promoting patient and family engagement in the inpatient setting.
© The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com
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20 MeSH Terms
Identifying collaborative care teams through electronic medical record utilization patterns.
Chen Y, Lorenzi NM, Sandberg WS, Wolgast K, Malin BA
(2017) J Am Med Inform Assoc 24: e111-e120
MeSH Terms: Cooperative Behavior, Data Mining, Electronic Health Records, Humans, Interprofessional Relations, Patient Care Team, Patient-Centered Care
Show Abstract · Added April 10, 2018
Objective - The goal of this investigation was to determine whether automated approaches can learn patient-oriented care teams via utilization of an electronic medical record (EMR) system.
Materials and Methods - To perform this investigation, we designed a data-mining framework that relies on a combination of latent topic modeling and network analysis to infer patterns of collaborative teams. We applied the framework to the EMR utilization records of over 10 000 employees and 17 000 inpatients at a large academic medical center during a 4-month window in 2010. Next, we conducted an extrinsic evaluation of the patterns to determine the plausibility of the inferred care teams via surveys with knowledgeable experts. Finally, we conducted an intrinsic evaluation to contextualize each team in terms of collaboration strength (via a cluster coefficient) and clinical credibility (via associations between teams and patient comorbidities).
Results - The framework discovered 34 collaborative care teams, 27 (79.4%) of which were confirmed as administratively plausible. Of those, 26 teams depicted strong collaborations, with a cluster coefficient > 0.5. There were 119 diagnostic conditions associated with 34 care teams. Additionally, to provide clarity on how the survey respondents arrived at their determinations, we worked with several oncologists to develop an illustrative example of how a certain team functions in cancer care.
Discussion - Inferred collaborative teams are plausible; translating such patterns into optimized collaborative care will require administrative review and integration with management practices.
Conclusions - EMR utilization records can be mined for collaborative care patterns in large complex medical centers.
© The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com
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MeSH Terms
Prioritizing patient-centered care implementation and research for patients with kidney disease.
Cavanaugh KL
(2015) Semin Dial 28: 131-40
MeSH Terms: Decision Making, Humans, Kidney Diseases, Patient-Centered Care, Quality of Health Care
Show Abstract · Added August 4, 2015
Patient-centered care is upheld as one of the fundamental components of high quality health care. Although a deceptively easy concept, patient-centered care is an elusive goal in clinical practice. A core objective for patient-centered care is a collaboration between health care providers and patients that aligns therapy with patients' values and preferences through shared decision making. Advances in communication training that are tailored to the specific requirements of nephrology care are promising methods for enhancing the skill-set of our providers. However, patient-centered care extends beyond shared decision-making and also involves attention to patients' physical and emotional symptoms, care coordination, and the inclusion of family members. Research about patient-centered care processes, interventions and outcomes among patients with kidney disease is sparse. Recent discussions among nephrology experts name patient-centered care as a priority for research and quality improvement in care. Given recent advances in methods for quantifying patient-centered care as well as patient reported outcomes, now is the time to prioritize our resources to evolve our health system and meet the needs of all patients with kidney disease.
© 2014 Wiley Periodicals, Inc.
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5 MeSH Terms
Identification of patient-centered outcomes among African American women with type 2 diabetes.
Miller ST, Akohoue SA, Brooks MA
(2014) Diabetes Res Clin Pract 106: 487-90
MeSH Terms: Adult, African Americans, Diabetes Mellitus, Type 2, Female, Humans, Life Style, Middle Aged, Patient Education as Topic, Patient Satisfaction, Patient-Centered Care, Self Care, United States
Show Abstract · Added July 28, 2016
AIMS - African American women carry a disproportionate diabetes burden, yet there is limited information on strategies to identify outcomes women perceive as important intervention outcomes (patient-centered outcomes). This study presents a brief strategy to solicit these outcomes and to describe outcomes identified using the highlighted strategy.
METHODS - Thirty-four African-American women with type 2 diabetes were enrolled in group-based, diabetes/weight management interventions. A diabetes educator asked participants to write down their intervention expectations followed by verbal sharing of responses. Expectation-related themes were identified using an iterative, qualitative, team analytic approach based on audio-recorded responses.
RESULTS - The majority of the expectation-related themes (6 of 10) were reflective of self-care education/management and weight loss-related patient-centered outcomes. The remaining themes were associated with desires to help others prevent or manage diabetes, reduce negative diabetes-related emotions, get rid of diabetes, and stop taking diabetes medications.
CONCLUSION - This study adds to a limited body of knowledge regarding patient-centered outcomes among a group that experiences a disproportionate diabetes burden. Future work could include integrating outcomes that are less commonly addressed in diabetes-related lifestyle interventions (e.g., diabetes-related negative emotions), along with more commonly addressed outcomes (e.g., weight loss), to increase the patient-centeredness of the interventions.
Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
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12 MeSH Terms
Health-related quality of life in children with sickle cell anemia: impact of blood transfusion therapy.
Beverung LM, Strouse JJ, Hulbert ML, Neville K, Liem RI, Inusa B, Fuh B, King A, Meier ER, Casella J, DeBaun MR, Panepinto JA, SIT trial investigators
(2015) Am J Hematol 90: 139-43
MeSH Terms: Adolescent, Anemia, Sickle Cell, Blood Transfusion, Cerebral Infarction, Child, Child, Preschool, Female, Humans, Male, Patient-Centered Care, Quality of Life, Severity of Illness Index, Surveys and Questionnaires, Treatment Outcome
Show Abstract · Added March 19, 2015
The completion of the Multicenter Silent Infarct Transfusion Trial demonstrated that children with pre-existing silent cerebral infarct and sickle cell anemia (SCA) who received regular blood transfusion therapy had a 58% relative risk reduction of infarct recurrence when compared to observation. However, the total benefit of blood transfusion therapy, as assessed by the parents, was not measured against the burden of monthly blood transfusion therapy. In this planned ancillary study, we tested the hypothesis that a patient centered outcome, health-related quality of life (HRQL), would be greater in participants randomly assigned to the blood transfusion therapy group than the observation group. A total of 89% (175 of 196) of the randomly allocated participants had evaluable entry and exit HRQL evaluations. The increase in Change in Health, measured as the child's health being better, was significantly greater for the transfusion group than the observation group (difference estimate = -0.54, P ≤ 0.001). This study provides the first evidence that children with SCA who received regular blood transfusion therapy felt better and had better overall HRQL than those who did not receive transfusion therapy.
© 2014 Wiley Periodicals, Inc.
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14 MeSH Terms
A novel approach to supporting relationship-centered care through electronic health record ergonomic training in preclerkship medical education.
Silverman H, Ho YX, Kaib S, Ellis WD, Moffitt MP, Chen Q, Nian H, Gadd CS
(2014) Acad Med 89: 1230-4
MeSH Terms: Adult, Arizona, Clinical Competence, Education, Medical, Undergraduate, Electronic Health Records, Ergonomics, Female, Humans, Linear Models, Male, Patient-Centered Care, Physician-Patient Relations, Self-Assessment
Show Abstract · Added January 20, 2015
PROBLEM - How can physicians incorporate the electronic health record (EHR) into clinical practice in a relationship-enhancing fashion ("EHR ergonomics")?
APPROACH - Three convenience samples of 40 second-year medical students with varying levels of EHR ergonomic training were compared in the 2012 spring semester. All participants first received basic EHR training and completed a presurvey. Two study groups were then instructed to use the EHR during the standardized patient (SP) encounter in each of four regularly scheduled Doctoring (clinical skills) course sessions. One group received additional ergonomic training in each session. Ergonomic assessment data were collected from students, faculty, and SPs in each session. A postsurvey was administered to all students, and data were compared across all three groups to assess the impact of EHR use and ergonomic training.
OUTCOMES - There was a significant positive effect of EHR ergonomics skills training on students' relationship-centered EHR use (P<.005). Students who received training reported that they were able to use the EHR to engage with patients more effectively, better articulate the benefits of using the EHR, better address patient concerns, more appropriately position the EHR device, and more effectively integrate the EHR into patient encounters. Additionally, students' self-assessments were strongly corroborated by SP and faculty assessments. A minimum of three ergonomic training sessions were needed to see an overall improvement in EHR use.
NEXT STEPS - In addition to replication of these results, further effectiveness studies of this educational intervention need to be carried out in GME, practice, and other environments.
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13 MeSH Terms
The Mid-South clinical Data Research Network.
Rosenbloom ST, Harris P, Pulley J, Basford M, Grant J, DuBuisson A, Rothman RL
(2014) J Am Med Inform Assoc 21: 627-32
MeSH Terms: Comparative Effectiveness Research, Computer Communication Networks, Delivery of Health Care, Electronic Health Records, Georgia, Humans, Information Dissemination, Information Systems, Medical Record Linkage, Outcome Assessment, Health Care, Patient-Centered Care, Tennessee
Show Abstract · Added January 26, 2016
The Mid-South Clinical Data Research Network (CDRN) encompasses three large health systems: (1) Vanderbilt Health System (VU) with electronic medical records for over 2 million patients, (2) the Vanderbilt Healthcare Affiliated Network (VHAN) which currently includes over 40 hospitals, hundreds of ambulatory practices, and over 3 million patients in the Mid-South, and (3) Greenway Medical Technologies, with access to 24 million patients nationally. Initial goals of the Mid-South CDRN include: (1) expansion of our VU data network to include the VHAN and Greenway systems, (2) developing data integration/interoperability across the three systems, (3) improving our current tools for extracting clinical data, (4) optimization of tools for collection of patient-reported data, and (5) expansion of clinical decision support. By 18 months, we anticipate our CDRN will robustly support projects in comparative effectiveness research, pragmatic clinical trials, and other key research areas and have the capacity to share data and health information technology tools nationally.
Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
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12 MeSH Terms
Patient-centered imaging: shared decision making for cardiac imaging procedures with exposure to ionizing radiation.
Einstein AJ, Berman DS, Min JK, Hendel RC, Gerber TC, Carr JJ, Cerqueira MD, Cullom SJ, DeKemp R, Dickert NW, Dorbala S, Fazel R, Garcia EV, Gibbons RJ, Halliburton SS, Hausleiter J, Heller GV, Jerome S, Lesser JR, Raff GL, Tilkemeier P, Williams KA, Shaw LJ
(2014) J Am Coll Cardiol 63: 1480-9
MeSH Terms: Cardiology, Cardiovascular Diseases, Decision Making, Diagnostic Imaging, Humans, Patient-Centered Care, Radiation Dosage, Radiation Injuries, Radiation, Ionizing
Show Abstract · Added February 28, 2014
The current paper details the recommendations arising from an NIH-NHLBI/NCI-sponsored symposium held in November 2012, aiming to identify key components of a radiation accountability framework fostering patient-centered imaging and shared decision-making in cardiac imaging. Symposium participants, working in 3 tracks, identified key components of a framework to target critical radiation safety issues for the patient, the laboratory, and the larger population of patients with known or suspected cardiovascular disease. The use of ionizing radiation during an imaging procedure should be disclosed to all patients by the ordering provider at the time of ordering, and reinforced by the performing provider team. An imaging protocol with effective dose ≤3 mSv is considered very low risk, not warranting extensive discussion or written informed consent. However, a protocol effective dose >20 mSv was proposed as a level requiring particular attention in terms of shared decision-making and either formal discussion or written informed consent. Laboratory reporting of radiation dosimetry is a critical component of creating a quality laboratory fostering a patient-centered environment with transparent procedural methodology. Efforts should be directed to avoiding testing involving radiation, in patients with inappropriate indications. Standardized reporting and diagnostic reference levels for computed tomography and nuclear cardiology are important for the goal of public reporting of laboratory radiation dose levels in conjunction with diagnostic performance. The development of cardiac imaging technologies revolutionized cardiology practice by allowing routine, noninvasive assessment of myocardial perfusion and anatomy. It is now incumbent upon the imaging community to create an accountability framework to safely drive appropriate imaging utilization.
Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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9 MeSH Terms
Nurse-managed health centers and patient-centered medical homes could mitigate expected primary care physician shortage.
Auerbach DI, Chen PG, Friedberg MW, Reid R, Lau C, Buerhaus PI, Mehrotra A
(2013) Health Aff (Millwood) 32: 1933-41
MeSH Terms: Delivery of Health Care, Health Services Needs and Demand, Humans, Nurse Practitioners, Patient-Centered Care, Physician Assistants, Physicians, Primary Care, Primary Health Care, United States, Workforce
Show Abstract · Added March 7, 2014
Numerous forecasts have predicted shortages of primary care providers, particularly in light of an expected increase in patient demand resulting from the Affordable Care Act. Yet these forecasts could be inaccurate because they generally do not allow for changes in the way primary care is delivered. We analyzed the impact of two emerging models of care--the patient-centered medical home and the nurse-managed health center--both of which use a provider mix that is richer in nurse practitioners and physician assistants than today's predominant models of care delivery. We found that projected physician shortages were substantially reduced in plausible scenarios that envisioned greater reliance on these new models, even without increases in the supply of physicians. Some less plausible scenarios even eliminated the shortage. All of these scenarios, however, may require additional changes, such as liberalized scope-of-practice laws; a larger supply of medical assistants, licensed practical nurses, and aides; and payment changes that reward providers for population health management.
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10 MeSH Terms
The effects of CenteringPregnancy group prenatal care on gestational age, birth weight, and fetal demise.
Tanner-Smith EE, Steinka-Fry KT, Lipsey MW
(2014) Matern Child Health J 18: 801-9
MeSH Terms: Adult, Birth Weight, Case-Control Studies, Cohort Studies, Confidence Intervals, Female, Fetal Death, Gestational Age, Humans, Patient-Centered Care, Pregnancy, Prenatal Care, Quality of Health Care, Standard of Care, Young Adult
Show Abstract · Added May 19, 2014
We examined the effects of CenteringPregnancy group prenatal care versus individually delivered prenatal care on gestational age, birth weight, and fetal demise. We conducted a retrospective chart review and used propensity score matching to form a sample of 6,155 women receiving prenatal care delivered in a group or individual format at five sites in Tennessee. Compared to the matched group of women receiving prenatal care in an individual format, women in CenteringPregnancy group prenatal care had longer weeks of gestation (b = .35, 95 % CI [.29, .41]), higher birth weight in grams (b = 28.6, 95 % CI [4.8, 52.3]), lower odds of very low birth weight (OR = .21, 95 % CI [.06, .70]), and lower odds of fetal demise (OR = .12, 95 % CI [.02, .92]). Results indicated no evidence of differences in the odds of preterm birth or low birth weight for participants in group versus individual prenatal care. CenteringPregnancy group prenatal care had statistically and clinically significant beneficial effects on very low birth weight and fetal demise outcomes relative to traditional individually delivered prenatal care. Group prenatal care had statistically significant beneficial effects on gestational age and birth weight, although the effects were relatively small in clinical magnitude.
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15 MeSH Terms