Browsing by Subject "Quality of Health Care"
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Item Analysis of Resident Conducted Social Determinants of Health Informed Home Visits(2020-01-21) Cline, Matthew; Day, Philip; Gimpel, Nora; Pagels, PattiCONTEXT: Home visits can improve quality of care, save money, improve health outcomes, and provide a unique opportunity for residents to learn more about patients' social context and assess the various social determinants of health (SDH) that impact patients' health and wellbeing. In order to facilitate a SDH-focused visit, the Department of Family and Community Medicine at UT Southwestern implemented a brief SDH questionnaire in all home visits. OBJECTIVE: The objective of this study is to assess patient self-reported SDH and resident reflections on patient social status, the utility of a SDH survey during home visits, and resident comfort levels with addressing patient SDH HUMAN SUBJECTS REVIEW: This study was approved as an "exempt" study by the UTSW IRB DESIGN: Mixed methods pilot study utilizing patient self-reported data and open- ended reflection questions SETTINGS: Home health visits for patients from an urban safety-net clinic in Dallas, TX. Participants: Adult patients >18 years of age, selected by the resident INTERVENTION/INSTRUMENT (AS PERTINENT): Quantitative survey domains include: demographics, financial status, social support, safety, employment, and living conditions. Open response questions queried resident impressions of the survey, comfort during the interview, new insights about the patient, impact on future practice, and ability to address SDH concerns. ANTICIPATED RESULTS: 42 surveys collected from 42 home visits. Most patients were female (61.9%) and African-American (45.2%), aging from 25 to 88 years (mean=60.24). Prevalence of adverse SDH were relatively low. Common themes of resident responses: positive utility of the survey as a guide for understanding and assessing patient SDH; wide variation in comfort level when inquiring about patient SDH with positive influence from prior experience, assistance from colleagues, or prior good relations with patients; and expressed intention to include SDH assessment in their continuing career. CONCLUSIONS: Residents recognized the value of assessing SDH during home visits and expressed implement a standardized process for selecting patients for home visits as this was largely left to the discretion of the resident. More thorough assessment of patient SDH may help to craft a more robust and standardized system to prioritize patients that would most benefit from receiving home visits.Item Beyond the walls: moving acute care out of the traditional setting(2021-07-09) Harder, StephenItem Certifying America's Best Hospitals: A Comparison of Consumer Oriented Hospital Ranking Systems(2015-03-25) Jones, Justin; Mihalic, AngelaBACKGROUND: Publicly available hospital rankings have the potential to improve hospital care by guiding patients to higher quality facilities and spurring quality improvement in lower-ranking hospitals. In 2003 the Centers for Medicare and Medicaid Services started requiring hospitals to report certain healthcare quality metrics. Since then many organizations have used this and other data to generate hospital ranking lists. Each organization is at least partially aimed at consumers and claims that their rankings will help them to find the "best hospitals" in their region and in the nation. While hailed by patient advocates and other groups, these ranking systems have received criticism from many stakeholders in healthcare. Such criticisms have included questions as to the validity of these organizations' methodologies and questions about what "best" means when it comes to quality in health care. While some have compared the different methodologies of these organizations, to date there has been no head to head comparison of the concordance between each organization's rankings. OBJECTIVE: Main research question: What is the concordance between publicly reported consumer-oriented hospital rankings, and do they each measure the same variables? Aim 1: Assess the magnitude of concordance between consumer oriented hospital ranking lists. Aim 2: Assess the similarities and differences in domains and methods used in calculating hospital rankings for each list. METHODS: Using a Google search for terms including "best hospital," "number one hospital," and other terms that a consumer might use the author identified multiple hospital ranking systems. Organizations included in this analysis were restricted to those with a nationwide hospital ranking list based on publically reported and/or individually collected data. Their data also had to be accessible without a membership fee or subscription. The author found five qualifying organizations: the Leapfrog Hospital Survey, Consumer Reports' Hospital Rankings, Healthgrades' America's Best Hospitals, Truven Health Analytics' Top 100 Hospitals, and the US News and World Report's Best Hospitals. In accordance with Aim 1, each organization's rank list was accessed and assessed for concordance. In accordance with Aim 2, the methodologies from each organization were compiled and assessed for types of metrics used. Metrics were organized using the Donabedian (Donabedian, 1966) framework as a model, dividing metrics into Outcome, Process, Patient Satisfaction, and Other (including structural) categories. RESULTS: Results from Aim 1 suggest that there is marked discordance between consumer oriented hospital ranking lists. Results from Aim 2 suggest that although most hospitals use data from the CMS database, they vary widely in the number and type of metrics that they use in calculating their ratings. CONCLUSION: The high level of discordance between ranking lists that all make similar claims (to help consumers find the "best" hospital) is likely frustrating to consumers. Given the high level of discordance between hospital ranking systems, many consumers and stakeholders may be prompted to ask whether such efforts serve any purpose in determining hospital quality. Results from Aim 2 suggest that, while frustrating, such results are not entirely unexpected. Different organizations using different methodologies to analyze different metrics are likely to generate different ratings. Future research should focus on determining which, if any, of these current hospital ranking methodologies correlates to patient-centered measures of quality.Item Comparative Ability of the Pain Disability Questionnaire in Predicting Health Outcomes and Healthcare Costs(2013-07-03) Lippe, Ben Jonathan; Gatchel, Robert J.; Noe, Carl; Kennard, Beth D.; Deschner, Martin; Whitfill, TravisGiven the tremendous personal and societal costs of chronic pain, efforts at improving pain conceptualization via the Biopsychosocial Model have become critical in addressing pain-related health outcomes and healthcare costs. The current study consisted of 254 (Average age= 49.72, SD= 14.55) adult chronic pain patients seeking treatment through an interdisciplinary chronic pain management clinic. Participants were administered a battery of assessments including the Pain Disability Questionnaire and other established measures of health and pain-related outcomes (e.g., SF-36, PROMIS pain-related measures) at baseline and post-treatment time points. Convergent validity was observed between the Pain Disability Questionnaire and other study measures. Hierarchical regression analyses demonstrated significant associations between pain-related disability as measured by the Pain Disability Questionnaire and a range of health and psychosocial outcomes. Pain Disability Questionnaire scores, as placed in categorical severity levels, demonstrated good discriminative abilities in terms of predicting health outcomes profiles. Further, logistic regression models established that the Pain Disability Questionnaire provided good predictive validity in terms of healthcare cost categorization at three month follow-up. These findings support the clinical use of the Pain Disability Questionnaire as an equivalent, and in some cases superior, empirically supported predictor of health-related outcomes as compared with other established measures of pain and health outcomes. Additionally, initial evaluation of the Pain Disability Questionnaire’s predictive utility in terms of pain-related healthcare costs displayed significant predictive abilities. Overall, these findings suggest that the Pain Disability Questionnaire is a valuable tool in efforts to understand and manage chronic pain as well as predict associated healthcare costs for chronic pain patients.Item Corruption in clinical research: what is it? -- and why it matters(2019-12-10) Sadler, John Z.Despite the seriousness of charging corruption in clinical research, the literature offers little about what corruption means in this setting. This lecture presents a technical/formal definition of 'corruption' in clinical research. I then present examples from the literature which illustrate clear-cut corruption, maybe cases, and non-corrupt deviations from good clinical research practices. I discuss clinical implications about evaluating clinical research quality as well as what corruption means for our evidence base of practice.Item The cost of dying in America(2023-06-09) Terauchi, StephanieItem Development of the Liang Handover Assessment Tool for Simulation (L-HATS)(2020-05-01T05:00:00.000Z) Liang, Tyler; Greilich, Philip; Phelps, Eleanor; Reed, W. GaryINTRODUCTION: Clinical handovers are critical to patient safety and outcomes. Handover simulation prepares healthcare students for handoffs in the clinical setting upon graduation. UT Southwestern has developed a longitudinal handover educational curriculum in which student handovers will be assessed. Although valid and reliable tools exist for assessing clinical handovers, assessment tools adapted for the undergraduate simulation environment currently do not exist. Our objective was to develop a reliable and valid assessment tool that could be used by scholarly healthcare students to assess undergraduate simulated handovers throughout the longitudinal handover education curriculum. METHODS: A literature review was conducted to identify critical elements of high-quality, effective handovers. Following the tool's creation, we underwent several PDSA cycles to optimize the tool for medical student evaluation and ease of grading. Grader inclusion criteria were students who had completed the transition to clerkship (T2C) handover activity. A training curriculum was developed to train graders on proper use of the tool and to promote reliable grading with the tool. 62 pre-clinical student handovers were conducted in the simulation setting and recorded. The handovers were stratified into three levels (low, intermediate, and high quality), and 10 handovers were selected from each of the three levels for grading (30 handovers total). Each handover was scored by four clerkship medical students "graders". Two-way random effects intra-class correlation coefficients (ICC) were used to establish inter-rater reliability and inter-rater agreement among graders using the tool. Three external handover experts were used to establish the tool's validity using face validity. RESULTS: The product of this project is Liang Handover Assessment Tool for Simulation (L-HATS) which evaluated three domains: handover content, handover process, and language with a maximum score of 28. Two-way random effects ICC for agreement was 0.804, 95% CI [0.601, 0.906]. Two-way random effects ICC for reliability was 0.866, 95% CI [0.765, 0.930]. Three external handover experts have sufficiently validated the tool. CONCLUSIONS: The L-HATS had good to excellent inter-rater reliability and agreement. The L-HATS is the first reliable and valid handover assessment tool used for undergraduate simulation education. By using a two-way random effects model, the results suggest that the tool can be used in settings outside of the T2C handover simulation activity. Having good to excellent absolute agreement suggests that the tool is suitable for assigning grades. Future studies include comparing faculty vs student grading of handovers as well as evaluating the tool in the clinical setting.Item Dignity in later life (The Daniel W. Foster, M.D., Visiting Lectureship in Medical Ethics)(2023-12-12) Jecker, Nancy S.Some argue dignity is a useless concept that bioethics can do without. Against this view, I show dignity is a central concern for bioethics, particularly for older people. Dignity's importance during later life is part of a broader view I call the life stage relativity of values. It holds that different values emerge as central at different periods of our lives. During early life, caring, trust, and nurturing figure prominently due to vulnerabilities that characterize infancy and childhood. By adulthood, greater physical and emotional independence leads to autonomy and self-reliance taking center stage. During later life, heightened risk for chronic disease and disability makes keeping dignity intact a critical concern. Across the lifespan, the highest value for an individual relates to their life stage circumstances. Ignoring this can lead to life stage bias, especially midlife bias, which occurs when we apply values central during midlife to all life stages.Item End of life care in the ICU(2016-05-13) Finklea, David JrItem Families in the ICU(2020-10-16) DeLisle, SylvainItem Getting to 100% insurance coverage: lessons from Canada's single-payer health insurance system(2021-10-29) Cram, PeterItem Health equity grands rounds: exploring some complexities of bias & health equity(2024-04-05) Ahmad, Zahid; Estelle, Carolee; Mauricio, Rina; Rashdan, Sawsan; Mathis, Henriette; Nero, AleciaItem High value health care: the role of palliative care(2021-01-22) Kutner, JeanItem Home based primary care: an economic(2018-07-27) Jamshed, NamirahItem Improving cardiac care at Parkland: lessons learned from the quality improvement front line(2014-01-09) Das, Sandeep R.Item It's just not the same: the crisis of sickle cell disease(2021-07-23) Nero, AleciaItem The M&M conference: let's stop sugar-coating the facts(2022-06-03) Desai, ShivaniItem [News](1989-03-27) Harrell, AnnItem The Perceptions of Shared Medical Appointments among Health Care Workers at Parkland Hospital's Community Oriented Primary Care Clinics(2014-05-22) Murthy, Neil C.; Gimpel, Nora; Pagels, Patti; Kindratt, TiffanyINTRODUCTION: Shared Medical Appointments (SMAs) are a novel way of delivering health care to patients in a group setting. Past research regarding SMA quality improvement have always been patient focused. There is a great deal in the literature that shows that patients perceive SMAs favorably and that patients experience better health outcomes through the SMA format. There is a paucity in the literature regarding providers’ perceptions regarding SMA efficacy and implementation, and whether or not these provider perceptions could affect care. The specific aims of this study were to determine the SMA team’s perceptions on 1) the quality of care delivered through an SMA, and 2) the feasibility of implementing an SMA in a primary care setting. This study was conducted at all eight of the Parkland Community Oriented Primary Care (COPC) clinics located in the Dallas, TX area. METHODS: This cross-sectional study recruited 72 participants who were employees at the Parkland COPCs. The 72 participants had to fill out a survey that covered a wide variety of topics, ranging from their perceptions regarding SMA job training, SMA facilitation, SMA implementation, and SMA quality of care. RESULTS: Quantitative analysis was conducted using SAS, and qualitative analysis was conducted on all subjective answers. We found that most SMA team members harbored positive perceptions regarding SMA format and structure, and SMA quality of care. SMA protocols and curricula were not standardized, and language assistants were most likely to be not trained for their roles on the SMA team. DISCUSSION: Non-standardized protocols/curricula and a lack of training for language assistants could affect the quality of care being delivered to patients. SMAs need to have standardized protocols/curricula, and all SMA team members are due for a refresher training course for their job roles.