Rehabilitation Consumers' Use and Understanding of Quality Information: A Health Literacy Perspective

Magasi S, Durkin E, Wolf MS, Deutsch A. Rehabilitation consumers' use and understanding of quality information: a health literacy perspective.

Objectives

To explore consumers' use and understanding of quality information about postacute rehabilitation facilities.

Design

Thematic, semistructured interviews.

Setting

Two skilled nursing facilities and 2 inpatient rehabilitation facilities in a large Midwestern city.

Participants

Rehabilitation inpatients (n=17) with stroke, hip fractures, and joint replacements and care partners (n=12) of rehabilitation inpatients.

Intervention

None.

Main Outcome Measure

None.

Results

Health literacy imposed barriers to participants' understanding of quality information. Using the Institute of Medicine's Health Literacy Framework, we identified specific barriers that limited participants' abilities to (1) obtain quality information, (2) process and understand quality information, and (3) make appropriate decisions about the quality of a rehabilitation facility. Participants tended to rely on informal and nonquality information when choosing a rehabilitation facility.

Conclusions

Given the barriers imposed by low health literacy, rehabilitation providers have a responsibility to present quality information in a way that consumers, especially those with low health literacy, can use and understand.     

Anatomy of Change: The Need for Effective Disability Policy Change Agents

Silverstein R. Anatomy of change: the need for effective disability policy change agents.The 2009 Coulter Lecture highlights the need for effective disability policy change agents to advocate for health care policy and research that focuses on optimizing the health and function of individuals with disabilities and chronic conditions-not only on their full restoration/cure. The lecture describes the “grotesque” historical treatment of persons with disabilities under the old policy framework, the treatment of people with disabilities under the new/emerging disability policy framework, and the critical role played by coalitions in bringing about progressive, sustainable change on behalf of individuals with disabilities.     

Advance Care Planning Documentation Practices and Accessibility in the Electronic Health Record: Implications for Patient Safety

Context

Documenting patients' advance care planning (ACP) wishes is essential to providing value-aligned care, as is having this documentation readily accessible. Little is known about ACP documentation practices in the electronic health record.

Data Mining Nursing Care Plans of End‐of‐Life Patients: A Study to Improve Healthcare Decision Making

PURPOSE: To reveal hidden patterns and knowledge present in nursing care information documented with standardized nursing terminologies on end‐of‐life (EOL) hospitalized patients. METHOD: 596 episodes of care that included pain as a problem on a patient's care plan were examined using statistical and data mining tools. The data were extracted from the Hands‐On Automated Nursing Data System database of nursing care plan episodes (n = 40,747) coded with NANDA‐I, Nursing Outcomes Classification, and Nursing Intervention Classification (NNN) terminologies. System episode data (episode = care plans updated at every hand‐off on a patient while staying on a hospital unit) had been previously gathered in eight units located in four different healthcare facilities (total episodes = 40,747; EOL episodes = 1,425) over 2 years and anonymized prior to this analyses. RESULTS: Results show multiple discoveries, including EOL patients with hospital stays (<72 hr) are less likely (p < .005) to meet the pain relief goals compared with EOL patients with longer hospital stays. CONCLUSIONS: The study demonstrates some major benefits of systematically integrating NNN into electronic health records.     

The Development and Piloting of the Ambulatory Electronic Health Record Evaluation Tool: Lessons Learned

Background  Substantial research has been performed about the impact of computerized physician order entry on medication safety in the inpatient setting; however, relatively little has been done in ambulatory care, where most medications are prescribed. Objective  To outline the development and piloting process of the Ambulatory Electronic Health Record (EHR) Evaluation Tool and to report the quantitative and qualitative results from the pilot. Methods  The Ambulatory EHR Evaluation Tool closely mirrors the inpatient version of the tool, which is administered by The Leapfrog Group. The tool was piloted with seven clinics in the United States, each using a different EHR. The tool consists of a medication safety test and a medication reconciliation module. For the medication test, clinics entered test patients and associated test orders into their EHR and recorded any decision support they received. An overall percentage score of unsafe orders detected, and order category scores were provided to clinics. For the medication reconciliation module, clinics demonstrated how their EHR electronically detected discrepancies between two medication lists. Results  For the medication safety test, the clinics correctly alerted on 54.6% of unsafe medication orders. Clinics scored highest in the drug allergy (100%) and drug–drug interaction (89.3%) categories. Lower scoring categories included drug age (39.3%) and therapeutic duplication (39.3%). None of the clinics alerted for the drug laboratory or drug monitoring orders. In the medication reconciliation module, three (42.8%) clinics had an EHR-based medication reconciliation function; however, only one of those clinics could demonstrate it during the pilot. Conclusion  Clinics struggled in areas of advanced decision support such as drug age, drug laboratory, and drub monitoring. Most clinics did not have an EHR-based medication reconciliation function and this process was dependent on accessing patients'' medication lists. Wider use of this tool could improve outpatient medication safety and can inform vendors about areas of improvement.     

Home Health Agency Characteristics and Quality Outcomes for Medicare Beneficiaries With Rehabilitation-Sensitive Conditions

Objective

To examine associations between organizational characteristics of home health agencies (eg, profit status, rehabilitation therapy staffing model, size, and rurality) and quality outcomes in Medicare beneficiaries with rehabilitation-sensitive conditions, conditions for which occupational, physical, and/or speech therapy have the potential to improve functioning, prevent or slow substantial decline in functioning, or increase ability to remain at home safely.

The Secure Medical Research Workspace: An IT Infrastructure to Enable Secure Research on Clinical Data

Clinical data have tremendous value for translational research, but only if security and privacy concerns can be addressed satisfactorily. A collaboration of clinical and informatics teams, including RENCI, NC TraCS, UNC''s School of Information and Library Science, Information Technology Service''s Research Computing and other partners at the University of North Carolina at Chapel Hill have developed a system called the Secure Medical Research Workspace (SMRW) that enables researchers to use clinical data securely for research. SMRW significantly minimizes the risk presented when using identified clinical data, thereby protecting patients, researchers, and institutions associated with the data. The SMRW is built on a novel combination of virtualization and data leakage protection and can be combined with other protection methodologies and scaled to production levels.     

Exercise and Quality of Life Among People With Multiple Sclerosis: Looking Beyond Physical Functioning to Mental Health and Participation in Life

Turner AP, Kivlahan DR, Haselkorn JK. Exercise and quality of life among people with multiple sclerosis: looking beyond physical functioning to mental health and participation in life.

Objective

To describe the prevalence of exercise in a national sample of veterans with multiple sclerosis (MS) and the association of exercise with quality of life, including physical health, mental health, and participation restriction.

Design

Cross-sectional cohort study linking computerized medical records to mailed survey data from 1999.

Setting

Veterans Health Administration.

Participants

Veterans with MS (N=2995; 86.5% men) who received services in the Veterans Health Administration and returned survey questionnaires.

Interventions

Not applicable.

Main Outcome Measures

Demographic information, Veteran RAND 36-Item Health Survey (VR-36), self-reported exercise frequency.

Results

Among all survey respondents with MS, only 28.6% (95% confidence interval, 26.9-30.2) endorsed any exercise. In adjusted logistic regression, exercise was associated with younger age, more education, living alone, lower levels of bodily pain, and higher body mass index. After adjusting for demographic variables and medical comorbidities, exercise was associated with better physical and mental health. People who exercised reported they had better social functioning and better role functioning (participation in life despite physical and emotional difficulties).

Conclusions

Exercise in veterans with MS is uncommon. In the context of chronic illness care, the identification of exercise patterns and promotion of physical activity may represent an important opportunity to improve mental health and quality of life among people with MS. Intervention should address factors associated with lower rates of exercise including age, education, and pain.     

FAmily-CEntered (FACE) Advance Care Planning Among African-American and Non-African-American Adults Living With HIV in Washington,DC: A Randomized Controlled Trial to Increase Documentation and Health Equity

Context

No prospective studies address disease-specific advance care planning (ACP) for adults living with HIV/AIDS.

Quality of care: the need for medical, contextual and policy evidence in primary care

The increasing availability of medical evidence in clinical practice was expected to improve the quality of care. However, this has not been realized. A possible explanation is that quality of care is a complex concept and needs a wider scope. Starting from the Donabedian triangle of structure, process and outcome, a framework for the analysis of quality of care is presented. The need for three types of evidence is identified and discussed: medical, contextual and policy evidence. Although the body of medical evidence is increasing, it has major flaws and gaps hampering its applicability in primary care. There is also a need to focus on the context of the medical encounter, which has been shown to influence outcome, but is still not well researched. Finally, evidence on costs, cost utility and equity needs to be considered. Taking these different aspects of evidence into account, an agenda for research in primary care is set. The analytical framework may provide new insights in the quest for improving quality of health care.     

Development,Implementation, and Use of a Process to Promote Knowledge Translation in Rehabilitation

Objective

To examine the use and effect of the Battery of Rehabilitation Assessments and Interventions on evidence-based practice (EBP) over 6 years.

Structured headache services as the solution to the ill-health burden of headache: 1. Rationale and description

In countries where headache services exist at all, their focus is usually on specialist (tertiary) care. This is clinically and economically inappropriate: most headache disorders can effectively and more efficiently (and at lower cost) be treated in educationally supported primary care. At the same time, compartmentalizing divisions between primary, secondary and tertiary care in many health-care systems create multiple inefficiencies, confronting patients attempting to navigate these levels (the “patient journey”) with perplexing obstacles.High demand for headache care, estimated here in a needs-assessment exercise, is the biggest of the challenges to reform. It is also the principal reason why reform is necessary.The structured headache services model presented here by experts from all world regions on behalf of the Global Campaign against Headache is the suggested health-care solution to headache. It develops and refines previous proposals, responding to the challenge of high demand by basing headache services in primary care, with two supporting arguments. First, only primary care can deliver headache services equitably to the large numbers of people needing it. Second, with educational supports, they can do so effectively to most of these people. The model calls for vertical integration between care levels (primary, secondary and tertiary), and protection of the more advanced levels for the minority of patients who need them. At the same time, it is amenable to horizontal integration with other care services. It is adaptable according to the broader national or regional health services in which headache services should be embedded.It is, according to evidence and argument presented, an efficient and cost-effective model, but these are claims to be tested in formal economic analyses.