Collecting Patient Race/Ethnicity and Primary Language Data in Ambulatory Care Settings: A Case Study in Methodology

Objective. To collect patient race/ethnicity and language (r/e/l) in an ambulatory care setting.
Data Sources/Study Setting. The Palo Alto Medical Foundation (PAMF), December 2006–May 2008.
Study Design. Three pilot studies: (1) Comparing mail versus telephone versus clinic visit questionnaire distribution; (2) comparing the front desk method (FDM) versus exam room method (ERM) in the clinic visit; and (3) determining resource allocation necessary for data entry.
Data Collection/Extraction Methods. Studies were planned and executed by PAMF's Quality and Planning division.
Principal Findings. Collecting r/e/l data during clinic visits elicited the highest response rate. The FDM yielded higher response rate than the ERM. One full-time equivalent is initially necessary for data entry.
Conclusions. Conducting sequential studies can help guide r/e/l collection in a short time frame.     

Accuracy of Monofilament Testing to Diagnose Peripheral Neuropathy: A Systematic Review

PURPOSE We wanted to summarize evidence about the diagnostic accuracy of the 5.07/10-g monofilament test in peripheral neuropathy.METHODS We conducted a systematic review of studies in which the accuracy of the 5.07/10-g monofilament was evaluated to detect peripheral neuropathy of any cause using nerve conduction as reference standard. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool.RESULTS We reviewed 173 titles and abstracts of articles to identify 54 potentially eligible studies, of which 3 were finally selected for data synthesis. All studies were limited to patients with diabetes mellitus and showed limitations according to the QUADAS tool. Sensitivity ranged from 41% to 93% and specificity ranged from 68% to 100%. Because of the heterogenous nature of the studies, a meta-analysis could not be accomplished.CONCLUSIONS Despite the frequent use of monofilament testing, little can be said about the test accuracy for detecting neuropathy in feet without visible ulcers. Optimal test application and defining a threshold should have priority in evaluating monofilament testing, as this test is advocated in many clinical guidelines. Accordingly, we do not recommend the sole use of monofilament testing to diagnose peripheral neuropathy.     

Emerging Issues in Child and Youth Care Education: A Platform for Planning

The authors explore key ingredients in the preparation of child and youth care workers with a focus on the conceptual and practical interconnectedness required if the workers are to be enabled to work professionally and effectively.     

Heart rate variability analysis: a useful assessment tool for diabetes associated cardiac dysfunction in rural and remote areas

OBJECTIVE: Cardiovascular complications are the main cause of death in people with diabetes. Early, asymptomatic changes are due to autonomic nervous system dysfunction, which if identified can lead to improved health. This study used detrended fluctuation analysis to identify changes in heart rate variability (HRV) associated with short-time electrocardiograph (ECG) recordings. The aim of the study was to determine whether heart rate variability analysis on short ECG recordings has the potential to be a useful adjunct to clinical practice. DESIGN: Comparative design with three independent simple random samples. SETTING: University-based research project. PARTICIPANTS: Forty-eight people with no diabetes or cardiovascular complications had a 20 min ECG recorded, which was subsequently analysed using mathematical procedures. All participants also had a lying-to-standing autonomic nervous system test. Data was analysed using a Student t-test. RESULTS: Heart rate variability expressed as a numeric value (alpha(1)), is reduced in disease states. We found a significant difference in alpha(1)(P = 0.03) between the ECG recordings of the diabetes and control groups. In addition lower alpha(1)values were obtained from people identified with autonomic dysfunction within the diabetes group. CONCLUSION: The importance of our findings is that abnormal HRV identifies people with cardiovascular disease, irrespective of diabetes status, that may have autonomic neuropathy. HRV analysis is easily implemented by primary health care providers and has the potential to lead to improved health care by reducing inequity in rural areas and specifically addressing cardiovascular complications associated with diabetes.     

Treatment Planning for Residential and Non-Residential Care: A Study on Indication-for-Treatment Statements as Input to the Care Process

The central issue in this contribution is the analysis of indication-for-treatment statements (IFT's) in Dutch child and youth care. In the Netherlands under the new Youth Care Act, clients can only obtain intensive forms of child and youth care on the basis of a so-called written IFT-statement. Two studies are presented: one investigating the general quality of the IFT-statements, the other focusing in more detail on the quality of IFT-statements. The main question in both studies is to what extent IFT-statements meet the basic requirements that represent a well-founded and explicit decision, and by meeting that requirement, create a firm basis for treatment planning in residential and non-residential child and youth care services. The authors advocate to make IFT-statements more explicit and, by doing so, to contribute to an increased transparency of the decision-making process at the entrance into child and youth care services.     

Generational Cohorts Hold the Key to Understanding Patients and Health Care Providers: Coming-of-Age Experiences Influence Health Care Behaviors for a Lifetime

The health care landscape is ever changing. Medical groups are experiencing challenges in recruiting staff, dealing with managing effective clinical teams, and tempering the growing tensions among partnerships and medical groups. Additionally, all clinicians report many patients are now approaching them differently than in the past. They come armed with medical information from the Internet and a more questioning attitude toward the clinician's directive for care. What accounts for these behavioral changes and management challenges within health care organizations? These issues may be best understood and addressed through generational cohort analysis.     

Physician Office vs Retail Clinic: Patient Preferences in Care Seeking for Minor Illnesses

PURPOSE Retail clinics are a relatively new phenomenon in the United States, offering cheaper and convenient alternatives to physician offices for minor illness and wellness care. The objective of this study was to investigate the effects of cost of care and appointment wait time on care-seeking decisions at retail clinics or physician offices.METHODS As part of a statewide random-digit-dial survey of households, adult residents of Georgia were interviewed to conduct a discrete choice experiment with 2 levels each of 4 attributes: price ($59; $75), appointment wait time (same day; 1 day or longer), care setting–clinician combination (nurse practitioner in retail clinic; physician in private office), and acute illness (urinary tract infection [UTI]; influenza). The respondents indicated whether they would seek care under each of the 16 resulting choice scenarios. A cooperation rate of 33.1% yielded 493 completed telephone interviews.RESULTS The respondents preferred to seek care for both conditions; were less likely to seek care for UTI (β =−0.149; P = .008); preferred to seek care from a physician (β =1.067; P <.001) and receive same day care (β =−2.789; P<.001). All else equal, cost savings of $31.42 would be required for them to seek care at a retail clinic and $82.12 to wait 1 day or more.CONCLUSIONS Time and cost savings offered by retail clinics are attractive to patients, and they are likely to seek care there given sufficient cost savings. Appointment wait time is the most important factor in care-seeking decisions and should be considered carefully in setting appointment policies in primary care practices.     

Patient Experiences of Continuity of Cancer Care: Development of a New Medical Care Questionnaire (MCQ) for Oncology Outpatients

Objectives:  To adapt the Components of Primary Care Index (CPCI) to be applicable to oncology outpatients and to assess the reliability and validity of the adapted instrument (renamed the Medical Care Questionnaire [MCQ]).
Methods:  The development and validation of the MCQ took place in four phases. Phase 1 reviewed the literature and examined existing measures. In Phase 2, the selected instrument (CPCI) was reviewed by a panel of experts using a stepwise consensus procedure. In Phase 3, the adapted 21-item MCQ was administered to 200 outpatients attending oncology appointments. The instrument was refined to 15 items and in Phase 4, it was completed by 477 oncology outpatients. The psychometric properties of the new instrument were assessed using exploratory factor analysis (EFA), confirmatory factor analysis, multitrait scaling analysis, and by comparing MCQ scores between known groups.
Results:  EFA of the 15-item MCQ suggested three subscales with acceptable to good reliability: "Communication"α = 0.69; "Coordination"α = 0.84; and "Preferences"α = 0.75. Comparing known groups showed that patients who saw fewer doctors during their clinic visits reported stronger "Preferences" to see their usual doctor and rated "Communication" with their doctors as better than patients who saw more doctors during their clinic visits.
Conclusion:  The MCQ demonstrates good psychometric properties in the target population. It is a brief and simple-to-use instrument, which provides a valid perspective on patients' experiences of communicating with doctors and their perceptions of the continuity and coordination of their cancer care.     

Quality of Hospital Communication and Patient Preparation for Home Health Care: Results From a Statewide Survey of Home Health Care Nurses and Staff

Objectives

To evaluate the quality of communication between hospitals and home health care (HHC) clinicians and patient preparedness to receive HHC in a statewide sample of HHC nurses and staff.

Struggles for maintenance: Patient activism and dialysis dilemmas amidst a global diabetes epidemic

ABSTRACT

Diabetes has become a leading cause of death in Belize, making this Central American country emblematic of challenges amplified by a growing global diabetes epidemic. The struggles people face as they seek care for chronic conditions like diabetes (and its complications such as kidney failure) are bringing citizens and institutions alike to revisit longstanding norms about the terms through which healthcare is accessed. Ethnographically tracing Belize’s first patient-driven healthcare protests and activism – an ad hoc movement for public dialysis that began over a decade ago – this paper examines patients’ and caregivers’ struggles to probe and shape a legacy of social justice health activism, drawing on perspectives from an often-overlooked part of Central America where basic healthcare access has not historically been framed as a right of citizens. It considers these dilemmas in relation to much larger chronic struggles ‘to maintain’ and repair bodies, medical technologies, and health systems in the aftermath of colonial legacies – with special attention to the challenges posed for small countries now facing rising issues of diabetes injuries and chronic complications – and the role of civic media and citizen activism in this context.     

Patient Navigation: Development of a Protocol for Describing What Navigators Do

Objective. To develop a structured protocol for observing patient navigators at work, describing and characterizing specific activities related to their goals. Data Sources/Setting. Fourteen extended observations of navigators at three programs within a national trial of patient navigation. Study Design. Preliminary observations were guided by a conceptual model derived from the literature and expert consensus, then coded to develop and refine observation categories. These findings were then used to develop the protocol. Methods. Observation fieldnotes were coded, using both a priori codes and new codes based on emergent themes. Using these codes, the team refined the model and constructed an observation tool that enables consistent categorization of the observed range of navigator actions. Findings. Navigator actions across a wide variety of settings can be categorized in a matrix with two dimensions. One dimension categorizes the individuals and organizational entities with whom the navigator interacts; the other characterizes the types of tasks carried out by the navigators in support of their patients. Conclusions. Use of this protocol will enable researchers to systematically characterize and compare navigator activities within and across programs.     

The case for improving road safety in Pacific Islands: a population‐based study from Fiji (TRIP 6)

Objective : To estimate the incidence and demographic characteristics associated with road traffic injuries (RTIs) resulting in deaths or hospital admission for 12 hours or more in Viti Levu, Fiji. Methods : Analysis of the prospective population‐based Fiji Injury Surveillance in Hospitals database (October 2005 – September 2006). Results: Of the 374 RTI cases identified (17% of all injuries), 72% were males and one third were aged 15–29 years. RTI fatalities (10.3 per 100,000 per year) were higher among Indians compared to Fijians. Two‐thirds of deaths (largely ascribed to head, chest and abdominal trauma) occurred before hospital admission. Conclusion and implications: While the RTI fatality rate was comparable to the global average for high‐income countries, the level of motorisation in Fiji is considerably lower. To avert rising RTI rates with increasing motorisation, Fiji requires a robust road safety strategy alongside effective trauma‐care services and a reliable population‐based RTI surveillance system.     

非肠道病毒A组71型感染手足口病重症危险因素分析

目的 分析非肠道病毒A组71型（enterovirus group A type 71,EV-A71）感染手足口病患者的重症危险因素,为尽早识别重症患者并及时治疗提供依据。方法 收集深圳市宝安人民医院2015年5月~2016年11月收治的手足口病病例,明确感染的肠道病毒血清分型后选取非EV-A71感染的轻症和重症患者各185例,采用多因素条件Logistic回归方法筛选出重症手足口病的影响因素。结果 经多因素条件Logistic回归分析,发现发热最高温≥ 39℃（OR=6.61,95% CI：3.17~13.81）、出疹类型为丘疹（OR=2.82,95% CI：1.40~5.69）、出疹部位为足部（OR=2.05,95% CI：1.08~3.90）、就诊延迟1 d内（OR=3.44,95% CI：1.56~7.58）、出生时有并发症（OR=7.37,95% CI：1.66~32.70）、非母乳喂养（OR=1.89,95% CI：1.01~3.54）、发病前常在小区玩耍（OR=2.92,95% CI：1.44~5.92）、经常咬玩具（OR=2.27,95% CI：1.13~4.53）为非EV-A71手足口病重症的危险因素（均有P<0.05）。结论 应密切关注患者临床、实验室和卫生习惯等多项指标,及时发现手足口病重症的危险因素并进行临床诊治和健康教育。     

Toward a Taxonomy for the Child and Youth Care Field: An Initial Proposal and an Invitation

As the child and youth care work literature expands, the need for ways of organizing it effectively becomes increasingly apparent. In this article, the authors present a proposed outline for such an organizational schema based largely on material in the senior author's files being prepared for inclusion in an archive reflecting the development of the field. Suggestions from readers to expand and enhance the proposed categorization are invited.     

An HIT Solution for Clinical Care and Disaster Planning: How One health Center in Joplin,MO Survived a Tornado and Avoided a Health Information Disaster

Since taking office, President Obama has made substantial investments in promoting the diffusion of health information technology (IT). The objective of the national health IT program is, generally, to enable health care providers to better manage patient care through secure use and sharing of health information. Through the use of technologies including electronic health records, providers can better maintain patient care information and facilitate communication, often improving care outcomes. The recent tornado in Joplin, MO highlights the importance of health information technology in the health center context, and illustrates the importance of secure electronic health information systems as a crucial element of disaster and business continuity planning. This article examines the experience of a community health center in the aftermath of the major tornado that swept through the American Midwest in the spring of 2011, and provides insight into the planning for disaster survival and recovery as it relates to patient records and health center data.     

Consumer Health Informatics: The Application of ICT in Improving Patient-Provider Partnership for a Better Health Care

Background

There is a growing interest concerning the potential of ICT solutions that are customized to consumers. This emerging discipline referred to as consumer health informatics (CHI) plays a major role in providing information to patients and the public, and facilitates the promotion of self-management.The concept of CHI has emerged out of the desire of most patients to shoulder responsibilities regarding their health and a growing desire of health practitioners to fully appreciate the potential of the patient.

Aim

To describe the role of ICT in improving the patient-provider partnership in consumer health informatics.

Methods

Systematic reviewing of literature, identification of reference sources and formulation of search strategies and manual search regarding the significance of developed CHI applications in healthcare delivery.

Results

New consumer health IT applications have been developed to be used on a variety of different platforms, including the Web, messaging systems, PDAs, and cell phones. These applications assists patients with self-management through reminders and prompts, delivery of real-time data on a patient’s health condition to patients and providers, web-based communication and personal electronic health information.

Conclusion

New tools are being developed for the purposes of providing information to patients and the public which has enhanced decision making in health matters and an avenue for clinicians and consumers to exchange health information for personal and public use. This calls for corroboration among healthcare organizations, governments and the ICT industry to develop new research and IT innovations which are tailored to the health needs of the consumer.