Sources of Palliative Care Knowledge Among Patients With Advanced or Metastatic Gynecologic Cancer

ContextA minority of patients with advanced or metastatic gynecologic cancer utilize palliative care and lack of knowledge may be a barrier to receiving palliative care services.ObjectivesTo identify sources used by patients with advanced or metastatic gynecologic cancer to learn about palliative care and evaluate for differences in knowledge about palliative care and palliative care utilization by knowledge source.MethodsPatients with gynecologic cancer receiving treatment for advanced or metastatic gynecologic cancer at a single academic medical center were surveyed about their awareness of and knowledge about palliative care. Medical chart review was conducted.ResultsOf the 111 women surveyed, 70 had heard of palliative care (63%). Sixty-eight specified from where they learned of palliative care: cancer care (n = 28; 41.2%), word of mouth (n = 26; 38.2%), work (n = 6; 8.8%), self-education (n = 4; 5.9%), personal experience (n = 2; 2.9%), or do not know (n = 2; 2.9%). Knowledge about palliative care (P = 0.35) and palliative care utilization (P = 0.81) did not differ by awareness of palliative care.ConclusionMost women receiving treatment for advanced gynecologic cancer have heard of palliative care from sources other than their cancer care providers. Knowledge about palliative care and source of knowledge about palliative care were not associated with palliative care utilization. Awareness of palliative care and palliative care utilization may be improved by increasing the low rate of health provider-based education and engaging cancer patients' social networks.     

Health Information Technology Knowledge and Skills Needed by HIT Employers

Objective

To evaluate the health information technology (HIT) workforce knowledge and skills needed by HIT employers.

Methods

Statewide face-to-face and online focus groups of identified HIT employer groups in Austin, Brownsville, College Station, Dallas, El Paso, Houston, Lubbock, San Antonio, and webinars for rural health and nursing informatics.

Results

HIT employers reported needing an HIT workforce with diverse knowledge and skills ranging from basic to advanced, while covering information technology, privacy and security, clinical practice, needs assessment, contract negotiation, and many other areas. Consistent themes were that employees needed to be able to learn on the job and must possess the ability to think critically and problem solve. Many employers wanted persons with technical skills, yet also the knowledge and understanding of healthcare operations.

Conclusion

The HIT employer focus groups provided valuable insight into employee skills needed in this fast-growing field. Additionally, this information will be utilized to develop a statewide HIT workforce needs assessment survey.     

The Effects of Health Information Technology Change Over Time: A Study of Tele-ICU Functions

Objectives

Longitudinal studies exploring the evolution of health information technology functions provide valuable information about how technology systems are integrated and exploited in situ. This study reports changes in the distribution of functions for a specific health information technology, the tele-ICU, over time. The studied tele-ICU provided care to six remote ICUs within a local geographic region in the same state and had nursing staff around the clock.

Methods

The intervention logs of tele-ICU nurses were collected during two discrete times and coded into nine emergent functional categories, who initiated the intervention and, if required, subsequent escalation. All coded functional categories were investigated for significant changes over time in the nursing logged interventions.

Results

A total of 1927 interventions were coded into the nine emergent functional categories. Seven of the nine categories (78%) were significantly different between 2005 and 2007. The functions of the tele-ICU system continue to change and develop over time.

Conclusion

These findings suggest that the tele-ICU increased support when ICU nurses were off the unit, inter-hospital coordinating and adherence to best practices, while simultaneously decreasing real-time support for ICU nurses. This research suggests that sustaining safety features in a new technology over time have post-conditions after implementation.     

Supportive Clinical Practice Environments Associated With Patient-Centered Care

A lack of organizational supports in clinical settings may prevent nurse practitioners (NPs) from providing patient-centered care. Using a cross-sectional survey design, data were collected from NPs in 1,571 practices across 4 states to investigate clinical practice environments and the extent to which they are associated with NP integration of patient preferences. Three-quarters of NPs reported frequent integration of patient preferences into clinical care. Overall, 371 practices (23.6%) were classified as good practice environments; the remaining 76.3% were mixed or poor environments. NPs in good environments were significantly more likely to integrate patient preferences.     

Evaluating the Psychometric Properties of the CAHPS Patient-Centered Medical Home Survey

Objective

The goal of this study was to evaluate the reliability and validity of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Patient-Centered Medical Home (PCMH) survey.

Methods

We conducted a field test of the CAHPS PCMH survey with 2740 adults. We collected information by mail (n = 1746), telephone (n = 672), and from the Web (n = 322) from 6 sites of care affiliated with a West Coast staff model health maintenance organization.

Results

An overall response rate of 37% was obtained. Internal consistency reliability estimates for 7 multi-item scales were as follows: access to care, 5 items, α = 0.79; communication with providers, 6 items, α = 0.93; office staff courtesy and respect, 2 items, α = 0.80; shared decision making about medicines, 3 items, α = 0.67; self-management support, 2 items, α = 0.61; attention to mental health issues, 3 items, α = 0.80; and care coordination, 4 items, α = 0.58. The number of responses needed to get reliable information at the site of care level for the composites was generally acceptable (<300 for 0.70 reliability-level) except for self-management support and shared decision making about medicines. Item-scale correlations provided support for distinct composites except for access to care and shared decision making about medicines, which overlapped with the communication with providers scale. Shared decision making and self-management support were significantly, uniquely associated with the global rating of the provider (dependent variable), along with access and communication in a multiple regression model.

Conclusions

This study provides further support for the reliability and validity of the CAHPS PCMH survey, but refinement of the self-management support and shared decision-making scales is needed. The survey can be used to provide information about the performance of different health plans on multiple domains of health care, but future efforts to improve some of the survey items is needed.     

History and Trends in Clinical Information Systems in the United States

Purpose: To provide a synopsis of issues about clinical information systems for nurses not schooled in nursing informatics.
Organizing construct: The past, present, and future of clinical computing, including major factors resulting in the early hospital information systems (HIS) and decision support systems (DSS) in the United States, current advances and issues in managing clinical information, and future trends and issues.
Methods: Literature review and analysis.
Findings and Conclusions: The first HIS and DSS were used in the late 1960s and were focused on applications for acute care. The change from fee-for-service to managed care required a change in the design of clinical information systems toward more patient-centered systems that span the care continuum, such as the computer-based patient record (CPR). Current difficulties with CPR systems include lack of systems integration, data standardization, and implementation. Increased advances in information and technology integration and increased use of the Internet for health information will shape the future of clinical information systems.     

老年糖尿病患者口腔健康知识和行为调查

目的调查老年糖尿病患者对糖尿病并发牙周疾病的认知和口腔保健行为,为提高糖尿病健康教育的针对性提供依据。方法调查表内容包含3方面,以访谈形式对102例老年糖尿病患者进行糖尿病并发牙周疾病认知和口腔保健行为调查。结果仅29例患者对糖尿病并发牙周疾病有足够的认知,占28．4％;39例经常接受糖尿病管理健康教育知识的患者仍有27例缺乏糖尿病并发牙周疾病的认知;51．0％的老年糖尿病患者,能坚持早晚各刷牙1次,47．1％的患者选用软毛牙刷刷牙,20．6％的患者做到2-3个月更换牙刷1次;但是仅31．4％的患者采用竖刷牙法刷牙;2．0％的患者定期看牙医,进行口腔检查和维护。结论老年糖尿病患者对糖尿病并发牙周疾病的认知水平低,口腔保健行为不良。因此在糖尿病健康教育中应增加对糖尿病并发牙周疾病相关知识和正确口腔保健知识和技能教育。     

Information Loss in Emergency Medical Services Handover of Trauma Patients

Introduction. Little is known about how effectively information is transferred from emergency medical services (EMS) personnel to clinicians in the emergency department receiving the patient. Information about prehospital events and findings can help ensure expedient and appropriate care. The trauma literature describes 16 prehospital data points that affect outcome and therefore should be included in the EMS report when applicable. Objective. To determine the degree to which information presented in the EMS trauma patient handover is degraded. Methods. At a level I trauma center, patients meeting criteria for the highest level of trauma team activation (“full trauma”) were enrolled. As part of routine performance improvement, the physician leadership of the trauma program watched all available video-recorded full trauma responses, checking off whether the data points appropriate to the case were verbally “transmitted” by the EMS provider. Two EMS physicians then each independently reviewed the trauma team's chart notes for 50% of the sample (and a randomly selected 15% of the charts to assess agreement) and checked off whether the same elements were documented (“received”) by the trauma team. The focus was on data elements that were “transmitted” but not “received.” Results. In 96 patient handovers, a total of 473 elements were transmitted, of which 329 were received (69.6%). On the average chart, 72.9% of the transmitted items were received (95% confidence interval 69.0%–76.8%). The most commonly transmitted data elements were mechanism of injury (94 times), anatomic location of injury (81), and age (67). Prehospital hypotension was received in only 10 of the 28 times it was transmitted; prehospital Glasgow Coma Scale [GCS] score 10 of 22 times; and pulse rate 13 of 49 times. Conclusions. Even in the controlled setting of a single-patient handover with direct verbal contact between EMS providers and in-hospital clinicians, only 72.9% of the key prehospital data points that were transmitted by the EMS personnel were documented by the receiving hospital staff. Elements such as prehospital hypotension, GCS score, and other prehospital vital signs were often not recorded. Methods of “transmitting” and “receiving” data in trauma as well as all other patients need further scrutiny.     

Unit-level variation in bed alarm use in US hospitals

Bed and chair alarms are widely used in hospitals, despite lack of effectiveness and unintended negative consequences. In this cross-sectional, observational study, we examined alarm prevalence and contributions of patient- and unit-level factors to alarm use on 59 acute care nursing units in 57 US hospitals participating in the National Database of Nursing Quality Indicators®. Nursing unit staff reported data on patient-level fall risk and fall prevention measures for 1,489 patients. Patient-level propensity scores for alarm use were estimated using logistic regression. Expected alarm use on each unit, defined as the mean patient propensity-for-alarm score, was compared with the observed rate of alarm use. Over one-third of patients assessed had an alarm in the “on” position. Patient characteristics associated with higher odds of alarm use included recent fall, need for ambulation assistance, poor mobility judgment, and altered mental status. Observed rates of unit alarm use ranged from 0% to 100% (median 33%, 10th percentile 5%, 90th percentile 67%). Expected alarm use varied less (median 31%, 10th percentile 27%, and 90th percentile 45%). Only 29% of variability in observed alarm use was accounted for by expected alarm use. Unit assignment was a stronger predictor of alarm use than patient-level fall risk variables. Alarm use is common, varies widely across hospitals, and cannot be fully explained by patient fall risk factors; alarm use is driven largely by unit practices. Alarms are used too frequently and too indiscriminately, and guidance is needed for optimizing alarm use to reduce noise and encourage mobility in appropriate patients.     

精神病患者家属精神卫生知识水平及结构调查

目的了解精神病患者家属的精神卫生知识水平和结构,为开展健康教育提供临床依据。方法采用自行设计的《患者家属精神卫生知识调查表,》对随机抽取的、在精神专科医院就诊的门诊和住院患者的家属,共308人进行调查。结果认为自己的精神卫生知识不足及希望接受健康教育的家属分别占89.6%和88.6%。52.3%、62.7%和54.5%的家属对“药物的作用”、“药物的不良反应”及“如何进行家庭护理”等知识不了解;63.3%家属了解亲人“所患疾病的名称;”了解防止精神病复发主要方法的家属占62.3%;对精神病的病因表示不了解的家属占31.5%。结论精神病专科医院患者家属的精神卫生知识较为缺乏,知识结构不均衡。在这一群体中开展针对性的健康教育非常必要。     

Keeping an Eye on Patient Safety Using Human Factors Engineering (HFE): A Family Affair for the Hospitalized Child

Barbara L. Wilson
Column Editor: Bonnie Gance-Cleveland
Family-Centered Care provides a forum for sharing information about basic components of caring for children and families, including respect, information sharing, collaboration, family-to-family support, and confidence building.     

对住院患者骨质疏松症知识和健康信念的调查

目的　了解住院患者关于骨质疏松症 (OP)知识、健康信念和自我效能以及相关行为。方法　对广州某三甲医院的 12 2名住院患者 ,用根据Kim等人编制的OP量表修订的问卷进行调查。结果　 ( 1)知识问卷平均得分 10 .8,及格率 2 3 %。不同学历之间的知识得分有显著差异 (P <0 .0 5 ) ,随着学历的增高知识得分也增高。 ( 2 )对OP的易感性和严重性认识不足 ,不同年龄和学历间健康信念得分有显著差异 (P <0 .0 5 ) ,其中中年组的健康信念得分高于青年和老年组 ,高中组高于其他学历组。 ( 3 )OP自我效能得分平均 77.5分 ,但在实践中 ,只有 2 /3的人从事运动、1/3的人补钙。不同年龄之间自我效能得分有显著差异 (P <0 0 5 ) ,中年组高于青年和老年组。讨论　应加强OP的健康教育 ,并重点在得分低的组别 ,从而提高患者的OP知识和预防意识 ,增强其OP健康信念和自我效能 ,推动建立健康的生活方式和采取疾病预防行为     

老年患者对新型冠状病毒肺炎防护知识的认知现状及其影响因素

目的了解老年患者对新型冠状病毒肺炎防护知识的认知情况并分析影响因素,以期为提高老年患者防护能力提供理论依据.方法2020年2月采用便利抽样法选取某三级甲等医院193例老年患者为研究对象,采用自编的新型冠状病毒肺炎防护知识测试卷对其进行调查,并分析影响因素.结果老年患者对新型冠状病毒肺炎防护知识得分为(39.34±11.88)分,不同年龄、居住地、文化程度、职业、家庭人均月收入的老年患者得分差异有统计学意义(均P<0.05),经多元逐步回归分析得出文化程度、年龄、居住地是其影响因素(P<0.001),可解释度为30.1%.结论老年患者对新型冠状病毒肺炎防护知识的认知现状不容乐观,且医务人员宣教不足,故应提高医务人员重视程度,并根据老年人不同特征采取有针对性的健康教育,以提高老年患者相关防护能力.     

The Influence of General Practitioners' Knowledge about their Patients on the Clinical Decision-Making Process

Continuity of care is claimed to be an important and integral part of general practice. A main result of continuity is the doctor's accumulated knowledge about his or her patients. The objective of the present study was to evaluate the modifying effects of this knowledge on the decision-making process that takes place in consultations, as experienced by practitioners. A representative sample of 133 Norwegian general practitioners evaluated a total of 3918 of their own consultations. The main independent variable was the doctor's own subjectively evaluated knowledge about the patient's medical history, while the major outcome measures included the perceived influence of accumulated knowledge on the consultation process in general, and on the diagnostic and management decisions in particular.

In two-thirds of all consultations, or in three out of four in which the doctor had previous knowledge about the patient, this knowledge was considered to be clinically useful. In more than one-third of all consultations with previously unknown patients, this lack of information was felt to be a hindrance. Among patients with new medical problems and when the doctor had prior knowledge about the patient, this knowledge was felt to have significantly more therapeutic than diagnostic impact. Accumulated knowledge was generally felt to be of most help in consultations due to psycho-social problems, and was of special diagnostic value in patients presenting new, unspecific problems such as fatigue, fever, and generalized pain. This study indicates that accumulated knowledge about the patient is felt by the general practitioners to play an important and integral part in their clinical decision-making process.     

Outcomes for Patients Who Contact the Emergency Ambulance Service and Are Not Transported to the Emergency Department: A Data Linkage Study

Objectives: Emergency ambulance services do not transport all patients to hospital. International literature reports non-transport rates ranging from 3.7–93.7%. In 2017, 38% of the 11 million calls received by ambulance services in England were attended by ambulance but not transported to an Emergency Department (ED). A further 10% received clinical advice over the telephone. Little is known about what happens to patients following a non-transport decision. We aimed to investigate what happens to patients following an emergency ambulance telephone call that resulted in a non-transport decision, using a linked routine data-set. Methods: Six-months individual patient level data from one ambulance service in England, linked with Hospital Episode Statistics and national mortality data, were used to identify subsequent health events (ambulance re-contact, ED attendance, hospital admission, death) within 3 days (primary analysis) and 7 days (secondary analysis) of an ambulance call ending in non-transport to hospital. Non-clinical staff used a priority dispatch system e.g. Medical Priority Dispatch System to prioritize calls for ambulance dispatch. Non-transport to ED was determined by ambulance crew members at scene or clinicians at the emergency operating center when an ambulance was not dispatched (telephone advice). Results: The data linkage rate was 85% for patients who were discharged at scene (43,108/50,894). After removal of deaths associated with end of life care (N?=?312), 9% (3,861/42,796) re-contacted the ambulance service, 12.6% (5,412/42,796) attended ED, 6.3% (2,694/42,796) were admitted to hospital, and 0.3% (129/42,796) died within 3 days of the call. Rates were higher for events occurring within 7 days. For example, 12% re-contacted the ambulance service, 16.1% attended ED, 9.3% were admitted to hospital, and 0.5% died. The linkage rate for telephone advice calls was low because ambulance services record less information about these patients (24% 2,514/10,634). A sensitivity analysis identified a range of subsequent event rates: 2.5–10.5% of patients were admitted to hospital and 0.06–0.24% of patient died within 3 days of the call. Conclusions: Most non-transported patients did not have subsequent health events. Deaths after non-transport are an infrequent event that could be selected for more detailed review of individual cases, to facilitate learning and improvement.     

Using patient-centered interviewing skills to manage complex patient encounters in primary care

PURPOSE: To describe effective and efficient patient-centered interviewing strategies to enhance the management of complex primary care patient encounters. DATA SOURCES: Research literature and applied case study analysis. CONCLUSIONS: Patient-centered interviewing can enhance effectiveness of care in complex patient encounters. A relatively small investment of time and energy has positive yields in regard to improvements in longer term physiological status, treatment adherence, quality of life, patient-provider working relationship, and patient and nurse practitioner satisfaction. IMPLICATIONS FOR PRACTICE: Use of patient-centered interviewing strategies can enhance effectiveness of patient care processes and outcomes while retaining efficiency of patient management.