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Matthew E. Modes Ruth A. Engelberg Lois Downey Elizabeth L. Nielsen J. Randall Curtis Erin K. Kross 《Journal of pain and symptom management》2019,57(2):251-259
Context
Goals-of-care discussions are associated with improved end-of-life care for patients and therefore may be used as a process measure in quality improvement, research, and reimbursement programs.Objectives
To examine three methods to assess occurrence of a goals-of-care discussion—patient report, clinician report, and documentation in the electronic health record (EHR)—at a clinic visit for seriously ill patients and determine whether each method is associated with patient-reported receipt of goal-concordant care.Methods
We conducted a secondary analysis of a multicenter cluster-randomized trial, with 494 patients and 124 clinicians caring for them. Self-reported surveys collected from patients and clinicians two weeks after a clinic visit assessed occurrence of a goals-of-care discussion. Documentation of a goals-of-care discussion was abstracted from the EHR. Patient-reported receipt of goal-concordant care was assessed by survey two weeks after the visit.Results
Fifty-two percent of patients reported occurrence of a goals-of-care discussion at the clinic visit; clinicians reported occurrence of a discussion at 66% of visits. EHR documentation occurred in 42% of visits (P < 0.001 for each compared with other two). Patients who reported occurrence of a goals-of-care discussion at the visit were more likely to report receipt of goal-concordant care than patients who reported no discussion (β 0.441, 95% CI 0.190–0.692; P = 0.001). Neither occurrence of a discussion by clinician report nor by EHR documentation was associated with goal-concordant care.Conclusion
Different approaches to assess goals-of-care discussions give differing results, yet each may have advantages. Patient report is most likely to correlate with patient-reported receipt of goal-concordant care. 相似文献55.
Client and clinical staff perceptions of barriers to and enablers of the uptake and delivery of behavioural interventions for urinary incontinence: qualitative evidence synthesis
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Beverley French PhD RN Lois H. Thomas BA PhD RN Joanna Harrison BA MA Jacqueline Coupe BSc MPH MBPsS Brenda Roe PhD RN RHV Joanne Booth BSc BA PhD RN Francine M. Cheater BA PhD RN Michael J. Leathley BA PhD PGDip Caroline L. Watkins BA PhD RN Jean Hay‐Smith PhD MSc DipPhysiotherapy MPNZ the ICONS Project Team the ICONS Patient Public Carer Groups 《Journal of advanced nursing》2017,73(1):21-38
56.
Clifton R. Hudson Nicolle T. Clements Lois A. Benishek Claire E. Nick 《Journal of psychoactive drugs》2014,46(2):106-113
Little normative information is available about the psychosocial functioning of women who have a substance-abusing intimate partner. This study examined whether the social adjustment of women who indicate that they have a substance-abusing partner (n=69) is compromised relative to that of women who indicate that their partner does not abuse substances (n=68). Women with a substance-abusing partner reported compromised social adjustment relative to a comparison sample both overall and in five of six life domains (work, social/leisure, primary relationship, parental, family). Results suggest the potential benefit of expanding the focus of research and treatment to include effects and outcomes for these women and to influence treatment-related policy. 相似文献
57.
A diaper bank and home visiting partnership: Initial exploration of research and policy questions
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58.
The emotional impact of errors or adverse events on healthcare providers in the NICU: The protective role of coworker support
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Elting LS Escalante CP Cooksley C Avritscher EB Kurtin D Hamblin L Khosla SG Rivera E 《Archives of internal medicine》2004,164(15):1653-1661
BACKGROUND: Although deep venous thrombosis (DVT) often complicates the clinical course in patients with cancer, few studies of the outcomes of DVT in this population have been published. Furthermore, the cost of DVT is largely undescribed. We herein report the largest study of DVT in this population to date. METHODS: We reviewed the medical records of 529 consecutive cancer patients in whom DVT developed from January 1, 1994, through December 31, 1997, and followed up these patients through December 31, 2000, for outcomes. The cost of hospitalization was obtained from our hospital's cost-accounting system and inflated to 2002 US dollars using the Consumer Price Index for Medical Care. Logistic regression was used to identify factors that were associated with a high risk of poor outcomes. RESULTS: The most common complication of DVT was bleeding, which occurred in 13% of patients. Pulmonary embolus occurred in 4%. Five patients (1%) died of complications of DVT and 5 (1%) of complications of anticoagulation. Recurrence of DVT was common (17% overall), particularly among those who had inferior vena cava filters (32%; P<.001) or a previous episode of DVT (P =.03). All but 4 patients were hospitalized for initial anticoagulation therapy, for a mean of 11 days. The mean cost of hospitalization was 2002 US $20 065. CONCLUSIONS: Among patients with cancer, DVT frequently is associated with serious clinical outcomes. Its treatment is resource intensive and costly. More effective agents and less costly management strategies could have a significant impact on the outcomes and cost of DVT in this population. 相似文献