Browsing by Subject "Patient-Centered Care"

Now showing 1 - 7 of 7
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    Agenda Setting in Psychiatric Consultations: An Exploratory Study
    (2013) Frankel, Richard M.; Salyers, Michelle P.; Bonfils, Kelsey; Oles, Sylwia; Matthias, Marianne S.
    Objective: Patient- or consumer-centeredness has been recognized as a critical component of quality in primary health care, but is only beginning to be recognized and studied in mental health. Among the first opportunities to be consumer-centered is collaboratively producing an agenda of topics to be covered during a clinic visit. Early agenda setting sets the stage for what is to come and can affect the course, direction, and quality of care. The purpose of this work is to study agenda setting practices among 8 prescribers (5 psychiatrists and 3 nurse practitioners) at the beginning of their encounters with 124 consumers diagnosed with schizophrenia spectrum disorders (56%), bipolar disorder (23%), major depression (15%), and other disorders (6%). Method: We modified an extant agenda-setting rubric by adding behaviors identified by a multidisciplinary team who iteratively reviewed transcripts of the visit openings. Once overall consensus was achieved, two research assistants coded all of the transcripts. Twenty-five transcripts were scored by both raters to establish interrater reliability. Results: We identified 10 essential elements of agenda setting. Almost 10% of visits had no agenda set, and only 1 of 3 encounters had partial or complete elicitation of a single concern. Few additional concerns (4%) were solicited, and no encounter contained more than 6 essential elements. Conclusions and implications for practice: Collaborative agenda setting represents a unique opportunity to translate the concept of consumer-centeredness into mental health care. Initial results suggest the rating system is reliable, but the essential elements are not being used in practice.
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    Development and use of an instrument adapted to assess the clinical skills learning environment in the pre-clinical years
    (Springer, 2015-09) Rdesinski, Rebecca E.; Chappelle, Kathryn G.; Elliot, Diane L.; Litzelman, Debra K.; Palmer, Ryan; Biagioli, Frances E.; Department of Medicine, IU School of Medicine
    BACKGROUND: The Communication, Curriculum, and Culture (C3) instrument is a well-established survey for measuring the professional learning climate or hidden curriculum in the clinical years of medical school. However, few instruments exist for assessing professionalism in the pre-clinical years. We adapted the C3 instrument and assessed its utility during the pre-clinical years at two U.S. medical schools. METHODS: The ten-item Pre-Clinical C3 survey was adapted from the C3 instrument. Surveys were administered at the conclusion of the first and second years of medical school using a repeated cross-sectional design. Factor analysis was performed and Cronbach's alphas were calculated for emerging dimensions. RESULTS: The authors collected 458 and 564 surveys at two medical schools during AY06-07 and AY07-09 years, respectively. Factor analysis of the survey data revealed nine items in three dimensions: "Patients as Objects", "Talking Respectfully of Colleagues", and "Patient-Centered Behaviors". Reliability measures (Cronbach's alpha) for the Pre-Clinical C3 survey data were similar to those of the C3 survey for comparable dimensions for each school. Gender analysis revealed significant differences in all three dimensions. CONCLUSIONS: The Pre-Clinical C3 instrument's performance was similar to the C3 instrument in measuring dimensions of professionalism. As medical education moves toward earlier and more frequent clinical and inter-professional educational experiences, the Pre-Clinical C3 instrument may be especially useful in evaluating the impact of curricular revisions.
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    Evaluating Overall Functioning Across Adaptive Domains in Children with Autism Spectrum Disorder: Implementation and Application of the Developmental Disabilities Modification of the Children's Global Assessment Scale (DD-CGAS)
    (2023-08-04) Devarapalli, Baby Amulya; Neal, Tiffany; Deodhar, Aditi; Swiezy, Naomi
    This practicum, completed at HANDS in Autism® in collaboration with the Indiana NeuroDiagnostic Institute (NDI), focused on evaluating overall functioning in adolescents with Autism Spectrum Disorder (ASD) using the Developmental Disabilities Modification of the Children's Global Assessment Scale (DD-CGAS). The study analyzed data from 58 patients across the pre-admission and post-discharge phases, with ratings assigned in key adaptive domains: Self-Care, Communication, Social Behavior, and School/Academic Functioning. Additional measures included Eating, Sleeping, and Dressing abilities. Data were extracted from the Cerner electronic health record system, cleaned and coded using REDCap, and analyzed using Python, Excel, and Power BI. By comparing DD-CGAS scores across age and gender groups, the project assessed the impact of integrated, patient-centered inpatient care on behavioral functioning. Findings support the utility of structured, quantitative behavioral assessments in improving treatment planning and measuring intervention outcomes in ASD-focused psychiatric settings.
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    Evaluating patient-centered care: feasibility of electronic data collection in hospitalized older adults
    (Ovid Technologies (Wolters Kluwer) - Lippincott Williams & Wilkins, 2012-10) Duffy, Joanne R.; Kooken, Wendy Carter; Wolverton, Cheryl L.; Weaver, Michael T.; IU School of Nursing
    Evaluating patient-centered care (PCC) is crucial to its improvement. This pilot study tested the feasibility of an electronic format to assess PCC during hospitalization. Using a validated indicator of PCC embedded on a mobile device, 86 older adults evaluated its delivery by registered nurses. Patients older than 85 years rated PCC poorer than those who were younger (r = -0.22; P = .04). The electronic format was appraised as feasible; it performed well and took on average 30 minutes to complete.
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    An informatics approach to medication adherence assessment and improvement using clinical, billing, and patient-entered data
    (Oxford University Press, 2014-05) Dixon, Brian E.; Jabour, Abdulrahman M.; O’Kelly Phillips, Erin; Marrero, David G.; BioHealth Informatics, School of Informatics and Computing
    The aim of this study was to describe an integrated informatics approach to aggregating and displaying clinically relevant data that can identify problems with medication adherence and facilitate patient-provider communication about strategies to improve medication use. We developed a clinical dashboard within an electronic health record (EHR) system that uses data from three sources: the medical record, pharmacy claims, and a personal health record. The data are integrated to inform clinician-patient discussions about medication adherence. Whereas prior research on assessing patterns of medication adherence focused on a single approach using the EHR, pharmacy data, or patient-entered data, we present an approach that integrates multiple electronic data sources increasingly found in practice. Medication adherence is a complex challenge that requires patient and provider team input, necessitating an integrated approach using advanced EHR, clinical decision support, and patient-controlled technologies. Future research should focus on integrated strategies to provide patients and providers with the right combination of informatics tools to help them adequately address the challenge of adherence to complex medication therapies.
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    A Model for Engaging Public–Private Partnerships
    (Wiley, 2011-04-04) Shekhar, Anantha; Denne, Scott; Tierney, William; Wilkes, David; Brater, D. Craig; Medicine, School of Medicine
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    A Review of the Evidence and Recommendations on Communication Skills and the Patient–Provider Relationship: A Rome Foundation Working Team Report
    (Elsevier, 2021-11) Drossman, Douglas A.; Chang, Lin; Deutsch, Jill K.; Ford, Alexander C.; Halpert, Albena; Kroenke, Kurt; Nurko, Samuel; Ruddy, Johannah; Snyder, Julie; Sperber, Ami; Medicine, School of Medicine
    Background & Aims Over several decades, changes in health care have negatively impacted meaningful communication between the patient and provider and adversely affected their relationship. Under increasing time pressure, physicians rely more on technology than face-to-face time gathering data to make clinical decisions. As a result, they find it more challenging to understand the illness context and fully address patient needs. Patients experience dissatisfaction and a diminution of their role in the care process. For patients with disorders of gut–brain interaction, stigma leads to greater care dissatisfaction, as there is no apparent structural basis to legitimize the symptoms. Recent evidence suggests that practical communication skills can improve the patient–provider relationship (PPR) and clinical outcomes, but these data are limited. Methods The Rome Foundation convened a multidisciplinary working team to review the scientific evidence with the following aims: a) to study the effect of communication skills on patient satisfaction and outcomes by performing an evidence-based review; b) to characterize the influence of sociocultural factors, health care system constraints, patient perspective, and telehealth on the PPR; c) to review the measurement and impact of communication skills training on these outcomes; and d) to make recommendations to improve communication skills training and the PPR. Results Evidence supports the fact that interventions targeting patient–provider interactions improve population health, patient and provider experience, and costs. Communication skills training leads to improved patient satisfaction and outcomes. The following are relevant factors to consider in establishing an effective PPR: addressing health care system constraints; incorporating sociocultural factors and the role of gender, age, and chronic illness; and considering the changing role of telehealth on the PPR. Conclusions We concluded that effective communication skills can improve the PPR and health outcomes. This is an achievable goal through training and system change. More research is needed to confirm these findings.