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Browsing by Subject "interprofessional relations"
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Item Combined interprofessional education and system intervention to improve screening older adults for dementia and falls(Taylor & Francis, 2021) Litzelman, Debra K.; Butler, Dawn E.; Iloabuchi, Tochukwu; Frank, Kathryn I.; Bo, Na; Tong, Yan; Garrison, Emilie; Roth, Sarah; Vannerson, Julie; Medicine, School of MedicineThe objective of this study was to increase screening for falls and dementia by improving interprofessional (IP) providers’ and staffs’ knowledge and attitudes toward the care of older patients and team-based care. An intervention, including education about screening and an electronic health record (EHR) flowsheet, was rolled-out across eight Federally Qualified Health Centers (FQHC). Participants were 262 IP health providers who served 6670 patients ≥ age 65 > age 65 . An EHR flowsheet with two-item screeners for falls and dementia triggered automatically for patients ≥ age 65. Documentation of screening for falls and dementia was abstracted from the EHR for the year prior to and the year after the interventions began. Baseline screening rates for falls and dementia were flat; from the start of education intervention until EHR live date, screening rates increased significantly; after EHR live date, the screening rates continued increasing significantly. A combined education-system intervention can improve screening for falls and dementia in FQHC.Item An Interprofessional Quality Improvement Initiative to Standardize Pediatric Extubation Readiness Assessment(Wolters Kluwer, 2017-10) Abu-Sultaneh, Samer; Hole, Acrista J.; Tori, Alvaro J.; Benneyworth, Brian D.; Lutfi, Riad; Mastropietro, Christopher W.; Pediatrics, School of MedicineObjectives: Establishing protocols to wean mechanical ventilation and assess readiness for extubation, with the goal of minimizing morbidity associated with extubation failure and prolonged mechanical ventilation, have become increasingly important in contemporary PICUs. The aim of this quality improvement initiative is to establish a respiratory therapist–led daily spontaneous breathing trial protocol to standardize extubation readiness assessment and documentation in our PICU. Design: A quality improvement project. Setting: Single center, tertiary care Children’s Hospital PICU. Patients: All intubated patients admitted to PICU requiring conventional mechanical ventilation between February 2013 and January 2016. Interventions: A working group of pediatric intensivists, respiratory therapists, nurses, and information technology specialists established the protocol, standardized documentation via the electronic medical record, and planned education. Daily spontaneous breathing trial protocol implementation began in February 2015. All patients on mechanical ventilation were screened daily at approximately 4 AM by a respiratory therapist to determine daily spontaneous breathing trial eligibility. If all screening criteria were met, patients were placed on continuous positive airway pressure of 5 cm H2O with pressure support of 8 cm H2O for up to 2 hours. If tolerated, patients would be extubated to supplemental oxygen delivered via nasal cannula in the morning, after intensivist approval. Daily audits were done to assess screening compliance and accuracy of documentation. Measurements and Main Results: We analyzed data from 398 mechanically ventilated patients during daily spontaneous breathing trial period (February 2015–January 2016), compared with 833 patients from the pre–daily spontaneous breathing trial period (February 2013–January 2015). During the daily spontaneous breathing trial period, daily screening occurred in 92% of patients. Extubation failure decreased from 7.8% in the pre–daily spontaneous breathing trial period to 4.5% in daily spontaneous breathing trial period. The use of high-flow nasal cannula slightly increased during the project, while there was no change in duration of mechanical ventilation or the use of noninvasive ventilation. Conclusions: An interprofessionally developed respiratory therapist–led extubation readiness protocol can be successfully implemented in a busy tertiary care PICU without adverse events.Item Use of Survivorship Care Plans in the United States: Associations With Survivorship Care(Oxford Journals, 2013-10-16) Forsythe, Laura P.; Parry, Carla; Alfano, Catherine M.; Kent, Erin E.; Leach, Corinne R.; Haggstrom, David A.; Ganz, Patricia A.; Aziz, Noreen; Rowland, Julia H.; Department of Medicine, IU School of MedicineBackground Survivorship care plans (SCPs), including a treatment summary and follow-up plan, intend to promote coordination of posttreatment cancer care; yet, little is known about the provision of these documents by oncologists to primary care physicians (PCPs). This study compared self-reported oncologist provision and PCP receipt of treatment summaries and follow-up plans, characterized oncologists who reported consistent provision of these documents to PCPs, and examined associations between PCP receipt of these documents and survivorship care. Methods A nationally representative sample of medical oncologists (n = 1130) and PCPs (n = 1020) were surveyed regarding follow-up care for breast and colon cancer survivors. All statistical tests were two-sided. Multivariable regression models identified factors associated with oncologist provision of treatment summaries and SCPs to PCPs (always/almost always vs less frequent). Results Nearly half of oncologists reported always/almost always providing treatment summaries, whereas 20.2% reported always/almost always providing SCPs (treatment summary + follow-up plan). Approximately one-third of PCPs indicated always/almost always receiving treatment summaries; 13.4% reported always/almost always receiving SCPs. Oncologists who reported training in late- and long-term effects of cancer and use of electronic medical records were more likely to report SCP provision (P < .05). PCP receipt of SCPs was associated with better PCP-reported care coordination, physician–physician communication, and confidence in survivorship care knowledge compared to receipt of neither treatment summaries nor SCPs (P < .05). Conclusions Providing SCPs to PCPs may enhance survivorship care coordination, physician–physician communication, and PCP confidence. However, considerable progress will be necessary to achieve implementation of sharing SCPs among oncologists and PCPs.