Browsing by Subject "patient care"

Now showing 1 - 9 of 9
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    “Anybody on this list that you're more worried about?” Qualitative analysis exploring the functions of questions during end of shift handoffs
    (BMJ, 2016-02) O'Brien, Colleen M.; Flanagan, Mindy E.; Bergman, Alicia A.; Ebright, Patricia R.; Frankel, Richard M.; Department of Health Policy and Management, Richard M. Fairbanks School of Public Health
    Background Shift change handoffs are known to be a point of vulnerability in the quality, safety and outcomes of healthcare. Despite numerous efforts to improve handoff reliability, few interventions have produced lasting change. Although the opportunity to ask questions during patient handoff has been required by some regulatory bodies, the function of questions during handoff has been less well explored and understood. Objective To investigate questions and the functions they serve in nursing and medicine handoffs. Research design Qualitative thematic analysis based on audio recordings of nurse-to-nurse, medical resident-to-resident and surgical intern-to-intern handoffs. Subjects Twenty-seven nurse handoff dyads and 18 medical resident and surgical intern handoff dyads at one VA Medical Center. Results Our analysis revealed that the vast majority of questions were asked by the Incoming Providers. Although topics varied widely, the bulk of Incoming Provider questions requested information that would best help them understand individual patient conditions and plan accordingly. Other question types sought consensus on clinical reasoning or framing and alignment between the two professionals. Conclusions Handoffs are a type of socially constructed work. Questions emerge with some frequency in virtually all handoffs but not in a linear or predictable way. Instead, they arise in the moment, as necessary, and without preplanning. A checklist cannot model this process element because it is a static memory aid and questions occur in a relational context that is emergent. Studying the different functions of questions during end of shift handoffs provides insights into the interface between the technical context in which information is transferred and the social context in which meaning is created.
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    Editorial The insufficient integration of medicine into clinical dental education: a missed opportunity or an ethical dilemma?
    (Elsevier, 2017) Bennett, Jeffrey; Department of Oral Surgery and Hospital Dentistry, School of Dentistry
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    Forty Years since “Taking Care of the Hateful Patient”
    (AMA, 2017-04) Gunderman, Richard B.; Gunderman, Peter R.; Radiology and Imaging Sciences, School of Medicine
    Using the word “hateful” is not the only option in describing patients who induce in clinicians feelings of dread. We suggest an alternative approach to the language of hate, one that seeks dignity and perhaps even a divine spark in every patient.
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    The Future of Radiology Consultation
    (RSNA, 2016-10) Gunderman, Richard B.; Chou, Harry Y.; Department of Radiology and Imaging Sciences, IU School of Medicine
    A more collaborative approach to consultation is one that every radiologist concerned about the future of radiology should be eager to embody.
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    Managing Patient Health Across Diverse Spaces: Using Activity Theory to Model Pervasive Decision Support
    (2012) Faiola, Anthony; Boston-Clay, Crystal; Jones, Josette; Downey, Michael; Newlon, Christine M.
    Clinical decision support (CDS) systems can offer health care providers and patient data that is intelligently filtered and presented in ways to enhance diagnosis and long-term health care management, both within and outside clinical spaces. Challenges to this information management include diagnostic error and inefficiencies from conflicting, incomplete, or suboptimal clinical systems [3] as well as extending care outside the traditional clinical environment. We propose a Clinical Activity Model (CAM) to understand pervasive CDS system design and use across multiple health care spaces as patients move between critical care, recovery, and long-term home care. We discuss CAM in the context of research findings comparing a novel CDS system with traditional modes of data delivery and by describing use of that system as a mobile diagnostic tool to bridge clinical care and home care.
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    Pancreatic Cancer Center: Providing the Research Tools Necessary to Advance Pancreatic Cancer Patient Care
    (Office of the Vice Chancellor for Research, 2013-04-05) Korc, Murray; Kelley, Mark R.
    There were approximately 43,000 new cases of pancreatic ductal adenocarcinoma (PDAC) in the U.S. in 2010, and approximately 37,000 deaths. PDAC thus constitutes the fourth leading cause of cancer deaths, and PDAC patients have a dismal 5-year survival rate of 6%; approximately 75% of patients die within the first year after diagnosis. PDAC is notoriously resistant to chemotherapy and radiation and even with our best treatment options, a complete margin-negative surgical resection, few patients achieve long-term survival. Despite these statistics, surprisingly only a small number of NCI-designated cancer centers have a specialized pancreatic cancer program. The creation of the IUPUI Signature Center for Pancreatic Cancer Research has been the foundation for putting IUPUI, the IU School of Medicine, Purdue University and the IU Simon Cancer Center at the forefront of pancreatic cancer treatment and research across the nation. The Signature Center, comprised of basic, translational and clinical researchers, represents the continuum of the disease from biological / molecular investigation to clinical trials. Funding from the Signature Center Initiative is being utilized to develop genetically engineered mouse models, generate orthotopic pancreatic cancer mouse models as well as provide funding for peer reviewed pilot projects. Establishment and characterization of these in vivo models provides the groundwork to be used by all members in their translational research projects; support of pilot projects provides preliminary data and identification of projects to be used in a SPORE application. Additionally, work has begun on a web portal to promote and educate both patients and clinicians about the IUSCC Pancreas Cancer Clinic which became operational in 2010. Taken together these activities provide the infrastructure to support pancreas cancer research at IU across the continuum of bench to bedside to practice. The availability of these resources to all members promotes inter-disciplinary collaborations aimed at increasing our understanding of pancreatic cancer so that advancements can be made in diagnosis, prevention and treatment of this malignancy.
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    Referral management and the care of patients with diabetes: the Translating Research Into Action for Diabetes (TRIAD) study.
    (2004-02) Kim, Catherine; Williamson, David F.; Herman, William H.; Safford, Monika M.; Selby, Joseph V.; Marrero, David G.; Curb, David; Thompson, Theodore J.; Narayan, KM Venkat; Mangione, Carol M.
    OBJECTIVE: To examine the effect of referral management on diabetes care. STUDY DESIGN: Cross-sectional analysis. PATIENTS AND METHODS: Translating Research Into Action for Diabetes (TRIAD) is a multicenter study of managed care enrollees with diabetes. Prospective referral management was defined as "gatekeeping" and mandatory preauthorization from a utilization management office, and retrospective referral management as referral profiling and appropriateness reviews. Outcomes included dilated eye exam; self-reported visit to specialists; and perception of difficulty in getting referrals. Hierarchical models adjusted for clustering and patient age, gender, race, ethnicity, type and duration of diabetes treatment, education, income, health status, and comorbidity. RESULTS: Referral management was commonly used by health plans (55%) and provider groups (52%). In adjusted analyses, we found no association between any referral management strategies and any of the outcome measures. CONCLUSIONS: Referral management does not appear to have an impact on referrals or perception of referrals related to diabetes care.
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