This document discusses the importance of doctors spending adequate time with patients. It notes that while appointment lengths have increased slightly in recent decades, many patients still feel their needs are not fully addressed in short consultations. The document recommends expanding appointment times to improve patient health outcomes and satisfaction in several ways. First, longer visits allow doctors to provide more preventive care advice, screenings, and health education. Second, they enable doctors to fully understand patients' health concerns and priorities through active listening. Third, preventive care and lifestyle counseling can help avert future acute illnesses and costly medical interventions. The document argues expanded appointment times offer medical, financial, and strategic benefits for healthcare practices.
Utilizing Care Management Nurses to Improve Transitions in Care in the Oupati...Tanisha Davis
This document discusses a proposal to utilize care management nurses to improve care transitions for high-risk congestive heart failure (CHF) patients in the outpatient setting. It identifies opportunities to improve medication reconciliation and CHF education using teach-back methods. A literature review supports interventions like medication reconciliation, care coordination, CHF education and post-discharge follow up to reduce readmissions. The proposal is to pilot this approach for CHF patients through a microsystem project using a PDSA framework to study workflows and standardized processes for assessments, education and medication reconciliation across care transitions.
The document discusses improving patient communication standards through evidence-based practice. It outlines the problem of communication vulnerabilities for certain patient populations and the complications that can arise. An evidence-based solution is proposed using standardized communication boards to improve outcomes. Research studies are cited that show communication boards reduce patient frustration and increase satisfaction.
This document discusses issues with patient misidentification in healthcare and proposes solutions. It notes that patient misidentification can lead to medical errors and harm patients. Interventions like using two patient identifiers, barcoding systems, and staff education on safety protocols may help reduce errors related to improper identification. The importance of ensuring patients receive the correct treatments and medications is emphasized.
Provider Based Patient Engagement - An Essential Strategy for Population HealthPhytel
As the healthcare industry starts to re-engineer care delivery to accommodate new reimbursement models, providers on the front lines of change recognize the need for population health management and for increasing patients’ engagement in their own care. These two approaches are inextricably bound together, because it is impossible to manage the health of a population without getting patients more involved in self-management and the modification of their own risk factors. This paper discusses the fundamentals of patient engagement and shows how automation tools and web-based care management can facilitate this key process.
This document discusses leadership for patient engagement in the NHS. While the NHS has focused on public consultations and one-off engagement initiatives, true culture change is required to make services patient-centered. Leaders face challenges in shifting beliefs, attitudes, and behaviors away from disease-focused care toward responsive, empowering care centered around patients' needs and preferences. Successful approaches require strategic, system-wide efforts to engage patients in shared decision-making, self-management of long-term conditions, and improving quality by understanding patients' perspectives. Isolated projects are easier than changing mainstream practice to prioritize the patient experience in all interactions and functions.
The survey of over 2,000 UK physicians found that while most feel confident treating homeless patients' acute medical issues, many lack training on the complex needs of this population. Nearly 30% were unsure if they had discharged homeless patients without housing arrangements. Coordinating health and social services is key to improving outcomes, but physicians feel constrained by limited resources and bed pressures. Developing multidisciplinary homeless healthcare teams and advocating for patients' housing needs can help address the social determinants worsening their health.
This document discusses ways to reduce pressures on general practice and free up clinicians' time for patient care. It outlines 10 high impact actions for practices to implement, including providing online patient portals, using phone and email consultations where appropriate, maximizing appointment slots by reducing missed appointments through reminders and easier cancellation policies, and introducing reception care navigation and group consultations for long-term conditions. The overall goal is to shift the model of care away from a focus on acute problems and toward better management of patients with multiple long-term conditions.
The document summarizes a presentation on health literacy. It identifies components of health literacy and discusses how limited health literacy impacts patient health and healthcare costs. It examines best practices for clear communication and reducing barriers to understanding health information. The presentation aims to improve health outcomes through better communication between healthcare professionals and diverse communities.
Utilizing Care Management Nurses to Improve Transitions in Care in the Oupati...Tanisha Davis
This document discusses a proposal to utilize care management nurses to improve care transitions for high-risk congestive heart failure (CHF) patients in the outpatient setting. It identifies opportunities to improve medication reconciliation and CHF education using teach-back methods. A literature review supports interventions like medication reconciliation, care coordination, CHF education and post-discharge follow up to reduce readmissions. The proposal is to pilot this approach for CHF patients through a microsystem project using a PDSA framework to study workflows and standardized processes for assessments, education and medication reconciliation across care transitions.
The document discusses improving patient communication standards through evidence-based practice. It outlines the problem of communication vulnerabilities for certain patient populations and the complications that can arise. An evidence-based solution is proposed using standardized communication boards to improve outcomes. Research studies are cited that show communication boards reduce patient frustration and increase satisfaction.
This document discusses issues with patient misidentification in healthcare and proposes solutions. It notes that patient misidentification can lead to medical errors and harm patients. Interventions like using two patient identifiers, barcoding systems, and staff education on safety protocols may help reduce errors related to improper identification. The importance of ensuring patients receive the correct treatments and medications is emphasized.
Provider Based Patient Engagement - An Essential Strategy for Population HealthPhytel
As the healthcare industry starts to re-engineer care delivery to accommodate new reimbursement models, providers on the front lines of change recognize the need for population health management and for increasing patients’ engagement in their own care. These two approaches are inextricably bound together, because it is impossible to manage the health of a population without getting patients more involved in self-management and the modification of their own risk factors. This paper discusses the fundamentals of patient engagement and shows how automation tools and web-based care management can facilitate this key process.
This document discusses leadership for patient engagement in the NHS. While the NHS has focused on public consultations and one-off engagement initiatives, true culture change is required to make services patient-centered. Leaders face challenges in shifting beliefs, attitudes, and behaviors away from disease-focused care toward responsive, empowering care centered around patients' needs and preferences. Successful approaches require strategic, system-wide efforts to engage patients in shared decision-making, self-management of long-term conditions, and improving quality by understanding patients' perspectives. Isolated projects are easier than changing mainstream practice to prioritize the patient experience in all interactions and functions.
The survey of over 2,000 UK physicians found that while most feel confident treating homeless patients' acute medical issues, many lack training on the complex needs of this population. Nearly 30% were unsure if they had discharged homeless patients without housing arrangements. Coordinating health and social services is key to improving outcomes, but physicians feel constrained by limited resources and bed pressures. Developing multidisciplinary homeless healthcare teams and advocating for patients' housing needs can help address the social determinants worsening their health.
This document discusses ways to reduce pressures on general practice and free up clinicians' time for patient care. It outlines 10 high impact actions for practices to implement, including providing online patient portals, using phone and email consultations where appropriate, maximizing appointment slots by reducing missed appointments through reminders and easier cancellation policies, and introducing reception care navigation and group consultations for long-term conditions. The overall goal is to shift the model of care away from a focus on acute problems and toward better management of patients with multiple long-term conditions.
The document summarizes a presentation on health literacy. It identifies components of health literacy and discusses how limited health literacy impacts patient health and healthcare costs. It examines best practices for clear communication and reducing barriers to understanding health information. The presentation aims to improve health outcomes through better communication between healthcare professionals and diverse communities.
An Evaluation of the Challenges of Doctor- Patient Communicationinventionjournals
1. Effective doctor-patient communication is important for building trust, facilitating information exchange, and involving patients in medical decisions. However, several challenges exist, including doctors' deteriorating communication skills over time, avoidance of discussing emotional issues, and discouraging patient collaboration.
2. Doctors can improve communication through training to develop skills like empathy and active listening. It is also important to understand patients' health beliefs as perceptions may impact treatment. With better communication, outcomes are improved through higher patient understanding, satisfaction, and adherence to care plans.
This document summarizes a presentation about communication experiences of children with cerebral palsy in health care settings and the potential for technologies to improve engagement. It discusses parent feedback wanting involvement in decision making and consideration of broader impacts. Using technologies like PCEHR and decision aids may help provide better evidence and access to information. Clinical implications discussed include involving parents and children in goal setting and information sharing. Future research directions explored uptake of PCEHR, health impacts of technologies, and communicative environments in health settings.
Where’s the evidence that screening for distress benefits cancer patients?James Coyne
“The case against screening for distress.” A presentation delivered as part of an invited debate with Alex Mitchell at the International Psycho Oncology Conference, Rotterdam, November 7, 2013
The document discusses patient-centered care and behavioral medicine in primary care. It covers several key areas: (1) understanding diverse patient cultures and beliefs around health; (2) improving communication methods to address low health literacy and non-adherence; and (3) using tools to assess health literacy levels and medication adherence given their relationship to health outcomes. The goal is for healthcare providers to incorporate cultural competence and address common barriers in order to improve patient experiences and compliance.
The document discusses key aspects of implementing a disease management program including:
1. Encouraging early detection of diseases through various forms of advertising and utilizing guidelines from organizations like the CDC and WHO.
2. Providing incentives for patients to proactively manage their health like lower costs, support groups, and easy access to their medical records.
3. Addressing factors like ensuring quality of care through measurements, making facilities accessible, and emphasizing the importance of prescription management.
At the end of the session patient/ family/ advisors/ champions as well as health providers/ leaders/ authorities will leave with at least one practical idea to advance patient engagement in medication safety as a result of their increased understanding of:
. the role and responsibilities of patients/ families in medication safety
. different approaches to patient engagement in medication safety
. influencing factors (e.g. health literacy, culture, organizational and public policy)
. supporting resources and leading practices
This document discusses a research study examining the impact of nurse-led outpatient follow-up care on reducing heart failure readmission rates. It begins by introducing heart failure as an increasing health problem, especially in those over 65. The population of focus is recently discharged heart failure patients at high risk of readmission. The intervention studied is additional nurse-led outpatient follow-up care including follow-up calls and educational sessions. Current practice involves discharge teaching but readmissions continue. The significance of the nursing role in education to reduce readmissions and costs is discussed.
Evaluation of the Inpatient Hospital Experience while on PrecautionsKathryn Cannon
This study assessed patient satisfaction of those under contact/airborne isolation precautions versus those not under precautions at Yale-New Haven Hospital. 87 patients were interviewed using a survey measuring satisfaction with communication, treatment explanations, help from staff, pain control, and overall experience. Small variations were found between groups in nurse communication, timely help, pain control, and overall satisfaction. No significant difference was seen in doctor communication, but those under precautions expressed higher satisfaction with treatment explanations. The study aimed to understand differences to improve hospital processes and performance under new CMS reimbursement policies tied to patient satisfaction.
The document discusses various forms of non-compliance with medication regimens, including forgetting to take medications, taking less than the recommended dose, and failing to fill prescriptions. It notes that non-compliance is a major cause of wasted medication and occurs in about 50% of patients. Reasons for non-compliance include medication costs, fear of side effects, distrust of doctors, and reluctance to acknowledge illness. Having multiple prescriptions can also increase non-compliance rates.
Perception of Dental Visits among Jazan University Students, Saudi Arabiainventionjournals
Background:regular dental check-ups is fundamental in preventing and detecting dental diseases.Majority of Saudi patients do not have the trend to visit dentist frequently and they go only for emergency treatment and mostly pain is the driving factor. Aim: to evaluate the knowledge, beliefs and attitude of Jazan university students towards dental visits. Materials and Methodology:This descriptive cross-sectional; questionnaire based survey was carried out to evaluate the perception of Jazan university Saudi students towards dental visits. 352 students participated, age range of 20-24 years old. Results: The study revealed pain is the driving factor for most of the dental visits. 47.9%, their 1 stvisits complain was pain, 58% the driving factor for last visit is also pain. Although 29.1% occasionally visit dentist; 43% of them their last visit to dentist was 6 month ago. 47.6% were irregular visitors to dentist because they are afraid from dental needle and pain. 75% of the participants described their feeling at1st visit to dentist to be anxious and afraid. Although 88% of the participants knew that regular dental check-ups is important but this knowledge was not practiced.Only4.3% of the participants are driven to dental visit by dentist advice. Conclusion: there are lack of knowledge, wrong beliefs and negligence of dental visits in our study participants. Dental professional and mass media are not playing their role to change the knowledge and beliefs of the population.Recommendation: dental professionals’ media should be utilized spread knowledge of proper dental care.
Perspectives on Transitional Care for Vulnerable Older Patients A Qualitative...Austin Publishing Group
Transitional care for vulnerable older patients is optimal if, on top of the organization of transitional care, these patients and their informal caregivers have trust in the professionals involved. Regarding the challenge of organizing increasingly complex transitional care for vulnerable older patients, the focus should shift towards optimizing trust.
Consumer Attitudes About Comparative EffectivenessMSL
Evidence as an essential—but insufficient—ingredient for medical decision-making. Presentation to the National Comparative Effectiveness Summit by Chuck Alston, SVP and Director of Public Affairs at MSLGROUP Washington, DC on September 16, 2013.
1) The document examines medical aliteracy among senior medical personnel in Akoko South West local government area of Ondo State, Nigeria. It finds that factors like ineffective supervision, low patient literacy, and lack of patient engagement can lead to medical aliteracy among senior personnel.
2) The study revealed an average level of aliteracy, with most personnel receiving medical journals annually and reading them often. The majority had reading rooms at home. Reading rates were average. Personnel preferred reading anytime and topics like surgery, physiology and pathology.
3) All personnel enjoyed reading about medical breakthroughs and other areas aside their specialty. Most interests were in public medicine and surgery. The study found no gender differences in
Factors that Influence Adherence to HAART - Naicker MHmichaela naicker
The document summarizes factors that influence adherence to highly active antiretroviral therapy (HAART) based on interviews with 13 HIV-positive individuals in South Africa. Key factors identified include: social support from family and friends which positively influences adherence; socioeconomic challenges like poverty, transportation costs, and unemployment which negatively impact adherence; and healthcare provider factors where public clinics raised privacy concerns but private providers offered more support and counseling. Disease symptoms and stigma also influence individual medication adherence. Overall, the study found social, economic, healthcare, personal, and treatment-related factors all play a role in levels of adherence.
Va Health Literacy Research Presentationguest169e62f
What is the Impact of Low VA Patient Literacy on VA Diabetes Patient Educational Initiatives?
Department of Veterans Affairs Medical Center, North Chicago, IL USA
Aligning Incentives for Patient Engagement: Enabling Widespread Implementation of Shared Decision Making
May 23, 2013
Angela Coulter, Informed Medical Decisions Foundation
Dominick Frosch, Gordon and Betty Moore Foundation
Floyd J. Fowler, Informed Medical Decisions Foundation
This document discusses outcomes research and defines key terms. It provides examples of positive outcome research studies from the Agency for Healthcare Research and Quality (AHRQ) and the Patient-Centered Outcomes Research Institute (PCORI) websites, including studies on chronic pain management, prostate cancer treatment, asthma treatment, and autism interventions. It also notes potential negative outcomes from a treatment decision aid for chest pain and concludes that while the studies are not wasteful, further research is still needed.
This document discusses definitions of outcomes research and nursing outcomes. It provides examples of positive outcome research from the Agency for Healthcare Research and Quality (AHRQ) and the Patient-Centered Outcomes Research Institute (PCORI) websites, including studies on chronic pain management, prostate cancer treatment, asthma treatment, and autism interventions. It also notes some examples that require further research and potential for negative outcomes from a treatment decision aid for chest pain. The conclusion is that while the studies are not wasteful, the results are incomplete and need more research.
Influence of medicare formulary restrictions on evidence based prescribing pr...TÀI LIỆU NGÀNH MAY
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: https://www.facebook.com/thuvienluanvan01
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tai lieu tong hop, thu vien luan van, luan van tong hop, do an chuyen nganh
Outcome research examines the end results of health services on individuals in order to provide scientific evidence to inform healthcare decisions. It helps people make informed healthcare choices and improves delivery and outcomes by producing evidence-guided research. While outcome research groups like AHRQ and PCORI improve patient care and outcomes, outcome research relies on funding, so less common illnesses or those in developing countries may be understudied. Overall, outcome research can significantly impact healthcare policies by using evidence to guide decisions.
An Evaluation of the Challenges of Doctor- Patient Communicationinventionjournals
1. Effective doctor-patient communication is important for building trust, facilitating information exchange, and involving patients in medical decisions. However, several challenges exist, including doctors' deteriorating communication skills over time, avoidance of discussing emotional issues, and discouraging patient collaboration.
2. Doctors can improve communication through training to develop skills like empathy and active listening. It is also important to understand patients' health beliefs as perceptions may impact treatment. With better communication, outcomes are improved through higher patient understanding, satisfaction, and adherence to care plans.
This document summarizes a presentation about communication experiences of children with cerebral palsy in health care settings and the potential for technologies to improve engagement. It discusses parent feedback wanting involvement in decision making and consideration of broader impacts. Using technologies like PCEHR and decision aids may help provide better evidence and access to information. Clinical implications discussed include involving parents and children in goal setting and information sharing. Future research directions explored uptake of PCEHR, health impacts of technologies, and communicative environments in health settings.
Where’s the evidence that screening for distress benefits cancer patients?James Coyne
“The case against screening for distress.” A presentation delivered as part of an invited debate with Alex Mitchell at the International Psycho Oncology Conference, Rotterdam, November 7, 2013
The document discusses patient-centered care and behavioral medicine in primary care. It covers several key areas: (1) understanding diverse patient cultures and beliefs around health; (2) improving communication methods to address low health literacy and non-adherence; and (3) using tools to assess health literacy levels and medication adherence given their relationship to health outcomes. The goal is for healthcare providers to incorporate cultural competence and address common barriers in order to improve patient experiences and compliance.
The document discusses key aspects of implementing a disease management program including:
1. Encouraging early detection of diseases through various forms of advertising and utilizing guidelines from organizations like the CDC and WHO.
2. Providing incentives for patients to proactively manage their health like lower costs, support groups, and easy access to their medical records.
3. Addressing factors like ensuring quality of care through measurements, making facilities accessible, and emphasizing the importance of prescription management.
At the end of the session patient/ family/ advisors/ champions as well as health providers/ leaders/ authorities will leave with at least one practical idea to advance patient engagement in medication safety as a result of their increased understanding of:
. the role and responsibilities of patients/ families in medication safety
. different approaches to patient engagement in medication safety
. influencing factors (e.g. health literacy, culture, organizational and public policy)
. supporting resources and leading practices
This document discusses a research study examining the impact of nurse-led outpatient follow-up care on reducing heart failure readmission rates. It begins by introducing heart failure as an increasing health problem, especially in those over 65. The population of focus is recently discharged heart failure patients at high risk of readmission. The intervention studied is additional nurse-led outpatient follow-up care including follow-up calls and educational sessions. Current practice involves discharge teaching but readmissions continue. The significance of the nursing role in education to reduce readmissions and costs is discussed.
Evaluation of the Inpatient Hospital Experience while on PrecautionsKathryn Cannon
This study assessed patient satisfaction of those under contact/airborne isolation precautions versus those not under precautions at Yale-New Haven Hospital. 87 patients were interviewed using a survey measuring satisfaction with communication, treatment explanations, help from staff, pain control, and overall experience. Small variations were found between groups in nurse communication, timely help, pain control, and overall satisfaction. No significant difference was seen in doctor communication, but those under precautions expressed higher satisfaction with treatment explanations. The study aimed to understand differences to improve hospital processes and performance under new CMS reimbursement policies tied to patient satisfaction.
The document discusses various forms of non-compliance with medication regimens, including forgetting to take medications, taking less than the recommended dose, and failing to fill prescriptions. It notes that non-compliance is a major cause of wasted medication and occurs in about 50% of patients. Reasons for non-compliance include medication costs, fear of side effects, distrust of doctors, and reluctance to acknowledge illness. Having multiple prescriptions can also increase non-compliance rates.
Perception of Dental Visits among Jazan University Students, Saudi Arabiainventionjournals
Background:regular dental check-ups is fundamental in preventing and detecting dental diseases.Majority of Saudi patients do not have the trend to visit dentist frequently and they go only for emergency treatment and mostly pain is the driving factor. Aim: to evaluate the knowledge, beliefs and attitude of Jazan university students towards dental visits. Materials and Methodology:This descriptive cross-sectional; questionnaire based survey was carried out to evaluate the perception of Jazan university Saudi students towards dental visits. 352 students participated, age range of 20-24 years old. Results: The study revealed pain is the driving factor for most of the dental visits. 47.9%, their 1 stvisits complain was pain, 58% the driving factor for last visit is also pain. Although 29.1% occasionally visit dentist; 43% of them their last visit to dentist was 6 month ago. 47.6% were irregular visitors to dentist because they are afraid from dental needle and pain. 75% of the participants described their feeling at1st visit to dentist to be anxious and afraid. Although 88% of the participants knew that regular dental check-ups is important but this knowledge was not practiced.Only4.3% of the participants are driven to dental visit by dentist advice. Conclusion: there are lack of knowledge, wrong beliefs and negligence of dental visits in our study participants. Dental professional and mass media are not playing their role to change the knowledge and beliefs of the population.Recommendation: dental professionals’ media should be utilized spread knowledge of proper dental care.
Perspectives on Transitional Care for Vulnerable Older Patients A Qualitative...Austin Publishing Group
Transitional care for vulnerable older patients is optimal if, on top of the organization of transitional care, these patients and their informal caregivers have trust in the professionals involved. Regarding the challenge of organizing increasingly complex transitional care for vulnerable older patients, the focus should shift towards optimizing trust.
Consumer Attitudes About Comparative EffectivenessMSL
Evidence as an essential—but insufficient—ingredient for medical decision-making. Presentation to the National Comparative Effectiveness Summit by Chuck Alston, SVP and Director of Public Affairs at MSLGROUP Washington, DC on September 16, 2013.
1) The document examines medical aliteracy among senior medical personnel in Akoko South West local government area of Ondo State, Nigeria. It finds that factors like ineffective supervision, low patient literacy, and lack of patient engagement can lead to medical aliteracy among senior personnel.
2) The study revealed an average level of aliteracy, with most personnel receiving medical journals annually and reading them often. The majority had reading rooms at home. Reading rates were average. Personnel preferred reading anytime and topics like surgery, physiology and pathology.
3) All personnel enjoyed reading about medical breakthroughs and other areas aside their specialty. Most interests were in public medicine and surgery. The study found no gender differences in
Factors that Influence Adherence to HAART - Naicker MHmichaela naicker
The document summarizes factors that influence adherence to highly active antiretroviral therapy (HAART) based on interviews with 13 HIV-positive individuals in South Africa. Key factors identified include: social support from family and friends which positively influences adherence; socioeconomic challenges like poverty, transportation costs, and unemployment which negatively impact adherence; and healthcare provider factors where public clinics raised privacy concerns but private providers offered more support and counseling. Disease symptoms and stigma also influence individual medication adherence. Overall, the study found social, economic, healthcare, personal, and treatment-related factors all play a role in levels of adherence.
Va Health Literacy Research Presentationguest169e62f
What is the Impact of Low VA Patient Literacy on VA Diabetes Patient Educational Initiatives?
Department of Veterans Affairs Medical Center, North Chicago, IL USA
Aligning Incentives for Patient Engagement: Enabling Widespread Implementation of Shared Decision Making
May 23, 2013
Angela Coulter, Informed Medical Decisions Foundation
Dominick Frosch, Gordon and Betty Moore Foundation
Floyd J. Fowler, Informed Medical Decisions Foundation
This document discusses outcomes research and defines key terms. It provides examples of positive outcome research studies from the Agency for Healthcare Research and Quality (AHRQ) and the Patient-Centered Outcomes Research Institute (PCORI) websites, including studies on chronic pain management, prostate cancer treatment, asthma treatment, and autism interventions. It also notes potential negative outcomes from a treatment decision aid for chest pain and concludes that while the studies are not wasteful, further research is still needed.
This document discusses definitions of outcomes research and nursing outcomes. It provides examples of positive outcome research from the Agency for Healthcare Research and Quality (AHRQ) and the Patient-Centered Outcomes Research Institute (PCORI) websites, including studies on chronic pain management, prostate cancer treatment, asthma treatment, and autism interventions. It also notes some examples that require further research and potential for negative outcomes from a treatment decision aid for chest pain. The conclusion is that while the studies are not wasteful, the results are incomplete and need more research.
Influence of medicare formulary restrictions on evidence based prescribing pr...TÀI LIỆU NGÀNH MAY
Để xem full tài liệu Xin vui long liên hệ page để được hỗ trợ
: https://www.facebook.com/thuvienluanvan01
HOẶC
https://www.facebook.com/garmentspace/
https://www.facebook.com/thuvienluanvan01
https://www.facebook.com/thuvienluanvan01
tai lieu tong hop, thu vien luan van, luan van tong hop, do an chuyen nganh
Outcome research examines the end results of health services on individuals in order to provide scientific evidence to inform healthcare decisions. It helps people make informed healthcare choices and improves delivery and outcomes by producing evidence-guided research. While outcome research groups like AHRQ and PCORI improve patient care and outcomes, outcome research relies on funding, so less common illnesses or those in developing countries may be understudied. Overall, outcome research can significantly impact healthcare policies by using evidence to guide decisions.
Copyright 2014 American Medical Association. All rights reserv.docxbobbywlane695641
This document discusses a study that surveyed primary care providers about their perspectives on using a colorectal cancer screening decision aid. The majority of providers felt that the decision aid complemented their usual approach, increased patient knowledge, helped patients identify a preferred screening option, improved the quality of decision making, and saved time. However, fewer than half felt it would be easy to implement in practice or that colleagues would widely use it. The decision aid was found to facilitate shared decision making from the provider perspective, but barriers to implementation need to be addressed for future use.
Running Head PICOT STATEMENT1PICOT STATEMENT4.docxglendar3
Running Head: PICOT STATEMENT 1
PICOT STATEMENT 4
PICOT statement
Name of the student:
Good start on your PICO question this week. However, I am not clear on what the PICOT question is. What is the specific intervention, comparison, and outcomes you are evaluating? I noted a few corrections and comments in your paper. Be sure to make corrections before including this in the final capstone paper in week 9. Thanks. – Mrs. Guzman
PICOT Sstatement
Patient/Ppopulation
The population that is mostly affected with hypertension are male adults between the ages of 40 and 70 with hypertension, and with different diseases, that shows alteration in lifestyle (attracting routinely in practice and taking in more advantageous and sufficient dinners), appeared differently in relation to patients who use solution to treat/manage their high blood pressure, assist to manage their heartbeat and lessen the threat of making cardiovascular sicknesses in their recovery time inside a half year. The period will be adequately long to make a sick be able not to encounter the evil impacts of high blood pressure and to in like manner diminish the threats that the general population will customarily experience (Dua, et.al, 2014). Comment by Melanie Guzman: Meaning is not clear Comment by Melanie Guzman: This is vague Comment by Melanie Guzman: 5 authors: Put all last names inn first citation, then et al. in subsequent citations
Intervention Comment by Melanie Guzman: Headings bolded
The essential strategy for mediation for sick with high blood pressure it is with no vulnerability to place them under medicine so that they can be restored. That is the most secure way as it will impact the patient to have the ability to manage themselves to the extent how they to think, what they eat and even the activities that they endeavor to take an interest in. The age of the patients will in like manner suggest that the sick are given arrangement that can oversee them in the most useful means and which they can recognize with everything taken into account. The medicine that can be provided for this circumstance is one that can diminish the brutality of a prescription. The nursing intercession for sick with high blood pressure is evaluating the migraine torments that sick is encountering and checking the obscured vision in like clockwork until the point when it leaves. Another nursing mediation is for an attendant to teach a sick on how they counsel with their specialist before the medicine is ceased (Dua, et.al, 2014). Comment by Melanie Guzman: This is not clear. What is the identified problem? PICOT statement? What evidenced-based interventions related to that problem are you proposing? Comment by Melanie Guzman: What interventions are being doing to prevent high blood pressure? Is evaluation of migraine a major issue with HTN? Comment by Melanie Guzman:
Comparison Comment by Melanie Guzman: What are you specifically comparing in your PICOT statement?
The first c.
Running Head PICOT STATEMENT1PICOT STATEMENT4.docxtodd581
Running Head: PICOT STATEMENT 1
PICOT STATEMENT 4
PICOT statement
Name of the student:
Good start on your PICO question this week. However, I am not clear on what the PICOT question is. What is the specific intervention, comparison, and outcomes you are evaluating? I noted a few corrections and comments in your paper. Be sure to make corrections before including this in the final capstone paper in week 9. Thanks. – Mrs. Guzman
PICOT Sstatement
Patient/Ppopulation
The population that is mostly affected with hypertension are male adults between the ages of 40 and 70 with hypertension, and with different diseases, that shows alteration in lifestyle (attracting routinely in practice and taking in more advantageous and sufficient dinners), appeared differently in relation to patients who use solution to treat/manage their high blood pressure, assist to manage their heartbeat and lessen the threat of making cardiovascular sicknesses in their recovery time inside a half year. The period will be adequately long to make a sick be able not to encounter the evil impacts of high blood pressure and to in like manner diminish the threats that the general population will customarily experience (Dua, et.al, 2014). Comment by Melanie Guzman: Meaning is not clear Comment by Melanie Guzman: This is vague Comment by Melanie Guzman: 5 authors: Put all last names inn first citation, then et al. in subsequent citations
Intervention Comment by Melanie Guzman: Headings bolded
The essential strategy for mediation for sick with high blood pressure it is with no vulnerability to place them under medicine so that they can be restored. That is the most secure way as it will impact the patient to have the ability to manage themselves to the extent how they to think, what they eat and even the activities that they endeavor to take an interest in. The age of the patients will in like manner suggest that the sick are given arrangement that can oversee them in the most useful means and which they can recognize with everything taken into account. The medicine that can be provided for this circumstance is one that can diminish the brutality of a prescription. The nursing intercession for sick with high blood pressure is evaluating the migraine torments that sick is encountering and checking the obscured vision in like clockwork until the point when it leaves. Another nursing mediation is for an attendant to teach a sick on how they counsel with their specialist before the medicine is ceased (Dua, et.al, 2014). Comment by Melanie Guzman: This is not clear. What is the identified problem? PICOT statement? What evidenced-based interventions related to that problem are you proposing? Comment by Melanie Guzman: What interventions are being doing to prevent high blood pressure? Is evaluation of migraine a major issue with HTN? Comment by Melanie Guzman:
Comparison Comment by Melanie Guzman: What are you specifically comparing in your PICOT statement?
The first c.
Dr. Harold Freeman founded the first patient navigation program in 1990 to help reduce barriers to care for low-income cancer patients. A study he conducted between 1995-2000 found that the five-year cancer survival rate increased to 70% for low-income patients who received help from patient navigators, compared to only 39% in an earlier study without navigators. Research has shown that patient navigators increase patient compliance, decrease delays in care, and can increase patient satisfaction scores by explaining treatment plans and helping patients overcome barriers to care. While start-up costs may be high initially, patient navigators ultimately save health systems money by reducing unnecessary emergency room visits and improving health outcomes.
Running Head: PATIENT NO-SHOWS 1
PATIENT NO-SHOWS 7
Patient No-Shows
Student’s name
Institutional affiliation
Part 1- shortage of same-day appointments
Shortage of same-day appointments
A recent study found that the number of same-day appointments increased by more than 20 percent in 2019; it also found that the number of same-day appointments decreased by 2 percent overall. This trend is expected to continue in 2022 and 2023 as the economy improves. The shortage of same-day appointments can cause issues with access to care, especially for people who cannot make regular appointments due to a medical condition or an illness (Hussein, Salim & Ahmed, 2019). The lack of availability also impacts those needing urgent care or treatment before making their regular appointment.
As a result, healthcare faces a shortage of same-day appointments. It is one of the significant issues that is facing the industry today. This is because most people don't have the power to schedule their appointments with the doctor or other health providers on time. They fail to schedule the same-day appointment and then wait several days to get their appointment scheduled again, making them lose out on their treatment. It is estimated that 25% of all patients have to wait for an appointment, which is a considerable amount (Speece, 2019). In addition, the number of patients waiting for same-day appointments will continue to rise because more people are getting sicker and sicker as time goes on. It means that more and more people will need their doctor's visit at the same time as everyone else so they can be seen immediately.
How to increase the utilization of same-day appointments
Some hospitals have implemented programs that allow patients with urgent needs to schedule an appointment on the same day without waiting until their next appointment time for a doctor or nurse practitioner (NP). Some hospitals are utilizing emerging technologies programs to solve the problem. Some programs use online booking tools such as WebMD Doctor Finder or HealthTap, while others allow patients to make an appointment through a phone call, text message, or email. The methods have been cost-effective since the patients do not have to go to the hospitals physically to book their appointment.
The other way a patient can increase the chances of getting a same-day appointment at their preferred facility is by scheduling appointments during off-peak hours and seasons. For instance, there is a period in the United States when most citizens are outside the country as a tourist. The second way is calling in advance and reaching out to your preferred providers. The process is essential since the provider will provide immediate feedback on the request. It will ensure the appointment w.
PUT YOUR HEADER HERE IN ALL CAPSvReducing th.docxwoodruffeloisa
This document is a research proposal submitted for a nursing capstone course. It aims to reduce hospital readmissions by analyzing causes of readmissions and developing interventions. The literature review found that readmissions are increasing, resulting in hospital penalties. Effective interventions include providing discharge education and follow-up care after discharge. The proposal will develop a plan to implement these strategies and evaluate their effectiveness in reducing readmissions.
The medical interview is the physician's most important diagnostic and therapeutic tool, but is difficult to master. It provides valuable patient information, yet receives little training focus. Effective communication skills like rapport building and active listening are especially important for EMTs and other pre-hospital providers to obtain information from patients. Models like partnership, shared decision making, and AIDET promote patient-centered care through open communication. Developing strong patient-doctor relationships requires commitment to caring communication skills.
Medication errors are a serious issue that compromise patient safety and result in harm. Some contributing factors include high patient acuity, heavy nursing workload, distractions during medication administration, and failure to follow safety policies. Proper staffing ratios and limiting workload are needed to decrease errors by reducing nurse fatigue and allowing them to focus on medication administration. Involving patients can also help catch errors and improve safety.
Capella university improving quality of care and patient safety assignment ...DrWillow1
This presentation focuses on developing a safety improvement plan using the Teach-back Method to prevent medication errors through enhanced patient-provider communication and education. Poor communication is a leading cause of errors. The plan aims to evaluate patient comprehension by having them explain medication instructions in their own words. Audience members like nurses and doctors will learn the Teach-back Method to improve engagement with patients and reduce errors. Their successful adoption of this role is critical to the plan's success.
This document discusses clinical decision making in nursing. It addresses several key points:
1) Clinical decision making is a complex process that involves critical thinking, reasoning, and integrating various types of knowledge to understand patient situations and choose appropriate actions.
2) Errors can occur in clinical decision making due to failures in judgment, slips, lapses, or mistakes. Nurses play an important role in decision making and helping to prevent errors.
3) Effective clinical decision making is important for positive patient outcomes. Nurses must analyze various factors like a patient's history, symptoms, and goals of care to make well-informed decisions.
The document discusses barriers and facilitators to policymakers using research evidence in decision making. It finds that the primary facilitator is personal contact between researchers and policymakers, while the main barrier is the lack of such contact. It also lists other factors that can encourage or discourage the use of evidence in policy, and strategies for bridging the gap between researchers and policymakers such as jointly setting agendas and facilitating interaction.
Importance of research in the feild of medical scienceIram Anwar
Medical education research aims to advance medical knowledge and skills by evaluating educational programs, policies, people, resources, culture, and students. Research helps build critical thinking skills, knowledge of academic literature, and connections in areas of interest. Involvement in research can strengthen residency applications and increase chances of interviews. While research is most important for competitive specialties, strong academic performance and clerkship evaluations are generally more significant factors than research alone. Research experience provides skills that are valuable for physicians, but should not detract from academic achievements.
5 annotated bibliographies #1 As much as we try to preve.docxtroutmanboris
5 annotated bibliographies
#1
As much as we try to prevent them, medication errors happen everyday. It is especially
common in skilled nursing facilities because many of them still use paper charts for
medication administration or documentation and do not have access to the newer
technology that other medical facilities do.
According to a study performed in 2014, medication distribution technology has been
proven to be effective in automatically detecting medication errors so that nurses can
have more of an opportunity to focus on their patients. Working on a long-term care unit,
most of my time is spent passing medications and doing treatments since I have 19
residents to tend to. Depending on how “smooth” the night goes, I sometimes do not get
a chance to spend that extra time with my residents as I would like to. This medication
distribution technology includes a mobile medication dispensing cart for long-term care
units. The medications would be pre-packed for each patient by the pharmacy and able
to be dispensed when needed. This would allow nurses to provide more one-on-one
time with their patients while also increasing the prevention of medication errors. It also
will help to lighten the nurses’ workload. Research shows that these mobile medication
cart have been successful. Medication error rates decreased from 2.9% to 0.6% (Baril,
Gascon & Brouillette, 2014).
Reference
Baril, C., Gascon, V., & Brouillette, C. (2014). Impact of technological innovation on a
nursing home performance and on the medication-use process safety. Journal of
Medical Systems, 38(3), 1–12. https://library.neit.edu:2404/10.1007/s10916-014-0022-4
#2
Adverse drug effects due to medication errors are estimated to cost the United States
$2 billion every year. After reviewing patient reports and reviewing charts, it was
discovered that 44% of these occur after the prescription was written. These errors were
found to be from registered nurses, licensed practical nurses and pharmacy technicians.
Therefore, the problem comes from administration of the medication. However, these
numbers only account for the errors that are actually reported. It is the more serious and
harmful errors that are recorded, probably because they are harder to hide. The Health
Care Finance Administration of the United States made it standard for hospitals and
skilled nursing facilities to have no more than 5% of medication error rates a year.
In a study conducted in 2014, researchers decided to put a hold on reviewing incident
reports and patient charts. Instead, they decided to directly observe medication
administration over 20 different hospitals or skilled nursing facilities. Other methods
included: attending medical rounds to see if a medication error had occurred,
interviewing health care workers to see if they would report anything, testing patients
urine to see if they had any unauthorized medications in their system, and comparing .
This document summarizes a presentation on how CRNAs can better help and understand their patients. It discusses several ways for CRNAs to improve patient care and understanding, such as understanding how the healthcare system works to help patients with affordable treatment options, staying updated on new technologies, learning to communicate collaboratively with anesthesiologists, and understanding patients' financial stresses. The presentation also reviews 6 articles on related topics and identifies some limitations in finding relevant sources. It concludes that sharing this information could help medical staff better understand and care for patients to reduce their emotional and physical stress.
This document analyzes racial disparities in flu vaccination rates in the United States using data from the 2010 National Health Interview Survey. It finds that minorities, especially Black individuals, have significantly lower flu vaccination rates than whites, likely due to barriers to healthcare access. Married individuals and those who are employed have higher vaccination rates than unmarried or unemployed individuals. The document controls for variables like age, sex, and employment status to better understand the independent effect of race and marital status on vaccination rates.
This document discusses the doctor-patient relationship and communication. It outlines Parsons' model of the sick role and doctor's role, and types of doctor-patient relationships including paternalism, mutuality, consumerism, and default. It covers influences on the relationship like time constraints, patient/doctor characteristics, and structural context. Effective communication skills, health literacy, consent, and partnerships in treatment decision making are also examined. The relationship has evolved from traditional paternalism to emphasize patient-centered care and shared decision making.
1. Ian Brewer 1
Health Services Operations Management
Final Project
Finding the Time: Why, Why, and How
Written by Ian Brewer
2. Ian Brewer 2
Table of Contents
I. Executive Summary p.3
II. Introduction p.4
a. Describing the Problem p.4
i. Face Time
ii. Health Promotion
iii. Prevention
III. Why You Should Find the Time Medically p.7
a. An Ounce of Prevention p.7
IV. Why You Should Find the Time Financially p.8
a. Assuming We Are Villains for a Moment p.8
b. Community as a Ship p.9
V. How You Should Find the Time Operationally p.9
a. Scheduling Plans p.9
b. Doctor-Patient Relations p.13
VI. Conclusion p.13
VII. Works Cited p.15
VIII. Appendix p.16
3. Ian Brewer 3
Executive Summary
I find wide-ranging support for expanded appointment windows as a means to achieve
better and more cost-effective health outcomes for patients. Patients value the time their doctors
spend with them. When that time is shortened or punctuated with distractions and interruptions,
the patients’ health and satisfaction can be adversely affected. Patients should be given the time
to state their needs at each visit and doctors must be taught the proper listening and solicitation
strategies. Important medical information can be left out or forgotten when communication
between doctor and patient is curtailed. A communicative doctor-patient relationship creates the
proper foundation for the provision of preventive advice, screening, and directives.
Preventive medicine makes sense both medically and financially. Averting the need for
acute intervention in the future is frequently cost-effective. The sacrifices and lifestyle changes
required to live a healthy life now are easier to undertake than drastic efforts to save a life
threatened by years of poor health decisions. Simple interventions are also cost-effective. Advice
and assistance can go a long way toward ending damaging dietary behaviors or smoking habits,
for instance.
Pursuant to instituting these changes, I provide a number of recommendations for
scheduling and no-show reduction strategies. My research also includes a scheduling tool which
will be useful to practices which take data collection and utilization seriously.
A deeper relationship between doctor and patient supports better health outcomes and can
be supported by the proper tools, strategies, and employee commitment.
4. Ian Brewer 4
Introduction
Describing the Problem
In our country, short doctors’ appointments have become a common complaint. This
problem is certainly not systemic in the United States. As Shaw, Davis, Fleischer, and Feldman
found in their 2014 study, appointment lengths have increased by an average of about two
minutes from 1993 to 2010 (p. 822). Many patients, however, feel that their needs are not being
met by the appointments they receive from their doctors. They describe three and four minute
consultations like the one described by Joan Eisenstodt in USA Today’s article detailing the
inadequacies patients are reporting in their care (Rabin, 2014). No matter how common these
sorts of practices are, your institution cannot afford to be among them.
Shaw et al. write, “According to a National Research Corporation Survey, patients listed
‘willingness to explain things’ as the most important factor in selecting a physician” (Shaw,
Davis, Fleischer Jr., & Feldman, 2014, p. 825). Practices could be in danger of losing patients to
competitors who are prepared to spend more time educating their patients. Shaw et al. point out
that patients are self-informed about medical matters to a higher degree than ever before due to
the availability of information online. This means that patients are more likely to be equipped to
have deeper discussions of their health with their doctors and are likely to be disappointed if a
doctor is unwilling to engage them.
Spending more explanatory time with patients is also a great avenue for presenting
educational material and preventive consultations to patients. One study found that extension of
appointments by only one minute produced a significant increase in prevention-focused activities
and educational discussions. They write, “Recording of blood pressure, smoking, alcohol
consumption, and advice about immunization was significantly more frequent in [longer
5. Ian Brewer 5
appointments] (Wilson, McDonald, Hayes, & Cooney, 1992, p. 227). The time spent on these
activities made an impression on patients in this case as well. Wilson et al. write, “Patients more
often reported discussion of smoking and alcohol consumption and coverage of previous health
problems in the [longer sessions] (Wilson, McDonald, Hayes, & Cooney, 1992, p. 227).
Another study focusing on one practice showed similar results. Wilson writes, “There
was a suggestion that lifestyle factors (smoking, alcohol and diet/weight) were discussed more
frequently and that screening activity increased after the change” (Wilson A. , 1989, p. 24). We
can see that longer appointments lead doctors to allocate more time to educational discussions
with their patients. Wilson also points out that other facets of the relationship do not appear to
suffer. Prescribing, investigation, and referral rates were stable in both conditions (Wilson A. ,
1989, p. 25).
Another related communication problem among doctors is their listening skills. A
University of South Carolina study showed that doctors have an interruption problem. The
authors write, “Patients spoke, uninterrupted, an average of 12 seconds after the resident entered
the room. One fourth of the time, residents interrupted patients before they finished speaking.
Residents averaged interrupting patients twice during a visit” (Rhoades, McFarland, Finch, &
Johnson, 2001, p. 528). They also point out to doctors that verbal interruptions are not the only
means by which a conversation with a patient can be disturbed. They write, “Computer use
during the office visit now accounts for more interruptions than beepers. Verbal interruptions, a
knock on the door, beeper interruptions, and computer use all interfere with communication”
(Rhoades, McFarland, Finch, & Johnson, 2001, p. 531).
Marvel, Epstein, Flowers, and Beckman studied the rate at which doctors solicited the
full agenda a patient wanted to discuss in a visit. They found a pathetic trend. They write,
6. Ian Brewer 6
“Physicians solicited patient concerns in 199 interviews (75.4%). Patients’ initial statements of
concerns were completed in in 74 interviews (28.0%) (1999, p. 283). This measure only analyzed
how often that initial statement went uninterrupted. In addition, when doctors redirect patient
agendas, as they frequently do, a patient’s full agenda is almost never completed. As they write
in the study, “Once the discussion became focused on a specific concern, the likelihood of
returning to complete the agenda was very low (8%) (Marvel, Epstein, Flowers, & Beckman,
1999, p. 286). The data in this study support a strategy of setting a full agenda at the outset of a
patient interview. After the conversation has been derailed by an interruption or focused on a
single issue, there is a very small likelihood that late-arising concerns will be brought up or that
important information will be shared by the patient. This disjointed communication creates a
“superior to inferior” relationship between the doctor and patient rather than a “service-provider
to customer” relationship as is normative in other industries (Marvel, Epstein, Flowers, &
Beckman, 1999).
Your practice can avoid these impediments to a positive relationship. With nationally
increasing consultation times, you do not want to fall behind the competition. At the same time,
other practices may not be aware of the other factors in the doctor-patient relationship that are
having an effect on the health of their patient population and their bottom line. Astute doctors
and managers will see the benefits to implementing improved processes to gain a strategic
advantage over other practices.
7. Ian Brewer 7
Why You Should Find the Time Medically
An Ounce of Prevention
Amidst all this talk of spending more and higher quality time with patients, it is
reasonable to ask whether we can expect to see a return on our investment in terms of the health
of the patient population. The CDC has this to say concerning prevention: “Chronic diseases,
such as heart disease, cancer, and diabetes, are responsible for 7 of every 10 deaths among
Americans each year…. These chronic diseases can be largely preventable through close
partnership with your healthcare team, or can be detected through appropriate screenings, when
treatment works best” (Centers for Disease Control and Prevention, 2013). When doctors take
the time to promote vaccinations, screenings, and healthy behaviors with their patients, they are
improving the health of those patients and averting the need for more difficult remedies to acute
illnesses in the future. For example, screenings could identify pre-diabetic patients who could
then be counselled on diet and exercise regimens rather than developing a chronic condition.
When patients are redirected and not able to communicate their full list of concerns to
their doctor, their doctors are more likely to miss key information. Even if the patient is unaware
of developing health concerns, doctors who take extra time to discuss screenings with their
patients are more likely to convince them to undertake them. This increase in screening activity
and the promotion of healthy habits will support a healthy population. Doctors can take the time
to counsel their patients to take advantage of their insurance companies’ prevention programs.
As the World Research Foundation writes, “These companies are happy to cover preventive
medical expenses because they have the statistics that proves how much it saves them down the
road” (WRF Staff, 2014). Patients with a doctor’s prompting and financial backing are going to
be more likely to get involved in efforts to manage their health proactively.
8. Ian Brewer 8
Why You Should Find the Time Financially
Assuming We Are Villains for a Moment
Why should we care if our patients are healthy or not? Perhaps it is more profitable to run
a practice addressing chronic illness after it develops rather than devoting resources to less
invasive, less labor intensive prevention programs. Cycling through patients as quickly as
possible could be a viable way to keep the money flowing and the illnesses treated (however
temporarily that treatment may last). Imagine that we throw the triple bottom line out the
window and operate our business only according to what makes the most money. Let us also
assume that no one would ever notice what a horrible thing we were doing and would let us get
away with treating them cost-effectively instead of effectively. Would we be able to make as
much money as a similar practice which employs preventive measures?
According to the data compiled by Maciosek, Coffield, Flottemesch, Edwards, and
Solberg, no. Exhibit 1 from their paper summarizes the life-years saved, the medical costs,
savings, and net costs of employing preventive measures (see the Appendix for Exhibit 1).
Several preventive measures jump out as medical savings. They write, “Clinical preventive
services that produce net medical savings . . . include the childhood immunization series,
pneumococcal immunization for adults, discussion of daily aspirin use, smoking cessation advice
and assistance, vision screening in older adults, alcohol screening and brief advice, and obesity
screening” (Greater Use Of Preventive Services In U.S. Health Care Could Save Lives At Little
Or No Cost, 2010, p. 1658).
Even if we turn out to be terrible people, we are still well-served to undertake many
preventive services for our own benefit as providers. We can see impressive savings from some
activities as easy as “discussing” daily aspirin use and “advice” regarding smoking.
9. Ian Brewer 9
The Community as a Ship
Thankfully, most of us are not bad people. We take the triple bottom line into account
when planning our services. Social, environmental, and financial integrity create a future for a
business. Preventive services are like regular maintenance on a ship. Palliative medicine is like
patching the holes in our hull as they appear. The community a health care institution serves is
like a ship. When we employ regular maintenance to the hull and its other systems, the ship runs
smoothly. Situations inevitably arise in which the only good option is to patch the hull. These
blows to our integrity can more easily be handled by a ship that undergoes regular maintenance.
When many flaws are allowed to build up, the cascade effect is more likely to take over the
system at any given time. Eventually, the straw will fall and break the camel’s back. A very well-
designed process of hull patching will only keep the ship sailing for so long. When the hull
buckles, the patchers will go down with the rest of the ship.
Just like this, spending a little extra time performing regular maintenance upon our
community keeps the community viable for a longer time than episodic treatment alone. Since
the human race is capable of self-perpetuation, a community can flourish indefinitely under the
right circumstances. Community health is an indispensable element of those right circumstances.
In your community, a proper practice should employ maintenance and patching methods both.
How You Should Find the Time Operationally
Scheduling Plans
Cayirli, Veral, and Rosen found a few factors that have a significant effect on keeping to
an appointment schedule. They write, “No-shows, walk-ins, clinic size and patient punctuality,
emerged as the major factors affecting the performance and the ultimate selection of an
10. Ian Brewer 10
appointment system” (Designing appointment scheduling systems for ambulatory care services,
2006, p. 57). How can we reduce the effect these factors have on the doctors’ and patients’ time
and put that time to the best use with the fewest delays? First, we must find an appropriate
appointment rule. An appointment rule is a model of patient intervals designed to keep doctors
and patients interacting at an optimal rate. Exhibit 2 in the Appendix details several appointment
rules studied by Cayirli et al.
They found three rules that perform with high efficiency among the seven rules they
studied. They write, “2BEG, MBFI and IBFI dominated the efficient frontiers as best
performers” (Cayirli, Veral, & Rosen, Designing appointment scheduling systems for
ambulatory care services, 2006, p. 57). Importantly for our purposes, they go on to make
recommendations based on the type of practice applying an appointment rule saying,
“Individual-block rules are mostly suited to specialties with short consultation times. In fact,
these rules should be avoided in clinics with long consultation times” (Cayirli, Veral, & Rosen,
Designing appointment scheduling systems for ambulatory care services, 2006, p. 57). Therefore,
if a practice is seeking to expand its consultation time, as I recommend, the best appointment rule
would be MBFI, a rule which calls patients two-at-a-time with intervals set at twice the mean
length of service in that practice. This will require data collection on the part of the practice
seeking to implement an efficient rule. Since the rule relies on an average of service time, I
recommend that its implementation be undertaken after efforts to increase the length and quality
of appointments are completed. I also recommend that this metric be frequently updated with
new average service times being applied to dates beyond the horizon of scheduled appointments.
The authors of this study also looked at strategies for scheduling new patients. They
write, “Placing new patients in the beginning of the session is preferred when doctor’s idle time
11. Ian Brewer 11
is assumed to be highly valuable compared to patients’ time” (Cayirli, Veral, & Rosen,
Designing appointment scheduling systems for ambulatory care services, 2006, p. 57). The
opposite structure was best when the opposite dynamic between doctors’ and patients’ time was
present. In cases where a parity of value between their times was the norm, an alternating rule
worked best. The combination of this rule and the appointment rule produced sixteen cases the
authors studied for optimal efficiency. They write, “Rules that utilize multiple-blocks, 2BEG and
MBFI, appear among the best performers in all the sixteen environments investigated” (Cayirli,
Veral, & Rosen, Designing appointment scheduling systems for ambulatory care services, 2006).
When seeking to increase efforts to educate patients and more frequently provide screenings and
other preventive care, this model should serve well.
Another study addressed the issue of no-shows and walk-ins. These rates will vary
depending on the practice, but they must be accounted for so that your efforts in scheduling
patients are not brought to ruin by the variations inherent in this type of service delivery. A
practice must begin by measuring the prevalence of walk-ins and no-shows in their practice.
With longer-running data, a practice could make tailored predictions every day as retailers do for
sales. This is demand planning. With the proper numbers, your practice can find the right number
of appointments to schedule per a given time period in order to reliably fill the time efficiently.
In order to facilitate this, the authors provide an open source online tool for scheduling at
http://www.appointmentschedulingtool.com/. The authors describe their process saying, “The
procedure adjusts the mean and standard deviation of service times based on the expected
probabilities of no-shows and walk-ins for a given target number of patients to be served, and it
is thus relevant for any appointment rule that uses the mean and standard deviation of service
times to construct an appointment schedule” (Cayirli, Yang, & Quek, 2012, p. 682). Data
12. Ian Brewer 12
collection should thus become a priority at your practice. An operations officer should be tasked
with collecting this information so that it can be put to the proper use as soon as possible.
Dealing with no-shows is just a form of institutionalized fire-fighting, though. In some
practices, this reality will never be eliminated. The practice can, however, be curtailed if the
proper interventions are undertaken. One study showed that multiple methods could be employed
to create a dramatic reduction in the no-show rate. The authors describe the various methods
used in the study writing, “The group designed a multi-method intervention to decrease the
clinic’s no-show rate: (1) an educational program focused on the NS cohort that discussed the
effects of no-shows, (2) a modified method of double-booking patients in providers’ schedules,
and (3) a modified advanced access scheduling system to replace the traditional scheduling
model of the clinic” (DuMontier, Rindfleisch, Pruszynski, & Frey III, 2013, p. 636). The NS
cohort was made up of the worst offenders of the no-show patients. These patients missed more
than six appointments in an 18-month period. As the authors say, “The NS cohort, although 2%
of the total practice population, accounted for almost one sixth of all no-shows in the pre-
intervention time period” (DuMontier, Rindfleisch, Pruszynski, & Frey III, 2013, pp. 636-637).
Exhibit 3 shows the results of their interventions. They saw an almost 13% reduction in
no-shows from the NS cohort and a 3% reduction in no-shows in the total population
(DuMontier, Rindfleisch, Pruszynski, & Frey III, 2013, p. 638). These improvements persisted
over the next four years of observation. This persistence in the change is likely due to the
commitment of the staff to the new system of education and scheduling. I recommend this study
highly for the purposes of educating your workforce so that they may be invested in the
implementation of these interventions.
13. Ian Brewer 13
Doctor-Patient Relations
The USC study cited earlier shows that doctors need not be concerned that a full
solicitation of the patient’s agenda will put them in a time crunch. They write, “Patients allowed
to complete their statement of concerns used only 6 seconds more on average than those who
were redirected before completion of concerns” (Marvel, Epstein, Flowers, & Beckman, 1999, p.
283). They point out that fellowship-trained physicians were more likely to solicit a full agenda
from their patients. Training all the doctors in your practice to employ the methods described in
this paper would be beneficial. It could be hurtful to a patient’s health to employ practices which
frequently leave important medical information unsaid. The authors describe the habits of these
fellowship-trained physicians saying, “The opening solicitation of patient concerns often was
characterized by an open-ended question followed by nondirective facilitating utterances (e.g.
‘Uh-huh’ or ‘What else?’) (Marvel, Epstein, Flowers, & Beckman, 1999, p. 286)
Doctors must also be aware that sensitive and emotional topics are likely to take
somewhat longer to come out in an interview and thus a few extra seconds can potentially lead to
the most important subject the patient wishes to address. The authors also recommend the use of
focused questions regarding the patient’s most recent complaint followed by open-ended
questions inviting the patient to air out any other concerns before moving on ( (Marvel, Epstein,
Flowers, & Beckman, 1999, p. 286).
Conclusion
A good practice supports a healthy community. This support can be provided responsibly,
not only with regard to social and environmental responsibility, but also to your financial well-
being. Patients value a doctor who addresses their needs by listening to them and clearly
14. Ian Brewer 14
explaining their treatments and recommendations. When those doctors take a little time to listen
to and educate their patients, many practices will see a net benefit.
Research has provided strategies and tools to accomplish the schedule you aim for in
your practice. According to your needs and the needs of your patients, you can use the tools they
provide to optimize your practice. One must remember, though, that these tools do not work on
their own. You must begin collecting data from your doctors and patients and the circumstances
of their meetings to determine what the best solution is for you.
Leaving no-shows and walk-ins at their natural levels is not beneficial to your practice.
Undertake educational efforts to fireproof your home instead of constantly putting fires out.
In short, implement policies that support preventive medicine. The strategies and tools
needed to successfully do so are at your disposal. Your practice can support a healthy population
by working with its patients educationally and cooperatively.
15. Ian Brewer 15
Works Cited
Cayirli, T., Veral, E., & Rosen, H. (2006). Designing appointment scheduling systems for
ambulatory care services. Health Care Manage Sci, 45-58.
Cayirli, T., Yang, K. K., & Quek, S. A. (2012). A Universal Appointment Rule in the Presence
of No-Shows and Walk-Ins. Production and Operations Management, 682-697.
Centers for Disease Control and Prevention. (2013, June 12). Preventive Health Care. Retrieved
from Centers for Disease Control and Prevention:
http://www.cdc.gov/healthcommunication/toolstemplates/entertainmented/tips/preventive
health.html
DuMontier, C., Rindfleisch, K., Pruszynski, J., & Frey III, J. J. (2013). A Multi-Method
Intervention to Reduce No-Shows in an Urban Residency Clinic. Family Medicine, 634-
641.
Maciosek, M. V., Coffield, A. B., Flottemesch, T. J., Edwards, N. M., & Solberg, L. I. (2010).
Greater Use Of Preventive Services In U.S. Health Care Could Save Lives At Little Or
No Cost. Health Affairs, 1655-1660.
Marvel, M. K., Epstein, R. M., Flowers, K., & Beckman, H. B. (1999). Soliciting the Patient's
Agenda: Have We Improved. JAMA, 283-287.
Rabin, R. C. (2014, April 20). USA Today. Retrieved from You're on the clock: Doctors rush
patients out the door: http://www.usatoday.com/story/news/nation/2014/04/20/doctor-
visits-time-crunch-health-care/7822161/
Rhoades, D. R., McFarland, K. F., Finch, W. H., & Johnson, A. O. (2001). Speaking and
Interruptions During Primary Care Office Visits. Family Medicine, 528-532.
Shaw, M. K., Davis, S. A., Fleischer Jr., A. B., & Feldman, S. R. (2014). The Duration of Office
Visits in the United States, 1993 to 2010. Am J Manag Care, 820-826.
Wilson, A. (1989). Extending appointment length -- the effect in one practice. Journal of the
Royal College of General Practitioners, 24-25.
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