This document summarizes a presentation about patient and family centered care (PFCC) in graduate medical education. It discusses the history and core values of PFCC, provides examples of how PFCC has been successfully implemented at institutions like the Medical College of Georgia, and shares results from a study that assessed resident performance through patient feedback surveys. The study found patient feedback improved residents' communication, patient care, and systems-based practice skills compared to traditional attending evaluations alone. The presentation concludes PFCC can enhance graduate medical education by providing meaningful feedback to help residents improve.
The keynote address was delivered at the NYSAVSA Annual Conference on June 7, 2012 in Geneva, NY. The purpose of the address was 3-fold: (1) Outline what patient- and family-centered care is, its core components, and benefits; (2)Highlight some best practice volunteer programs aligned with the PFCC philosophy; (3) Provide conference participants with an assessment grid to evaluate their volunteer programming based on two PFCC standards and walk away from the presentation with concrete strategic next steps to enhance and strengthen their volunteer programming based on the PFCC model and philosophy.
Krames Patient Education is the only choice for enterprise-wide patient education. In this presentation, practices will learn who Krames Patient Education is and What we can do for you.
We will review Patient-Centered Care and Patient Education; The Case for a Patient Education Investment, The Krames Differencet; Return on Investment; and Krames Solutions.
Definition: Patient-Centered Care
Definition Patient-centered care (patient centred care): “Is a model in which providers partner with families to identify and satisfy the full range of patient needs and preferences.”
To expand this definition, patient-centered care is dependent on the involvement of the staff and care team as well.
“To succeed, a patient-centered approach must also address the staff experience as staff’s ability and inclination to effectively care for patients is unquestionably compromised if they do not feel care for themselves" (Picker Institute).
Researchers from Harvard Medical School, on behalf of Picker Institute and The Commonwealth Fund, defined seven primary dimensions of patient-centered care model.
These factors are identified as:
Respect for patients’ values, preferences and expressed needs
Coordination and integration of care
Information, communication and education
Physical comfort
Emotional support and alleviation of fear and anxiety
Involvement of family and friends
Transition and continuity
The keynote address was delivered at the NYSAVSA Annual Conference on June 7, 2012 in Geneva, NY. The purpose of the address was 3-fold: (1) Outline what patient- and family-centered care is, its core components, and benefits; (2)Highlight some best practice volunteer programs aligned with the PFCC philosophy; (3) Provide conference participants with an assessment grid to evaluate their volunteer programming based on two PFCC standards and walk away from the presentation with concrete strategic next steps to enhance and strengthen their volunteer programming based on the PFCC model and philosophy.
Krames Patient Education is the only choice for enterprise-wide patient education. In this presentation, practices will learn who Krames Patient Education is and What we can do for you.
We will review Patient-Centered Care and Patient Education; The Case for a Patient Education Investment, The Krames Differencet; Return on Investment; and Krames Solutions.
Definition: Patient-Centered Care
Definition Patient-centered care (patient centred care): “Is a model in which providers partner with families to identify and satisfy the full range of patient needs and preferences.”
To expand this definition, patient-centered care is dependent on the involvement of the staff and care team as well.
“To succeed, a patient-centered approach must also address the staff experience as staff’s ability and inclination to effectively care for patients is unquestionably compromised if they do not feel care for themselves" (Picker Institute).
Researchers from Harvard Medical School, on behalf of Picker Institute and The Commonwealth Fund, defined seven primary dimensions of patient-centered care model.
These factors are identified as:
Respect for patients’ values, preferences and expressed needs
Coordination and integration of care
Information, communication and education
Physical comfort
Emotional support and alleviation of fear and anxiety
Involvement of family and friends
Transition and continuity
Human Care Systems provides comprehensive patient and HCP support programs for biopharm and medtech companies and provider and payer organizations in the rare disease market. We help organizations reach patient and HCP initiation, adherence and retention goals by integrating a proprietary intelligent stakeholder algorithm. The result is Real World Outcomes: optimized patient quality of life, HCP brand preference and brand ROI
Presented at the 2015 IHI International Forum byThe Royal Melbourne Hospital of Victoria,Australia, this poster,speaks to the power of Shadowing to engage patients and families in decisions of care, specifically the post-discharge planning process.
At the end of the session patient/family champions as well as health authorities will leave armed with best practices, resources and ideas on how to open the door for patient/family engagement with health authorities and how to make the most of the time together.
Aligning Incentives for Patient Engagement: Enabling Widespread Implementation of Shared Decision Making
May 24, 2013
John E. Wennberg, The Dartmouth Institute
Overview of Patient Experience Definitions and Measurement ToolsInnovations2Solutions
This publication will provide an overview of patient experience, how it is measured, and how to achieve it optimally within the healthcare setting. Sodexo’s definition of Patient Experience will also be explored.
Human Care Systems provides comprehensive patient and HCP support programs for biopharm and medtech companies and provider and payer organizations in the rare disease market. We help organizations reach patient and HCP initiation, adherence and retention goals by integrating a proprietary intelligent stakeholder algorithm. The result is Real World Outcomes: optimized patient quality of life, HCP brand preference and brand ROI
Presented at the 2015 IHI International Forum byThe Royal Melbourne Hospital of Victoria,Australia, this poster,speaks to the power of Shadowing to engage patients and families in decisions of care, specifically the post-discharge planning process.
At the end of the session patient/family champions as well as health authorities will leave armed with best practices, resources and ideas on how to open the door for patient/family engagement with health authorities and how to make the most of the time together.
Aligning Incentives for Patient Engagement: Enabling Widespread Implementation of Shared Decision Making
May 24, 2013
John E. Wennberg, The Dartmouth Institute
Overview of Patient Experience Definitions and Measurement ToolsInnovations2Solutions
This publication will provide an overview of patient experience, how it is measured, and how to achieve it optimally within the healthcare setting. Sodexo’s definition of Patient Experience will also be explored.
evidence based practice is best for the people working with patients
ebp should be used by the heath care provider.
ebp based upon clinical experties
best research evidence
patient preference and values
Acute hospitals end of life care best practiceNHSRobBenson
Delivering reliable best practice in an acute hospital setting for patients whose recovery is uncertain. Including details of the AMBER care bundle. Presentation from Anita Hayes and colleagues from England's National End of Life Care Programme as part of the Department of Health's QIPP end of life care workstream seminar series at Healthcare Innovation Expo 2011
Improving Patient Rounds (IPR): Medical College of Georgia/Georgia HealthPicker Institute, Inc.
Principal investigator: Walter J. Moore, MD, Center for Patient- and Family-Centered Care
The IPR project will initiate patient- and family-centered- care rounds in adult medical and surgical rounds. Project will initially follow and measure improvement of one service team, practicing patient- and family-centered rounds, on the inpatient medicine unit, with attention to patient, family, staff and physician satisfaction; unit costs; resident and unit efficiency; and quality and safety. Educational effectiveness and team performance in PFCC rounds will also be evaluated through student/faculty culture survey (pre/post), written evaluations, student debriefing and videotaped session(s). Project results include identifying steps and strategies applicable to other adult-care units, and discovering and overcoming specific obstacles in PFCC rounds. Results will be developed into a blueprint for use in MCG units and other institutions.
Week 2 The Clinical Question77 unread replies.2525 replies..docxcockekeshia
Week 2: The Clinical Question
77 unread replies.2525 replies.
Your capstone change project begins this week when you identify a practice issue that you believe needs to change. The practice issue must pertain to a systematic review that you must choose from a List of Approved Systematic Reviews (Links to an external site.)Links to an external site. for the capstone project.
· Choose a systematic review from the list of approved reviews based on your interests or your practice situation.
· Formulate a significant clinical question related to the topic of the systematic review that will be the basis for your capstone change project.
· Relate how you developed the question.
· Describe the importance of this question to your clinical practice previously, currently, or in the future.
· Describe what a research-practice gap is.
· Collapse Subdiscussion
Julie White
Julie White
SundayOct 29 at 9:39am
Manage Discussion Entry
Opening Post_Julie
On a daily basis, healthcare providers are faced with an array of clinical decisions to be made in an efficient and timely manner. Translating evidence into best practices is one way to achieve this. Without current best evidence, practice is rapidly outdated, often to the detriment of the patient. Evidence based practice is the conscientious use of current best practice in making decisions about patient care (Sackett, Richardson, Rosenberg, & Hayes, 2000). It is important for health care professionals to ask questions about their current clinical practice. In this week’s threaded discussion you will ask that burning question that you ask in your daily care of your patients.
You’ll need to focus on asking the right questions, narrowing the questions to one that is nurse driven and the need for change is evident. The question that you formulate will be the question for your Capstone Project.
The process of reviewing scholarly articles for a change in practice is an important part of the development of any type of research project that can lead to a change in practice. As you are appraising the systematic review and other scholarly articles for your change project, think about areas of the article such as sample size, the population, type of study, discussion and limitations. Critiquing a research article will allow you to evaluate the scientific merit of the study and decide how the results may be useful in practice.
ReplyReply to Comment
·
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Adele Allen
Adele Allen
SundayOct 29 at 12:58pm
Manage Discussion Entry
Hello Professor and Classmates,
Nurses are called to rely on current research to guide evidence-based practice. The research on a topic can be vast and contradictory. Traditional reviews of the evidence are no longer appropriate. The information sifting called for with the wealth of information available is too great a task. The reviewer needs guidelines to ensure bias is minimized and th.
evidence based practice that hlps in you reasarch and ease you in reaseach practice. in this presentation many things are given which you learn n your research article.
Strategies for Safe and Effective Resident SupervisionVineet Arora
Presented at Accreditation Council of Graduate Medical Education (ACGME) meeting in Nashville, TN Mar 2010. Includes overview of resident supervision, function and type of supervision in various specialties, and the SUPERB/SAFETY model of effective supervision. Includes link to video on YouTube for facilitating discussion.
Jim Warren
National Institute for Health Innovation (NIHI)
The University of Auckland
The presentation was accompanied by this video:
http://www.youtube.com/watch?v=jbvmGqmIxXY
As new payment models emerge that emphasize value over volume, providers are being compelled to look more closely at how to motivate patients—especially those with multiple chronic conditions—to actively manage their care, make better decisions and change behaviors. This editorial webinar will explore the relationships between engagement and improved health outcomes, greater patient satisfaction and better resource utilization. Our panel of experts will share proven strategies for building patients' confidence, disseminating self-management tools and making the best use of your care team.
Healthcare -- putting prevention into practiceZafar Hasan
This slidedeck is submitted by Zafar Hasan because one of the trends in medicine for the last 20 years isa focus on prevention and this deck is an outstanding practice primer.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Patient- and Family Centered Care: "Resident Performance from the Patient's View"
1. Patient and Family Centered Care (PFCC): Lessons from Graduate Medical Education Medicine Grand Rounds March 15th, 2011 Richard M. Wardrop III, M.D., Ph.D. WakeMed Faculty Physicians
2. Disclosure I had grant support to perform research from the Picker Institute and ACGME I currently serve as an external reviewer to the Picker Institute and their challenge grant program
4. Objectives Introduction Review what PFCC is Review history of PFCC Give resources for PFCC practice Show examples of successful implementation of PFCC in GME and beyond Research Share some data from my experience at Carilion Mixed methods project Speculate on what we can do here in PFCC and in GME
5. Background Setting The PFCC movement is enormous There is no fixed history Multiple players on multiple levels The work of others is very humbling Just good medical practice? We have to start somewhere….
6. How can I get you to practice PFCC? Patients like it? Patients feel empowered? It saves money? It leads to safer care? It does not cost anything extra? Anyone can do it?
7. We are (I was 2008 – 2010)…..Carilion Clinic 500+ physicians in a multi-specialty group practice and eight not-for-profit hospitals. Specializing in patient-centered care, medical education, and clinical research.
8. What is PFCC? “Patient- and family-centered care is an innovative approach to the planning, delivery, and evaluation of health care that is grounded in mutually beneficial partnerships among health care patients, families, and providers.” “Patient- and family-centered care applies to patients of all ages, and it may be practiced in any health care setting “ www.familycenteredcare.org
9. Core Values of PFCC Dignity and Respect Information Sharing Participation Collaboration
10. Core Values of PFCC – Picker Institute Respect for patient values, preferences, and expressed needs Coordination and integration of care Information, communication, and education Emotional support and alleviation of fear and anxiety Inclusion of family in care Transition and continuity Physical Comfort Access to care www.pickerinstitute.org
11. Core Values of PFCC Belief oriented….Planetree Foundation that we are human beings, caring for other human beings we are all caregivers care giving is best achieved through kindness and compassion safe, accessible, high quality care is fundamental to patient centered care is a holistic approach to meeting people's needs of body, mind and spirit families, friends and loved ones are vital to the healing process
12. Core Values of PFCC Belief oriented….cont access to understandable health information can empower individuals to participate in their health. the opportunity for individuals to make personal choices related to their care is essential physical environments can enhance healing, health and wellbeing illness can be a transformational experience for patients, families and caregivers www.planetree.org
13. Pause Pause…. Are you saying…. “I agree with that – why do we need to hear this?” “I already do all these things…I’m good” Or are you saying “I want to do more but the system won’t let me….” “I’m to busy to worry about this…..” Out of respect for my audience… welcome your thoughts
14. Brief History of PFCC – Divergent Events / Efforts Converging on a point…. Started with the Planetree Foundation in 1978 Had many roots in pediatrics and HIV/AIDS population A system in need of major change – Institute of Medicine Reports and C.E. Coop
15. Brief History of PFCC The Institute for Family Centered Care Picker Institute for Patient Centered Care Center for Patient and Family Centered Care - MCG National Priorities Partnership AHRQ, CDC, CMS, IOM, Joint Commission and 20+ others Defined Priorities in Patient Care – many of which adhere to PFCC principles www.qualityforum.org/about/npp
16. Brief History of PFCC Other Organizations involved with guidelines or statements SCCM ABIM American Hospital Association American Academy of Orthopedic Surgeons Countless medical centers recognized
17. Resources Partnering with Patients and Families to Design a Patient- and Family-Centered Health Care System: Recommendations and Promising Practices – free 178 page document Supported by RWJ Other titles available from evidence based architecture to bibliographies for resources and references http://www.familycenteredcare.org/resources/other/index.html
18. Resources Picker Institute Picker Surveys Challenge grants Profiles of successful Centers Downloadable seminars and workshops Other grants and resources http://www.pickerinstitute.org/Research/pickerchallenge.html
19. Reading and Resources for GME GME Assessment and Tips Books Downloads….from ABIM http://www.abimfoundation.org/
21. Beacon of PFCC Medical College of Georgia http://cpfcc.org Started movement in 1993 by including patients in design of Children's Hospital In 2002 set behavioral standards for all staff
22. MCG – UME and GME Since 1993 Institutional commitment to change clinical environments to PFCC Developed family faculty for patients and families to serve as expert advisors and teachers Foster resident involvement with family and patient advisors Create opportunities that allow residents to apply this to their practice Developed standards for how teaching rounds will take place
23. MCG – UME and GME Teaching examples at MCG MS Clinic Behavioral Health Cystic Fibrosis Family Medicine Clinic Cancer Center Peri-natal clinic Research ePHR HTN project Involve patients and families in faculty and resident recruitment Integrate patients and families into research efforts
25. PFCC Success….in a clinical unit Neurosciences Center of Excellence - at MCG: PFCC experience Patient satisfaction 10%-95th%tile Length of stay on Neurosurgery decreased 50% 62% decrease in medication errors Staff vacancy from ~8% 0% (wait list)
26. MCG Institutional Improvement? Increased / Improved Patient satisfaction Clinical quality Payer mix Market share Profitability Decreased Malpractice claims Show me the Money! Featured in PBS Documentary – Remaking of American Medicine
27. Summary PFCC has a 30 year history at least At its deepest levels, we probably all agree with it Differences are in the execution Research exists Success stories exist Real improvements in a medical center can happen It can not only co-exist with GME but also drive GME
28. Resident performance from the patient’s view: A novel prospective assessment of performance and performance improvement in delivering patient-centered care
29. A common motivating theme is some experience….. Dr. Harvey Picker – Picker Institute Angelica Thieriot – Planetree Me – what got me interested?
31. The questions I started having as I started at Carilion Should doctors finish training without getting feedback from patients? If we give them feedback will they be better in cultivating good communication and productive relationships with patients and families?
33. The Problem As a young attending I felt a few pieces of information were missing as I went to fill out the ACGME competency based evaluations….
34. The Art of Feedback Make observations and collect facts Time and data dependant Need a framework to standardize feedback Provide a mirror image
35. The Problem It occurred to me during my 7th or 8th two week block… when a patient fired one of the residents I was supervising and then a nurse complained about a different resident then a patient gave the same resident praise…. I was not really sure what was going on between the residents and patients when I was not around to observe them.
36. What to do? Spying? Using a wire tap? Video taping? Interrogating the patients? Sneaking around?
37. What to do? Patient care is complex and emotional Supervising residents is complex There are only 24 hours in a day But I need to know!
38. What to do? Sentinel events (firing by patients, complaints, or praise) cannot dominate the entire recorded experience all the time…. How to empower and enlists the patients in the feedback process consistently?
39. The Resources What did we have at our disposal to solve this problem...?
40. What we had experimented with…. How useful? Learner Centered? Patient Centered?
42. Opportunity knocks… We had problem / hypothesis Call for grants from OSP Struck me at the right time I had time We had core team We had resources There was money up for grabs
43. Eureka! Make a new mousetrap… Distribute it to everyone Share the feedback with the residents Ask the patients anonymously about the residents using a survey Make it competency based Make it portable Make it easy
44. Make a new mousetrap… Most of all make it patient centered
45. Hypothesis and Aims Hypothesis - the regular use of the a patient-centered, core competency-based survey tool combined with specific learner centered feedback would improve the performance of residents in delivering patient-centered care when compared to the conventional practice of attending-only assessment and feedback.
46. Hypothesis and Aims AIM 1: To adapt the evaluation tool into a concise, valid and reliable instrument that enables patients assess resident performance on 4/6 ACGME competencies. AIM 2: To compare residents who receive feedback and coaching using the tool developed under AIM 1 to traditional attending-only assessment and feedback.
47. Picker Challenge Grant Program Started in 2005 for projects in 2006 4 per year at $25,000 Requires matching funds (in kind) 2008 cycle had 119 applications Grants focused on research in PFCC in GME Picker Principles $50,000 total / project Transitioning Adolescent Patients (TAP) from Pediatric to Adult CarePrincipal investigator: Emily von Scheven, MD, MAS, Pediatric Rheumatology, University of California San Francisco Improving Patient Rounds (IPR)Principal investigator: Walter J. Moore, MD, Center for Patient- and Family-Centered Care, Medical College of Georgia Patient-Centered Training of Residents on a Medical Ward Principal investigator: Robert C. Smith, MD, MS, Internal Medicine,EW Sparrow Hospital/Michigan State University College of Human Medicine Resident Performance from the Patient’s ViewPrincipal investigator: R.M. Wardrop, MD, PhD, FAAP, Director of Resident Research, Internal Medicine, Carillion Clinic, Roanoke, Va.
50. The tool – used by patients, residents and attending
51. The Picker Principles - Assessed Respect for patient values, preferences, and expressed needs Coordination and integration of care Information, communication, and education Emotional support and alleviation of fear and anxiety Transition and continuity
52. Hypothesis and Aims AIM 1: To adapt the evaluation tool into a concise, valid and reliable instrument that enables patients assess resident performance on 4/6 ACGME competencies. AIM 2: To compare residents who receive feedback and coaching using the tool developed under AIM 1 to traditional attending-only assessment and feedback.
53. End points Quantitative Reliable? Valid and on how many scales? Measure performance Effect on performance when combined with feedback? Qualitative Patients appreciate? Residents appreciate? Comments have any meaningful content?
54. Other measures Residents evaluate themselves in these patient centered domains Attending physicians evaluate residents in patient centered domains Conduct patient-centered interviews regarding the process
59. We did the unthinkable… Selected patient interviews by study faculty To focus survey Have patients tell us what the questions mean to them in their own words.
65. Scale Validity and Reliability Reliability (consistency) Consistency in the ratings on any measure is important Differences in rating not due to chance Measure Chronbach’s Alpha across all raters and ACGME domains All were >0.75 indicating the scale and the raters were using it consistently Validity (accuracy) Assessing validity determines whether or not the survey is measuring what it was intended to measure The instrument had built-in content validity Structural validity testing only found 1 valid scale with no subscales (patients and attending rated with little variability between domains (good in one good in all)
66. Sample Comments from Patients (over 300 written) The good “I know this looks like we just circled all 5's but Dr B. truly met all of them. Our family was REALLY impressed with Dr B. of all the doctors we have seen. He stands at the top.” +/PC/ICS/P “Dr T shows great leadership, he is a listener and very helpful to me about getting to the problem and ruling out disease and ordering tests and explaining special tests. He LISTENS. That smile also will take him a long way. I'm glad he was on my team of recovery. My heart goes (out to him).” +/P/PC/ICS “Very compassionate, caring and professional. Takes time to listen to pts. (the resident) explained everything to myself and family in layman's terms to understand. Excellent Dr. Wish him success in the world. Thanks for excellent care.” +/PC/P/ICS Other “He (the resident) seems caring my only problem is its hard to understand his when he's talking. Otheriwise he seems OK. I've only seen him once since my husband's been here. Everyone else has been very good to him.” +/-P/ICS “No contact. I have been in the hosp for over 35 hrs in this 3 day stay and never spoke with this Dr. (written by wife)” - P/ICS
71. Sample Resident Comments Name two distinct things you learned from this process about yourself or about how patients view you. “I thought the patients would be more concerned with my medical decision making” “glad to know I helped my patients so much – it makes it easier to work so hard knowing this” “Patients value giving input into care” “Patient’s know what is going on with their care” “It was more positive than I expected” “the patients view me more favorably than I thought” “I am my own worst critic” “Patients think I am a great doctor” “I need to interrupt patients less” What one thing will you commit to change because of this process? “more discussion of the plan with patients or family” “I will stop interrupting patients so much” “Maybe going back to round on my patients in the afternoon (to update them) “trying to better incorporate patient preferences into management” Comments and suggestions? “Get as many back from patients as possible to assure accuracy” “Worried attending physicians may not be best to hand out the surveys may skew the results towards good evals to not get anyone in trouble” “Pleasant patients may get more attention” “Patients with multiple co-morbidities may not get a form as frequently and this could create bias”
72. Resident Performance – prior to feedback No significant differences between groups prior to feedback
73. Resident Performance – prior to feedback No significant differences between groups prior to feedback
74. Resident Performance improved when associated with having received feedback – communication, patient care, systems based practice * * * * *
75. Challenges for prime time use Curriculum Making sense of the data Validity and reliability testing in your populations Survey collection and distribution Finding meaning in the non-numerical data
76. Conclusions Patients provided regular feedback using the instrument and scales Patient appreciated providing feedback The survey was reliable and valid. Scale validity for one scale Providing feedback during the year improved performance of residents in the patients’ and the attending physicians’ “eyes” in several areas
77. Conclusions Patients regularly provided qualitatively rich and competency-based feedback Residents appreciate the feedback from the patients They feel it helps direct them for self- improvement in these areas
78. Implications for WakeMed Use these resources / ideas at your own level Hospitalist face-card Do what you do only potentially change focus PFCC rounds on Pediatrics Stroke Rounds with MD Know who else feels this is important Ideas?
79. Many thanks to…. The Picker Institute ACGME leadership and staff Carilion Clinic Our team Our faculty Our residents Our patients
80. Core Study Team Richard M. Wardrop III, MD, PHD, FAAP, FACP Chad J. DeMott, MD, FACP Jon M. Sweet , MD, FACP – Program Director David Baker, PhD Robert Herbertson, MS SowjanyaKolluri, MD RoshanBowansingh, MD Study Coordinators Dawn Bowles, RN Jacqueline Baker, RN Grant Management: W. Eryn Perry
82. Selected Bibliography Putting Patients First: Best Practices in Patient Centered Care, 2nd Ed. Susan Frampton and Patrick Charmel eds. Josey-Bass Publishers. San Francisco, 2008. Partnering with Patients and Families to Design a Patient- and Family-Centered Health Care System: Recommendations and Promising Practices Institute for Family-Centered Care – 2008. Available online at www.familycenteredcare.org National Partnership Priorities Executive Report. National Priorities Partnership – at the National Quality Forum. November 2008. www.qualityforum.org Synthesis of Definitions of Patient-, Family-, and Relationship-Centered Care. Amy Cunningham. ABIM Foundation. www.abimfoundation.org Patient- and Family-Centered Care and Graduate Medical Education: A Primer. Beverely H. Johnson. Presented at 2009 ACGME Educational Conference, Grapevine, TX. www.acgme.org Patient- and Family-Centered Care and Resident Learning. Patricia Sodomka. Presented at 2009 ACGME Educational Conference, Grapevine, TX. www.acgme.org
83. Selected WebBibliography Extensive references for specific specialties in PFCC available at the Institute for Family Centered Care www.familycenteredcare.org Planetree Foundation. All in one site with complete model and programs. www.planetree.org Additional resources results, links, survey tools, description of challenge grant awards and results available at www.pickerinstitute.org Center for Patient and Family Centered Care at UCG. Links, research in PFCC and GME research www.cpfcc.org
Editor's Notes
I’ll start with a quote from our website that exhorts our specialization in patient centered care…..I do this to set the stage for what I am going to talk about and let you make your own decisions about whether this is true or not?I think we have challenges and room to grow in this area.