Impact of a brief faculty training to improve patient-centered communication while using electronic health records

Objective Despite rapid EHR adoption, few faculty receive training in how to implement patient-centered communication skills while using computers in exam rooms. We piloted a patient-centered EHR use training to address this issue. Methods Faculty received four hours of training at Cleveland Clinic and a condensed 90-minute version at the University of Chicago. Both included a lecture and a Group-Objective Structured Clinical Exam (GOSCE) experience. Direct observations of 10 faculty in their clinical practices were performed pre- and post-workshop. Results Thirty participants (94%) completed a post-workshop evaluation assessing knowledge, attitude, and skills. Faculty reported that training was important, relevant, and should be required for all providers; no differences were found between longer versus shorter training. Participants in the longer training reported higher GOSCE efficacy, however shorter workshop participants agreed more with the statement that they had gained new knowledge. Faculty improved their patient-centered EHR use skills in clinical practice on post- versus pre-workshop ratings using a validated direct-observation rating tool. Conclusion A brief lecture and GOSCE can be effective in training busy faculty on patient-centered EHR use skills. Practice Implications Faculty training on patient-centered EHR skills can enhance patient-doctor communication and promotes positive role modeling of these skills to learners

The Electronic Health Record Scorecard: A Measure of Utilization and Communication Skills

As the adoption rate of electronic health records (EHRs) in the United States continues to grow, both providers and patients will need to adapt to the reality of a third actor being present during the visit encounter. The purpose of this project is to provide insight on “best” practice patterns for effective communication and efficient use of the EHR in the clinical practice setting. Through the development of a comprehensive scorecard, this project assessed current status of EHR use and communication skills among health care providers in various clinical practice settings. Anticipated benefits of this project are increased comfortability in interfacing with the EHR and increased satisfaction on the part of the provider as well as the patient. Serving as a benchmark, this assessment has the potential to help guide future health information technology development, training, and education for both students and health care providers

Patient Satisfaction in a Statewide Cervical Cancer Screening Program

A cross-sectional study of patients participating in the Nevada State Health Division’s Women Health Connection Program (WHC) was conducted to assess patient satisfaction for cervical cancer screening. In this study, 528 WHC program patients provided information regarding their satisfaction with the treatment services they received, accessibility issues, breast and cervical cancer health education and information, and overall program satisfaction. A large majority of patients reported high levels of satisfaction with the program services and clinic personnel. Significant positive correlations were found when comparing satisfaction with services received at the clinic to treatment received by physicians, nurses, and admissions personnel, how well information provided to patients eased their concerns, and when results were discussed with patients. Wait time for admission and to see a physician were negatively correlated to satisfaction. Those who reported that they would not use services again indicated lower levels of satisfaction with the information received and treatment from caregivers and admissions personnel when compared to those who would use the program again

Health Care Disparities for Persons with Limited English Proficiency: Relationships from the 2006 Medical Expenditure Panel Survey (MEPS)

Inadequate communication between patients with limited English proficiency (LEP) and providers can be associated with lower access to health care. The purpose of this research was to determine if there is a significant difference among those persons whose primary language is English and those with LEP in ability to access care and preventative screenings and perception of interaction with their physician. Chi square analysis was performed to determine if there was a significant relationship between primary language spoken and access to health care and patient-provider interaction. Data were obtained from the 2006 Medical Expenditure Panel Study. Results show that there is a significant difference in ability to access health care and screenings for persons with LEP. Those persons with LEP also perceived poorer patient-physician interaction compared to those persons who primarily speak English. Strategies such as interpretative services, translation of health care materials and provider education and training in communication with persons who are LEP and cultural competency should be established to improve access and communication between patient and provider

Racial/Ethnic Disparities in Diabetes Care and Outcomes: A Mixed Methods Study

Limited research has examined racial/ethnic differences in diabetes care and outcomes among primary care patients. This study examined racial/ethnic differences in diabetes care and outcomes among an ambulatory patient population and explored patient perceptions of the patient-provider relationship to inform strategies to improve care delivery. Using data from 62,149 adults with diabetes who received care within Atrium Health in 2013, regression models assessed associations between race/ethnicity and the following outcomes: glycated hemoglobin (HbA1c) tests, low density lipoprotein (LDL) and blood pressure (BP) screening, foot and eye exams, and HbA1c, LDL, and BP control. Eleven patients with diabetes and uncontrolled hypertension participated in three focus groups about their perceptions of the patient-provider relationship. Compared to non-Hispanic Whites, non-Hispanic Blacks had 22% to 73% higher odds of receiving screenings (HbA1c, LDL, BP, foot and eye exams;

Echocardiography curriculum development for physician assistants using entrustable professional activities

BACKGROUND: With the projected increase of cardiovascular disease in the aging population, a higher demand for echocardiography use is predicted. However, there is a shortage in the supply of cardiologists, to the point that a 2009 American College of Cardiology survey report called it a "cardiology workforce crisis". The report also recommends a more aggressive use of PAs and NPs as one of the solutions to fill the shortage. Currently, echocardiography is not routinely included in the scope of practice for PAs in cardiology. While PAs attain strong basic science knowledge and clinical training experience in PA school, they typically do not receive additional formal postgraduate training. PAs have limited training opportunities to train in echocardiography and receive certification of recognition, but a formally standardized training program and certifying examination geared specifically for PAs are yet to be developed. This study seeks to develop a pilot curriculum in training echocardiography which can be standardized for utilization across various regions and medical subspecialties. The curriculum draws on the concept of Entrustable Professional Activities (EPA), which is being actively used in graduate medical education. HYPOTHESIS: After participating in the proposed pilot curriculum which involves online didactic learning and supervised hands-on clinical training, trained PAs will be able to reach proficiency in echocardiography operation and interpretation at level 4 supervision according to the EPA guidelines. METHODS: This study proposes a pilot curriculum with framework based on the EPA titled “performing and interpreting echocardiography” by PAs. The curriculum involves didactic and clinical training in echocardiography, with the goal to achieve mastery of level 4 supervision (minimal supervision). 2 subjects will be recruited from a teaching medical institution in the Greater Boston area with an IAC accredited echocardiography laboratory. After the 12-month training, participants will take ASCeXAM/ReASCE Online Practice Exam Simulation offered by the ASE. Upon 1) achievement of individualized EPAs as assessed by supervisor, and 2) simulation exam score of >80%, participants will earn a STAR in echocardiography. CONCLUSION: The study is the first step to establishing an effective training curriculum that will eventually be a basis for creating a certifying exam in echocardiography, designed specifically for PAs. As this study merely suggests a new curriculum, future studies should focus on identifying strengths and weaknesses of the curriculum after implementation and expansion to multiple sites, and gather data to use for continual improvement of the training curriculum

Language Barriers in Health Care Settings: An Annotated Bibliography of Research Literature

Provides an overview of resources related to the prevalence, role, and effects of language barriers and access in health care

A Quality Improvement Project to Increase Eye Care Screenings and Recommendations for Patients With Type II Diabetes Mellitus

Type 2 diabetes affects more than 90 million people and is a major cause of reduced vision and blindness in the United States (Lu et al., 2016). Without proper preventative measures, T2D damages the microvascular within the retina causing diabetic retinopathy (Lima, Cavalieri, Lima, Nazorio, & Lim, 2016). Despite the success of early detection and the availability of diabetic retinopathy screenings, many people diagnosed with T2D do not complete the recommended routine eye exam (Lu et al., 2016). Healthy People 2020’s (HP2020) (2016) target goal for annual dilated eye exams for patients with T2D is 58%. At baseline, only 2% of patients received eye care screenings & referrals within the host Internal Medicine clinic. The purpose of this quality improvement project was to increase the number of eye care screenings performed and referrals completed in non-WellMed patients over the age of 18 diagnosed with T2D. The primary objective was to increase eye care screenings and ophthalmology referrals and educate patients and staff regarding diabetic retinopathy. The intervention included staff training, a patient education handout, and the development of a provider protocol checklist. Between June 12 and August 4, 2017, 76 patients met the inclusion criteria. Following the intervention, 40 patients (53%) received a complete eye care assessment, 29 patients (38%) were recommended to an ophthalmologist, and 33 patients (43%) received patient education handouts. Results suggest that a combination of staff training, patient education, and assistance with the assessment and referral process can influence provider’s adherence to recommended care