Formative evaluation of a patient-specific clinical knowledge summarization tool

To iteratively design a prototype of a computerized clinical knowledge summarization (CKS) tool aimed at helping clinicians finding answers to their clinical questions; and to conduct a formative assessment of the usability, usefulness, efficiency, and impact of the CKS prototype on physicians’ perceived decision quality compared with standard search of UpToDate and PubMed

Patient Record Summarization Through Joint Phenotype Learning and Interactive Visualization

Complex patient are becoming more and more of a challenge to the health care system given the amount of care they require and the amount of documentation needed to keep track of their state of health and treatment. Record keeping using the EHR makes this easier but mounting amounts of patient data also means that clinicians are faced with information overload. Information overload has been shown to have deleterious effects on care, with increased safety concerns due to missed information. Patient record summarization has been a promising mitigator for information overload. Subsequently, a lot of research has been dedicated to record summarization since the introduction of EHRs. In this dissertation we examine whether unsupervised inference methods can derive patient problem-oriented summaries, that are robust to different patients. By grounding our experiments with HIV patients we leverage the data of a group of patients that are similar in that they share one common disease (HIV) but also exhibit complex histories of diverse comorbidities. Using a user-centered, iterative design process, we design an interactive, longitudinal patient record summarization tool, that leverages automated inferences about the patient's problems. We find that unsupervised, joint learning of problems using correlated topic models, adapted to handle the multiple data types (structured and unstructured) of the EHR, is successful in identifying the salient problems of complex patients. Utilizing interactive visualization that exposes inference results to users enables them to make sense of a patient's problems over time and to answer questions about a patient more accurately and faster than using the EHR alone

The Effects of Formative and Summative Assessment on Student\u27s Connectedness, Satisfaction, Learning and Academic Performance within an Online Healthcare Course

The quantitative study presented here evaluates the effects of formative and summative assessment on student’s connectedness, satisfaction, learning and academic performance within a university three-credit 400 level online healthcare course. Literature exploring the role that formative assessment plays within an online environment is currently lacking. Additionally, understanding how assessment practices can help support the goals of online healthcare education is vitally important given the rise in popularity of this delivery format. This study investigated student outcomes in the form of connectedness, satisfaction, learning and academic performance. Four cohorts of students were included in this study. Two cohorts were provided with formative assessment procedures while the other two cohorts were provided with primarily summative assessment. A survey-based tool was created and delivered to students’ post-course completion which gathered information on a students’ sense of connectedness, satisfaction, and learning, whereas academic performance equated to final course grade earned. A one-way ANOVA was performed utilizing SPSS to identify statistical differences between formative and summative assessment cohorts. Analysis results indicated that the formative cohorts were higher in all areas explored and statistically significantly higher in the areas of learning and academic performance. Additional discussion regarding the results as well as future research recommendations are provided at the conclusion of this quantitative study within chapter five

Transforming Vulnerable Interactions to Effective Communication: An Application of Evidence for the Tele-Intensive Care Unit Nurse

Tele-intensive care collaboration in care of critically ill patients improves both the safety and quality of nursing care. However, the full benefits of the telemedicine service may not be realized unless tele-critical care nurses have the ability to communicate clearly with their remote nursing peers. The purpose of this DNP project was to create and validate an acronym style communication tool to assist the tele-critical care nurses with their communication. The relational coordination theory was the primary communication theory utilized for tool development. The tool creation phase of the project included informal observations and discussion with a convenience sample of 11 tele-critical care staff nurses. The formative feedback from this group helped to identify the episode of communication for which the tool was designed and suggested communication elements for inclusion. During the validation phase of this project, 9 volunteer experts evaluated the communication tool with a 5-point Likert scale survey. Descriptive statistics were used to analyze the survey results and provided summative feedback for validation of the tool. Mean scores between 3.44 and 4.44 demonstrated that the experts agreed with the applicability, relevance, and necessity of the tool. Feedback indicated the need for a pilot study implementing the tool to compare it with traditional communication practices and to evaluate its performance in clinical practice. This tool will be useful for future partnerships utilizing telemedicine. The project is socially significant because of its focus on communication and collaboration among healthcare providers in facilitating the patient experience and safety

Development of a Guideline for Hospice Staff, Patients, and Families on Appropriate Opioid Use

There is an identified problem with patients receiving suboptimal pain management at a hospice agency in the northwestern United States. At this agency, undertreatment of pain is prevalent. Evidence indicates that this may be a result of a lack of guidelines, education, and knowledge of appropriate prescribing. Known barriers to the correct prescription and administration of potent opioids in the hospice setting include prevailing beliefs, knowledge, skills, and attitudes, all of which can impact care negatively. Contextually, hospice principles mandate patient comfort and caregiver involvement in continuous quality improvement, which includes adequate and informed pain management. Moreover, hospice metrics demand requisite knowledge, skills, and attitudes for optimal care, including pain management at the end of life. The Academic Center for Evidence-Based Practice (ACE) star model was used to guide the development of an evidence-based, guideline-supported educational program that will improve pain management at the hospice agency when implemented. The purpose of this project was to use transdisciplinary expertise and team collaboration to develop the program and then to conduct a formative and summative evaluation utilizing experts to prepare the guidelines and process for implementation. Ten experts reviewed the guideline, the educational materials, the process, and the evaluation plan and conducted reviews using the AGREE II tool. The panel of experts agreed within the 6 AGREE domains. Future implementation of this guideline, translation process, and evaluation tool will impact social change through the empowerment of the clinical staff, patients, and caregivers to provide the best pain control and comfort at end of life, a vulnerable time for all patients

Transitional Care for the Cardiac Surgery Population: Development of a Clinical Practice Guideline

Recovering from a cardiac surgery procedure and the transition to home can be an overwhelming experience for patients and caregivers. A tertiary care hospital\u27s cardiothoracic surgery department suspended a nurse-practitioner-coordinated transitional care program in the 1st quarter of 2016. Following this decision, the readmission rate increased from its previous rate of 15.6% in quarter 1 to 20% in quarter 3. The purpose of this scholarly project was to develop a clinical practice guideline (CPG) that can bridge the gap in the transitional care process. The transitional care model informed the design of the project. A draft guideline was distributed to 5 stakeholders from the inpatient cardiac surgery care team for initial review. After initial review and revisions an edited version was then distributed to 5 additional stakeholders. Those stakeholders provided an assessment utilizing the AGREE II tool to assess the 6 domains of scope and purpose, stakeholder involvement, rigor of development, clarity and presentation, application and editorial independence, and overall quality. Four domains indicated a high level of agreement (96%-100%) and 2 domains indicated a response of \u3c 76% for domains related to rigor and organizational resources. The overall guideline assessment of the quality of the CPG received a score of 96%, with a recommendation to adopt the guideline. Advanced practice nurses will utilize this guideline to provide a systematic process in bridging gaps in care for the transition of the cardiac surgery patient population from hospital to home. Social change will be promoted through improved patient management by using evidence-based transitional care, decreased readmissions, and improved health outcomes for the cardiac surgical population

Increasing Referrals of Hospitalized Obese Patients

The rate of obesity continues to rise in the United States and globally, placing populations at increased risk of obesity related conditions, such as diabetes, hypertension, heart disease, cancer, and other disease states. Literature review shows that there have been many different methods utilized to halt obesity\u27s progression, however rates continue to increase. The United States Preventative Services Task Force (USPSTF), American Heart Association (AHA), and other agencies recommend obesity screening and counseling at every patient encounter, but most hospitals do not have a current obesity policy in place to accomplish this task. The purpose of this project is to develop a program proposal for a hospital-based, obesity tool based on the 5 A\u27s framework to increase screening and referrals of obese, adult patients ages 18 and over. The logic model was utilized to guide the program development, implementation, evaluation, and dissemination. The program was accepted by the hospitalist group and nurse leaders for full development and evaluation. Key stakeholders and content experts were convened to create a proposal and algorithm to guide the project. The obesity program will increase screenings and referrals upon full adoption. Increase in screenings and referrals will improve care, quality of life, weight status, and decrease health care expenditure. The results of dissemination of the program may stimulate other facilities to adopt the program to combat obesity and contribute to social change The rate of obesity continues to rise in the United States and globally, placing populations at increased risk of obesity related conditions, such as diabetes, hypertension, heart disease, cancer, and other disease states. Literature review shows that there have been many different methods utilized to halt obesity\u27s progression, however rates continue to increase. The United States Preventative Services Task Force (USPSTF), American Heart Association (AHA), and other agencies recommend obesity screening and counseling at every patient encounter, but most hospitals do not have a current obesity policy in place to accomplish this task. The purpose of this project is to develop a program proposal for a hospital-based, obesity tool based on the 5 A\u27s framework to increase screening and referrals of obese, adult patients ages 18 and over. The logic model was utilized to guide the program development, implementation, evaluation, and dissemination. The program was accepted by the hospitalist group and nurse leaders for full development and evaluation. Key stakeholders and content experts were convened to create a proposal and algorithm to guide the project. The obesity program will increase screenings and referrals upon full adoption. Increase in screenings and referrals will improve care, quality of life, weight status, and decrease health care expenditure. The results of dissemination of the program may stimulate other facilities to adopt the program to combat obesity and contribute to social change The rate of obesity continues to rise in the United States and globally, placing populations at increased risk of obesity-related conditions, such as diabetes, hypertension, heart disease, cancer, and other disease states. A review of the literature showed that multiple methods have been used to address the rate of progression; however, obesity rates continue to increase. The U.S. Preventative Services Task Force, American Heart Association, and other agencies recommend obesity screening and counseling at every patient encounter; most hospitals do not have a policy to accomplish this task. The purpose of this project was to develop an obesity screening and referral tool for the hospital setting. The resulting tool was based on the 5 As framework to increase screening and referrals of obese patients. The logic model was used to guide program development, implementation, evaluation, and dissemination. Results of the obesity screening and referral program showed an increase in screenings and referrals upon a trial adoption, raising the number of identified referrals to 23, compared to 2 patients identified for referral prior to program implementation (p = 0.035). An increase in screenings and referrals can bring about positive change by improving care, quality of life, and weight status of patients and decreasing health care expenditure

AI Chatbot for Generating Episodic Future Thinking (EFT) Cue Texts for Health

We describe an AI-powered chatbot to aid with health improvement by generating Episodic Future Thinking (EFT) cue texts that should reduce delay discounting. In prior studies, EFT has been shown to address maladaptive health behaviors. Those studies involved participants, working with researchers, vividly imagining future events, and writing a description that they subsequently will frequently review, to ensure a shift from an inclination towards immediate rewards. That should promote behavior change, aiding in health tasks such as treatment adherence and lifestyle modifications. The AI chatbot is designed to guide users in generating personalized EFTs, automating the current labor-intensive interview-based process. This can enhance the efficiency of EFT interventions and make them more accessible, targeting specifically those with limited educational backgrounds or communication challenges. By leveraging AI for EFT intervention, we anticipate broadened access and improved health outcomes across diverse population