Impact of Patient Access to Online VA Notes on Healthcare Utilization and Clinician Documentation: a Retrospective Cohort Study

BACKGROUND: In an effort to foster patient engagement, some healthcare systems provide their patients with open notes, enabling them to access their clinical notes online. In January 2013, the Veterans Health Administration (VA) implemented online access to clinical notes ( VA Notes ) through the Blue Button feature of its patient portal. OBJECTIVE: To measure the association of online patient access to clinical notes with changes in healthcare utilization and clinician documentation behaviors. DESIGN: A retrospective cohort study. PATIENTS: Patients accessing My HealtheVet (MHV), the VA\u27s online patient portal, between July 2011 and January 2015. MAIN MEASURES: Use of healthcare services (primary care clinic visits and online electronic secure messaging), and characteristics of physician clinical documentation (readability of notes). KEY RESULTS: Among 882,575 unique portal users, those who accessed clinical notes (16.2%; N = 122,972) were younger, more racially homogenous (white), and less likely to be financially vulnerable. Compared with non-users, Notes users more frequently used the secure messaging feature on the portal (mean of 2.6 messages (SD 7.0) v. 0.87 messages (SD 3.3) in January-July 2013), but their higher use of secure messaging began prior to VA Notes implementation, and thus was not temporally related to the implementation. When comparing clinic visit rates pre- and post-implementation, Notes users had a small but significant increase in rate of 0.36 primary care clinic visits (2012 v. 2013) compared to portal users who did not view their Notes (p = 0.01). At baseline, the mean reading ease of primary care clinical notes was 53.8 (SD 10.1) and did not improve after implementation of VA Notes. CONCLUSIONS: VA Notes users were different than patients with portal access who did not view their notes online, and they had higher rates of healthcare service use prior to and after VA Notes implementation. Opportunities exist to improve clinical note access and readability

The Next Frontier in Communication and the ECLIPPSE Study: Bridging the Linguistic Divide in Secure Messaging

abstract: Health systems are heavily promoting patient portals. However, limited health literacy (HL) can restrict online communication via secure messaging (SM) because patients’ literacy skills must be sufficient to convey and comprehend content while clinicians must encourage and elicit communication from patients and match patients’ literacy level. This paper describes the Employing Computational Linguistics to Improve Patient-Provider Secure Email (ECLIPPSE) study, an interdisciplinary effort bringing together scientists in communication, computational linguistics, and health services to employ computational linguistic methods to (1) create a novel Linguistic Complexity Profile (LCP) to characterize communications of patients and clinicians and demonstrate its validity and (2) examine whether providers accommodate communication needs of patients with limited HL by tailoring their SM responses. We will study >5 million SMs generated by >150,000 ethnically diverse type 2 diabetes patients and >9000 clinicians from two settings: an integrated delivery system and a public (safety net) system. Finally, we will then create an LCP-based automated aid that delivers real-time feedback to clinicians to reduce the linguistic complexity of their SMs. This research will support health systems’ journeys to become health literate healthcare organizations and reduce HL-related disparities in diabetes care.The article is published at https://www.hindawi.com/journals/jdr/2017/1348242

Health Portal Functionality and the Use of Patient-Centered Technology

Health portals are dedicated web pages for medical practices to provide patients access to their electronic health records. The problem identified in this quality improvement project was that the health portal in the urgent care setting had not been available to staff nor patients. To provide leadership with information related to opening the portal, the first purpose of the project was to assess staff and patients\u27 perceived use, ease of use, attitude toward using, and intention to use the portal. The second purpose was to evaluate the portal education materials for the top 5 urgent care diagnoses: diabetes, hypertension, asthma, otitis media, and bronchitis for understandability and actionability using the Patient Education Material Assessment Tool, Simple Measures of Goobledygook, and the Up to Date application. The first purpose was framed within the technology acceptance model which used a 26-item Likert scale ranging from -3 (total disagreement) to +3 (total agreement). The staff (n = 8) and patients (n = 75) perceived the portal as useful (62%; 60%), easy to use (72%; 70%), expressed a positive attitude toward using (71%; 73%), and would use the technology (54%; 70%). All materials were deemed understandable (74%-95%) with 70% being the acceptable percentage. Diabetes, otitis media, and bronchitis were deemed actionable (71-100%), but hypertension (57%) and asthma (40%) had lower actionability percentages. Hypertension, asthma, and otitis media had appropriate reading levels (6-8th grade). However, diabetes (10th grade) and bronchitis (12th grade) were higher with the target being less than 8th grade level. All handouts were found to be evidence-based. Recommendations were to revise the diabetes and bronchitis educational handouts to improve readability. Social change can be promoted by this project by facilitating positive patient outcomes at urgent care clinics

Oncology Patient Education by a Nurse Practitioner and Stress Reduction

Approved May 2020 by the faculty of UMKC in partial fulfillment of the requirements for the degree of Doctor of Nursing PracticeAccording to the American Cancer Society, approximately 1.7 million new cancer cases were diagnosed in 2018. With a new diagnosis of cancer, patient education can be used to decrease anxiety about the diagnosis and chemotherapy treatment plan; the individual is a novice to the experience, thus necessitating education. The purpose of this evidence-based practice quality improvement initiative was based on the inquiry, in adult oncology patients who are scheduled for first-time chemotherapy, does an educational meeting with a nurse practitioner before chemotherapy decrease the stress level? A quasi-experimental design, single group with a pre- and post-evaluation used the National Comprehensive Cancer Network Distress Monitoring Tool to evaluate level of stress. The intervention included an educational meeting with the nurse practitioner to discuss general side effects of chemotherapy and the specific treatment plan for each patient. Participants’ distress level decreased from the pre-test mean score of 4.21 to the post-test mean score of 3.17 (p= 0.002), thus suggesting it was a successful intervention. The impact on healthcare, specifically oncology patients, is to reduce feelings of distress related to their first-time receiving chemotherapy

Health Literacy Universal Precautions: A Quality Improvement Project to Promote Effective Use of Clear, Plain Language Communication Within Primary Care

Background/Purpose: Understanding the dynamics involved for patients to truly comprehend their health care needs for optimal self-care management are complex. The ways patients interact within the healthcare system can be stressful, overwhelming, and confusing. Failing to grasp even basic instructions can make patients prone to poor health outcomes. Evidence indicates that 36% of adults in the United States have basic or below basic health literacy levels and only 12% of adults are considered health literate. The purpose of this project was to implement clear, plain language communications, or health literacy universal precautions, within a primary care office. Methods: The DNP student used The Health Literacy Universal Precautions Toolkit, designed by The Agency for Healthcare Research and Quality (AHRQ) in conjunction with Lewin’s Theory of Planned Change, to implement: 1) a one-hour health literacy education session for healthcare staff and 2) a health literacy readability assessment and replacement of current patient forms and education materials to achieve the desired fifth to sixth grade literacy level. Results/Interpretation: Education session results revealed an average score increase from 76.2% on the pre-quiz to 97.6% on the post-quiz. The readability of office forms increased from only 12.5% of forms being at a fifth to sixth grade reading level initially to 50% of the forms meeting this criterion at the conclusion of the readability intervention. The results highlighted that the AHRQ Toolkit was beneficial in increasing healthcare staff knowledge of health literacy and improving the readability of office forms being provided to patients. Discussion/Conclusion: This quality improvement project provided an opportunity for the healthcare staff to become more aware of, and align their efforts in support of, health literacy universal precautions, which has the potential to impact positive change in patient care outcomes

Hospital Fall Prevention Using Interactive Patient Care Technology

The impact of patient engagement in hospital fall prevention using interactive patient care technology is not known. The purpose of this investigation was to examine the engagement of hospitalized patients in a computer-based, interactive patient care fall prevention pathway, comprised of a self-assessment of fall risk questionnaire and a fall prevention video, and hospital fall outcomes. The aims were to 1) formulate an interactive patient care technology conceptual framework to guide the study, 2) provide reliability and validity evidence for a patient self-assessment of fall risk questionnaire, and 3) explore the relationship between the fall prevention pathway engagement characteristics and a fall outcome. A conceptual framework for interactive patient care technology was developed and applied to the research investigation. The methodology included a retrospective, cross-sectional design using a convenience sample of 120 subjects to establish preliminary reliability and validity evidence for the patient self- assessment of fall risk questionnaire, and a matched 1:4 case-control design using 73 cases and 292 controls to examine the relationship between the fall prevention pathway engagement characteristics and a fall outcome. Findings indicated the patient self-assessment of fall risk questionnaire is reliable, with a Cronbach\u27s alpha of .73, and valid, with a statistically significant correlation to the nurses fall risk assessment tool, r (118) = .45, p \u3c .001. Using conditional logistic regression, length of stay, number of automatic video prompts, and fall prevention video completion status were significantly associated with a hospital fall. As length of stay increased by one day, the odds of a fall were 11% higher. With each additional automatic video prompt, the odds of a fall increased by a factor of 1.58. Cases were .38 times less likely to complete the fall prevention video than to complete it. Conclusions included an interactive fall prevention pathway promoted engagement and engagement at the empowerment level (video completion) prevented a fall. Limitations of this investigation included the use of secondary data, subject related assumptions, and the inability to generalize due to site, technology, and sample. This investigation contributes new knowledge regarding patient engagement in hospital fall prevention using interactive patient care technology

Roadblocks, Stop Signs : Health Literacy, Education and Communication at a Free Medical Clinic

This qualitative study, which takes place in a free medical clinic for low-income and uninsured patients, addresses the patients\u27 health literacy and access to health information inside and outside of the clinic setting, as well as the strategies clinic providers use to effectively communicate health information. This study is based on participant observation in an urban clinic in the Northeast, interviews of 22 patients and 20 health-care providers, and direct observation of the patient/provider communication in nine instances. In the clinic, the providers serve as educators for vulnerable, stressed patients, who are adult learners. The patients were interviewed in order to understand their health education needs, their comprehension of the health information that they received at the clinic, and their access to health information outside of the clinic. The providers, who were volunteers at the clinic, were interviewed to understand their strategies to effectively communicate with their patients. This study, therefore, provides insights into how adults learn in nonformal educational settings and what strategies appear to be effective to communicate with people who are marginalized and stressed

The Language of Type 1 Diabetes: Why It Matters in Online Patient Education

This is an Accepted Manuscript of an article published by Taylor & Francis in Journal of Consumer Health on the Internet on 07 Mar 2023, available at: https://doi.org/10.1080/15398285.2023.2167424.This article discusses online patient education materials (PEMs) in the context of type 1 diabetes and the language used to describe the condition. The role of healthcare providers and health information professionals in the delivery of online PEMs is described. Relevant theories regarding the impact of language are discussed. A theoretical framework for understanding and assessing PEMs is presented, along with the introduction of in-progress research on the use of language in online PEMs for adults with type 1 diabetes

Using Teach Back to Evaluate the Efficacy of a Pediatric Headache Program: A DNP Project

abstract: Background: Only 40%-80% of health information is retained during an office visit due to ineffective communication. Caregivers, and patients, are unable to remember how to manage their health care needs. Teach back is an effective tool that encourages a conversation between the caregiver/patient and provider. The purpose of this project is to increase knowledge retention and self-management behaviors using a headache teach back tool. Methods: The quality department at a large children’s hospital in the southwestern United States approved the project as a practice change and parent consent was not required. The project design was a randomized controlled group: pretest-posttest design, quality improvement method. Participants were chosen by convenience sample. Required diagnoses were headache or migraine. Each group had 18 participants, for a total of 36 participants. Ages ranged from four to 18 years of age, with legal guardians present for the intervention group only. New and follow-up patients were included in the project. Demographics for each group were statistically similar. Questionnaires were used to assess knowledge pre and post implementation of teach back tool. Self-management was measured by a follow-up phone call after their appointment to inquire regarding implementation of the headache diary. Charts were reviewed for both groups regarding the number and type of phone calls received by the office. Outcomes: Paired sample t-test was used to evaluate mean differences in knowledge from pre and post questions of teach back tool. Data analysis concluded a statistical increase in knowledge of triggers and prevention techniques. Cohen’s d for triggers was 2.21 and 1.87 for prevention. Self-management of behavior was measured by use of headache diary and determined by a percentage. Sixty-seven individuals started to use the headache diary. Independent t-test was used to compare number of phone calls from each group. Data concluded a decrease in phone calls. However, due to a small sample size, statistical significance could not be established. Conclusion: Teach back encourages caregiver/patient and provider interaction, which increases health literacy retention and increases self-management behaviors. Future research should focus on patients with headaches with unknown triggers for their headaches

The development of a culturally-informed cervical cancer screening and prevention mhealth intervention for African American women.

Background: Significant strides have been made in reducing the burden of cervical cancer and HPV. Between pap smear screenings and HPV vaccinations, there has been a reduction in cervical cancer incidence in the United States. Unfortunately, those reductions have not been experienced by all ethnic groups. Cervical cancer disparities are a threat to the health of African American women, and innovation in education and the healthcare experience is needed to eliminate this threat. This study aimed to develop and evaluate a culturally tailored intervention using mHealth services to improve cervical cancer and HPV knowledge. Methods: The development and evaluation of this mHealth intervention involved two phases. The first phase included the culturally tailoring of health messages using a community advisory board of African American women. By meeting in person and virtually, the women were able to tailor twenty-four messages to be disseminated using mHealth. The second phase of this study involved testing of the intervention and evaluation. African American women were recruited and then assessed on their baseline knowledge of cervical cancer and their experiences of discrimination in medical settings. Participants were then assigned to either the control or intervention group. Those in the intervention group received health messages three times a week for four weeks on their mobile phones. After four weeks had passed, both the control and intervention group were reassessed on their cervical cancer knowledge. mHealth was evaluated for its acceptability, appropriateness, and feasibility using three evaluation measures and qualitative interviews. Results: Forty-eight women were recruited for this study, with non-random assignment of twenty-five to the intervention group and twenty-three to the control. The baseline scores on the cervical cancer awareness measure indicated a need for education in both groups. Additionally, all participants expressed having experienced some form of discrimination in medical settings. Using a paired-samples t-test the complete-case analysis shows an improvement in cervical cancer knowledge for women in the intervention group. Conclusions: mHealth intervention shows potential in educating African American women about cervical cancer and HPV. Using mobile phone technology allowed the women to be educated at their convenience and to return to the material later. Future research and practice should consider using the mHealth intervention with hard-to-reach populations or as educational material along with appointment reminders