სამედიცინო პერსონალის მოტივაციური და დემოტივაციური ფაქტორები

Introduction: A motivated, result-oriented and responsible human resources is needed to effectively perform activities and functions in medical institutions. For this, organizations should have effective motivational and demotivating factors elimination mechanisms. In modern management, staff motivation allows us to optimally use labor resources. The purpose of the study is to determine the motivation and demotivation factors of medical staff in Georgia. Method: There were used quantitative and qualitative methods in the research. 146 medical personnel were interviewed through quantitative research. In-depth interviews of 6 experts were conducted using the qualitative research method. Results, Discussion: The correlation between employees\u27 and management\u27s attitudes is low, management doesn’t have complete and valuable information on individual needs of employees, existing demotivating factors and desired motivating factors. Despite full and comprehensive feedback from experts, employees have far more needs and problems in the workplace than management realizes. A large part of the motivational mechanisms in medical organizations contain material motivating factors, against the background of which the intangible motivator, which is really valuable for the work efficiency of employees, is not brought to the fore. Conclusion: It is recommended to create a motivational system for employees of a medical institution, identify motivational stimulating factors and use them, strengthen the indirect motivational system.შესავალი: სამედიცინო დაწესებულებებში საქმიანობის ეფექტურად სრულყოფისთვის საჭიროა მოტივირებული, შედეგზე ორიენტირებული, პასუხისმგებლიანი ადამიანური რესურსები. ამისათვის, ორგანიზაციებს უნდა ჰქონდეთ, ეფექტური სამოტივაციო და დემოტივაციური ფაქტორების აღმოფხვრის მექანიზმები. თანამედროვე მენეჯმენტში პერსონალის მოტივაცია საშუალებას გვაძლევს ოპტიმალურად გამოვიყენოთ შრომითი რესურსი. კვლევის მიზანია საქართველოში სამედიცინო პერსონალის მოტივაციისა და დემოტივაციის ფაქტორების განსაზღვრა. მეთოდი: გამოყენებულ იქნა რაოდენობრივი და თვისობრივი მეთოდები. რაოდენობრივი კვლევის საშუალებით გამოკითხულ იქნა 146 სამედიცინო პერსონალი. თვისობრივი კვლევის მეთოდით ჩატარდა 6 ექსპერტის სიღრმისეული ინტერვიუ. შედეგები, დისკუსია: თანამშრომლებისა და მენეჯმენტის დამოკიდებულებებს შორის კორელაცია დაბალია, მენეჯმენტი არ ფლობს სრულ და ფასეულ ინფორმაციას თანამშრომელთა ინდივიდუალურ საჭიროებებზე, არსებულ დემოტივატორ ფაქტორებსა და სასურველ მოტივატორ ფაქტორებზე.  მიუხედავად ექსპერტების სრული და ყოვლისმომცველი უკუკავშრისა, თანამშრომლებს ბევრად მეტი საჭიროება და პრობლემა აქვთ სამუშაო სივრცეში, ვიდრე მენეჯმენტი აღიქვამს. სამედიცინო ორგანიზაციებში არსებული სამოტივაციო მექანიზმების დიდი წილი მატერიალურ მოტივატორ ფაქტორებს უჭირავს, რის ფონზეც არამატერიალური მოტივატორი, რაც ნამდვილად ღირებულია თანამშრომელთა შრომითი ეფექტურობისთვის, არ არის წინა პლანზე წამოწეული. დასკვნა: რეკომენდირებულია სამედიცინო დაწესებულების თანამშრომელთა მოტივაციის სისტემის შექმნა, მოტივაციის მასტიმულირებელი ფაქტორების გამოვლენა და მათი გამოყენება, არაპირდაპირი მოტივაციის სისტემის გაძლიერება

AN ELECTRONIC MEDICAL RECORD BASED ALGORITHM TO TAILOR CARDIOVASCULAR DISEASE PREVENTION USING LIPOPROTEIN(A), APOLIPOPROTEIN B, CHOLESTEROL AND MYOCARDIAL INFARCTION DIAGNOSIS: ABCDS PREVENTION PROGRAM

Therapeutic Area: CVD Prevention – Primary and Secondary; ASCVD/CVD Risk Assessment; Preventive Cardiology Best Practices Background: According to the 2022 American Heart Association Heart Disease and Stroke Statistics, coronary heart disease remains the leading cause of death attributable to cardiovascular disease (CVD). Opportunity exists to utilize electronic medical records (EMRs) and biomarkers to facilitate early identification of patients at high risk for CVD. Additionally, automatic or opt-out orders are EMR-based tools that have the potential to improve referral rates to prevention programs. The role of cardiovascular biomarkers and electronic medical records (EMRs) in optimizing identification and referral of patients at risk for CVD are explored in the ABCDs PREVENTION program. Methods: A multidisciplinary team of cardiologists, internists, engineers, and clinical informaticists defined the logic for the guideline based ABCDs PREVENTION tool. The EMR algorithm used the cardiovascular risk biomarker thresholds of lipoprotein(a) > 70 nmol/L, apolipoprotein B > 90 mg/dL, low-density lipoprotein cholesterol  > 150 mg/dL, and triglycerides > 200 mg/dL, and/or a diagnosis of ST-elevation myocardial infarction (STEMI) or non-ST-elevation MI (NSTEMI) based on ICD-10 codes to generate automatic referrals to (1) cardiac rehabilitation (CR), (2) the advanced lipid disorders clinic, and/or (3) Corrie Cardiovascular Health Program (Figure 1). Results: In a test environment, the algorithm was applied to 27 patients identified by the clinical team with STEMI or NSTEMI. The algorithm was 90% successful in triggering automatic referrals to CR and Corrie. Fail rates can be attributed to our current algorithm not detecting some ICD codes related to NSTEMI. The automatic referral to lipid disorders clinic based on abnormal lipid biomarkers is now live and undergoing automation optimization to validate accuracy. Conclusion: Building an EMR-based algorithm to individualize CVD prevention using cardiovascular risk biomarkers and diagnoses may enable early identification and intervention on high-risk patients. Future directions include applying the algorithm to clinical decision support tools as well as an automated order set to increase referral rates to evidenced-based programs focused on primary and secondary CVD prevention. Ultimately, use analysis will determine if the algorithm improves referral rates to CR, lipid clinic, and the Corrie Cardiovascular Health Program to improve access to these evidence-based services

Abstract 15928: Cardiovascular Stroke Nursing Best Abstract Award: Association of Posttraumatic Stress Disorder With Repolarization Heterogeneity in Veteran Twins

Introduction: Posttraumatic stress disorder (PTSD) is a debilitating psychological condition that is prevalent amongst veterans and associated with increased risk of CHD. The elevated sympathetic nervous system activity that characterizes PTSD could affect cardiac electrophysiology and increase the risk of sudden cardiac death. We hypothesized that PTSD is associated with increased microvolt T-wave alternans (TWA), a measure of repolarization heterogeneity that is associated with increased risk of sudden cardiac death. Methods: We studied 186 male twins from the Vietnam Era Twin Registry. The twins wore a Holter monitor for 24 hours, and a thorough baseline assessment was performed, including a structured clinical interview for diagnosing psychiatric disorders, as well as cardiovascular assessment for traditional risk factors. The maximum T-wave alternans in 24 hours of monitoring was measured using the modified moving average method (GE Medical). Mixed models were used in analysis to assess covariance within pairs, and co-twin control modeling was performed to evaluate genetic and familial confounding. Results: The average (SD) age was 57 (2) years, and 28 twins had PTSD symptoms within 30 days of assessment. The twins with active PTSD had a 28% higher TWA compared to the others (p=0.03). This relationship did not change after adding heart rate to the model; further addition of CHD history and traditional CHD risk factors to the model also did not significantly influence the association. When analyzing the association within 22 pairs discordant for PTSD (to adjust for familial factors), the brother with PTSD had a 42% higher TWA compared to the brother without PTSD in fully adjusted models. An interaction with zygosity was also found (p=0.03), such that the effect was significant within the dizygotic (10 pairs), but not monozygotic twin pairs (12 pairs). Within the dizygotic twin pairs, the PTSD brother was found to have a 127% (p=0.001, adjusted) higher TWA compared to the non-PTSD brother. Conclusion: PTSD is associated with increased TWA in veteran twins, but this relationship is confounded by genetic factors. This suggests common genetic factors may predispose to both PTSD and repolarization heterogeneity. Further research is warranted

HYBRID CARDIAC REHABILITATION: EARLY EXPERIENCE FROM RECRUITMENT TO GRADUATION

Disclosures: EMS serves as a consultant to Corrie Health. Under a license agreement between Corrie Health and the Johns Hopkins University, the University owns equity in Corrie Health and the University, FAM, and SSM are entitled to royalty distributions related to technology described in the study discussed in this publication. Additionally, FAM and SSM are founders of and hold equity in Corrie Health. ML and JS have equity ownership in Corrie Health. This arrangement has been reviewed and approved by the Johns Hopkins University in accordance with its conflict-of-interest policies. Therapeutic Area: Cardiac Rehabilitation; Secondary Prevention of CVD; Digital Health Background: Low participation in cardiac rehabilitation (CR) is a missed opportunity to improve outcomes in secondary prevention of cardiovascular disease. To increase participation in CR, a multidisciplinary team launched a 12-week hybrid CR program utilizing in-center and virtual CR sessions via an evidence-based digital health platform. Our early experience with >40 participants provides valuable lessons learned for creating a scalable hybrid CR program. Methods: We established a 5-phase approach from recruitment to graduation. Phase 1 - Pre-Bedside: We used the electronic medical record system, Epic, to identify low to moderate risk CR-eligible inpatients. Phase 2 - Bedside: Patient navigators approached inpatients to inform them about hybrid CR, conduct further screening, and for enrollment. Patients were coached how to use the digital health platform including a smartphone application, smartwatch, and blood pressure monitor. Phase 3 - Pre-CR: During hospitalization and after discharge, patients tracked medication use and vital signs, engaged with educational videos, and entered lab values (ex. LDL). Coaches conducted weekly check-in sessions to review progress, safety, and address any technical issues. Phase 4 - CR: Patients completed 2 in-center safety assessments prior to starting home-exercise. Phase 5 - Graduation: Patients received a graduation coaching session at week 12 to celebrate and plan for sustainable healthy lifestyle habits. Results: We identified multiple areas for improvement and enhanced our program. Phase 1: We streamlined patient identification using Epic reports and auto-referral ordersets for eligible patients. Phase 2: We developed flexible onboarding methods with instructional videos tailored for different levels of digital literacy. We also found that assembling a diverse CR team was key for recruiting patients traditionally underrepresented in CR. Phase 3: We created a structured weekly coaching curriculum to promote engagement. Phase 4: We refined low to moderate risk criteria to adjust for lack of exercise data during hospitalization and implemented 2 in-person safety assessments. Phase 5: Some patients expressed interest in advocacy after graduating, possibly through social media support groups. Conclusion: Drawing on lessons learned, we developed a hybrid CR program that adapted to patients’ experiences and provided a scalable solution for patients who cannot attend CR on a regular basis

The Virtual Inclusive Digital Health Intervention Design to Promote Health Equity (iDesign) Framework for Atrial Fibrillation: Co-design and Development Study

BackgroundSmartphone ownership and mobile app use are steadily increasing in individuals of diverse racial and ethnic backgrounds living in the United States. Growing adoption of technology creates a perfect opportunity for digital health interventions to increase access to health care. To successfully implement digital health interventions and engage users, intervention development should be guided by user input, which is best achieved by the process of co-design. Digital health interventions co-designed with the active engagement of users have the potential to increase the uptake of guideline recommendations, which can reduce morbidity and mortality and advance health equity. ObjectiveWe aimed to co-design a digital health intervention for patients with atrial fibrillation, the most common cardiac arrhythmia, with patient, caregiver, and clinician feedback and to describe our approach to human-centered design for building digital health interventions. MethodsWe conducted virtual meetings with patients with atrial fibrillation (n=8), their caregivers, and clinicians (n=8). We used the following 7 steps in our co-design process: step 1, a virtual meeting focused on defining challenges and empathizing with problems that are faced in daily life by individuals with atrial fibrillation and clinicians; step 2, a virtual meeting focused on ideation and brainstorming the top challenges identified during the first meeting; step 3, individualized onboarding of patients with an existing minimally viable version of the atrial fibrillation app; step 4, virtual prototyping of the top 3 ideas generated during ideation; step 5, further ranking by the study investigators and engineers of the ideas that were generated during ideation but were not chosen as top-3 solutions to be prototyped in step 4; step 6, ongoing engineering work to incorporate top-priority features in the app; and step 7, obtaining further feedback from patients and testing the atrial fibrillation digital health intervention in a pilot clinical study. ResultsThe top challenges identified by patients and caregivers included addressing risk factor modification, medication adherence, and guidance during atrial fibrillation episodes. Challenges identified by clinicians were complementary and included patient education, addressing modifiable atrial fibrillation risk factors, and remote atrial fibrillation episode management. Patients brainstormed more than 30 ideas to address the top challenges, and the clinicians generated more than 20 ideas. Ranking of the ideas informed several novel or modified features aligned with the Theory of Health Behavior Change, features that were geared toward risk factor modification; patient education; rhythm, symptom, and trigger correlation for remote atrial fibrillation management; and social support. ConclusionsWe co-designed an atrial fibrillation digital health intervention in partnership with patients, caregivers, and clinicians by virtually engaging in collaborative creation through the design process. We summarize our experience and describe a flexible approach to human-centered design for digital health intervention development that can guide innovative clinical investigators

Rationale and Design of the mTECH‐Rehab Randomized Controlled Trial: Impact of a Mobile Technology Enabled Corrie Cardiac Rehabilitation Program on Functional Status and Cardiovascular Health

Background Cardiac rehabilitation (CR) is an evidence‐based, guideline‐recommended intervention for patients recovering from a cardiac event, surgery or procedure that improves morbidity, mortality, and functional status. CR is traditionally provided in‐center, which limits access and engagement, most notably among underrepresented racial and ethnic groups due to barriers including cost, scheduling, and transportation access. This study is designed to evaluate the Corrie Hybrid CR, a technology‐based, multicomponent health equity‐focused intervention as an alternative to traditional in‐center CR among patients recovering from a cardiac event, surgery, or procedure compared with usual care alone. Methods The mTECH‐Rehab (Impact of a Mobile Technology Enabled Corrie CR Program) trial will randomize 200 patients who either have a diagnosis of type 1 myocardial infarction or who undergo coronary artery bypass grafting surgery, percutaneous coronary intervention, heart valve repair, or replacement presenting to 4 hospitals in a large academic health system in Maryland, United States, to the Corrie Hybrid CR program combined with usual care CR (intervention group) or usual care CR alone (control group) in a parallel arm, randomized controlled trial. The Corrie Hybrid CR program leverages 5 components: (1) a patient‐facing mobile application that encourages behavior change, patient empowerment, and engagement with guideline‐directed therapy; (2) Food and Drug Administration‐approved smart devices that collect health metrics; (3) 2 upfront in‐center CR sessions to facilitate personalization, self‐efficacy, and evaluation for the safety of home exercise, followed by a combination of in‐center and home‐based sessions per participant preference; (4) a clinician dashboard to track health data; and (5) weekly virtual coaching sessions delivered over 12 weeks for education, encouragement, and risk factor modification. The primary outcome is the mean difference between the intervention versus control groups in distance walked on the 6‐minute walk test (ie, functional capacity) at 12 weeks post randomization. Key secondary and exploratory outcomes include improvement in a composite cardiovascular health metric, CR engagement, quality of life, health factors (including low‐density lipoprotein‐cholesterol, hemoglobin A1c, weight, diet, smoking cessation, blood pressure), and psychosocial factors. Approval for the study was granted by the local institutional review board. Results of the trial will be published once data collection and analysis have been completed. Conclusions The Corrie Hybrid CR program has the potential to improve functional status, cardiovascular health, and CR engagement and advance equity in access to cardiac rehabilitation. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT05238103