Individualized cost-effectiveness analysis of patient-centered care: a case series of hospitalized patient preferences departing from practice-based guidelines

<p><b>Objective:</b> To develop cases of preference-sensitive care and analyze the individualized cost-effectiveness of respecting patient preference compared to guidelines.</p> <p><b>Methods:</b> Four cases were analyzed comparing patient preference to guidelines: (a) high-risk cancer patient preferring to forgo colonoscopy; (b) decubitus patient preferring to forgo air-fluidized bed use; (c) anemic patient preferring to forgo transfusion; (d) end-of-life patient requesting all resuscitative measures. Decision trees were modeled to analyze cost-effectiveness of alternative treatments that respect preference compared to guidelines in USD per quality-adjusted life year (QALY) at a $100,000/QALY willingness-to-pay threshold from patient, provider and societal perspectives.</p> <p><b>Results:</b> Forgoing colonoscopy dominates colonoscopy from patient, provider, and societal perspectives. Forgoing transfusion and air-fluidized bed are cost-effective from all three perspectives. Palliative care is cost-effective from provider and societal perspectives, but not from the patient perspective.</p> <p><b>Conclusion:</b> Prioritizing incorporation of patient preferences within guidelines holds good value and should be prioritized when developing new guidelines. </p

Patient Preferences for Receiving Education on Venous Thromboembolism Prevention – A Survey of Stakeholder Organizations

<div><p>Importance</p><p>Venous thromboembolism (VTE) is a major cause of morbidity and mortality among hospitalized patients and is largely preventable. Strategies to decrease the burden of VTE have focused on improving clinicians’ prescribing of prophylaxis with relatively less emphasis on patient education.</p><p>Objective</p><p>To develop a patient-centered approach to education of patients and their families on VTE: including importance, risk factors, and benefit/harm of VTE prophylaxis in hospital settings.</p><p>Design, Setting and Participants</p><p>The objective of this study was to develop a patient-centered approach to education of patients and their families on VTE: including importance, risk factors, and benefit/harm of VTE prophylaxis in hospital settings. We implemented a three-phase, web-based survey (SurveyMonkey) between March 2014 and September 2014 and analyzed survey data using descriptive statistics. Four hundred twenty one members of several national stakeholder organizations and a single local patient and family advisory board were invited to participate via email. We assessed participants’ preferences for VTE education topics and methods of delivery.</p><p>Participants wanted to learn about VTE symptoms, risk factors, prevention, and complications in a context that emphasized harm. Although participants were willing to learn using a variety of methods, most preferred to receive education in the context of a doctor-patient encounter. The next most common preferences were for video and paper educational materials.</p><p>Conclusions</p><p>Patients want to learn about the harm associated with VTE through a variety of methods. Efforts to improve VTE prophylaxis and decrease preventable harm from VTE should target the entire continuum of care and a variety of stakeholders including patients and their families.</p></div

Preferred route of administration of Pharmacologic VTE prophylaxis.

<p>Preferred route of administration of Pharmacologic VTE prophylaxis.</p

Respondents’ preferences for receiving VTE education (methods).

<p>A bar graph showing stakeholders’ preferred methods for receiving VTE education. Respondents were asked to rank methods of receiving VTE education in order of preference. Preference categories, 1^st, 2^nd and 3^rd were assigned weights of 3, 2 and 1 respectively and a category that is not ranked was assigned a weight of 0. Borda Counts were derived as the sum of weights allocated to the respective preference ranks by participants.</p

Respondents’ preferences for the length of educational material (video).

<p>A pie chart showing stakeholders’ preferences in regards to the length of educational material (video). Patients were asked whether or not they would be willing to watch a video that is 5, 10, 15 or 20 minutes long.</p

Effectiveness of two distinct web-based education tools for bedside nurses on medication administration practice for venous thromboembolism prevention: A randomized clinical trial

<div><p>Background</p><p>Venous thromboembolism (VTE) is a common cause of preventable harm in hospitalized patients. While numerous successful interventions have been implemented to improve prescription of VTE prophylaxis, a substantial proportion of doses of prescribed preventive medications are not administered to hospitalized patients. The purpose of this trial was to evaluate the effectiveness of nurse education on medication administration practice.</p><p>Methods</p><p>This was a double-blinded, cluster randomized trial in 21 medical or surgical floors of 933 nurses at The Johns Hopkins Hospital, an academic medical center, from April 1, 2014 –March 31, 2015. Nurses were cluster-randomized by hospital floor to receive either a linear static education (Static) module with voiceover or an interactive learner-centric dynamic scenario-based education (Dynamic) module. The primary and secondary outcomes were non-administration of prescribed VTE prophylaxis medication and nurse-reported satisfaction with education modules, respectively.</p><p>Results</p><p>Overall, non-administration improved significantly following education (12.4% vs. 11.1%, conditional OR: 0.87, 95% CI: 0.80–0.95, p = 0.002) achieving our primary objective. The reduction in non-administration was greater for those randomized to the Dynamic arm (10.8% vs. 9.2%, conditional OR: 0.83, 95% CI: 0.72–0.95) versus the Static arm (14.5% vs. 13.5%, conditional OR: 0.92, 95% CI: 0.81–1.03), although the difference between arms was not statistically significant (p = 0.26). Satisfaction scores were significantly higher (p<0.05) for all survey items for nurses in the Dynamic arm.</p><p>Conclusions</p><p>Education for nurses significantly improves medication administration practice. Dynamic learner-centered education is more effective at engaging nurses. These findings suggest that education should be tailored to the learner.</p><p>Trial registration</p><p>ClinicalTrials.gov <a href="https://clinicaltrials.gov/ct2/show/NCT02301793" target="_blank">NCT02301793</a></p></div

Comparison of the pattern of non-administration of prescribed venous thromboembolism prophylaxis medication doses for the dynamic and static education interventions.

<p>The pre- and post-education periods are defined either based upon the overall training period (i.e. excluding all visits within the training period regardless of the individual nurses’ training with a common pre- and post- period) or based upon the individual nurses’ training (i.e. includes all visits within the pre- and post- period for each individual nurse).</p

Nurse-reported satisfaction with and perception of Dynamic education module and the Static education module across five domains of engagement among nurses who completed their assigned education module.

<p>Nurse-reported satisfaction with and perception of Dynamic education module and the Static education module across five domains of engagement among nurses who completed their assigned education module.</p

Demographic characteristics of patient visits during the Baseline period, by arm.

<p>Demographic characteristics of patient visits during the Baseline period, by arm.</p

Flow of nurse participants through trial comparing Dynamic education with static education on medication administration practice for venous thromboembolism prevention.

<p>Flow of nurse participants through trial comparing Dynamic education with static education on medication administration practice for venous thromboembolism prevention.</p