Novel patient-centered approach to facilitate same-day discharge in patients undergoing elective percutaneous coronary intervention

Background Same‐day discharge ( SDD ) after elective percutaneous coronary intervention is safe, less costly, and preferred by patients, but it is usually performed in low‐risk patients, if at all. To increase the appropriate use of SDD in more complex patients, we implemented a “patient‐centered” protocol based on risk of complications at Barnes‐Jewish Hospital. Methods and Results Our objectives were as follows: (1) to evaluate time trends in SDD ; (2) to compare (a) mortality, bleeding, and acute kidney injury, (b) patient satisfaction, and (c) hospital costs by SDD versus no SDD ( NSDD ); and (3) to compare SDD eligibility by our patient‐centered approach versus Society for Cardiovascular Angiography and Interventions guidelines. Our patient‐centered approach was based on prospectively identifying personalized bleeding, mortality, and acute kidney injury risks, with a personalized safe contrast limit and mitigating those risks. We analyzed Barnes‐Jewish Hospital's National Cardiovascular Data Registry Cath PCI Registry data from July 1, 2009 to September 30, 2015 (N=1752). SDD increased rapidly from 0% to 77% ( P &lt;0.001), independent of radial access. Although SDD patients were comparable to NSDD patients, SDD was not associated with adverse outcomes (0% mortality, 0% bleeds, and 0.4% acute kidney injury). Patient satisfaction was high with SDD . Propensity score–adjusted costs were 7331 lower/ SDD patient ( P <0.001), saving an estimated 1.8 million annually. Only 16 patients (6.95%) met the eligibility for SDD by Society for Cardiovascular Angiography and Interventions guidelines, implying our patient‐centered approach markedly increased SDD eligibility. Conclusions With a patient‐centered approach, SDD rapidly increased and was safe in 75% of patients undergoing elective percutaneous coronary intervention, despite patient complexity. Patient satisfaction was high, and hospital costs were lower. Patient‐centered decision making to facilitate SDD is an important opportunity to improve the value of percutaneous coronary intervention. </jats:sec

Wake up, wake up! It's me! It's my life! patient narratives on person-centeredness in the integrated care context: a qualitative study

Person-centered care emphasizes a holistic, humanistic approach that puts patients first, at the center of medical care. Person-centeredness is also considered a core element of integrated care. Yet typologies of integrated care mainly describe how patients fit within integrated services, rather than how services fit into the patient's world. Patient-centeredness has been commonly defined through physician's behaviors aimed at delivering patient-centered care. Yet, it is unclear how 'person-centeredness' is realized in integrated care through the patient voice. We aimed to explore patient narratives of person-centeredness in the integrated care context

Providers and women's perspectives on person-centered maternity care: a mixed methods study in Kenya.

BackgroundGlobally, there has been increasing attention to women's experiences of care and calls for a person-centered care approach. At the heart of this approach is the patient-provider relationship. It is necessary to examine the extent to which providers and women agree on the care that is provided and received. Studies have found that incongruence between women's and providers' perceptions may negatively impact women's compliance, satisfaction, and future use of health facilities. However, there are no studies that examine patient and provider perspectives on person-centered care.MethodsTo fill this gap in the literature, we use cross-sectional data of 531 women and 33 providers in seven government health facilities in Kenya to assess concordance and discordance in person-centered care measures. Additionally, we analyze 41 in-depth interviews with providers from three of these facilities to examine why differences in reporting may occur. Descriptive statistical methods were used to measure the magnitude of differences between reports of women and reports of providers. Thematic analyses were conducted for provider surveys.ResultsOur findings suggest high discordance between women and providers' perspectives in regard to person-centered care experiences. On average, women reported lower levels of person-centered care compared to providers, including low respectful and dignified care, communication and autonomy, and supportive care. Providers were more likely to report higher rates of poor health facility environment such as having sufficient staff. We summarize the overarching reasons for the divergence in women and provider reports as: 1) different understanding or interpretation of person-centered care behaviors, and 2) different expectations, norms or values of provider behaviors. Providers rationalized abuse towards women, did not allow a companion of choice, and blamed women for poor patient-provider communication. Women lacked assurance in privacy and confidentiality, and faced challenges related to the health facility environment. Providers attributed poor person-centered care to both individual and facility/systemic factors.ConclusionsImplications of this study suggests that providers should be trained on person-centered care approaches and women should be counseled on understanding patient rights and how to communicate with health professionals

Patients’ Perspective of Patient-Centered Approach vs. Biomedical Approach

Evidence-based practice in audiology may consist of a patient-centered approach or a biomedical approach when offering individuals the results of hearing evaluations. Boisvert et al. (2017) and the Institute for Defense Analysis confirmed that audiologists preferred to select one approach. The question was if an audiology patient is presented with two options of explaining the hearing health issues, which model/approach will be his or her preference? Participants may have had unconscious biases related to race or gender that could have unknowingly impacted their perception of the videos. The results of this research will facilitate clinical understanding of individual preferences regarding hearing aid recommendations, leading to improved health outcomes. The author addressed the decisions patients and doctors may encounter specific to chosen approaches for interpreting hearing diagnostics to individuals. The question of preferred approaches for both patients and audiologists to hearing health care recommendations is emerging in the literature, and this study continues to address the preferences. Clinical implications, limitations, and future research needs were also discussed

Preoperative Education: A Patient-Centered Care Approach

Abstract This project addresses the need for delivering high quality preoperative education to the Arabic speaking patient population served by Sharp Healthcare’s orthopedic service line. A goal set during the institution’s 2015 The Joint Commission Disease-Specific Care survey is to discharge major joint patients to home in two days or less. Data abstracted from Sharp Healthcare’s orthopedic registry revealed that only 30% of Arabic speaking patients are meeting this goal. The current process for educating Arabic speaking patients preoperatively during a one to one educational session with a third party interpreter takes three hours, costs $402.00 per patient, and education is fragmented, abbreviated, and low in quality. When compared to time and costs associated with educating major joint patients at the weekly 90 minute group educational session, costing$3.75 per patient educated, the need for creating a PowerPoint presentation with voice over in the Arabic language to be viewed on a laptop with earbuds during the group educational session was identified. Following a microsystem assessment and root cause analysis, using Kotter’s 8 Step Change Model, preoperative joint replacement education was translated into the Arabic language and a PowerPoint with voice over presentation is being created. The projected outcome is equitable access to knowledge needed by patients to partner in their healthcare and plan for a safe discharge to home in two days or less

A Patient-Centered Approach to Fall Prevention

Practice Problem: In 2019, a rural hospital in South Texas reported 102 incidents of patient falls. Although below the corporate fall rate benchmark of 2.2/1000 patient days, the hospital recognized that it was clinically significant and aimed at improving its fall prevention outcomes. PICOT: The PICOT question that guided this project was: Among adult patients in the acute care setting would the implementation of patient-centered interventions be more effective compared to the usual fall prevention interventions in reducing incidence of falls one month after implementation? Evidence: Seven pertinent studies, which included a randomized controlled trial and a systematic review, recommended the implementation of patient-centered fall prevention interventions in reducing fall rates in the acute care setting. The studies supported that patient and family engagement were key in reducing fall incidents in the acute care setting. Intervention: The evidence-based intervention involved the utilization of a bedside Fall TIPS (Tailoring Interventions for Patient Safety) poster in promoting patient and family engagement in the fall prevention plan to reduce incidents of falls. Outcome: The project resulted in nurses utilizing the Fall TIPS poster (79%) in engaging patients in their fall prevention plan through knowledge of their fall risk factors (80%) and personalized fall prevention intervention (69%). There was no reduction in fall rate after 30 days of implementation when compared to the previous year’s fall rate of the same month. Conclusion: Although the project did not result in a reduction of fall rate, the implementation of patient-centered interventions using the Fall TIPS poster promoted patient engagement in the fall prevention process

Promoting Patient-Centered Care in Chronic Disease

Nowadays, many people around the world are seeing their lives being shattered and even shortened due to one or more chronic conditions. Chronic illness is a dynamic ongoing process that is determined by a complexity of factors. Patient literacy, motivation, emotional well-being, and resources play an important role on patient adaption and are important challenges for healthcare providers. A systematic patient-centered approach that enables chronic patients to play an active role in their condition management and in the decision-making process on a day-to-day basis is required. However, some studies show that health professionals do not always guide their actions by Patient-centered orientation, either by personal issues or by professional and/or institutional barriers. The present chapter aimed to provide a comprehensive approach to patient-centered care in chronic disease and offer a structured guideline as a tool for formal academic education in chronic patient-centered care. This chapter is structured in five sections: (1) Chronic disease: the challenge of the twenty-first century, (2) The patient with a chronic disease, (3) Patient-centered care in chronic diseases, (4) Issues and barriers to achieve patient-centered care, and (5) Guide tool for health professionals’ training and education in patient-centered care

Precision oncology for patients with advanced cancer: the challenges of malignant snowflakes.

Precision oncology implies customizing treatment to the unique molecular and biologic characteristics of each individual and their cancer. Its implementation is being facilitated by remarkable technological advances in genomic sequencing, as well as the increasing availability of targeted and immunotherapeutic drugs. Yet, next generation sequencing may be a disruptive technology in that its results suggest that classic paradigms for clinical research and practice are a poor fit with the complex reality encountered in metastatic malignancies. Indeed, it is evident that advanced tumors have heterogeneous molecular landscapes that mostly differ between patients. Traditional modes of clinical research/practice are drug centered, with a strategy of finding commonalities between patients so that they can be grouped together and treated similarly. However, if each patient with metastatic cancer has a unique molecular portfolio, a new patient-centered, N-of-one approach that utilizes individually tailored treatment is needed

Patient-Centered Communication for Discussing Oncotype DX Testing

Oncotype DX testing (ODX), a tumor gene expression test, may improve breast cancer care, however communicating results remains challenging. We identified patient-centered communication strategies/gaps for discussing ODX results. We applied a patient-centered communication framework to analyze qualitative interviews with oncologists about how they communicate about ODX with patients, using template analysis in Atlas.ti. Overall, providers discussed four patient-centered communication domains: exchanging information, assessing uncertainty, making decisions and cross-cutting themes. Providers did not report discussing emotional aspects of managing uncertainty, assessing decision-making preferences, and evaluating decisions. A patient-centered approach may be a model for communicating about tumor gene expression tests