Development of a novel hospitalist advanced practice provider assessment instrument: A pilot study.
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ABSTRACT:
SUBMITTER: Singh A
PROVIDER: S-EPMC9305217 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:PurposeThe SAGIT instrument is a comprehensive clinician-reported outcome instrument assessing key features of acromegaly: signs and symptoms, associated comorbidities; growth hormone levels; insulin-like growth factor-1 levels; and tumor profile. The SAGIT instrument has been designed to assist endocrinologists managing acromegaly in practice. Here, we report on pre-testing (to assess ease of understanding and acceptability) and a pilot study (to assess relevance, ease of use, and utility in real-life conditions) (NCT02231593).MethodsFor pre-testing, 11 endocrinologists completed the SAGIT instrument using patient medical records and were also interviewed. They subsequently completed a PRAgmatic Content and face validity Test (PRAC-Test(©)) to report their experiences using SAGIT, and feedback was used to revise the instrument. In the pilot study, nine endocrinologists completed the SAGIT instrument in real-time with patients belonging to three different categories (stable/controlled, active/uncontrolled acromegaly, treatment-naïve), while four completed the instrument based on medical-record review. All participants then completed the PRAC-Test(©) and their feedback was used to update the instrument.ResultsThe SAGIT instrument was well accepted by endocrinologists, with most indicating that it was concise, practical, easy to understand, useful for assessing treatment response, and valuable as a component of the patient's medical record. The pilot study confirmed the instrument's acceptability, utility, and ease of use, and indicated its potential for distinguishing acromegaly clinical stages.ConclusionsThe SAGIT instrument is promising as a tool for use by endocrinologists in everyday practice to assess the status and evolution of disease in patients with acromegaly and to guide treatment decision-making.
| S-EPMC4710645 | biostudies-literature
Project description:Incorporating the advanced practice provider (APP) in the delivery of tele critical care medicine (teleCCM) addresses the critical care provider shortage. However, the current literature lacks details of potential workflows, deployment difficulties and implementation outcomes while suggesting that expanding teleCCM service may be difficult. Here, we demonstrate the implementation of a telemedicine APP (eAPP) pilot service within an existing teleCCM program with the objective of determining the feasibility and ease of deployment. The goal is to augment an existing tele-ICU system with a balanced APP service to assess the feasibility and potential impact on the ICU performance in several hospitals affiliated within a large academic center. A REDCap survey was used to assess eAPP workflows, expediency of interventions, duration of tasks, and types of assignments within different service locations. Between 02/01/2021 and 08/31/2021, 204 interventions (across 133 12-h shift) were recorded by eAPP (nroutine = 109 (53.4%); nurgent = 82 (40.2%); nemergent = 13 (6.4%). The average task duration was 10.9 ± 6.22 min, but there was a significant difference based on the expediency of the task (F [2; 202] = 3.89; p < 0.022) and type of tasks (F [7; 220] = 6.69; p < 0.001). Furthermore, the eAPP task type and expediency varied depending upon the unit engaged and timeframe since implementation. The eAPP interventions were effectively communicated with bedside staff with only 0.5% of suggestions rejected. Only in 2% cases did the eAPP report distress. In summary, the eAPP can be rapidly deployed in existing teleCCM settings, providing adaptable and valuable care that addresses the specific needs of different ICUs while simultaneously enhancing the delivery of ICU care. Further studies are needed to quantify the input more robustly.
| S-EPMC9250728 | biostudies-literature
Project description:The demand for advanced practice providers (APPs) is increasing across the United States to meet necessary provider staffing requirements including in intensive care settings. Currently, participation in formal postgraduate training programs, or residencies, for APPs is not required for clinical practice, such that most of the APPs immediately enter into the workforce following completion of their initial graduate-level training. Consequently, this results in a supervised training period until APPs develop the necessary competencies to practice more autonomously. Educational programs that support specialty competency development may facilitate the transition of APPs into clinical practice, allowing them to be credentialed to perform essential procedures as quickly as possible. The goal of this boot camp was to provide training for APPs in common critical care, high-risk procedures, and to provide leadership development for high-risk cases to expedite their orientation process. The following manuscript describes our experience with the development, implementation, and short-term evaluation of this training program.
| S-EPMC6454646 | biostudies-literature
Project description:ObjectiveFew methodological studies address the prioritization of clinical topics for the development of Clinical Practice Guidelines (CPGs). The aim of this study was to validate a methodology for Priority Determination of Topics (PDT) of CPGs.Methods and resultsFirstly, we developed an instrument for PDT with 41 criteria that were grouped under 10 domains, based on a comprehensive systematic search. Secondly, we performed a survey of stakeholders involved in CPGs development, and end users of guidelines, using the instrument. Thirdly, a pilot testing of the PDT procedure was performed in order to choose 10 guideline topics among 34 proposed projects; using a multi-criteria analysis approach, we validated a mechanism that followed five stages: determination of the composition of groups, item/domain scoring, weights determination, quality of the information used to support judgments, and finally, topic selection. Participants first scored the importance of each domain, after which four different weighting procedures were calculated (including the survey results). The process of weighting was determined by correlating the data between them. We also reported the quality of evidence used for PDT. Finally, we provided a qualitative analysis of the process. The main domains used to support judgement, having higher quality scores and weightings, were feasibility, disease burden, implementation and information needs. Other important domains such as user preferences, adverse events, potential for health promotion, social effects, and economic impact had lower relevance for clinicians. Criteria for prioritization were mainly judged through professional experience, while good quality information was only used in 15% of cases.ConclusionThe main advantages of the proposed methodology are supported by the use of a systematic approach to identify, score and weight guideline topics selection, limiting or exposing the influence of personal biases. However, the methodology was complex and included a number of quantitative and qualitative approaches reflecting the difficulties of the prioritization process.
| S-EPMC2846928 | biostudies-literature
Project description:To investigate miRNA expression levels, RNA sequencing analysis (RNA-seq) was performed in synovial tissue and compared between the two groups.
2022-09-04 | GSE212544 | GEO
Project description:ObjectiveIn response to concerns about patient care and safety, our urban, tertiary care, Level 1 trauma center adult emergency department (ED) created an advanced practice provider-staffed critical care step-down unit (CCSU). We conducted a comprehensive evaluation of the CCSU's impact on patient care, safety, and ED operations.MethodsWe compared ED length of stay, return visits to the ED within 72 hours, billing code assignments (current procedural terminology evaluation and management [CPT E&M] codes), and quality of electronic health record documentation per QNOTE for the 2 years after the CCSU was initiated (CCSU period) versus before its initiation (pre-CCSU period).ResultsThere were 31,418 critical care ED patient visits in the pre-CCSU period and 33,396 in the CCSU period. Median ED length of stay did not change overall between the CCSU versus pre-CCSU period (∆1 [95% confidence interval (CI) = -2.4, 4.4] minutes), but decreased for patients who remained in the critical care suites (∆-4 [95% CI = -7.8, -0.2] minutes). 72-hour return ED visits also did not change overall (∆0% [95% CI = -0.1, 0]), but decreased for patients who remained in the critical care suites (∆0.4% [95% CI = -0.05, -0.4]). CPT E&M billing increased for highest-level visits (99,291: ∆1.3% [95% CI= 0.5, 2.0]). Quality of electronic health record documentation as measured by QNOTE also improved (∆11.5% [95% CI = 4.9, 18.1]).ConclusionThis ED's CCSU performance metrics indicate at least moderate improvement in ED length of stay, 72-hour return visits, critical care patient billing, and electronic health record documentation. EDs elsewhere can consider implementation of this advanced practice provider-staffed solution to improvement in critical care in ED.
| S-EPMC7493497 | biostudies-literature
Project description:BackgroundPediatric intensive care units (PICUs) are increasingly staffed with advanced practice providers (APPs), supplementing traditional physician staffing models.ObjectivesWe evaluate the effect of APP-inclusive staffing models on clinical outcomes and resource utilization in US PICUs.Research designRetrospective cohort study of children admitted to PICUs in 9 states in 2016 using the Healthcare Cost and Utilization Project's State Inpatient Databases. PICU staffing models were assessed using a contemporaneous staffing survey. We used multivariate regression to examine associations between staffing models with and without APPs and outcomes.MeasuresThe primary outcome was in-hospital mortality. Secondary outcomes included odds of hospital acquired conditions and ICU and hospital lengths of stay.ResultsThe sample included 38,788 children in 40 PICUs. Patients admitted to PICUs with APP-inclusive staffing were younger (6.1±5.9 vs. 7.1±6.2 y) and more likely to have complex chronic conditions (64% vs. 43%) and organ failure on admission (25% vs. 22%), compared with patients in PICUs with physician-only staffing. There was no difference in mortality between PICU types [adjusted odds ratio (AOR): 1.23, 95% confidence interval (CI): 0.83-1.81, P=0.30]. Patients in PICUs with APP-inclusive staffing had lower odds of central line-associated blood stream infections (AOR: 0.76, 95% CI: 0.59-0.98, P=0.03) and catheter-associated urinary tract infections (AOR: 0.73, 95% CI: 0.61-0.86, P<0.001). There were no differences in lengths of stay.ConclusionsDespite being younger and sicker, children admitted to PICUs with APP-inclusive staffing had no increased odds of mortality and lower odds of some hospital acquired conditions compared with those in PICUs with physician-only staffing. Further research can inform APP integration strategies which optimize outcomes.
| S-EPMC8187846 | biostudies-literature
Project description:Background:Patient engagement is a key quality component of cancer guideline development; however, the optimal strategy for engaging patients in guideline development remains unclear. The feasibility and efficacy of two patient engagement models was tested by Cancer Care Ontario's cancer guideline development program, the Program in Evidence-Based Care (pebc). Methods:In model 1, patients participated in the guideline development process as active members of a working group. In model 2, patients formed a separate consultation group to review project plans and recommendations generated by multiple working groups. Training included online resources (model 1) and an in-person orientation (model 2). The pebc's standard patient engagement process acted as a control. The study was conducted for 1 year. Surveys measured the satisfaction of patients and members of the guideline working groups with the process and the outcome of each model. Results:Three guideline projects used model 1 to engage patients, six projects used model 2 to receive feedback, and one project was used as a control group (14 patients total). Most participants, whatever the model, reported satisfaction with their experience. Key challenges to implementation included patient recruitment and long wait times between meetings (model 1), and difficulty focusing on the discussion topic and poor meeting attendance on the part of patients (model 2). Conclusions:The pilot study demonstrated that, although both models are feasible and effective for the engagement of patients in cancer guideline development, modifications are required to optimize their continued interest. The pebc will use the study results to inform the implementation of a patient engagement strategy for its program.
| S-EPMC6092053 | biostudies-literature
Project description:AimTo develop health literacy assessment instrument for patients with chronic pain.DesignQualitative methods based on Delphi technique, assessed against the CREDES checklist.MethodsA 2-round Delphi method was adopted in this study. The panel consisted of 19 experts.ResultsThe health literacy assessment instrument for chronic pain patients was constructed, which contained 3 dimensions (functional health literacy, interactive health literacy and critical health literacy) and 41 items. The positive coefficients of two rounds Delphi were 100.00% and 89.5%, respectively. The authority coefficient of experts was 0.848 and 0.858, respectively. The coordination coefficients of dimension and items were 0.222 and 0.364, respectively.ConclusionsThe health literacy assessment instrument dimensions and items for patients with chronic pain based on a Delphi method are valid. This instrument is suitable for investigating the health literacy level of patients with chronic pain.
| S-EPMC10006601 | biostudies-literature
Project description:This study aimed to develop and validate a checklist instrument as a first step for the risk assessment of the hygienic-sanitary practices and conditions of food trucks. We invited sixteen experienced experts in the food safety field to take part in the process. The checklist was designed based on the Codex Alimentarius, Brazilian resolutions Collegiate Board Resolution 216, Brazilian Collegiate Board Resolution 275, Brazilian Federal District Law no. 5.627 and Brazilian Federal District Normative Instruction 11. The preliminary version of the checklist-composed of 29 items (nine sections)-was evaluated by 13 experts. They evaluated the items regarding their importance (content validation) and clarity (semantic evaluation) by the Delphi technique. The criteria for the approval of the content validation (Likert scale from 1 to 5) and semantic evaluation (Likert scale from 0 to 5) processes were as follows: a minimum of 75% agreement among the experts (W-values ? 0.75) and a mean grade ? 4. We performed the complete validation process in three rounds. The final version of the assessment instrument comprised 39 items, following suggestions from experts to add or subdivide some questions. The checklist can be used to conduct inspections of food trucks by health surveillance auditors, of food truck vendors' decision-making processes and also as a diagnostic tool. The application of this checklist will allow the effective risk assessment of the hygienic-sanitary practices and conditions in food trucks and potentially ensure consumers' access to safe street food.
| S-EPMC6313429 | biostudies-literature