Parkview Health Research Repository
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Naturalistic Decision Making in Everyday Self-care Among Older Adults With Heart Failure
No full textBackground
Every day, older adults living with heart failure make decisions regarding their health that may ultimately affect their disease trajectory. Experts describe these decisions as instances of naturalistic decision making influenced by the surrounding social and physical environment and involving shifting goals, high stakes, and the involvement of others. Objective
This study applied a naturalistic decision-making approach to better understand everyday decision making by older adults with heart failure. Methods
We present a cross-sectional qualitative field research study using a naturalistic decision-making conceptual model and critical incident technique to study health-related decision making. The study recruited 24 older adults with heart failure and 14 of their accompanying support persons from an ambulatory cardiology center. Critical incident interviews were performed and qualitatively analyzed to understand in depth how individuals made everyday health-related decisions. Results
White, male (66.7%), older adults\u27 decision making accorded with a preliminary conceptual model of naturalistic decision making occurring in phases of monitoring, interpreting, and acting, both independently and in sequence, for various decisions. Analyses also uncovered that there are barriers and strategies affecting the performance of these phases, other actors can play important roles, and health decisions are made in the context of personal priorities, values, and emotions. Conclusions
Study findings lead to an expanded conceptual model of naturalistic decision making by older adults with heart failure. In turn, the model bears implications for future research and the design of interventions grounded in the realities of everyday decision making
Evaluation of a Pharmacist-Led Health Literacy Workflow in the Ambulatory Clinic
Get PDFPresented at the 36th Great Lakes Pharmacy Residency Conference
A Proposed Value Metric to Quantify Value in Outpatient Therapy
Get PDFABSTRACT
Study Design: Case report
Objectives: The purpose of this study is to report the steps towards developing a single number Value Metric that represents both the quality and cost of clinical care for outpatient therapy that can be used in real time.
Background: As healthcare continues to move towards value-based and risk-based reimbursement, it is imperative that leaders in outpatient therapy settings understand and can quantify the value of the services that therapists provide.
Methods and Measures: This study proposes a Value Metric to quantify value in outpatient therapy using existing quality and cost data. The Value Metric was then validated through comparison of existing leader value rankings of those therapists.
Results: The Value Metric, calculated using existing quality and cost data, was consistent with existing leader rankings on perceived therapist value. The equation demonstrated an adequate affirmation of our Value Metric concept to quantify value.
Conclusion: The proposed equation for quantifying value in outpatient therapy was effective and useful to reflect the quality and cost of clinical practice. We were confident moving from proof of concept to developing a system for real-time evaluation while continuing to evaluate utility of concept. This equation can be utilized in outpatient therapies to shift metrics centered on cost to a metric focused on value
Evaluation of Intravenous Loop Diuretic Use in Acute Decompensated Heart Failure in a Community Hospital
Get PDFPoster presentation completed at ASHP Midyear Clinical Conference & Exhibition
Objective: To characterize the use of intravenous loop diuretics in patients hospitalized with fluid overload secondary to acute decompensated heart failure (ADHF) within the heart failure service of a community hospita
Impact of Specialty Pharmacy Services on Pneumococcal Vaccination Rates in a Large Inflammatory Bowel Disease Population
Get PDFPoster presentation completed at ASHP Midyear Clinical Conference & Exhibition.
Objective: The purpose of this study is to assess the impact of clinical specialty pharmacy services and education on compliance with vaccine recommendations in subjects with IBD
Closing the Experience Complexity Gap Using Peripheral IV Education
Get PDFPoster Presented at the Nursing Research Symposium, 2022
Introduction
At Parkview Health System, a gap in peripheral IV (PIV) insertion education was identified. • PIV insertion is not a curriculum priority in nursing school. • In practice, IV insertion needs to be completed in a timely manner to avoid care delays. • An aversion to starting PIVs, by new and seasoned nurses, create unique barriers to PIV insertion. • Experienced nurses may not be well versed in placing IVs due to the availability of a hospital IV team. To close the experience complexity gap and incorporate all learning styles, the Vascular Access Services (VAS) team at Parkview Health created a new concept PIV class. The class offers opportunities to visualize the material, listen to certified expert presenters, practice with the equipment hands on, and place an IV on a hospital patient with expert help and supervision.
Goals
Initial Goals: - Increase confidence and empower bedside staff to evaluate current IV access for appropriate location and function - Encourage staff to assess patients\u27 veins - Encourage staff to attempt to obtain IV access when needed
Secondary Goals: - Increase the trust and connection between clinical staff and the VAS team - See a decrease in requests for simple IV start
Neuropsychological Outcomes in Individuals With Type 1 and Type 2 Diabetes.
Get PDFOBJECTIVE: To determine the prevalence of neuropsychological outcomes in individuals with type 1 diabetes compared to individuals with type 2 diabetes or without diabetes, and to evaluate the association of diabetes status and microvascular/macrovascular complications with neuropsychological outcomes.
PATIENTS AND METHODS: We used a nationally representative healthcare claims database of privately insured individuals (1/1/2001-12/31/2018) to identify individuals with type 1 diabetes. Propensity score matching was used as a quasi-randomization technique to match type 1 diabetes individuals to type 2 diabetes individuals and controls. Diabetes status, microvascular/macrovascular complications (retinopathy, neuropathy, nephropathy, stroke, myocardial infarction, peripheral vascular disease, amputations), and neuropsychological outcomes (mental health, cognitive, chronic pain, addiction, sleep disorders) were defined using ICD-9/10 codes. Logistic regression determined associations between diabetes status, microvascular/macrovascular complications, and neuropsychological outcomes.
RESULTS: We identified 184,765 type 1 diabetes individuals matched to 524,602 type 2 diabetes individuals and 522,768 controls. With the exception of cognitive disorders, type 2 diabetes individuals had the highest prevalence of neuropsychological outcomes, followed by type 1 diabetes, and controls. After adjusting for the presence of microvascular/macrovascular complications, type 1 diabetes was not significantly associated with a higher risk of neuropsychological outcomes; however, type 2 diabetes remained associated with mental health, cognitive, and sleep disorders. The presence of microvascular/macrovascular complications was independently associated with each neuropsychological outcome regardless of diabetes status.
CONCLUSION: Microvascular/macrovascular complications are associated with a high risk of neuropsychological outcomes regardless of diabetes status. Therefore, preventing microvascular and macrovascular complications will likely help reduce the likelihood of neuropsychological outcomes either as the result of similar pathophysiologic processes or by preventing the direct and indirect consequences of these complications. For individuals with type 2 diabetes, risk factors beyond complications (such as obesity) likely contribute to neuropsychological outcomes
Health informatics interventions to minimize out-of-pocket medication costs for patients: what providers want.
Get PDFOBJECTIVE: To explore diverse provider perspectives on: strategies for addressing patient medication cost barriers; patient medication cost information gaps; current medication cost-related informatics tools; and design features for future tool development.
MATERIALS AND METHODS: We conducted 38 semistructured interviews with providers (physicians, nurses, pharmacists, social workers, and administrators) in a Midwestern health system in the United States. We used 3 rounds of qualitative coding to identify themes.
RESULTS: Providers lacked access to information about: patients\u27 ability to pay for medications; true costs of full medication regimens; and cost impacts of patient insurance changes. Some providers said that while existing cost-related tools were helpful, they contained unclear insurance information and several questioned the information\u27s quality. Cost-related information was not available to everyone who needed it and was not always available when needed. Fragmentation of information across sources made cost-alleviation information difficult to access. Providers desired future tools to compare medication costs more directly; provide quick references on costs to facilitate clinical conversations; streamline medication resource referrals; and provide centrally accessible visual summaries of patient affordability challenges.
DISCUSSION: These findings can inform the next generation of informatics tools for minimizing patients\u27 out-of-pocket costs. Future tools should support the work of a wider range of providers and situations and use cases than current tools do. Such tools would have the potential to improve prescribing decisions and better link patients to resources.
CONCLUSION: Results identified opportunities to fill multidisciplinary providers\u27 information gaps and ways in which new tools could better support medication affordability for patients
It\u27s a mess sometimes : patient perspectives on provider responses to healthcare costs, and how informatics interventions can help support cost-sensitive care decisions.
Get PDFOBJECTIVE: We investigated patient experiences with medication- and test-related cost conversations with healthcare providers to identify their preferences for future informatics tools to facilitate cost-sensitive care decisions.
MATERIALS AND METHODS: We conducted 18 semistructured interviews with diverse patients (ages 24-81) in a Midwestern health system in the United States. We identified themes through 2 rounds of qualitative coding.
RESULTS: Patients believed their providers could help reduce medication-related costs but did not see how providers could influence test-related costs. Patients viewed cost conversations about medications as beneficial when providers could adjust medical recommendations or provide resources. However, cost conversations did not always occur when patients felt they were needed. Consequently, patients faced a cascade of work to address affordability challenges. To prevent this, collaborative informatics tools could facilitate cost conversations and shared decision-making by providing information about a patient\u27s financial constraints, enabling comparisons of medication/testing options, and addressing transportation logistics to facilitate patient follow-through.
DISCUSSION: Like providers, patients want informatics tools that address patient out-of-pocket costs. They want to discuss healthcare costs to reduce the frequency of unaffordable costs and obtain proactive assistance. Informatics interventions could minimize the cascade of patient work through shared decision-making and preventative actions. Such tools might integrate information about efficacy, costs, and side effects to support decisions, present patient decision aids, facilitate coordination among healthcare units, and eventually improve patient outcomes.
CONCLUSION: To prevent a burdensome cascade of work for patients, informatics tools could be designed to support cost conversations and decisions between patients and providers
Integrating Pharmacists in HFrEF Outpatient Care to Improve Use of Guideline-Directed Medical Therapy
Get PDFBackground: Guideline directed medical therapy (GDMT) is the cornerstone of reducing mortality and morbidity in patients with heart failure with reduced ejection fraction (HFrEF); however, uniform prescribing remains low. There is potential for multidisciplinary care teams, including pharmacists, to improve GDMT use in outpatient care for patients with HFrEF. Investigation is needed to understand the impact of pharmacists in outpatient HFrEF care on GDMT prescribing.
Objectives: To examine the impact of integrating a pharmacist into an outpatient cardiology setting on GDMT prescription rates during HFrEF-related clinic visits.
Methods: This retrospective chart review study examined cardiology clinic visits (HF clinic, “general cardiology” clinic, and pharmacist-only visits) before and after integration of pharmacists in the clinic. Visits were included for HFrEF patients (EF \u3c 40%) from January 1, 2018 to July 1, 2019.
Results:Pharmacist visits had a significantly higher rate of GDMT compliance and significantly lower rate of harmful medication prescriptions than general cardiology visits (p
Conclusions: Integrating a pharmacist in the outpatient HFrEF care team can improve GDMT prescribing. Efforts should focus on workflow to optimize the role of the pharmacist in the clinic, and improving quality of data entry, such as standardized documentation of GDMT exceptions