ObjectivesUnderstanding the difficulties faced by different migrant groups is vital to address disparities and inform targeted health-care service delivery. Migrant oncology patients experience increased morbidity, mortality and psychological distress, with this tentatively linked to language and communication difficulties. The objective of this exploratory study was to investigate the communication barriers and challenges experienced by Arabic, Greek and Chinese (Mandarin and Cantonese) speaking oncology patients in Australia. MethodsThis study employed a cross-sectional design using patient-reported outcome survey data from migrant and English-speaking Australian-born patients with cancer. Patients were recruited through oncology clinics and Australian state cancer registries. Data were collected regarding patient clinical and demographic characteristics and health-care and communication experiences. Data from the clinics and registries were combined for analysis. ResultsSignificant differences were found between migrant groups in demographic characteristics, communication and health-care experiences, and information and care preferences. Chinese patients cited problems with understanding medical information, the Australian health-care system, and communicating with their health-care team. Conversely, Arabic- and Greek-speaking patients reported higher understanding of the health-care system, and less communication difficulties. ConclusionsOur study findings suggest that migrant groups differ from each other in their health communication expectations and requirements. Lower education and health literacy of some groups may play a role in poorer health outcomes. Public health interventions and assistance provided to migrants should be tailored to the specific needs and characteristics of that language or cultural group. Future research directions are discussed.

Fragmentation in healthcare has led to a desire to align and integrate care processes horizontally. The concept of value-based healthcare has been introduced, suggesting a maximized value creation to occur when optimal conditions are created for selected patient segments, integrating all activities that jointly determine the success in meeting a set of patient needs. While targeting specialized segments has been shown to be beneficial, theories of diversification suggests that an increased scope may be an even more efficient approach to improve performance. By sharing resources and capabilities across several specialized units, coordination and knowledge sharing of a hospital’s ancillary services becomes important.   In this study, we examine how an ancillary service function, providing resources and capabilities that are shared across specialized units, can be organized to ensure contribution to the overarching goal of maximizing value for patients. This is done through a qualitative case study of the Karolinska University Laboratory – an ancillary service function of the Karolinska University Hospital. It is concluded that an ancillary service function can, in a diversified context, facilitate and support the value creation around medical conditions by developing a comprehensive structure for knowledge management and sharing, both externally towards medical conditions and internally within the ancillary service function. If structured properly, clear benefits, such as economies of scale, scope and knowledge spillovers, can be achieved by separating sharable resources from the patient flows.

Class of 2017 Abstract / Objectives: To conduct a scoping review of studies involving healthcare professionals as study subjects and to describe the methods used, identify the topics researched, and describe the rationale and limitations of using healthcare professionals as subjects. Methods: The study was a scoping review of research utilizing health professionals as study subjects. A comprehensive literature search was conducted in several databases. Two investigators independently screened studies, collected data, and met to resolve discrepancies. Results: Sixty-five studies met the eligibility criteria. Forty-six percent of the studies evaluated cardiovascular events, 25% evaluated cancer, 9% examined ophthalmic events, 5% examined cognitive issues, and 17% miscellaneous topics. Of the 65 studies, 88% were prospective cohort studies. Questionnaires were utilized as the data collection method in 59 studies (91%). Physicians were the primary study subject in 30 studies (46%) and nurses in 20 studies (31%). No study included in the sample identified pharmacists as study subjects. A total of 41 studies (63%) did not list rationales or limitations to utilizing health professionals as subjects. Of the 24 studies that did discuss rationales and limitations, the most frequently cited advantage was reliable self-reporting (38%). The most common limitation to generalizability was high socioeconomic status. Conclusions: Questionnaires were the most common method used to collect data. Physicians were the most often studied health professional. High reliability of data reporting was a common rationale in using health professionals as subjects. The lack of studies utilizing pharmacists as subjects demonstrates an opportunity that should be further evaluated.

Class of 2013 Abstract / Specific Aims: To assess associations between clinical and economic outcomes of metastatic thyroid cancer within inpatient settings in the United States from 2001-2010. To determine the direct inpatient burden of and describe the characteristics of patients and hospitals associated with metastatic thyroid cancer. Methods: A multivariate retrospective cohort study was performed on the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample database, for the years 2001-2010, focusing on three main outcomes: inpatient mortality, inpatient charges, and inpatient length of stay. Regression analyses controlled for patient demographics, hospital characteristics, payer, clinical comorbidities, and site of metastases. Inclusion criteria included: age ≥ 18 years, any listed diagnosis of thyroid cancer, and any listed secondary malignancy. Main Results: Overall, 84,191 inpatient cases were observed for metastatic thyroid cancer with 3,032 resulting in mortality (3.6%). The total charges were $3.1 billion (USD 2012) for overall inpatient hospitalizations with average inpatient charges at $38,292 (SD±56,135) for each overall case and $80,948 (SD±117,645) for each mortality-only case. Higher inpatient mortality, charges, and length of stay were significantly associated with central nervous system and lung metastatic cancer sites (p < 0.01) and deficiency anemias, coagulopathy, fluid and electrolyte disorders, pulmonary circulation disorders, and weight loss comorbidities (p < 0.01). Conclusion: There is a considerable national inpatient burden of metastatic thyroid cancer. The analyses in this study quantify the associations and outcomes, and as such can be used to assist in the prediction of those outcomes and clinical decision-making.

>Magister Scientiae - MSc / Healthcare professionals (HCPs) have a primary role to play in the detection, assessment and spontaneous reporting of adverse drug reactions (ADRs). An improvement of their related knowledge, attitude and practice concerning pharmacovigilance and ADR reporting is vital. The objective of the study was to determine whether or not pharmacovigilance training, provided by a Pharmaceutical Company, would improve HCP’s perceptions and adherence to pharmacovigilance and ADR reporting. A quasi-experimental research design was used. A total of 44 HCPs participated in the study. Participants were divided into two groups: an experimental group that received pharmaceutical training intervention; and a control group that did not receive any training. Using a self-administered questionnaire before and after the training intervention assessed the knowledge, attitudes, and practice of pharmacovigilance and ADR reporting displayed amongst the HCPs.

Objectives: The management of depression and anxiety in primary care in the UK is not consistent with clinical guidelines. This has led to training initiatives that aim to change practice by improving the implementation of research evidence, but little is known about what constitutes effective healthcare professional training in this area. This thesis addressed this issue by identifying what determines effective training to improve the management of psychological distress in primary care. Methods: The research was undertaken in three stages. A systematic review and narrative synthesis was conducted to investigate the effects of controlled trials of training interventions delivered to primary care practitioners (PCPs) to improve the management of psychological distress on process outcomes (practitioner behaviour, knowledge, attitudes). Then two qualitative studies using semi structured interviews with PCPs (n=18) and experts in training/behaviour change (n=16) were conducted to explore their perceptions of effective healthcare professional training in this area and in general. The qualitative data were synthesised to produce recommendations for designing effective healthcare professional training to improve the primary care management of psychological distress. The research findings were used to develop a taxonomy of training intervention components for use in the design and reporting of healthcare professional training interventions in this area and more widely. Results: Forty Papers (36 studies) were included in the systematic review. The papers reviewed provide a mixed picture of the effective characteristics of training interventions. Two components: the inclusion of skills practice (role-play) and the use of theory to inform intervention content were associated with positive outcomes. Limitations with outcome measures, absence of theory and poor descriptions of the interventions made it difficult to determine effective intervention components. The analysis of the qualitative studies resulted in the development of the Perceived Effectiveness of Training (PET) framework. It incorporates five themes or core areas that underpin effective training: social interaction, credibility, relevance, information processing, and practicalities. The PET framework was used to identify effective training intervention components. Finally, the qualitative synthesis led to the development of a taxonomy of training intervention components, which was evaluated for comprehensiveness by mapping the training components to the interventions identified in the systematic review. This culminated in a 171 item taxonomy with hierarchical groupings divided into three phases: pre-training, training delivery and post training. Conclusions: Healthcare professional training to improve the management of psychological distress in primary care can be optimised for effectiveness using the PET framework to address core quality training standards. It is recommended that the taxonomy of training intervention components should be used to improve the science of healthcare professional training interventions. Further research to develop the taxonomy and to establish valid training evaluation measures would provide further scope to identify which training components can predict healthcare professional behaviour change and improve the management of psychological distress in primary care.

Health and care services need to be optimised to meet the future demand that will be placed on them. This will require a closer coupling of service and research, whereby innovations in services can be rapidly tested and evaluated, and feed back into a continual process of service optimisation. The timely delivery of information from services into research is critical to this cycle. However, there are serious problems with the evidence on which healthcare and public health practice is based: it is expensive to produce; it takes a long time to produce; it takes a long time to influence professional practice; it is crude, relating to the average participant and simple treatment definitions under ideal conditions. In other words, it gives a low-resolution picture of how a patient might respond to treatment or a how a sub-group of the community might respond to a public health intervention. This work is an exploration of informatics solutions to these problems with an aim to re-engineer health care systems to make best use of the evidence available.

This study is a qualitative analysis of the author's previous publications, academic and operational practitioners input, the literature, and accreditation requirements for ethics education in healthcare. Two research questions were addressed: 1. Is a typology of ethics education in healthcare needed, and 2. Is more specificity of ethics education in healthcare required? Both research questions were answered in the affirmative. The results indicated that a typology of ethics education in healthcare is needed with the primary reason being the need for a focused manuscript that uses content validity to illustrate the hierarchy of ethical reasoning in healthcare. No one manuscript brings together the six ethics education domains that were identified as required for appropriate ethics education in healthcare. The second research question result indicated that there are sparse educational objectives available in the context of cognitive and affective educational domains, especially for the six ethics domains presented here: 1. Decision ethics, 2. Professional ethics, 3. Clinical ethics, 4. Business ethics, 5. Organizational ethics, and 6. Social ethics. Due to the limited specificity of the ethics education objectives identified in the literature, the author developed and presented a typology, beginning with 270 ethics educational objectives, for use in healthcare instruction. A discussion is provided on how healthcare can be improved by including more specific ethics education objectives within healthcare programs. Further recommendations include the creation of a taxonomy based on the typology developed here.

Burnout in healthcare professionals (HCPs) can negatively affect HCPs’ health and the overall functioning of the healthcare system. Of great concern is the negative effect of HCP burnout on psychological, cognitive, and work-relevant functioning. Mindfulness-based interventions have been shown to decrease burnout in HCPs and preliminary evidence suggests they may improve work-relevant outcomes. However, the literature is limited by methodological issues and generalizability concerns. The current pragmatic trial investigated feasibility, acceptability, and effectiveness of Mindfulness for Interdisciplinary Healthcare Professionals (MIHP) using a partially randomized, waitlist-controlled, crossover design [intention-to-treat sample: 22 in the mindfulness group (MG), 26 in the control group (CG)] on psychological, cognitive, and interprofessional measures. The present study also included an explanatory aim evaluating mindfulness practice time and practice quality as mediators of change. Within-group changes were assessed with the combined crossover data for mediation and three-month follow-up analyses. Finally, the present study explored the perceived effects of MIHP and how MIHP had its effects using a grounded theory approach. Results found mixed evidence for feasibility and acceptability. Small to large effects were found for the MG on outcomes of burnout, perceived stress, and mindfulness. These effects were present with groups combined and remained at the follow-up. No effect of MIHP was found on cognitive or interprofessional outcomes. Practice time and quality were not significant mediators of main effects. A grounded theory model is proposed for how MIHP may exert its positive effects within the context of healthcare.

Nearly a third of all emergency department (ED) visits are for non-emergent conditions. Several factors contribute to non-emergent ED use, though the relative importance of these factors and how non-emergent ED users differ from those seeking similar care in primary care (PC) settings are less clear. Surveys were administered to adult, English-speaking, primary care patients seeking same-day, non-emergent care in the ED and PC clinic at an urban, safety-net hospital during normal clinic hours. ED patients were eligible if they had a primary care physician (PCP) located at the hospital and thus the ability to seek same-day care in the PC clinic. Surveys assessed sociodemographics and six major care-seeking factors (perceived urgency, cost, convenience, beliefs about alternative sites, access, and referral). Patient characteristics were compared between sites using t-tests and Fisher’s exact test, and multivariable logistic regression identified predictors of ED use. Compared to PC patients (n=61), ED patients (n=59) were significantly more likely to be male, middle-aged, homeless, Medicaid-insured, and unmarried with a trend toward being non-White and less educated. ED patients were significantly more likely to perceive the cost of an ED and PC visit to be the same/free (69.1% vs. 37.1%; p<0.01) and to believe the ED would provide higher quality care (24.6% vs. 3.6%; p<0.001). PC patients were more likely to consider their doctor’s office as their usual source of care (83.1% vs. 37.9%; p<0.0001) and believe it is easy to make PCP appointments on short notice (74.5% vs. 54.2%; p=0.04). In the adjusted model, patients whose usual source of care was not the doctor’s office had the highest odds of non-emergent ED use (aOR 4.25, 95% CI 1.28–15.20), and patients reporting ease of scheduling PCP appointments on short notice had significantly lower odds of ED use (aOR 0.19, 95% CI 0.04–0.67). Non-emergent patients in the ED and primary care clinic differed by sociodemographics, usual source of care, and perceptions of cost, care quality, and ease of scheduling appointments. Opportunities exist to reduce unnecessary ED use in similar populations by promoting the primary care clinic as a routine and easily accessible source of high-quality care. / 2019-11-08T00:00:00Z