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Background: The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) has long recognized and championed increasing diversity within the surgical workplace. SAGES initiated the Fundamentals of Leadership Development (FLD) Curriculum to address these needs and to provide surgeon leaders with the necessary tools and skills to promote diversity, equity, and inclusion (DEI) in surgical practice. In 2019, the American College of Surgeons issued a request for anti-racism initiatives which lead to the partnering of the two societies. The primary goal of FLD was to create the first surgeon-focused leadership curriculum dedicated to DEI. The rationale/development of this curriculum and its evaluation/feedback methods are detailed in this White Paper. Methods: The FLD curriculum was developed by a multidisciplinary task force that included surgeons, education experts, and diversity consultants. The curriculum development followed the Analysis, Design, Development, Implementation and Evaluation (ADDIE) instructional design model and utilized a problem-based learning approach. Competencies were identified, and specific learning objectives and assessments were developed. The implementation of the curriculum was designed to be completed in short intervals (virtual and in-person). Post-course surveys used the Kirkpatrick's model to evaluate the curriculum and provide valuable feedback. Results: The curriculum consisted of interactive online modules, an online discussion forum, and small group interactive sessions focused in three key areas: (1) increasing pipeline of underrepresented individuals in surgical leadership, (2) healthcare equity, and (3) conflict negotiation. By focusing on positive action items and utilizing a problem-solving approach, the curriculum aimed to provide a framework for surgical leaders to make meaningful changes in their institutions and organizations. Conclusion: The FLD curriculum is a novel leadership curriculum that provided surgeon leaders with the knowledge and tools to improve diversity in three areas: pipeline improvement, healthcare equity, and conflict negotiation. Future directions include using pilot course feedback to enhance curricular effectiveness and delivery. [ABSTRACT FROM AUTHOR]

Objectives: Using Google online reviews, this study investigated why patients were satisfied or dissatisfied with their public dental clinic in Victoria, Australia. Methods: This mixed methods study gathered Google reviews published by users pre-March, 2021. The reviews were coded and subthemes and major themes were identified. The most common reasons why patients gave reviews were tabulated and stratified according to star rating, remoteness and accessibility index classification, and socio-economic status. Results: Of the 522 reviews included in this study, in 317 (60.7%) satisfaction was expressed. Compliments and complaints were documented. A total of 53 subthemes were identified. Major themes included Treatment, Staff, Communication and Professionalism, Patient Factors and Non-Clinical Reasons. From the reviews, more patients were satisfied with general unspecified treatment (n = 195; 14.7%) and dissatisfied with reception staff (n = 64; 4.8%). More reviews were generated by patients who visited clinics in major cities and lower socio-economic areas. Conclusion: This study found that most patients expressed satisfaction and identified reasons why patients were satisfied or dissatisfied. Consumer feedback, including compliments and complaints, is an integral aspect of monitoring and improving health service quality. It is important to continue seeking feedback and improve accordingly. What is known about the topic? Research has identified common factors for patient satisfaction or dissatisfaction with dental clinics including: facilities and location, waiting list time, cost, gentleness during procedures, communication, and staffing. What does this paper add? This study identified causes of patient satisfaction and dissatisfaction with Victorian public dental clinics. The focus is on the Victorian public dental system because almost half of the eligible population for public dental services are not utilising them. What are the implications for practitioners? Practitioners can use this study to self-reflect and improve the quality of health service delivery. [ABSTRACT FROM AUTHOR]

Professional training of physicians able to apply their skills in order to reflect the patients' needs related to care, prevention and treatment of the diseases is one of the most common current trends in higher medical education. Due to the development of patient-centered relationships of physicians the attention of medical educators and scientists to the problem of professional communication and factors stimulating its development has grown drastically. The medical schools and colleges of US universities have already reached significant results in this area. Communicative training is one of the primary educational tasks of higher medical education in this country. Communicative courses are an obligatory component of professional training programs and curricula throughout all years of study. Valuable experience of the USA in this sphere may be useful for the educational development of our country. The paper analyzes the process of communicative training of future physicians at US universities; researches on the structure, content and evolution of professional communication programs and courses during the undergraduate years at medical schools and colleges. The key communicative skills have been defined and described. The main aspects of educational methodology referring to the evaluation of the communicative skills have been determined. The importance of physicians' professional communication and its influence on the treatment outcomes have been stated. Moreover, the paper discusses the difficulties of the professional communicative training implementation into the undergraduate university curriculum in the USA and describes the ways of solving the problematic aspects of professional communication training of medical students caused by the personal ethical and educational issues. [ABSTRACT FROM AUTHOR]

Suboptimal maternal nutrition and excessive gestational weight gain (GWG) establish in mothers and their offspring a weight gain trajectory towards overweight and obesity. Therefore, pregnancy may be the best opportunity to disrupt the generational cycle of obesity. More than half of women in the UK now enter pregnancy overweight or obese, highlighting that if interventions are not targeted towards women in higher weight categories before conception they are likely to 'miss the mark'. To address issues of suboptimal maternal nutrition and excessive GWG in antenatal care, health professionals need to consider how women's requirements and expectations may have changed in recent years and the impact of weight stigma on the care of women who are obese. This paper aims to drive changes in clinical practice guidelines, medical curricula, the language used by health professionals, and ultimately promote maternal nutrition and weight management in pregnancy as key priorities during antenatal care. Evidence indicates that women want non-judgemental, simple and encouraging guidance in these areas. Small changes to health professionals' practice can improve how advice regarding nutrition and weight management in pregnancy is delivered, and has the potential to reduce overweight and obesity prevalence in women and their children in the years to come. Surely that goal is worth pursuing. [ABSTRACT FROM AUTHOR]

Purpose - Implicit bias is the application of an unconscious attitude or belief; in the clinical setting, a provider's perception of a patient, based upon perceived race or ethnicity, is hypothesized to affect clinical decisions, provider-patient interactions and patient health. The purpose of this paper is to provide a brief synopsis of and critique the relevant works over the past 15 years while highlighting the strengths of this body of literature. Design/methodology/approach - A MEDLINE search, from 2000 to 2015, using the terms "implicit bias," "unconscious bias" and "aversive racism" was performed. US-based studies investigating the effect of racial or ethnic implicit bias on the clinical encounter or patient outcomes were assessed. In total, 15 articles were eligible for review. Findings - Despite well-reasoned hypotheses that racial/ethnic bias negatively affects patient care, this review found mixed results. Largely, studies showed that US-providers hold an anti-black implicit bias negatively affecting patient-provider communication and patient satisfaction. But studies have not shown that this bias consistently negatively affects diagnosis and treatment regimens of black patients in comparison to white patients. There is a significant dearth of implicit bias literature addressing the care of other patient groups of color. Originality/value - This review of the recent literature challenges the black-white dichotomy of most implicit bias research in the USA and highlights the lack of patient-oriented outcome research in this field. Furthermore, it demonstrates that regardless of the effect of implicit bias on patient outcomes, focus on eliminating implicit bias is insufficient to improve the health of people of color. [ABSTRACT FROM AUTHOR]

Despite many benefits, the extensive deployment of Health Information Technology (HIT) systems by healthcare organizations has encountered many challenges, particularly in the field of telemetry concerning patient monitoring and its operational workflow. These challenges can add more layers of complexity when an unplanned software security patching is performed, affecting patient monitoring and causing disruption in daily clinical operations. This study is a reflection on what happened associated with software security patching and why it happened through the lens of an incident report to develop potential preventive and corrective strategies using qualitative analyses--inductive and deductive approaches. There is a need for such analyses to identify the underlying mechanism behind such issues since very limited research has been conducted on the study of software patching. The incident was classified as a "software functionality" issue, and the consequence was an "incident with a noticeable consequence but no patient harm", and the contributing factor was a software update, i.e., software security patching. This report describes how insufficient planning of software patching, lack of training for healthcare professionals, contingency planning on unplanned system disruption, and HIT system configuration can compromise healthcare quality and cause risks to patient safety. We propose 15 preventive and corrective strategies grouped under four key areas based on the system approach and socialtechnical aspects of the patching process. The key areas are (i) preparing, developing, and deploying patches; (ii) training the frontline operators; (iii) ensuring contingency planning; and (iv) establishing configuration and communication between systems. These strategies are expected to minimize the risk of HIT-related incidents, enhance software security patch management in healthcare organizations, and improve patient safety. However, further discussion should be continued about general HIT problems connected to software security patching. [ABSTRACT FROM AUTHOR]

Summary Background Presentations to emergency departments (EDs) and patient acuity continue to increase. Whilst strategies to deliver safe patient care in the ED are evolving, emergency nurses need to be well educated through specialist qualifications to enable delivery of advanced patient care. This paper presents a comparative analysis of available international practice and competency standards for nurses graduating from emergency nursing courses in Australia, Canada, New Zealand, the United Kingdom, and the United States. Methods CINAHL, Scopus, Ovid MEDLINE, and Embase were searched for papers, published in English, using the terms: ‘emergency’, ‘accident and emergency’, ‘nursing’, ‘competency’, ‘practice standards’, ‘scope of practice’, ‘regulation’, and ‘specialist standards’. Secondary sources from relevant reference lists and professional websites were also searched. Results The standards from the five countries were common across five domains: clinical expertise, communication, teamwork, resources and environment, and legal. None of the standards were specific to the emergency nursing graduate, and there was variability in the level of expertise required for which the standards apply. Conclusions The available practice standards demonstrated some commonality. Consideration of the utility of a universal framework for informing the development of emergency nursing practice standards and emergency nursing curriculum for nurses wishing to specialise is needed. [ABSTRACT FROM AUTHOR]

Research suggests participant engagement is a key mediator of mHealth alcohol interventions' effectiveness in reducing alcohol consumption among users. Understanding the features that promote engagement is critical to maximizing the effectiveness of mHealth-delivered alcohol interventions. The purpose of this study was to identify facilitators and barriers to mHealth alcohol intervention utilization among hazardous-drinking participants who were randomized to use either an app (Step Away) or Artificial Intelligence (AI) chatbot-based intervention for reducing drinking (the Step Away chatbot). We conducted semi-structured interviews from December 2019 to January 2020 with 20 participants who used the app or chatbot for three months, identifying common facilitators and barriers to use. Participants of both interventions reported that tracking their drinking, receiving feedback about their drinking, feeling held accountable, notifications about high-risk drinking times, and reminders to track their drinking promoted continued engagement. Positivity, personalization, gaining insight into their drinking, and daily tips were stronger facilitator themes among bot users, indicating these may be strengths of the AI chatbot-based intervention when compared to a user-directed app. While tracking drinking was a theme among both groups, it was more salient among app users, potentially due to the option to quickly track drinks in the app that was not present with the conversational chatbot. Notification glitches, technology glitches, and difficulty with tracking drinking data were usage barriers for both groups. Lengthy setup processes were a stronger barrier for app users. Repetitiveness of the bot conversation, receipt of non-tailored daily tips, and inability to self-navigate to desired content were reported as barriers by bot users. To maximize engagement with AI interventions, future developers should include tracking to reinforce behavior change self-monitoring and be mindful of repetitive conversations, lengthy setup, and pathways that limit self-directed navigation. [ABSTRACT FROM AUTHOR]

Purpose: The COVID-19 pandemic caused significant changes for family-- professional interactions. Many services shifted to telepractice, with new opportunities for parents and speech-language pathologists (SLPs) to partner for service delivery. Parent-coached models of augmentative and alternative communication (AAC) intervention provide positive outcomes for children; however, SLPs have reported difficulty building strong partnerships with families. The shift to telepractice during the COVID-19 pandemic provided a unique context to examine factors influencing parent--SLP partnerships, particularly for parents with children who use aided AAC. Method: Twenty-five parents and 25 SLPs who engaged in services with children and youth from 3 to 21 years of age who used aided AAC during the initial stages of the COVID-19 pandemic in June 2020 participated. Semistructured interviews were conducted individually with parents and SLPs to understand perspectives on whether the change in service delivery facilitated or hindered family-oriented practice. Inductive qualitative analysis was used to analyze information about the factors impacting parent--SLP partnerships. Results: The parent--SLP partnership was influenced by setting and systemic determinants, and intrinsic determinants to the parent and the SLP that included their history and rapport, beliefs about partnering, and knowledge and skills. These determinants served as barriers or facilitators to their partnership. Conclusions: It is essential to consider the relationship, expectations, and knowledge and skills that SLPs and parents bring to the partnership, along with extrinsic structural factors that can impact this partnership. Positive rapport, valued partnership, and an openness to sharing knowledge through teaming and collaboration provided for positive parent--SLP partnerships. [ABSTRACT FROM AUTHOR]

Abstract In 1965, Glaser and Strauss (1965) offered the concept of "awareness contexts" to explain what patients in hospitals do or don't know about their death trajectories. Awareness ranges from closed (where patients are completely unaware and family and providers protect "the secret") to open (where all parties communicate openly and honestly). While closed awareness was the norm in 1960s, open awareness is now considered standard practice in US, a reflection of mounting evidence that patients, families, and providers benefit from clear and honest communication at end of life (Seale et al., 1997; Wright et al., 2008). Despite the known benefits of open awareness, many terminal patients remain unaware or confused about their prognoses (Chen et al., 2017). This paper asks why, in an era of open awareness, are patients and families uncertain about dying? To answer this question, we focus on an aspect of Glaser and Strauss's theory that remains relatively understudied by researchers, namely the role of institutional and organizational realities in shaping awareness contexts. Based on interviews with 43 family members of deceased patients who died at General Hospital in the Midwestern US, we argue that two related conditions in hospitals—the increased specialization of medical professionals and the fragmentation of patient care—serve as important context for the death awareness of patients and families. Highlights • Specialized and fragmented health care impacts end of life experiences for patients and families. • Patients and families experiencing specialized and fragmented care experience uncertain prognoses. • Uncertain prognoses at end of life can leave families unprepared for death and/or grief stricken. [ABSTRACT FROM AUTHOR]

Voice in healthcare is crucial because of its ability to improve organizational performance and prevent medical errors. This paper contends that a comparative analysis of voice promotion in the American and German healthcare industries can strengthen a culture of safety in both countries. It provides a brief introduction to the concept of voice in healthcare, including its impact on safety culture, barriers to voice, and the dual influences of confidentiality and transparency on voice promotion policies. It then examines the theoretical basis, practical workings, and legal aspects of voluntary error reporting and error disclosure as avenues for exercising voice in the U.S. and Germany. Finally, it identifies transferable practices that can remedy shortcomings in each country's voice promotion policy. [ABSTRACT FROM AUTHOR]

Purpose: Conversation analysis (CA) is an established method that has been used to understand how aphasia impacts the conversational success of individuals with aphasia (IWAs) and their conversation partners. This article demonstrates CA as a valuable analytic tool for studying text messaging in aphasia to better understand the specific co-constructed actions of IWAs and their partners as they engage in this communication modality. Method: CA was applied to transcribed text message data from eight IWAs. Conversational structures present in face-to-face interactions were identified, segmented, and explicated with a focus on how IWAs and their partners negotiate interaction in this medium. Results: Three key elements of CA, namely, sequential organization, repair, and topic negotiation, were identified within the texting exchanges of participants and their texting partners and compared with existing CA studies on electronic messaging in adults without brain injury. Conclusions: Findings suggest a multitude of strategies that IWAs and their partners used to meet both transactional and interactional goals of communication. Understanding gained from applying CA to texting in aphasia can inform the development of interventions that improve access to digital communication for IWAs. [ABSTRACT FROM AUTHOR]

What were the impacts of the Covid‐19 pandemic on trust in public health information, and what can be done to rebuild trust in public health authorities? This essay synthesizes insights from science and technology studies, information studies, and bioethics to explore sociotechnical factors that may have contributed to the breakdown of trust in public health information during the Covid‐19 pandemic. The field of science and technology studies lays out the dynamic nature of facts, helping to explain rapid shifts in public health messaging during Covid‐19 and reasons they produced a lack of trust in public health authorities. The information field looks at how facts are sociotechnically constructed through systems of classification, illustrating how extrascientific factors influence public health authorities. Putting these perspectives alongside bioethics principles raises additional factors to consider. The goal of this essay is to learn from past failures to point toward a brighter future where trust in public health authorities can be rebuilt, not on faith, but rather through striving for calibrated trust within which, through a virtuous circle, trust is validated. [ABSTRACT FROM AUTHOR]

The delivery of comprehensive breast care seems to be undergoing a paradigm shift driven by advances in technology, interprofessional collaboration and patient dissatisfaction with interruptions in care. This paradigm shift includes the emergence of new models of care that optimize the use of embedded radiology services and encourage greater interprofessional collaboration. This paper briefly reviews the three drivers (advances in technology, expectations regarding interprofessional collaboration and patient dissatisfaction with interrupted care) underlying the paradigm shift in comprehensive breast care as well as introduces the environment of care model, which describes the proximity of radiology services and interprofessional collaboration between the Women's Wellness Clinic (WWC) and Radiology at the Karmanos Cancer Institute (KCI) - both based in the United States. In addition, this model is proposed as a way to facilitate improved patient satisfaction and early appropriate referral. Finally, plans for evaluating the effectiveness of this model are presented. [ABSTRACT FROM AUTHOR]

Aims: To explore the role of transfer centre nurses and how they facilitate communication between referring and accepting providers during calls about interhospital transfers, including their strategies to overcome communication challenges. Design: A qualitative interview study. Methods: We conducted semi‐structured interviews with 17 transfer centre nurses at one tertiary medical centre from March to August 2019, asking participants to describe their work. We performed content analysis, applying codes based on the Relational Coordination Framework and generating emergent codes, then organized codes in higher‐order concepts. We followed the COREQ checklist. Results: Transfer centre nurses employed multiple strategies to mitigate communication challenges. When referring providers had misconceptions about the transfer centre nurse's role and the accepting hospital's processes, the nurses informed referring providers why sharing information with them was necessary. If providers expressed frustrations or lacked understanding about their counterpart's caseload, the nurses managed providers' emotions by letting them "vent," explaining the other provider's situational context and describing the hospital's capabilities. Some nurses also mediated conflict and sought to break the tension if providers debated about the best course of action. When providers struggled to share complete and accurate information, the nurses hunted down details and 'filled in the blanks'. Conclusion: Transfer centre nurses perform invisible work throughout the lifespan of interhospital transfers. Nurses' expert knowledge of the transfer process and hospitals' capabilities can enhance provider communication. Meanwhile, providers' lack of knowledge of the nurse's role can impede respectful and efficient transfer conversations. Interventions to support and optimize the transfer centre nurses' critical work are needed. Impact This study describes how transfer centre nurses facilitate communication and overcome challenges during calls about interhospital transfers. An intervention that supports this critical work has the potential to benefit nurses, providers and patients by ensuring accurate and complete information exchange in an effective, efficient manner that respects all parties. Patient or public contribution: This study was designed to capture the perspectives and experiences of transfer centre nurses themselves through interviews. Therefore, it was not conducted using input or suggestions from the public or the patient population served by the organization. [ABSTRACT FROM AUTHOR]

Background: COVID-19 significantly impacted care delivery to seriously ill patients, especially around including family and caregivers in patient care. Aim: Based on routinely collected bereaved family reports, actionable practices were identified to maintain and improve care in the last month of life, with potential application to all seriously ill patients. Design: The Veterans Health Administration's Bereaved Family Survey is used nationally to gather routine feedback from families and caregivers of recent in-patient decedents; the survey includes multiple structured items as well as space for open narrative responses. The responses were analyzed using qualitative content analysis with dual review. Setting/participants: Between February 2020 and March 2021, there were 5372 responses to the free response questions of which 1000 (18.6%) responses were randomly selected. The 445 (44.5%) responses from 377 unique individuals included actionable practices. Results: Bereaved family members and caregivers identified four opportunities with a total of 32 actionable practices. Opportunity 1: Facilitate the use of video communication, included four actionable practices. Opportunity 2: Provide timely and accurate responses to family concerns, included 17 actionable practices. Opportunity 3: Accommodate family/caregiver visitation, included eight actionable practices. Opportunity 4: Offer physical presence to the patient when family/caregivers are unable to visit, included three actionable practices. Conclusion: The findings from this quality improvement project are applicable during a pandemic, but also translate to improving the care of seriously ill patients in other circumstances, such as when family members or caregivers are geographically distant from a loved one during the last weeks of life. [ABSTRACT FROM AUTHOR]

Perinatal communication is one factor driving racial disparities in maternal and infant morbidity. The murder of George Floyd in May 2020, in addition to the disproportionate impacts of the Covid-19 pandemic on communities of color, was a catalyst for American society to address racial injustices with a renewed sense of urgency. Drawing upon sociotechnical systems (STS) theory, this rapid review describes changes in the literature regarding the organizational, social, technical, and external subsystems that affect communication between perinatal providers and their Black patients. The goal of this work is to support health system optimization of health communication initiatives and, as a result, improve patient experience and parent and child outcomes. As part of a multi-year project designed to improve health communications about safe fish consumption during pregnancy, and in response to racial disparities among our health system's patient population related to receipt of nutrition messages during prenatal visits, we conducted a rapid review of literature on Black parents' experience of all communication while receiving perinatal care. A search of PubMed identified relevant articles published in English since 2000. Articles were screened to include articles that focused on Black people receiving perinatal care. Article content was then coded using deductive content analysis guided by STS theory to inform healthcare system improvement efforts. Differences in the prevalence of codes pre- and post-2020 are compared using chi-square statistics. The search in PubMed yielded 2419 articles. After screening, 172 articles were included in the rapid review. There was an increased recognition of communication as a key component of quality perinatal care after 2020 (P =.012) and of the limitations of standardized technical communication (P =.002) after 2020. Emerging literature suggests improving perinatal health communication and relationships with Black parents would address disparities in perinatal patient and baby outcomes. Healthcare systems must address the racial disparities in maternal and child outcomes. Since 2020, public attention and published research on this issue has increased. Understanding perinatal communication using STS theory aligns subsystems in service of racial justice. [ABSTRACT FROM AUTHOR]

Research suggests that women with intellectual and developmental disabilities are at increased risk for adverse pregnancy outcomes. Further, they report unmet perinatal care needs. This qualitative study examined clinician perspectives on barriers to providing perinatal care to women with intellectual and developmental disabilities. We conducted semi-structured interviews and one focus group with US obstetric care clinicians (n = 17). We used a content analysis approach to code data and analyse them for larger themes and relationships. the majority of participants were white, non-Hispanic, and female. Participants reported barriers providing care to pregnant women with intellectual and developmental disabilities across individual (e.g., communication challenges), practice (e.g., identification of disability status), and system levels (e.g., lack of clinician training). clinician training and evidence-based guidelines for perinatal care of women with intellectual and developmental disabilities as well as services and supports during pregnancy are needed. [ABSTRACT FROM AUTHOR]

Several types of professionals support families of young children with disabilities as they navigate the early intervention and early childhood special education systems (EI/ECSE). Medical professionals are often the first to discuss service provision with families, while EI/ECSE providers are responsible for evaluating, determining eligibility, and providing services. The alignment between these two groups can directly influence child and family outcomes. We explored the experiences of medical professionals and EI/ECSE providers working in one large Northeastern U.S. city to understand how each group views their respective roles within the system and to gauge the degree to which they collaborate. Our findings revealed that both groups are committed to the families they serve but are often frustrated by conflicting recommendations for EI/ECSE service delivery. We provide suggestions to improve opportunities to communicate and collaborate to increase the effectiveness of support for children and their families. [ABSTRACT FROM AUTHOR]

Background: When doctors have honest conversations with patients about their illness and involve them in decisions about their care, patients express greater satisfaction with care and lowered anxiety and depression. The Serious Illness Care Programme (the Programme), originally developed in the United States (U.S), promotes meaningful, realistic and focused conversations about patient's wishes, fears and worries for the future with their illness. The Serious Illness Conversation Guide (the guide) provides a framework to structure these conversations. The aim of this paper is to present findings from a study to examine the 'face validity', acceptability and relevance of the Guide for use within the United Kingdom (UK) health care setting.Methods: A multi-stage approach was undertaken, using three separate techniques: 1. Nominal Group Technique with clinician 'expert groups' to review the Serious Illness Conversation Guide: 14 'experts' in Oncology, Palliative Care and Communication Skills; 2. Cognitive Interviews with 6 patient and public representatives, using the 'think aloud technique'; to explore the cognitive processes involved in answering the questions in the guide, including appropriateness of language, question wording and format 3. Final stakeholder review and consensus.Results: Nominal Group Technique Unanimous agreement the conversation guide could provide a useful support to clinicians. Amendments are required but should be informed directly from the cognitive interviews. Training highlighted as key to underpin the use of the guide. Cognitive interviews The 'holistic' attention to the person as a whole was valued rather than a narrow focus on their disease. Some concern was raised regarding the 'formality' of some wording however and suggestions for amendments were made. Final stakeholder review Stakeholders agreed amendments to 5/13 prompts and unanimously agreed the UK guide should be implemented as a part of the pilot implementation of the Serious Illness Care Programme UK.Conclusion: Use of the guide has the potential to benefit patients, facilitating a 'person-centred' approach to these important conversations, and providing a framework to promote shared decision making and care planning. Further research is ongoing, to understand the impact of these conversations on patients, families and clinicians and on concordance of care delivery with expressed patient wishes. [ABSTRACT FROM AUTHOR]

Introduction: There is inadequate information available about many of the smaller minority groups living in the United States. Mongolian culture has unique traditions that warrant understanding to provide culturally congruent care. The purpose of this study was to explore the lived experiences of Mongolian immigrants seeking perinatal care in the United States. Method: Using a phenomenological approach, 12 Mongolian women were interviewed using semi-structured interviews. The study follows the "consolidated criteria for reporting qualitative studies" guidelines for qualitative studies. Results: Results focus on successes and failures of the health care system in meeting the needs of these women. Discussion: Cultural communication barriers, disparate health practice beliefs, and limited cultural awareness among providers reduce quality of care. Study findings support practice interventions that enhance provider sensitivity for immigrant women. Relevance to Practice: Improved cultural awareness of Asian cultures increases sensitivity to the needs of Mongolian women and can help providers deliver high-quality care. [ABSTRACT FROM AUTHOR]

Background: The concept of resilience has been used as a descriptor for individuals and organizations with the dominant themes of bouncing back and moving forward. Aims: To examine the concept of resilience in providers and healthcare teams during pandemic disasters. Research Design: Walker and Avant's eight‐step concept analysis method. Data Source: CINAHL, EBSCO Host, PubMed, and SCOPUS were searched using the combined terms "resilience" or "resiliency" or "resilient" and "healthcare professionals," or "healthcare worker" or "healthcare team" or "physician" or "nurse" or "doctor" and "pandemic" or "disaster." Methods: The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses Checklist was used to review the literature and apply findings using the eight‐step Walker and Avant method for concept analysis. Results: Three clusters emerged as attributes of individual resilience that may be applied to healthcare teams in times of pandemic disasters: (1) resilience is a dynamic contextual process, (2) resilience stabilizes the team to maintain a routine level of function, and (3) resilience is a catalyst for the actualization of innate or acquired skills and ability within the healthcare team. Conclusion: This analysis suggests that resilience enhances the healthcare team's ability to maintain function during acute changes created by pandemic disasters. Resilience in healthcare teams during pandemics requires future research to explore the phenomenon. [ABSTRACT FROM AUTHOR]

U.S. suicide rates have risen every year over the past two decades with self-directed firearm use as the method accounting for the highest proportion of deaths. This pattern is particularly pronounced among veterans and members of the U.S. Armed Forces. The numerical burden of firearmrelated suicide accompanied by characteristics of self-directed firearm injury have motivated the development of lethal means safety initiatives focused on firearms. Simultaneously, research has sought to characterize patterns of firearm ownership and use among veterans as well as optimal strategies for clinicians to deliver suicide prevention messages to firearm owners. Increasingly, findings from research have been understood as cultural factors that warrant greater attention to improve the quality of lethal means counseling. Here, we review and interpret selected research on cultural aspects of firearm ownership and suggest that cultural differences between health care practitioners and firearm owners may result in health care practitioners delivering clinical interventions that are broadly divergent from perspectives within the cultural frameworks of firearm owners. We follow by organizing these cultural factors into existing frameworks of cultural competency training as a basis for developing curriculum for health care practitioners to improve clinical care. [ABSTRACT FROM AUTHOR]

The aim of this paper is discussion of a new middle‐range theory of patient safety goal priming via safety culture communication. Bedside nurses are key to safe care, but there is little theory about how organizations can influence nursing behavior through safety culture to improve patient safety outcomes. We theorize patient safety goal priming via safety culture communication may support organizations in this endeavor. According to this theory, hospital safety culture communication activates a previously held patient safety goal and increases the perceived value of actions nurses can take to achieve that goal. Nurses subsequently prioritize and are motivated to perform tasks and risk assessment related to achieving patient safety. These efforts continue until nurses mitigate or ameliorate identified risks and hazards during the patient care encounter. Critically, this process requires nurses to have a previously held safety goal associated with a repertoire of appropriate actions. This theory suggests undergraduate educators should foster an outcomes focus emphasizing the connections between nursing interventions and safety outcomes, hospitals should strategically structure patient safety primes into communicative activities, and organizations should support professional development including new skills and the latest evidence supporting nursing practice for patient safety. [ABSTRACT FROM AUTHOR]

Purpose: An emerging need to improve health care transition planning has developed worldwide as more youth with special health care needs are surviving to adulthood. Nurses have been instrumental in facilitating transition planning and supporting youth throughout this process. While various transition tools have been developed, health professionals' utilization and perception of these tools have yet to be explored. Furthermore, there are no universally‐accepted documentation tools for transition planning. The purpose of this study was to develop and implement a transition process planning and communication tool to facilitate transition planning among multiple, pediatric subspecialties within a system‐wide transition program. Design and Methods: This project was a cross‐sectional quality improvement initiative. Eligible encounters in the electronic medical record (N = 20,645) were obtained from 38 subspecialty clinics at a large, freestanding pediatric health system. Transition planning documentation was monitored for 8 months pre‐implementation and 14 months post‐implementation of the tool. Health professionals (N = 89) completed a survey to assess the tool's feasibility. Results: Implementation of the tool was feasible and corresponded with increased transition planning documentation post‐implementation. Nurses represented 33% of the sample that utilized the tool. Survey results revealed barriers to documentation and utilization of the tool, along with strategies for improvement. Practice Implications: This study demonstrates that health professionals, especially pediatric nurses and nurse practitioners, are willing to adopt new, electronic documentation tools to enhance multidisciplinary transition planning consistent with best practices. Future studies should address identified barriers, assess the effectiveness of the tool on improving transition outcomes, and consider implications for integration into global health care models. System‐wide implementation of such tools may improve multidisciplinary communication and coordination of care for youth with special health care needs. [ABSTRACT FROM AUTHOR]

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A considerable portion of the US population still lacks access to technology, which causes challenges for marginalized communities to access information and services. Research on the digital divide exists in various contexts, but few have examined it in the context of human services. This study examines the impact of socioeconomic status on the methods of communication used when searching for service-related information. We analyzed both quantitative and qualitative data collected from 63 low-income and/or current human service users in Albany, New York. Education showed positive associations with smartphone ownership and personal computer use. Income was found only significant for tablet use. Non-whites were more likely to use mobile apps to web browsers compared to whites. Qualitative analysis revealed three key themes (i.e., availability, ease of use, and usefulness) as influencers of individual preference of methods. Our findings suggest that the digital divide is not merely about the income level but also educational background and culture. Human service professionals need to consider multiple channels to reach targeted populations for service delivery. Particularly, the collaboration between service providers and public libraries is worth examining to ensure the physical access and skills training for those who experience the digital divide at multiple levels. [ABSTRACT FROM AUTHOR]

Effective communication is integral to the patient–provider relationship. Yet, as a result of structural factors that ignore the unique health care needs of different populations of patients who identify as Black—both African American and African immigrants—are confronted with communication challenges during health care seeking encounters. Using cultural safety as a framework, in this article, we thematically review communication challenges specifically experienced by patients of African descent in the U.S. health care system. In our review, we focus on complications that might arise from discrimination, mistrust, health literacy, and impacts of culture and language barriers on health literacy. In conclusion, we offer recommendations for improving the health care experiences and potential health outcomes for this population, through nursing care and health care delivery. [ABSTRACT FROM AUTHOR]

With implementation of Centers for Medicare and Medicaid's Hospital Readmissions Reduction Program, which lowers payments to hospitals with high 30-day readmission rates, hospitals have a financial incentive to improve hospital-to-home care transitions. Brain injury is a leading cause of 30-day hospital readmissions. Traditional discharge planning has not met the needs of brain injury survivors and caregivers especially Latinas/os whom experience worse rates of depression and caregiver burden. Trabajadora de Salud, a bilingual, bicultural, 90-day home visitation, family-focused, care transitions intervention, has demonstrated efficacy in improving outcomes among Latinas/os with brain injuries and their caregivers. This study described three case examples from the intervention to illustrate common needs among Latinas/os with brain injuries and methods of intervention. [ABSTRACT FROM AUTHOR]

In both library reference work and dementia care, communication between personnel and service recipients can be both complex and complicated. Professionals in both fields have therefore developed protocols and standards to assist personnel in handling these interactions. In this article we detail an exploratory comparative study that used an ethic of care framework to compare prominent guidelines for reference librarians (American Library Association's Reference and User Services Association's Guidelines for behavioral performance of reference and information service providers) with guidelines for workers in long-term dementia care settings (the National Institute for Health and Care Excellence's Guideline on supporting people with dementia and their carers in health and social care). We explored how both sets of Guidelines frame the act of communication as a combination of regulated procedure and empathetic discourse to determine how the similarities among and differences between these two guidelines provide useful insights into each other. Our examination was structured using an ethic of care lens, which emphasizes the importance of interpersonal relationships, reciprocity, and empathetic benevolence. Using specific phrases in each set of Guidelines that align with and are evidence of Tronto's four moral principles of care, we ultimately discovered, in both sets of Guidelines, an underlying ethic of care: a repeated insistence upon embedding procedures within behaviour that manifests attentiveness, responsibility, responsiveness, and competence. [ABSTRACT FROM AUTHOR]

Despite substantial efforts in the past 15 years to professionalise the field of clinical ethics consultation, sociologists have not re‐examined past hypotheses about the role of such services in medical decision‐making and their effect on physician authority. In relation to those hypotheses, we explore two questions: (i) What kinds of issues does ethics consultation resolve? and (ii) what is the nature of the resolution afforded by these consults? We examined ethics consultation records created between 2011 and mid‐2015 at a large tertiary care US hospital and found that in most cases, the problems addressed are not novel ethical dilemmas as classically conceived, but are instead disagreements between clinicians and patients or their surrogates about treatment. The resolution offered by a typical ethics consultation involves strategies to improve communication rather than the parsing of ethical obligations. In cases where disagreements persist, the proposed solution is most often based on technical clinical judgements, reinforcing the role of physician authority in patient care and the ethical decisions made about that care. [ABSTRACT FROM AUTHOR]

The 2014-2016 Ebola epidemic in West Africa influenced how public health officials considered migration and emerging infectious diseases. Responding to the public's concerns, the US government introduced enhanced entry screening and post-arrival monitoring by public health authorities to reduce the risk of importation and domestic transmission of Ebola while continuing to allow travel from West Africa. This case study describes a new initiative, the Check and Report Ebola (CARE+) program that engaged travelers arriving to the United States from countries with Ebola outbreaks. The Centers for Disease Control and Prevention employed CARE ambassadors, who quickly communicated with incoming travelers and gave them practical resources to boost their participation in monitoring for Ebola. The program aimed to increase travelers' knowledge of Ebola symptoms and how to seek medical care safely, increase travelers' awareness of monitoring requirements, reduce barriers to monitoring, and increase trust in the US public health system. This program could be adapted for use in future outbreaks that involve the potential importation of disease and require the education and active engagement of travelers to participate in post-arrival monitoring. [ABSTRACT FROM AUTHOR]

Objective: To quantify the impact of two approaches (directed and query-based) to health information exchange (HIE) on potentially avoidable use of health care services.Data Sources/study Setting: Data on ambulatory care providers' adoption of HIE were merged with Medicare fee-for-service claims from 2008 to 2014. Providers were from 13 counties in New York served by the Rochester Regional Health Information Organization (RHIO).Study Design: Linear regression models with provider and year fixed effects were used to estimate changes in the probability of utilization outcomes for Medicare beneficiaries attributed to providers adopting directed and/or query-based HIE compared with beneficiaries attributed to providers who had not adopted HIE.Data Collection: Providers' HIE adoption status was determined through Rochester RHIO registration records. RHIO and claims data were linked via National Provider Identifiers.Principal Findings: Query-based HIE adoption was associated with a 0.2 percentage point reduction in the probability of an ambulatory care sensitive hospitalization and a 1.1 percentage point decrease in the likelihood of an unplanned readmission. Directed HIE adoption was not associated with any outcome.Conclusions: The Centers for Medicare & Medicaid Services' (CMS) EHR certification criteria includes requirements for directed HIE, but not query-based HIE. Pending further research, certification criteria should place equal weight on facilitating query-based and directed exchange. [ABSTRACT FROM AUTHOR]

Objective: To assess physician‐patient communication and identify the frequency of use of specific communication techniques by analyzing recordings of routinely scheduled medical encounters for patients with clinician‐identified chronic migraine. Background: Chronic migraine is an under‐diagnosed, under‐treated, and highly burdensome disease. Effective medical communication is integral to optimal medical care, including providing accurate diagnoses, creating effective treatment plans, and enhancing patient adherence. Communication patterns during office visits may be a target for intervention to improve outcomes for people with chronic migraine. Design: This was a prospective, observational study based on analysis of audio recordings collected during neurologist‐patient chronic migraine dialogues. Methods: Twenty neurologists from a US neurology panel maintained by Verilogue, Inc., a research organization specializing in healthcare dialogues, were invited to identify patients with chronic migraine and record clinical encounters with their patients. Both new patient visits and follow‐up visits were included in this analysis. Neurologist‐patient dialogues were audio‐recorded, anonymized, transcribed, and analyzed by a sociolinguist for the presence of prespecified communication parameters, strategies, and specific language indicative of optimal migraine‐related medical care. Results: Fourteen out of the 20 invited neurologists (70.0%) accepted the study invitation and recorded 35 encounters with patients eligible for the study. The patient sample was 91.4% female (n = 32/35), with a mean age of 46 years. On average, there were 17 headache‐related questions per visit; 82.0% of questions were closed‐ended (n = 369/450). Headache/migraine frequency was elicited in 77.1% of the dialogues (n = 27/35), but headache days per month was assessed in only a single dialogue. Only one neurologist utilized the ask‐tell‐ask technique. Headache‐related disability was discussed in 22.9%of the dialogues (n = 8/35), with only one using open‐ended questions. None of the dialogues discussed ictal vs interictal headache‐related disability. Chronic migraine was mentioned in 8.6% of dialogues (n = 3/35) and treatment plans were discussed in 37.1% of the dialogues (n = 13/35). Conclusions: Results from this preliminary study showed that the majority of the neurologist‐chronic migraine patient dialogues did not assess elements crucial for diagnosis and treatment (eg, headache days per month and headache related disability) or use standard communication techniques (eg, open‐ended questions, ask‐tell‐ask). We recommend intervention studies designed to assess the benefits of improved communication on diagnostic accuracy, treatment decisions, and patient reported outcomes. [ABSTRACT FROM AUTHOR]

People commonly use the Internet to search for health information and tend to use the information they find without regard to source or credibility. Although regulation plays some role in minimizing false claims made by manufacturers of self-help products, effective communication with health professionals likely offers greater protection to the patient or consumer accessing self-help materials. In order to best serve patients (or healthcare consumers), providers should educate them about their healthcare needs, inquire about self-help product use, understand appropriate use, discuss the risks and benefits of use, monitor the patients' condition during use, and document these conversations. Although some people fear that patient use of brain-themed self-help will undermine the doctor-patient relationship, it is more likely to open another avenue of communication if providers are knowledgeable about self-help products. Given the rise in importance of the Internet as a source of information for people, opting out of these discussions is realistically not an option. [ABSTRACT FROM AUTHOR]

At the fall component meetings of the American Psychiatric Association in Arlington, Va., September 13-16, 2017, the APA councils heard reports from their components. Following are summaries of the activities of the councils and their components. [ABSTRACT FROM AUTHOR]

Background: The clinical research enterprise is not producing the evidence decision makers arguably need in a timely and cost effective manner; research currently involves the use of labor-intensive parallel systems that are separate from clinical care. The emergence of pragmatic clinical trials (PCTs) poses a possible solution: these large-scale trials are embedded within routine clinical care and often involve cluster randomization of hospitals, clinics, primary care providers, etc. Interventions can be implemented by health system personnel through usual communication channels and quality improvement infrastructure, and data collected as part of routine clinical care. However, experience with these trials is nascent and best practices regarding design operational, analytic, and reporting methodologies are undeveloped.Methods: To strengthen the national capacity to implement cost-effective, large-scale PCTs, the Common Fund of the National Institutes of Health created the Health Care Systems Research Collaboratory (Collaboratory) to support the design, execution, and dissemination of a series of demonstration projects using a pragmatic research design.Results: In this article, we will describe the Collaboratory, highlight some of the challenges encountered and solutions developed thus far, and discuss remaining barriers and opportunities for large-scale evidence generation using PCTs.Conclusion: A planning phase is critical, and even with careful planning, new challenges arise during execution; comparisons between arms can be complicated by unanticipated changes. Early and ongoing engagement with both health care system leaders and front-line clinicians is critical for success. There is also marked uncertainty when applying existing ethical and regulatory frameworks to PCTS, and using existing electronic health records for data capture adds complexity. [ABSTRACT FROM AUTHOR]

The article reflects on advancements and services offered by the periodical since 50 years. It mentions a section of special issue that was drawn on by doctoral training programs in health services research and health policy analysis. It also highlights the challenges faced by the medical journal editors and efforts to tackle head on the issue of authorship.

Despite published guidelines on the need to provide comprehensive care to lesbian, gay, bisexual, transgender, and questioning/queer (LGBTQ) youth, there has been limited research related to the deliverance of primary health care to this population. The goals of this study were to learn about LGBTQ youth’s experiences with their primary care physicians and to identify areas for improvement. Youth attending 1 of 5 community-based programs completed a written questionnaire and participated in a focus group discussion regarding experiences at primary care visits, including topics discussed, counselling received, and physician communication. Most of the youth did not feel their health care needs were well met. The majority acknowledged poor patient-provider communication, disrespect, and lack of discussions about important topics such as sexual and emotional health. Participants cited concerns about confidentiality and inappropriate comments as barriers to care. Youth expressed a strong desire to have physicians be more aware of their needs and concerns. [ABSTRACT FROM AUTHOR]

Background: It is becoming increasingly common for individuals and organizations to use social media platforms such as Facebook. These are being used for a wide variety of purposes including disseminating, discussing and seeking health related information. U.S. Federal health agencies are leveraging these platforms to 'engage' social media users to read, spread, promote and encourage health related discussions. However, different agencies and their communications get varying levels of engagement. In this study we use statistical models to identify factors that associate with engagement.Methods: We analyze over 45,000 Facebook posts from 72 Facebook accounts belonging to 24 health agencies. Account usage, user activity, sentiment and content of these posts are studied. We use the hurdle regression model to identify factors associated with the level of engagement and Cox proportional hazards model to identify factors associated with duration of engagement.Results: In our analysis we find that agencies and accounts vary widely in their usage of social media and activity they generate. Statistical analysis shows, for instance, that Facebook posts with more visual cues such as photos or videos or those which express positive sentiment generate more engagement. We further find that posts on certain topics such as occupation or organizations negatively affect the duration of engagement.Conclusions: We present the first comprehensive analyses of engagement with U.S. Federal health agencies on Facebook. In addition, we briefly compare and contrast findings from this study to our earlier study with similar focus but on Twitter to show the robustness of our methods. [ABSTRACT FROM AUTHOR]

The article discusses the authors' assessment of a network of 159 community agencies in Illinois that promote healthy eating and lifestyles among the state's populations with limited resources, and it mentions examinations of the communications, funding, cooperation, and collaboration networks between various agencies in Illinois. According to the article, agencies such as healthcare service providers, housing complexes, and schools need to work together to promote health eating and lifestyles.

Background: A number of private and public companies calculate and publish proprietary hospital patient safety scores based on publicly available quality measures initially reported by the U.S. federal government. This study examines whether patient safety culture perceptions of U.S. hospital staff in a large national survey are related to publicly reported patient safety ratings of hospitals.Methods: The Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture (Hospital SOPS) assesses provider and staff perceptions of hospital patient safety culture. Consumer Reports (CR), a U.S. based non-profit organization, calculates and shares with its subscribers a Hospital Safety Score calculated annually from patient experience survey data and outcomes data gathered from federal databases. Linking data collected during similar time periods, we analyzed relationships between staff perceptions of patient safety culture composites and the CR Hospital Safety Score and its five components using multiple multivariate linear regressions.Results: We analyzed data from 164 hospitals, with patient safety culture survey responses from 140,316 providers and staff, with an average of 856 completed surveys per hospital and an average response rate per hospital of 56%. Higher overall Hospital SOPS composite average scores were significantly associated with higher overall CR Hospital Safety Scores (β = 0.24, p < 0.05). For 10 of the 12 Hospital SOPS composites, higher patient safety culture scores were associated with higher CR patient experience scores on communication about medications and discharge.Conclusion: This study found a relationship between hospital staff perceptions of patient safety culture and the Consumer Reports Hospital Safety Score, which is a composite of patient experience and outcomes data from federal databases. As hospital managers allocate resources to improve patient safety culture within their organizations, their efforts may also indirectly improve consumer-focused, publicly reported hospital rating scores like the Consumer Reports Hospital Safety Score. [ABSTRACT FROM AUTHOR]

The swift global spread of COVID-19 prompted public health authorities to explore digital technologies to aid in contact tracing for infection control. Exposure notification, a mobile device–based technology that notifies individuals of potential exposure to COVID-19 without requiring personally identifiable information, has been broadly favored because of its relative ease of use, scalability, and protection of personal privacy. Although several exposure notification protocols were developed, a partnership between Google and Apple led to the development of the most widely implemented exposure notification protocol in the world, including in the United States. In this article, we first describe the development of the Google Apple Exposure Notification (GAEN) protocol, noting the value of the discourse among software developers and public health authorities concerning the protocol's design and features. We track states' deployment of GAEN mobile applications (apps) and population-level adoption rates, finding the nationwide rollout of GAEN apps to be more fragmented than anticipated. We then discuss how the limited data collected from these apps make assessments of their effectiveness challenging. Finally, we consider the importance of the federal government playing a greater role in GAEN's early development, emphasize the power of public–private partnerships, and highlight the overriding importance of public messaging over technological details. [ABSTRACT FROM AUTHOR]

Background: The healthcare system is ill-equipped to meet the needs of adults on the autism spectrum.Objective: Our goal was to use a community-based participatory research (CBPR) approach to develop and evaluate tools to facilitate the primary healthcare of autistic adults.Design: Toolkit development included cognitive interviewing and test-retest reliability studies. Evaluation consisted of a mixed-methods, single-arm pre/post-intervention comparison.Participants: A total of 259 autistic adults and 51 primary care providers (PCPs) residing in the United States.Interventions: The AASPIRE Healthcare toolkit includes the Autism Healthcare Accommodations Tool (AHAT)-a tool that allows patients to create a personalized accommodations report for their PCP-and general healthcare- and autism-related information, worksheets, checklists, and resources for patients and healthcare providers.Main Measures: Satisfaction with patient-provider communication, healthcare self-efficacy, barriers to healthcare, and satisfaction with the toolkit's usability and utility; responses to open-ended questions.Key Results: Preliminary testing of the AHAT demonstrated strong content validity and adequate test-retest stability. Almost all patient participants (>94 %) felt that the AHAT and the toolkit were easy to use, important, and useful. In pre/post-intervention comparisons, the mean number of barriers decreased (from 4.07 to 2.82, p < 0.0001), healthcare self-efficacy increased (from 37.9 to 39.4, p = 0.02), and satisfaction with PCP communication improved (from 30.9 to 32.6, p = 0.03). Patients stated that the toolkit helped clarify their needs, enabled them to self-advocate and prepare for visits more effectively, and positively influenced provider behavior. Most of the PCPs surveyed read the AHAT (97 %), rated it as moderately or very useful (82 %), and would recommend it to other patients (87 %).Conclusions: The CBPR process resulted in a reliable healthcare accommodation tool and a highly accessible healthcare toolkit. Patients and providers indicated that the tools positively impacted healthcare interactions. The toolkit has the potential to reduce barriers to healthcare and improve healthcare self-efficacy and patient-provider communication. [ABSTRACT FROM AUTHOR]

Background: Health information technology (HIT) could improve care coordination by providing clinicians remote access to information, improving legibility, and allowing asynchronous communication, among other mechanisms. We sought to determine, from a clinician perspective, how care is coordinated and to what extent HIT is involved when transitioning patients between emergency departments, acute care hospitals, skilled nursing facilities, and home health agencies in settings across the United States.Methods: We performed a qualitative study with clinicians and information technology professionals from six regions of the U.S. which were chosen as national leaders in HIT. We analyzed data through a two person consensus approach, assigning responses to each of nine care coordination activities. We also conducted a literature review of MEDLINE®, CINAHL®, and Embase, analyzing results of studies that examined interventions to improve information transfer during transitions of care.Results: We enrolled 29 respondents from 17 organizations and conducted six focus groups. Respondents reported how HIT is currently used for care coordination activities. HIT is currently used to monitor patients and to align systems-level resources with population needs. However, we identified multiple areas where the lack of interoperability leads to inefficient processes and missing data. Additionally, the literature review identified ten intervention studies that address information transfer, seven of which employed HIT and three of which utilized other communication methods such as telephone calls, faxed records, and nurse case management.Conclusions: Significant care coordination gaps exist due to the lack of interoperability across the United States. We must design, evaluate, and incentivize the use of HIT for care coordination. We should focus on the domains where we found the largest gaps: information transfer, systems to monitor patients, tools to support patients' self-management goals, and tools to link patients and their caregivers with community resources. [ABSTRACT FROM AUTHOR]

Importance: Patients are increasingly being given access to their test results, but little is known about how preferences vary with the test under consideration or the results of the test (normal or abnormal).Objective: This study was conducted to examine preferences for test result communication.Design, Setting, and Participants: We surveyed adults to explore their preferences for test result notification for three common diagnostic tests of varying "emotional impact" (dual-energy x-ray absorptiometry [DXA], genital herpes, and cancer biopsy) when test results were 1) normal and 2) abnormal. We conducted our survey between June and August 2012 on the campus of an academic medical center. For each scenario, subjects were asked to rank seven methods that might be used to communicate test results (letter, unsecured email, secured email, text message, telephone call, secure Web portal, office visit) in order of acceptability.Main Outcome Measures: The main measures were the percentage of respondents who ranked a particular test result notification method favorably and the percentage who ranked it as unacceptable.Results: When test results were normal, subjects' notification preferences were generally similar for DXA, herpes and cancer biopsy, with telephone and letter ranked most favorably for all three tests. Conversely, text message and unsecured email were viewed as unacceptable notification methods for normal results by 45.0-55.0 % of subjects across all three tests. When test results were abnormal, office visits became more popular. A higher proportion of subjects ranked office visits as their most preferred notification method for our test with high "emotional impact" (cancer biopsy) (38.4 %) as compared to DXA (28.2 %) and herpes (27.9 %) (P = 0.02). For most test scenarios, younger subjects appeared to rank electronic communication modalities (secure email or Web portal) higher than older subjects, though this difference did not reach statistical significance (P = 0.29).Conclusions: Preferences for test result notification can differ substantially depending upon the test under consideration and results of the test. Providers and health care systems should consider these factors when deciding how to communicate results to patients. [ABSTRACT FROM AUTHOR]

This article compares the doctor-patient communication styles of the United States with those of three Asian countries: Pakistan, Japan, and Thailand. Based on intercultural comparisons drawn between those countries, this analysis reveals that, overall, the United States has very little in common with the philosophical, cultural, societal, and communicative approaches to the traditional doctor-patient communication styles used in these three Asian nations. However, major similarities have been found across all three Asian nations. Although the doctor-patient relationship has been studied extensively in the United States and most of the Western world, rarely do those studies integrate, concurrently within their doctor-patient communication framework, dimensions such as power distance, individualism-collectivism, and communication styles. These are three important concepts in this analysis; they improve our understanding of what constitutes effective doctor-patient communication across dissimilar cultures. [ABSTRACT FROM PUBLISHER]

The Latino population in the US is projected to grow substantially in the years ahead. Although often referred to as a single group, Latinos are not homogeneous. This article, based mainly on a national telephone survey of 1,478 Latino adults, examines the perspectives of six Latino heritage groups on the health care issues they face. The six groups differ in their reported health care experiences in: the types facilities they use in getting medical care, their ratings of the quality of care they receive, their experiences with discrimination in getting quality care, the level of confidence they have in being able to pay for a major illness. One thing the heritage groups agree on is that diabetes is the biggest health problem facing their families. Community health leaders, particularly at the state level, need to focus on the specific Latino groups in their state or area and their unique situations. [ABSTRACT FROM AUTHOR]

Background: There is a lack of research on the organisational operations of integrative healthcare (IHC) practices. IHC is a therapeutic strategy integrating conventional and complementary medicine in a shared context to administer individualized treatment. To better understand the process of care in IHC - the way in which patients are triaged and treatment plans are constructed, interviews were conducted with integrative health care leaders and practitioners in the US. Methods: Semi-structured interviews were conducted with a pragmatic group of fourteen leaders and practitioners from nine different IHC settings. All interviews were conducted face-to-face with the exception of one phone interview. Questions focussed on understanding the "process of care" in an integrative healthcare setting. Deductive categories were formed from the aims of the study, focusing on: organisational structure, processes of care (subcategories: patient intake, treatment and charting, use of guidelines or protocols), prevalent diseases or conditions treated, and the role of research in the organisation. The similarities and differences of the ITH entities emerged from this process. Results: On an organisational level, conventional and CM services and therapies were co-located in all nine settings. For patients, this means there is more opportunity for 'seamless care'. Shared information systems enabled easy communication using internal messaging or email systems, and shared patient intake information. But beyond this infrastructure alignment for integrative health care was less supported. There were no use of protocols or guidelines within any centre, no patient monitoring mechanism beyond that which occurred within one-on-one appointments. Joint planning for a patient treatment was typically ad hoc through informal mechanisms. Additional duties typically come at a direct financial cost to fee-for-service practitioners. In contrast, service delivery and the process of care within hospital inpatient services followed a more formalised structure. Conclusions: IHC is a complex, emerging field with divergent meanings and interpretations. The structures and processes of the IHC entities reported provide insight to the variable ways in which IHC manifests whilst commonly holding a similar vision. This report contributes to understanding IHC, providing evidence for future planning, implementation and evaluation to meet patient needs and demands in this area. [ABSTRACT FROM AUTHOR]