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Introduction: Emerging evidence from private sector hospitals indicates that a chief well-being officer (CWO) can be an impactful role to lead organizational burnout mitigation efforts in health care systems. A descriptive process evaluation was conducted to learn about facilitators and barriers of integrating this role within the Veterans Health Administration (VA). A pilot intervention inclusive of three domains—culture of well-being, efficiency of practice, and personal resilience—was implemented. Method: Eight VA medical centers and two regional network offices received 18 months of implementation support from October 2021 to March 2023. Appointed CWOs were tasked with implementing key interventions in at least two work units at each location. Administrative records were used to track implementation progress. Surveys were administered to participating work units pre- and postintervention to assess changes in key measures. Qualitative interviews elicited information about intervention implementation including barriers and facilitators. Results: Not formally hiring CWOs in the role resulted in limited time to work on intervention implementation. This was insufficient and it impacted their ability to truly function in the role. Several work units experienced multiple challenges and were unable to implement the full intervention. Despite these challenges, when examining work unit changes, improvements in culture of health and well-being and change readiness were observed. Conclusion: The results support the importance of a formalized CWO role; however, findings highlight important factors that must be addressed for successful integration of role to drive intervention effectiveness. Comprehensive interventions addressing both system- and individual-level drivers of burnout show promise for improving VA workforce well-being but warrant further study. Public Significance Statement: Public and private health care systems have made significant investments in initiatives to mitigate burnout and foster clinician well-being, including establishing executive-level wellness leadership roles with the responsibility to strategically embed such efforts within the organizational culture. Very little information has been published that provides guidance on how wellness leaders can implement organization-wide interventions to foster well-being and demonstrate effectiveness. Our results suggest that contextual factors, including site readiness, executive leadership active engagement, dedicated resources (including staff), and relative priority, may impact successful implementation of such efforts. [ABSTRACT FROM AUTHOR]

Daddi Fadel Center for Ocular Research & Education (CORE), School of Optometry & Vision Science, University of Waterloo, Waterloo, ON, CanadaCorrespondence: Daddi Fadel, Tel +1 (226) 899 7801, Email daddi.fadel@uwaterloo.caAbstract: In recent years, advanced diagnostic instruments have become widely available in optometric practices, offering various functions that optimize clinical information gathering. This article focuses on the Medmont Meridia™, a state-of-the-art multipurpose diagnostic device with corneal topography and cutting-edge features. Corneal topography is pivotal in the early diagnosis of corneal disorders, determining baseline ocular surface assessment, helping in contact lens fitting, and monitoring ocular health over time. The Medmont Meridia boasts Placido-disc-based imaging with extensive corneal coverage. Furthermore, the Meridia accurately measures the horizontal visible iris diameter, pupil diameter, and palpebral fissure width, which assists in making contact lens parameter decisions. Additionally, it offers sagittal height data for scleral lens design and first lens selection, streamlining the fitting process. Beyond its topography capabilities, the Meridia excels as a comprehensive dry eye assessment tool. With features like tear meniscus height, tear film surface quality, and meibography capabilities, it aids in diagnosing dry eye and monitoring its progression. The device also provides customizable dry eye reports with integrated grading scales and questionnaires, making dry eye management, patient education, and compliance more accessible. In conclusion, the Medmont Meridia consolidates a multitude of examination tools in a single instrument, enhancing practice efficiency and elevating patient care and communication. Its versatility and accuracy make it an invaluable asset in optometric practices worldwide.Keywords: corneal topography, multipurpose devices, dry eye disease, dry eye assessment, diagnostic instruments, ocular health monitoring, contact lens fitting, practice efficiency

We studied the effect of peer- and self-observational feedback versus coaching feedback during technique training on performance in competitive adolescent cross-country skiers. Fifty-four skiers (14.3 ± 0.6 years) were divided into a control group and three intervention groups (dyad practice, video, or coaching feedback), which practiced in the asymmetrical uphill sub-technique G2 on one side (non-dominant side), but not the other (dominant side) for 6 x 30 min over a 5 weeks period, on roller skis outdoors. High-speed performance and skiing economy were assessed on a roller ski treadmill before and after the intervention, and a questionnaire was answered post-intervention. The video feedback (p = .025, d = .65) and coaching feedback (p = .007, d = .89) groups improved high-speed performance during the intervention and an ANCOVA showed a tendency for different change scores between interventions (F3,49 = 2.5, p = .068, η²p = .134), with a difference between the coaching feedback and dyad practice (p = .05). No change was seen in skiing economy in any group. Coaching feedback ranked higher on enjoyment compared with dyad practice (p < .001) and led to higher self-perception of improved technique compared with the control group (p = .038). Overall, feedback from a competent coach seems better than observation for improving performance in young athletes, although self-observation through video with attentional cues seems a promising tool for increasing individual feedback when coaching large groups. [ABSTRACT FROM AUTHOR]

Aim: Novel treatment options for relapsed/refractory diffuse large B-cell lymphoma include T-cell targeting therapies. Practice efficiency and cost are important for informed treatment decisions. Materials/methods: An institutional decision-maker cost model was developed for 6-month, 1-year and median cycles of treatment time horizons comparing practice efficiency and costs of epcoritamab vs glofitamab and axicabtagene ciloleucel (axi-cel). Results: Overall, epcoritamab required the shortest personnel and chair time, except over 1 year (second shortest chair time). Across all time horizons, epcoritamab was cost-saving vs axi-cel and had similar costs to glofitamab on a per-month basis. Conclusion: Epcoritamab reduced personnel and chair time. Additionally, epcoritamab was cost-saving vs axi-cel and had similar costs to glofitamab on a per-month basis.

The article presents a joint opinion from the American College of Cardiology, American Heart Association, European Society of Cardiology, and World Heart Federation, on global needs for improvements in the health care field. Topics discussed include drivers of burnout and its consequences, focus of health care organizations, and role of medical specialty societies.

Doctoring is difficult mental work, involving many cognitively demanding processes such as diagnosing, decision-making, parallel processing, communicating, and managing the emotions of others. According to cognitive load theory (CLT), working memory is a limited cognitive resource that can support a finite amount of cognitive load. While the intrinsic cognitive load is the innate load associated with a task, the extraneous load is generated by inefficiency or suboptimal work conditions. Causes of extraneous cognitive load in healthcare include inefficiency, distractions, interruptions, multitasking, stress, poor communication, conflict, and incivility. High levels of cognitive load are associated with impaired function and an increased risk of burnout among physicians. Cognitive ergonomics is the branch of human factors and ergonomics (HFE) focused on supporting the cognitive processes of individuals within a system. In health care, where the cognitive burden on physicians is high, cognitive ergonomics can establish practices and systems that decrease extraneous cognitive load and support pertinent cognitive processes. In this review, we present cognitive ergonomics as a useful framework for conceptualizing an oft-overlooked dimension of labor and apply theory to practice by summarizing evidence-based cognitive ergonomics interventions for outpatient care settings. Our proposed interventions are structured within four general recommendations: 1. minimize distractions, interruptions, and multitasking; 2. optimize the use of the electronic health record (EHR); 3. optimize the use of health information systems (HIS); and 4. support good communication and teamwork. Best practices in cognitive ergonomics can benefit patients, minimize practice inefficiency, and support physician career longevity., Competing Interests: The authors have declared financial relationships, which are detailed in the next section., (Copyright © 2023, Li-Wang et al.)

Background In a previous study we reported on the impact of point-of-care testing (POCT) on practice efficiency in an academic primary care practice that was established to develop new models of care delivery. Here we report a follow-on confirmation study in a more typical primary care practice in the community. Methods In this observational study with a retrospective comparison analysis we measured metrics of practice efficiency on two patient cohorts: those that did not receive POCT and those that did. Results In the patient cohort that received POCT there was a 99% reduction in letters to patients (p < 0.001), a 75% decrease in calls to patients (not significant due to small numbers), a 50% reduction in follow-up tests per visit (p = 0.044) and a 38% reduction in follow-up visits due to abnormal test results (p = 0.178). Financial analysis including testing costs, revenues and efficiency gains to the practice demonstrated a net financial benefit of $11.90–14.74 per patient visit. Conclusions Our data confirm the earlier published findings that POCT can improve metrics of practice efficiency in a primary care practice. [ABSTRACT FROM AUTHOR]

An innovative interprofessional model is described for the delivery of dental care in the year 2026 to optimize efficiency and profitability while enhancing quality of care. Background The dental practice of tomorrow may look different than today. Although not broken, the current system can be improved in efficiency and effectiveness. Although traditional private practices will continue to exist and many will thrive over the next decades, they may not present the optimal model for dental practice. To manage complex patient needs, a more collaborative model of multidisciplinary, interprofessional clinical teams capable of treating patients comprehensively has been suggested by the authors. They explore an alternative model of practice that may be possible in the next 10 years to better serve patients and improve outcomes while honoring the role of practitioners. Methods Landmark publications and reviews are used to examine evidence showing the potential benefits of an innovative interprofessional approach to the delivery of care in the oral health care setting. Conclusions By examining key studies, the authors provide commentary on the potential for enhanced efficiency, profitability, and quality of care in the oral health care setting through a collaborative model of multidisciplinary, interprofessional clinical teams capable of treating patients comprehensively. [ABSTRACT FROM AUTHOR]

Objectives: Point-of-care laboratory testing (POCT) offers reduced turnaround time and may promote improved operational efficiency. Few studies have been reported that document improvements from implementing POCT in primary care. Methods: We measured metrics of practice efficiency in a primary care practice before and after implementation of POCT, including the total number of tests ordered, letters and phone calls to patients, and revisits due to abnormal test results. We performed a cost and revenue analysis. Results: Following implementation of POCT, there was a 21% decrease in tests ordered per patient (P < .0001); a decrease in follow-up phone calls and letters by 89% and 85%, respectively (P < .0001 and P < .0001); and a 61% decrease in patient revisits (P = .0002). Estimated testing revenues exceeded expenses by $6.62 per patient, and potential cost savings from improved efficiency were $24.64 per patient. Conclusions: POCT can significantly improve clinical operations with cost reductions through improved practice efficiency. [ABSTRACT FROM AUTHOR]

This study examined the impact of expanded function allied dental personnel on the productivity and efficiency of general dental practices. Detailed practice financial and clinical data were obtained from a convenience sample of 154 general dental practices in Colorado. In this state, expanded function dental assistants can provide a wide range of reversible dental services/procedures, and dental hygienists can give local anesthesia. The survey identified practices that currently use expanded function allied dental personnel and the specific services/procedures delegated. Practice productivity was measured using patient visits, gross billings, and net income. Practice efficiency was assessed using a multivariate linear program, Data Envelopment Analysis. Sixty-four percent of the practices were found to use expanded function allied dental personnel, and on average they delegated 31.4 percent of delegatable services/procedures. Practices that used expanded function allied dental personnel treated more patients and had higher gross billings and net incomes than those practices that did not; the more services they delegated, the higher was the practice's productivity and efficiency. The effective use of expanded function allied dental personnel has the potential to substantially expand the capacity of general dental practices to treat more patients and to generate higher incomes for dental practices. [ABSTRACT FROM AUTHOR]

Various models of cancer genetics service delivery have been published, and practice guidelines were set forth by the National Society of Genetic Counselors (NSGC) in 2004. While the demand for services has increased, there has not been a comprehensive study of current practice models. An online survey of the NSGC Familial Cancer Risk Counseling Special Interest Group was conducted to study current methods of providing clinical cancer genetics services. Respondents were asked to quantify patient volume, support staff availability, and physician involvement in cases. Two case examples were used to further describe current practices including the number of genetic counseling tasks performed, time spent in these tasks, and number of in-person visits versus phone encounters. Although published cancer genetic counseling guidelines advise a 3-visit model (initial consult, sample draw, and result disclosure), 29.3% of respondents have adopted a 1-visit model, where the sample is drawn at the first visit and phone disclosure replaces the third visit. The content of the initial consult does not vary significantly, and is consistent with the NSGC practice guidelines. Furthermore, 56% report spending >15 min on case preparation, and 27 respondents self-reported redundancy in tasks such as documentation. It appears that a proportion of genetic counselors are following a new model of service delivery. However, insufficient documentation and case preparation are apparent, and many respondents reported lack of support staff as a barrier to efficient patient care. Factors contributing to the variability in current practice, and how they affect efficiency, require further study. [ABSTRACT FROM AUTHOR]

Objectives: To quantify labor and time expended, resources used, and the net impact on patient throughput and staff time (from the institution's perspective) associated with short-acting (epoetin alfa) and long-acting (darbepoetin alfa) erythropoietin stimulating proteins (ESPs). Design: Prospective time/motion assessment and retrospective chart review of patient visits and resources used. Setting: Single hospital-based ambulatory oncology clinic. Methods: Time and motion measurements related to patient treatment and drug preparation were collected for (1) patient check-in; (2) phlebotomy; (3) laboratory processing; (4) pharmacist assessment/counseling; and (5) ESP preparation, administration, and documentation, ESP use for 266 chemotherapy cycles administered between August 1, 2003 and March 31, 2004 was grouped as epoetin alfa only and darbepoetin alfa only. Results: For 313 observed events, the mean total time Calculated for the 5 prespecified activities associated with a visit for ESP administration was 55.4 minutes, of which pharmacy assessment/counseling was responsible for the majority of time expended (22.6 min). A significant (23%) reduction in the number of mean visits per cycle was recorded for the darbepoetin alfa group (P < 0.001, resulting in 1 less visit per average chemotherapy cycle). This difference remained statistically different (42% reduction; P < 0.001) when the mean number of visits specifically for ESP administration was compared between the darbepoetin alfa and epoetin alfa groups. Darbepoetin alfa recipients also received significantly fewer doses of ESP per cycle compared with those given epoetin alfa (P < 0.001). The use of darbepoetin alfa saved the clinic 125 hours of staff/patient time per cycle with a potential of 120 hours/cycle additional savings if the epoetin alfa patients had received this long-acting ESP. During calendar year 2004, 610 patients received a red-cell growth factor following chemotherapy for a solid tumor. These patients represent an average of 3,660 cycles of chemotherapy per year. The reduction in visits (i/cycle) with long-acting ESP, at 55.4 minutes of staff time per visit, will potentially result in avoidance of 3,379.4 hours of staff time or 1.62 full-time equivalents per year. Conclusions: Patient office visits for ESP administration are associated with significant time for clinic staff. A long-acting ESP, such as darbepoetin alfa, may enable significant time savings for clinic staff and providers by reducing the number of necessary visits for ESP administration. The time Saved also provides an opportunity to reallocate staff to perform additional supportive care activities. [ABSTRACT FROM AUTHOR]

In this study, we present preliminary data on the effect of automated 3D image alignment on the time to arrive at a decision about an imaging finding, the agreement of multiple of multiple observers, the prevalence of comparison examinations, and technical success rates for the image alignment algorithm. We found that automated image alignment reduced the average time to make a decision by 25% for cases where the structures are rigid, and when the scanning protocol is similar. For cases where these are not true, there is little or no benefit. In our practice, 54% of cases had prior examinations that could be automatically aligned. The overall benefit seen in our department for highly similar exams might be 20% for neuro and 10% for body; the benefit seen in other practices is likely to vary based on scanning practices and prevalence of prior examinations. [ABSTRACT FROM AUTHOR]

To investigate whether different risk-adjustment methodologies and economic profiling or “practice efficiency” metrics produce differences in practice efficiency rankings for a set of primary care physicians (PCPs). Twelve months of claims records (inpatient, outpatient, professional, and pharmacy) for an independent practice association HMO. Patient risk scores obtained with six profiling risk-adjustment methodologies were used in conjunction with claims cost tabulations to measure practice efficiency of all primary care physicians who managed 25 or more members of an HMO. For each of the risk-adjustment methodologies, two measures of “efficiency” were constructed: the standardized cost difference between total observed (standardized actual) and total expected costs for patients managed by each PCP, and the ratio of the PCP's total observed to total expected costs (O/E ratio). Primary care physicians were ranked from most to least efficient according to each risk-adjusted measure, and level of agreement among measures was tested using weighted kappa. Separate rankings were constructed for pediatricians and for other primary care physicians. Moderate to high levels of agreement were observed among the six risk-adjusted measures of practice efficiency. Agreement was greater among pediatrician rankings than among adult primary care physician rankings, and, with the standardized difference measure, greater for identifying the least efficient than the most efficient physicians. The O/E ratio was shown to be a biased measure of physician practice efficiency, disproportionately targeting smaller sized panels as outliers. Although we observed moderate consistency among different risk-adjusted PCP rankings, consistency of measures does not prove that practice efficiency rankings are valid, and health plans should be careful in how they use practice efficiency information. Indicators of practice efficiency should be based on the standardized cost difference, which controls for number of patients in a panel, instead of O/E ratio, which does not. [ABSTRACT FROM AUTHOR]