Views and perspectives toward implementing the Global Spine Care Initiative (GSCI) model of care, and related spine care program by the people in Cross Lake, Northern Manitoba, Canada: a qualitative study using the Theoretical Domain Framework (TDF).

BACKGROUND: Back pain is very common and a leading cause of disability worldwide. Due to health care system inequalities, Indigenous communities have a disproportionately higher prevalence of injury and acute and chronic diseases compared to the general Canadian population. Indigenous communities, particularly in northern Canada, have limited access to evidence-based spine care. Strategies established in collaboration with Indigenous peoples are needed to address unmet healthcare needs, including spine care (chiropractic and movement program) services. This study aimed to understand the views and perspectives of Cross Lake community leaders and clinicians working at Cross Lake Nursing Station (CLNS) in northern Manitoba regarding the implementation of the Global Spine Care Initiative (GSCI) model of spine care (MoC) and related implementation strategies. METHOD: A qualitative exploratory design using an interpretivist paradigm was used. Twenty community partners were invited to participate in semi-structured interviews underpinned by the Theoretical Domains Framework (TDF) adapted to capture pertinent information. Data were analyzed deductively and inductively, and the interpretation of findings were explored in consultation with community members and partners. RESULTS: Community leaders (n = 9) and physicians, nurses, and allied health workers (n = 11) emphasized: 1) the importance of contextualizing the MoC (triaging and care pathway) and proposed new services through in-person community engagement; 2) the need and desire for local non-pharmacological spine care approaches; and 3) streamlining patient triage and CLNS workflow. Recommendations for the streamlining included reducing managerial/administrative duties, educating new incoming clinicians, incorporating follow-up appointments for spine pain patients, and establishing an electronic medical record system along with a patient portal. Suggestions regarding how to sustain the new spine care services included providing transportation, protecting allocated clinic space, resolving insurance coverage discrepancies, addressing misconceptions about chiropractic care, instilling the value of physical activity for self-care and pain relief, and a short-term (30-day) incentivised movement program which considers a variety of movement options and offers a social component after each session. CONCLUSION: Community partners were favorable to the inclusion of a refined GSCI MoC. Adapting the TDF to unique Indigenous needs may help understand how best to implement the MoC in communities with similar needs.

Care at a distance: Understanding lived experiences of people with MSK disorders receiving non-pharmacological interventions delivered through synchronous telehealth: A systematic rapid review.

Background: Little is known about lived experience of synchronous telehealth in patients with musculoskeletal (MSK) disorders. Objective: We conducted a rapid systematic review to answer: (1) what are the lived experiences and/or perspectives of people with MSK disorders receiving non-pharmacological interventions delivered through synchronous telehealth; and (2) what clinical implications can be inferred from qualitative studies focusing on lived experiences for how telehealth is delivered in the management of MSK disorders? Data sources: A comprehensive search of MEDLINE, CINAHL, PsycINFO, ProQuest, and Google Scholar from June 2010 to July 2023. Eligible qualitative and mixed methods studies capturing lived experiences of adults with MSK disorders receiving non-pharmacological interventions via synchronous telehealth were included. Study methods: Systematic rapid review conducted according to WHO guidelines. Titles and abstracts screened by reviewers independently, eligible studies critically appraised, and data was extracted. Themes summarized using the Consolidated Framework for Implementation Research (CFIR). GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) used to assess confidence in synthesis findings. Results: We identified 9782 references, screened 8029, and critically appraised 22, and included 17 studies. There is evidence to suggest that the experience of telehealth prior to and during the pandemic was shaped by (1) patient perception of telehealth, (2) existing relationships with practitioners, (3) availability and accessibility of telehealth technologies, and (4) perceptions about the importance of the role of the physical exam in assessing and treating MSK disorders. Conclusion: The five identified implications could be used to inform future research, policy, and strategy development.

Information is power: a qualitative study exploring the lived experiences of patients with degenerative cervical radiculopathy.

ABSTRACT: Degenerative cervical radiculopathy (DCR) can lead to severe pain, paraesthesia, and/or motor weakness, resulting in significant morbidity, disability, and reduced quality of life. Typically, individuals suffer from prolonged symptoms, with time to complete recovery spanning months to years. Little is known about the impact DCR has on peoples' lives. Therefore, this study aimed to explore the everyday experiences of individuals living with DCR. A qualitative study was conducted through an interpretivist lens exploring the experiences of participants. Participants were purposefully recruited and interviewed with 2 research team members. Transcripts were independently analyzed by 2 reviewers and coding was finalized by consensus. Analysis was performed using an interpretative phenomenological approach, with emergent themes mapped onto the 5 domains of the International Classification of Functioning, Disability and Health framework. Eleven participants were interviewed between December 2021 and April 2022. Three themes emerged: the biopsychosocial impact of DCR, role of the health care provider, and uncertainty surrounding DCR. Pain and paraesthesia were the most common symptoms experienced by participants, leading to significant psychological distress and impact to daily activities, most notably driving, housecleaning, sleep, and ability to work. Participants described the uncertainty they experienced as a result of the unpredictable nature of DCR and the important role that health care providers play in their journey with DCR. Health care providers were seen acting as either a facilitator or a barrier to their recovery. The findings from this study can be used by clinicians providing patient-centered care to better understand the experiences of people with DCR.

It might take a village: developing a rehabilitation program of care for degenerative cervical radiculopathy from the patient perspective.

PURPOSE: The aim of our study is to inform the development of a rehabilitation program of care from the perspectives of those suffering from degenerative cervical radiculopathy (DCR). MATERIAL AND METHODS: We conducted a qualitative study, purposefully recruiting individuals with DCR. Transcripts from virtual semi-structured interviews were iteratively analyzed using interpretative phenomenological methods. RESULTS: Eleven participants were recruited and depicted their ideal rehabilitation program of care. Participants described the importance of a patient centered-approach, health care providers who were validating, reassuring and attentive, easier access to health services, a supportive and collaborative team environment, and receiving peer support. Furthermore, participants expressed that they would expect the program of care to result in their symptoms being less intense and intermittent. In consideration of the participant perspectives, the ideal rehabilitation program of care can be conceptualized by the enactive-biopsychosocial model, which provides a theoretical framework for developing and implementing the program of care. CONCLUSION: We obtained valuable information from individuals living with DCR regarding their preferences and expectations of a rehabilitation program of care. The participant descriptions will provide the groundwork for its development to meet patient needs and expectations. Future research to guide implementation will also be explored.

The lives of those suffering from cervical radiculopathy are significantly impacted.Incorporating patient perspectives in the development of care plans can lead to the inclusion of interventions considered patient-centered and may improve implementation, adherence, and outcomes.Participants described their preferences and expectations of a rehabilitation program of care that may assist in its future development to meet patient needs and expectations.From participants' perspectives, the ideal rehabilitation program of care would be framed by the enactive-biopsychosocial model, thus providing a theoretical context for its development and implementation.

Problematic Risk Adjustment in National Healthcare Safety Network Measures.

This article reviews the risk-adjustment models underpinning the National Healthcare Safety Network (NHSN) standardized infection ratios. After first describing the models, the authors focus on hospital intensive care unit (ICU) designation as a variable employed across the various risk models. The risk-adjusted frequency with which ICU services are reported in Medicare fee-for-service claims data was compared as a proxy for determining whether reporting of ICU days is similar across hospitals. Extreme variation was found in the reporting of ICU utilization among admissions for congestive heart failure, ranging from 25% in the lowest admission hospital quartile to 95% in the highest. The across-hospital variation in reported ICU utilization was found to be unrelated to patient severity. Given that such extreme variation appears in a designation of ICU versus non-ICU utilization, the NHSN risk-adjustment models' dependence on nursing unit designation should be a cause for concern.

Care in context: Becoming an STS researcher.

This collaborative article, written by graduate students who attended the Politics of Care in Technoscience Workshop, brings the themes in this volume to bear on their own developing science and technology study projects and research practices. Exploring the contours of five specific moments where questions of care have arisen in the course of their everyday research, they do not find a single or untroubled definition of care; instead, care is often a site of ambivalence, tension, and puzzlement. However, despite this uneasiness, they argue that taking the time to reflect on the multiple, sometimes conflicting, forms and definitions of care within a specific research context can inform the way that science and technology studies scholars envision and conduct their work.

Indications of biased risk adjustment in the hospital readmission reduction program.

The Centers for Medicare and Medicaid Services hospital readmission reduction program administers substantial penalties to hospitals with excess readmissions. In our analysis of Medicare claims data, we find hospitals with the highest percentages of patients with several chronic conditions and advanced age have excess readmission ratios that are overstated because of inadequate risk adjustment. The distribution of chronic conditions and age is sufficient to cause 4.5% (heart failure), 6.2% (pneumonia), and 13.8% (acute myocardial infarction) of high disproportionate share hospitals to inappropriately receive penalties out of keeping with the intent of the hospital readmission reduction program. We believe that the risk adjustment model underlying the HRRP requires urgent independent review.