The patient-centered medical home model: healthcare services utilization and cost for non-elderly adults with mental illness.

BACKGROUND: The patient-centered medical home (PCMH) model is designed to improve health outcomes while containing the cost of care. However, the evidence is inconclusive. AIMS: The aim of this study was to examine the associations between receipt of care consistent with the PCMH and healthcare services utilization and expenditures for non-elderly adults with mental illness in the USA. METHOD: A surveillance study was conducted using self-reported data for 6908 non-elderly adults with mental illness participating in the 2007-2012 Medical Expenditure Panel Survey. Healthcare services utilization and expenditures were compared for study participants who received care consistent with the PCMH, participants with a non-PCMH usual source of care (USC), and participants without a USC. RESULTS: Differences in utilization and expenditures between participants who received care consistent with the PCMH and participants who had a non-PCMH USC were not statistically significant for any healthcare services category. CONCLUSIONS: Receipt of care consistent with the PCMH was not significantly associated with differences in healthcare services utilization or expenditures compared to having a non-PCMH USC. Research assessing whether the PCMH is cost-effective for non-elderly adults with mental illness is needed.

Associations between the patient-centered medical home and preventive care and healthcare quality for non-elderly adults with mental illness: A surveillance study analysis.

BACKGROUND: Patient-centered medical homes (PCMHs) may improve outcomes for non-elderly adults with mental illness, but the extent to which PCMHs are associated with preventive care and healthcare quality for this population is largely unknown. Our study addresses this gap by assessing the associations between receipt of care consistent with the PCMH and preventive care and healthcare quality for non-elderly adults with mental illness. METHODS: This surveillance study used self-reported data for 6,908 non-elderly adults with mental illness participating in the 2007-2012 Medical Expenditure Panel Survey. Preventive care and healthcare quality measures included: participant rating of all healthcare; cervical, breast, and colorectal cancer screening; current smoking; smoking cessation advice; flu shot; foot exam and eye exam for people with diabetes; and follow-up after emergency room visit for mental illness. Multiple logistic regression models were developed to compare the odds of meeting preventive care and healthcare quality measures for participants without a usual source of care, participants with a non-PCMH usual source of care, and participants who received care consistent with the PCMH. RESULTS: Compared to participants without a usual source of care, those with a non-PCMH usual source of care had better odds of meeting almost all measures examined, while those who received care consistent with the PCMH had better odds of meeting most measures. Participants who received care consistent with the PCMH had better odds of meeting only one measure compared to participants with a non-PCMH usual source of care. CONCLUSIONS: Compared with having a non-PCMH usual source of care, receipt of care consistent with the PCMH does not appear to be associated with most preventive care or healthcare quality measures. These findings raise concerns about the potential value of the PCMH for non-elderly adults with mental illness and suggest that alternative models of primary care are needed to improve outcomes and address disparities for this population.

Eye tracking as a debriefing mechanism in the simulated setting improves patient safety practices.

INTRODUCTION: Human patient simulation has been widely adopted in healthcare education despite little research supporting its efficacy. The debriefing process is central to simulation education, yet alternative evaluation methods to support providing optimal feedback to students have not been well explored. Eye tracking technology is an innovative method for providing objective evaluative feedback to students after a simulation experience. The purpose of this study was to compare 3 forms of simulation-based student feedback (verbal debrief only, eye tracking only, and combined verbal debrief and eye tracking) to determine the most effective method for improving student knowledge and performance. METHODS: An experimental study using a pretest-posttest design was used to compare the effectiveness of 3 types of feedback. The subjects were senior baccalaureate nursing students in their final semester enrolled at a large university in the northeast United States. Students were randomly assigned to 1 of the 3 intervention groups. RESULTS: All groups performed better in the posttest evaluation than in the pretest. Certain safety practices improved significantly in the eye tracking-only group. These criteria were those that required an auditory and visual comparison of 2 artifacts such as "Compares patient stated name with name on ID band." CONCLUSIONS: Eye tracking offers a unique opportunity to provide students with objective data about their behaviors during simulation experiences, particularly related to safety practices that involve the comparison of patient stated data to an artifact such as an ID band. Despite the limitations of current eye tracking technology, there is significant potential for the use of this technology as a method for the study and evaluation of patient safety practices.

Use of a homecare electronic health record to find associations between patient characteristics and re-hospitalizations in patients with heart failure using telehealth.

Data from homecare electronic health records were used to explore the association of patient characteristics with re-hospitalizations of patients with heart failure (HF) during a 60-day period of telemonitoring following hospital discharge. Data from 403 Medicare patients with HF who had used telehealth from 2008 to 2010 were analysed. There were 112 all-cause (29%) and 73 cardiac-related (19%) re-hospitalizations within 60 days of the start of telemonitoring. In adjusted analyses, the patients' number of medications and type of cardiac medications were significantly (P < 0.05) associated with an increased risk of re-hospitalization. After stratifying the sample by illness severity, age and gender, other significant (P < 0.05) predictors associated with an increased risk of all-cause and cardiac re-hospitalization were psychiatric co-morbidity, pulmonary and obesity co-morbidities within gender, beta blocker prescription in females and primary HF diagnosis in the oldest age stratum. The study's findings may assist homecare agencies seeking to allocate resources without compromising patient care.

Association of comorbidities with home care service utilization of patients with heart failure while receiving telehealth.

BACKGROUND: Comorbidities adversely impact heart failure (HF) outcomes. Telehealth can assist healthcare providers, especially nurses, in guiding their patients to follow the HF regimen. However, factors, including comorbidity patterns, that act in combination with telehealth to reduce home care nursing utilization are still unclear. PURPOSE: The purpose of this article was to examine the association of the comorbidity characteristics of HF patients with nursing utilization along with withdrawal from telehealth service during an episode of tele-home care. METHODOLOGY: A descriptive, correlational study design using retrospective chart review was used. The sample comprised Medicare patients admitted to a New England home care agency who had HF as a diagnosis and had used telehealth from 2008 to 2010. The electronic documentation at the home care agency served as the data source, which included Outcome and Assessment Information Set data of patients with HF. Logistic and multiple regression analyses were used to analyze data. RESULTS: The sample consisted of 403 participants, of whom 70% were older than 75 years, 55% were female, and 94% were white. Comorbidities averaged 5.19 (SD, 1.92), ranging from 1 to 11, and nearly 40% of the participants had 5 or more comorbidities. The mean (SD) nursing contacts in the sample was 9.9 (4.7), ranging from 1 to 26, and 52 (12.7%) patients withdrew from telehealth service. For patients with HF on telehealth, comorbidity characteristics of anemia, anxiety, musculoskeletal, and depression were significantly associated with nursing utilization patterns, and renal failure, cancer, and depression comorbidities were significantly associated with withdrawal from telehealth service. CLINICAL IMPLICATIONS: Knowledge of the association of comorbidity characteristics with the home care service utilization patterns of patients with HF on telehealth can assist the home health nurse to develop a tailored care plan that attains optimal patient outcomes. Knowledge of such associations would also focus home care resources, avoiding redundancy of resource utilization in this era of strained healthcare resources.

Intentionality and hatha yoga: an exploration of the theory of intentionality, the matrix of healing--a growth model.

Hatha yoga increases self-awareness and well-being. Intentionality is creating motivation and then action. This qualitative study explored intentionality during hatha yoga sessions using narrative analysis. The results supported and expanded Zahourek's theory of intentionality, the matrix of healing, and provide new insights into intentionality in healing.

Research regarding methods of assessing learning outcomes.

As the use of simulation-based assessment expands for healthcare workers, there is a growing need for research to quantify the psychometric properties of the associated process and outcome measures.

Using simulated clinical scenarios to evaluate student performance.

Given the high financial investment that nursing education programs make to incorporate high-fidelity simulation training, it is important to evaluate its usefulness in student learning and evaluation. Faculty developed an evaluation tool for simulated clinical scenarios, using both high- and low-fidelity modalities that delineated components and their relative weights, adapted to match the changing expectations for evolving novices. The authors discuss scoring, debriefing, and remediation.

Error identification and recovery by student nurses using human patient simulation: opportunity to improve patient safety.

This study examined types of errors that occurred or were recovered in a simulated environment by student nurses. Errors occurred in all four rule-based error categories, and all students committed at least one error. The most frequent errors occurred in the verification category. Another common error was related to physician interactions. The least common errors were related to coordinating information with the patient and family. Our finding that 100% of student subjects committed rule-based errors is cause for concern. To decrease errors and improve safe clinical practice, nurse educators must identify effective strategies that students can use to improve patient surveillance.

Testing a work empowerment-work relationship model to explain expertise in experienced acute care nurses.

OBJECTIVE: This study tested the ability of work relationships and work empowerment to predict nursing expertise in experienced acute care nurses. BACKGROUND: With high patient acuity, constant system changes, and multiple changing members of the healthcare team, expert nurses are increasingly important to ensure positive patient outcomes in acute care settings. METHOD: This study was an exploratory, predictive correlational design with a stratified random sample of 115 staff nurses from a large tertiary care center. Data were collected on work empowerment, work relationships, and nursing expertise. RESULTS: A modified study model was supported in this sample of acute care nurses (R = 0.258, P = .000) and explained 26% of nurses' reported expertise. CONCLUSION: Work relationships explained the largest portion of the variance in nurses' reported expertise (16%), more than experience in the specialty (9%) with an indirect link between work empowerment and nursing expertise.

Patient and family education for fall prevention: involving patients and families in a fall prevention program on a neuroscience unit.

A neuroscience unit in an acute care hospital reported the highest number of falls among the inpatient units. Patient and family education for fall prevention on this unit was added to an existing multifactorial fall prevention program. Through this project, a new fall prevention poster was developed with patient, family, and staff involvement and disseminated throughout the hospital. Using the Plan-Do-Study-Act model to evaluate the project, there were no fall among the patients educated on fall prevention.

Providers do not verify patient identity during computer order entry.

INTRODUCTION: Improving patient identification (ID), by using two identifiers, is a Joint Commission safety goal. Appropriate identifiers include name, date of birth (DOB), or medical record number (MRN). OBJECTIVES: The objectives were to determine the frequency of verifying patient ID during computerized provider order entry (CPOE). METHODS: This was a prospective study using simulated scenarios with an eye-tracking device. Medical providers were asked to review 10 charts (scenarios), select the patient from a computer alphabetical list, and order tests. Two scenarios had embedded ID errors compared to the computer (incorrect DOB or misspelled last name), and a third had a potential error (second patient on alphabetical list with same last name). Providers were not aware the focus was patient ID. Verifying patient ID was defined as looking at name and either DOB or MRN on the computer. RESULTS: Twenty-five of 25 providers (100%; 95% confidence interval [CI] = 86% to 100%) selected the correct patient when there was a second patient with the same last name. Two of 25 (8%; 95% CI = 1% to 26%) noted the DOB error; the remaining 23 ordered tests on an incorrect patient. One of 25 (4%, 95% CI = 0% to 20%) noted the last name error; 12 ordered tests on an incorrect patient. No participant (0%, 0/107; 95% CI = 0% to 3%) verified patient ID by looking at MRN prior to selecting a patient from the alphabetical list. Twenty-three percent (45/200; 95% CI = 17% to 29%) verified patient ID prior to ordering tests. CONCLUSIONS: Medical providers often miss ID errors and infrequently verify patient ID with two identifiers during CPOE.

Human patient simulation: teaching students to provide safe care.

The use of human patient simulation as a teaching methodology for nursing students has become popular. Using human patient simulation effectively demands paying careful attention to the details of the simulation, debriefing, and evaluation processes. Our experience in designing simulation experiences and evaluating student behaviors confirms the resource-intensive nature of human patient simulation and the need for clear, measurable objectives. When used properly, human patient simulation offers a unique opportunity to teach nursing students important patient safety principles.

Measuring clinical practice parameters with human patient simulation: a pilot study.

Human Patient Simulators (HPS), electronically controlled mannequins as patient models, are increasingly being used in nursing education. However, no studies have validated the influence of systematic practice with HPS on clinical performance of nursing students. This pilot study attempted to identify the nursing clinical practice parameters influenced by HPS by evaluating the clinical performance of 12 senior second degree BSN students in five categories: safety, basic assessment skills, prioritization, problem-focused assessment, ensuing interventions, delegation and communication in a complex two-patient, simulated assignment. Students who practiced with the HPS in addition to their usual clinical training had significantly higher scores than the control group (usual clinical training alone) on Patient Identification (a subcategory of the safety category; p = 0.001), and on Assessing Vital Signs (a subcategory of the basic assessment category; p = 0.009). The control and intervention groups' performances were similar in every other category. Replication of this pilot with a larger sample is recommended.

A partnership between nursing education and practice: using an empowerment model to retain new nurses.

A school of nursing and a health system in Massachusetts developed a unique partnership to create a system to attract and retain new nurses in acute care. The structure of this partnership was designed to increase the faculty of the school of nursing and add to the educational expertise in the department of staff development in the health system's major acute care hospital. The process was developed using an empowerment model. The authors describe the structure, process, and outcomes of this partnership.