Improving Patient Portal Activation for Newborns in the Well Baby Nursery.

BACKGROUND: Patient portals provide parents access to their child's health information and direct communication with providers. Our study aimed to improve portal activation rates of newborns during nursery hospitalization to >70% over 6 months. Secondarily, we describe the facilitators and barriers to portal use. METHODS: The study design used a mixed-methodology framework of quality improvement (QI) and cross-sectional analyses. The Model for Improvement guided QI efforts. The primary outcome was the proportion of portals activated for newborns during nursery hospitalization. Interventions included portal activation algorithm, staff huddles, and documentation templates. Telephone interviews were conducted with a randomized sample of mothers of infants who activated the portal. These mothers were divided into portal "users" and "nonusers." We examined sociodemographic variables and health care utilization outcomes in the 2 groups. RESULTS: Portal activation increased from 12.9% to 85.4% after interventions. Among 482 mothers with active portals, 127 (26.3%) were interviewed. Of those, 70% (89 of 127) reported using the portal, and 85.4% (76 of 89) found it useful. Reasons for accessing the portal included checking appointments and reviewing test results. Lack of knowledge of portal functionality was the main barrier to portal use (42.1%). Portal users were less likely to have a no-show to primary care appointments compared with nonusers (44.9% versus 78.9%, P < .001). CONCLUSIONS: Portal activation rates increased after QI interventions in the nursery. Most parents accessed the portal and found it useful. Portals can improve health care delivery and patient engagement in the newborn period.

Factors Influencing Social and Community Participation of People with Spinal Cord Injury in Karnataka, India.

Background: Social and community participation are major indicators to assess the adequacy of treatment and rehabilitation in patients with spinal cord injury (SCI). This study examined the relationship between functional independence, level of disability, and social and community participation among people with SCI in India. Materials and Method: In this cross sectional study, 110 persons with SCI, aged 18 years and above participated in a community setting, in Karnataka, India. Spinal Cord Independence Measure Version III-self-reporting (SCIM III-SR), Craig Handicap Assessment and Reporting Technique (CHART), and WHO Disability Assessment Schedule 2.0 (WHODAS) were the clinical outcome measures. Spearman's correlation and stepwise multiple linear regression were done to determine association and identify the factors determining the community participation of people with SCI. Results: CHART physical independence had a positive correlation with SCIM self-care (R = 0.446) and SCIM mobility (r = 0.434). CHART cognitive independence (R = -0.38) and CHART mobility (R = -0.396) had a weak correlation with WHODAS. SCIM self-care and SCIM mobility (R2 = 0.34) were determinants of CHART cognitive independence. SCIM respiratory and sphincter management and SCIM self-care (R2 = 0.327) were determinants of CHART mobility. Conclusion: Self-care and mobility of people with SCI determine their ability to successfully reintegrate into the community, warranting a comprehensive community rehabilitation program.

Patient handling in India-Evidence from a pilot study.

BACKGROUND: Manual handling forms an important part of a health care worker's daily routine. Faulty techniques may result in musculoskeletal injuries in health workers and further injury to patients. OBJECTIVES: In our study, we assessed the techniques of patient moving and handling by health care workers in our hospital. Our aim was to educate them on standard moving and handling techniques and assess the impact of the same. METHODS: We carried out a time-bound prospective clinical audit wherein we observed workers in the emergency department for a period of 2 weeks to evaluate their moving and handling techniques. This was followed by a training session where the workers were trained in "best-practices," and a 2-week period of reevaluation to assess compliance with standard practices. RESULTS: During bed-to-bed transfers, we found improvements in the following seven parameters after the training session: (a) the use of good posture, (b) the use of wheel stoppers, (c) adjustment of bed height, (d) positioning the receiving bed parallel to patient's bed, (e) general risk assessment before transferring a patient, (f) involvement of at least three carers, and (g) the use of a standard command like "GO" before the transfer. CONCLUSION: Apart from serving the purpose of an audit, our study has revealed that the training of health care providers in safe moving and handling of patients is a neglected subject in India.