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Background Evidence-based interventions to reduce hospital readmissions may not generalize to resource-constrained safety-net hospitals. Objective To determine if an intervention by patient navigators (PNs), hospital-based Community Health Workers, reduces readmissions among high risk, low socioeconomic status patients. Design Randomized controlled trial. Participants General medicine inpatients having at least one of the following readmission risk factors: (1) age ≥60 years, (2) any in-network inpatient admission within the past 6 months, (3) length of stay ≥3 days, (4) admission diagnosis of heart failure, or (5) chronic obstructive pulmonary disease. The analytic sample included 585 intervention patients and 925 controls. Interventions PNs provided coaching and assistance in navigating the transition from hospital to home through hospital visits and weekly telephone outreach, supporting patients for 30 days post-discharge with discharge preparation, medication management, scheduling of follow-up appointments, communication with primary care, and symptom management. Main Measures The primary outcome was in-network 30-day hospital readmissions. Secondary outcomes included rates of outpatient follow-up. We evaluated outcomes for the entire cohort and stratified by patient age >60 years (425 intervention/584 controls) and ≤60 years (160 intervention/341 controls). Key Results Overall, 30-day readmission rates did not differ between intervention and control patients. However, the two age groups demonstrated marked differences. Intervention patients >60 years showed a statistically significant adjusted absolute 4.1 % decrease [95 % CI: −8.0 %, -0.2 %] in readmission with an increase in 30-day outpatient follow-up. Intervention patients ≤60 years showed a statistically significant adjusted absolute 11.8 % increase [95 % CI: 4.4 %, 19.0 %] in readmission with no change in 30-day outpatient follow-up. Conclusions A patient navigator intervention among high risk, safety-net patients decreased readmission among older patients while increasing readmissions among younger patients. Care transition strategies should be evaluated among diverse populations, and younger high risk patients may require novel strategies.

Background Patient participation is key in person-centred care, emphasizing individual choices in treatment. Oral health, integral to overall well-being, is sometimes a neglected part of health. This intervention introduces a novel approach to strengthen person-centred care in homecare settings, employing collaborative, interprofessional teamwork and shared documentation across care organizations. This protocol outlines the design of a cluster-randomized controlled trial (RCT) in Sweden, comparing traditional oral assessments with an interorganizational, team-based oral health care planning model facilitated by a shared digital platform for documentation. The overall aim is to evaluate a person-centred interprofessional and interorganizational model for oral health care planning supported by a digital platform to enable healthy ageing. Methods/design The intervention, co-designed with older adults, academic institutions, healthcare providers in public dental care, and municipal organizations, will undergo ethical approval. The RCT will randomize older adults, dental hygienists (DHs) and nursing assistants (NAs) into two groups. The intervention group will attend a two-day workshop on a person-centred, three-step team-based model, while the control group will continue using standard procedures. Thereafter, the three-step collaborative model will be compared to standard procedures. Primary outcomes will be measured using the Revised Oral Assessment Guide (ROAG) and the General Oral Health Assessment Index (GOHAI). Secondary outcomes include health economic evaluations, participation rates and quality of care assessments. Qualitative studies from theoretical perspectives of change and learning based on interviews with key stakeholders will be conducted in both the test and control groups. Discussion Taking a co-produced approach where theory and practice shape the research iteratively, a person-centred health care planning model supported by a shared digital platform for home settings is evaluated. Anticipated outcomes include improved oral assessments and a deeper understanding of effective person-centred care practices. The co-produced approach of the intervention is also expected to further develop knowledge regarding co-production within domains of healthy ageing from an oral health perspective. As such, the intervention shapes and fosters co-produced person-centred care and healthy ageing. Trial registration ClinicalTrials.gov NCT06310798. Registered on 13 March 2024.

\"When Dr. Jack Cochran took over leadership of the Colorado Permanente Medical Group in the mid-1990s, he oversaw high-quality medical teams providing excellent care, but dealt with organizational troubles so deep rooted that patients and physicians fled in droves. In The Doctor Crisis, Cochran, now executive director of The Permanente Federation, and author Charles Kenney show how we can improve health care on a grass roots level, regardless of political policy disputes, by improving conditions for physicians and asking them to take on broader accountability. Doctors, they argue, are the key to making health care in the United States truly great, and we must do all we can to preserve and enhance the careers of physicians. They clarify the steps needed to take to support doctors so that they can focus on patient care, and offer concrete ideas for creating an environment and establishing systems that encourage doctors to put patients' needs above all else\"--Provided by publisher.

Purpose This study assessed the feasibility of implementing a novel model of integrated prostate cancer care involving an online prostate cancer-specific holistic needs assessment (sHNA) and shared digital communication between patients and their healthcare professionals (HCPs). The sHNA produces a semi-automated care plan that is finalised in consultation between the patient and their practice nurse. Methods Men living with and beyond prostate cancer were invited to participate in a 9-month non-randomised cluster controlled feasibility study. The intervention group was asked to complete the sHNA on three occasions. Data were collected using Patient Reported Outcome Measures (PROMs) at baseline, 10 and 24 weeks, and 9 months. Outcomes included recruitment, retention, acceptability, and engagement with the sHNA and PROMs. Results Fourteen general practices (8 intervention and 6 control), and 41 men (29 intervention and 12 control) participated. Initial patient engagement with the sHNA was high, with all but one receiving practice nurse-led follow-up and an individualised care plan. The sHNA proved useful in identifying ‘red flag’ symptoms, and helping practice nurses decide when to seek further medical care for the patients. There was a high level of acceptability for patients and HCPs. However, integration of care did not occur as intended because of problems linking hospital and general practice IT systems. Conclusion While the study demonstrated the feasibility of implementing the sHNA, it did not meet the a priori progression criteria; as such, undertaking a definitive randomised controlled trial is not appropriate until the identified methodological and technical issues have been addressed.

\"In Clinical Supervision of Psychoanalytic Psychotherapy, psychotherapy supervisors from the fields of psychology, psychiatry, social work, and dance movement therapy deal with the ambiguity and complexity of the supervisory role. They attend to the need to establish open, respectful verbal and non-verbal communication, a trusting relationship, a shared language, and a commitment to examining unconscious conflict in the supervisory encounter as well as the patient-therapist dynamics. The contributors show how the supervisor makes room for the supervisee to express her anxieties without becoming her therapist, thereby providing a model for empathic listening but within appropriate boundaries. They also describe the many ways in which the therapist's issues reflect or are triggered by those of the patient, are further reflected in the dynamics of the supervisory pair, and in the institution where supervisee and supervisor work. The contributors approach task, boundary, focus, and interaction in supervision from multiple vertices - research, analytic sensibility, group process, bodily and artistic expression, cross-cultural challenges, and individual teaching and learning in clinical supervision. A clear picture emerges of the qualities that characterize the good supervisor for any psychotherapist. The volume concludes with a list of further reading for those who must educate themselves and those who are inspired to establish a course or training program in analytic psychotherapy supervision.\"--Publisher's website.

Background Women Veterans’ numerical minority, high rates of military sexual trauma, and gender-specific healthcare needs have complicated implementation of comprehensive primary care (PC) under VA’s patient-centered medical home model, Patient Aligned Care Teams (PACT). Objective We deployed an evidence-based quality improvement (EBQI) approach to tailor PACT to meet women Veterans’ needs and studied its effects on women’s health (WH) care readiness, team-based care, and burnout. Design We evaluated EBQI effectiveness in a cluster randomized trial with unbalanced random allocation of 12 VAMCs (8 EBQI vs. 4 control). Clinicians/staff completed web-based surveys at baseline (2014) and 24 months (2016). We adjusted for individual-level covariates (e.g., years at VA) and weighted for non-response in difference-in-difference analyses for readiness and team-based care overall and by teamlet type (mixed-gender PC-PACTs vs. women-only WH-PACTs), as well as post-only burnout comparisons. Participants We surveyed all clinicians/staff in general PC and WH clinics. Intervention EBQI involved structured engagement of multilevel, multidisciplinary stakeholders at network, VAMC, and clinic levels toward network-specific QI roadmaps. The research team provided QI training, formative feedback, and external practice facilitation, and support for cross-site collaboration calls to VAMC-level QI teams, which developed roadmap-linked projects adapted to local contexts. Main Measures WH care readiness (confidence providing WH care, self-efficacy implementing PACT for women, barriers to providing care for women, gender sensitivity); team-based care (change-readiness, communication, decision-making, PACT-related QI, functioning); burnout. Key Results Overall, EBQI had mixed effects which varied substantively by type of PACT. In PC-PACTs, EBQI increased self-efficacy implementing PACT for women and gender sensitivity, even as it lowered confidence. In contrast, in WH-PACTs, EBQI improved change-readiness, team-based communication, and functioning, and was associated with lower burnout. Conclusions EBQI effectiveness varied, with WH-PACTs experiencing broader benefits and PC-PACTs improving basic WH care readiness. Lower confidence delivering WH care by PC-PACT members warrants further study. Trial Registration The data in this paper represent results from a cluster randomized controlled trial registered in ClinicalTrials.gov (NCT02039856).

Provides a business model based on the UCLA Health System and explains how other businesses can use the same system to provide excellent customer experiences and dominate their industry.

ImportanceThough interprofessional bedside rounds have been promoted to enhance patient-centred care for hospitalised patients, few studies have been conducted in adult hospital settings and evidence of impact is lacking.ObjectiveTo evaluate the effect of patient-centred bedside rounds (PCBRs) on measures of patient-centred care.Design and settingCluster randomised controlled trial involving four similar non-teaching hospitalist service units in a large urban hospital.ParticipantsHospitalised general medical patients.InterventionWe assembled working groups on two intervention units, consisting of professionals and patient/family members, to determine the optimal timing, duration and format for PCBR. Nurses and hospitalists rounded together in PCBR using a communication tool to provide a framework for discussion and unit leaders joined PCBR to provide coaching during initial weeks of implementation.Main outcomesUsing patient interviews, we assessed preferred and experienced roles in medical decision-making using the Control Preferences Scale, activation using the Short Form of the Patient Activation Measure, and satisfaction. We also compared postdischarge patient satisfaction survey items related to teamwork, involvement in decisions and overall care. We assessed nurses’, physicians’ and advanced practice providers’ (APP) perceptions of PCBR using a survey developed for this study.ResultsOverall, 650 patients were approached for structured interview during hospitalisation: 284 were excluded because of disorientation, 54 were excluded because of non-English language, 72 declined to participate and 4 withdrew from the study after enrolment. Interview data were available for 236 (122 control and 114 intervention unit) patients, and postdischarge satisfaction survey data were available for 493 (274 control and 219 intervention unit) patients. We found no significant differences in patients’ perceptions of shared decision-making, activation or satisfaction with care. Results were similar in analyses based on whether PCBR had been performed (ie, per protocol). We also found no difference in postdischarge patient satisfaction items. Results were similar in multivariate analyses controlling for patient characteristics and clustering of patients within study units. A majority of nurses (78.6%), but only about half of hospitalist physicians and APPs felt that PCBR improved communication with patients (47.4%). A minority of nurses (46.4%) and physicians and APPs (36.8%) agreed that PCBR had improved the efficiency of their workday.ConclusionsPCBR had no impact on patients’ perceptions of shared decision-making, activation or satisfaction with care. Additional research is needed to identify optimal approaches that can be reliably implemented in hospital settings to improve patient-centred care.