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  • 1
    Online Resource
    Online Resource
    Assessing Anticoagulation Management and Shared Decision-Making Documentation From Providers Participating in the SUPPORT-AF II Study
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Journal of Continuing Education in the Health Professions Vol. 40, No. 2 ( 2020), p. 76-80
    Details
    In: Journal of Continuing Education in the Health Professions, Ovid Technologies (Wolters Kluwer Health), Vol. 40, No. 2 ( 2020), p. 76-80
    Abstract: A previously tested intervention featured educational outreach with modified academic detailing (AD) to increase anticoagulation use in patients with atrial fibrillation. Currently, this study compares providers receiving and not receiving AD in terms of inclusion of AD educational topics and shared decision-making elements in documentation. Methods: Physicians reviewed themes discussed with providers during AD and evaluated charts for evidence of shared decision-making. Frequencies of documentation of individual items for providers receiving AD versus non-AD providers were compared. To understand baseline documentation practices of AD providers, encounters of AD providers before their AD participation were randomly selected. Results: There were 113 eligible encounters in the four months after AD—36 from AD providers and 77 from non-AD providers. Thirty-five encounters were identified from AD providers before participating in the intervention. Providers infrequently documented many reviewed items (% documenting): anticoagulation mentioned (44%), multiple options for anticoagulation (5%), CHA 2 DS 2 -VASc score (11%), bleeding risk factors (2%). Compared with non-AD providers, AD providers had statistically significant higher percentages for the following items: mention of anticoagulation (64% versus 35%), stroke risk (11% versus 0%), anticoagulation benefits (8% versus 0%), and patient involvement (17% versus 0%). There was no improvement, however, for AD providers compared with baseline documentation percentages. Discussion: Providers infrequently documented important items in anticoagulation management and shared decision-making. AD participation did not improve documentation. Improving adoption of AD educational items may require more prolonged interaction with providers. Improving shared decision-making may require an intervention more focused on it and its documentation.
    Type of Medium: Online Resource
    ISSN: 0894-1912 , 1554-558X
    URL: Article
    DOI: 10.1097/CEH.0000000000000293
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 2069156-7
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  • 2
    Online Resource
    Online Resource
    SUPPORT‐AF: Piloting a Multi‐Faceted, Electronic Medical Record‐Based Intervention to Improve Prescription of Anticoagulation
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Journal of the American Heart Association Vol. 7, No. 17 ( 2018-09-04)
    Details
    In: Journal of the American Heart Association, Ovid Technologies (Wolters Kluwer Health), Vol. 7, No. 17 ( 2018-09-04)
    Abstract: Only 50% of eligible atrial fibrillation ( AF ) patients receive anticoagulation ( AC ). Feasibility and effectiveness of electronic medical record (EMR)–based interventions to profile and raise provider AC percentage is poorly understood. The SUPPORT‐AF (Supporting Use of AC Through Provider Profiling of Oral AC Therapy for AF) study aims to improve rates of adherence to AC guidelines by developing and delivering supportive tools based on the EMR to providers treating patients with AF. Methods and Results We emailed cardiologists and community‐based primary care providers affiliated with our institution reports of their AC percentage relative to peers. We also sent an electronic medical record–based message to these providers the day before an appointment with an atrial fibrillation patient who was eligible but not receiving AC . The electronic medical record message asked the provider to discuss AC with the patient if he or she deemed it appropriate. To assess feasibility, we tracked provider review of our correspondence. We also tracked the change in AC for intervention providers relative to alternate primary care providers not receiving our intervention. We identified 3786, 1054, and 566 patients cared for by 49 cardiology providers, 90 community‐based primary care providers, and 88 control providers, respectively. At baseline, the percentage of AC was 71.3%, 63.5%, and 58.3% for these 3 respective groups. Intervention providers reviewed our e‐mails and electronic medical record messages 45% and 96% of the time, respectively. For providers responding, patient refusal was the most common reason for patients not being on AC (21%) followed by high bleeding risk (19%). At follow‐up 10 weeks later, change in AC was no different for either cardiology or community‐based primary care providers relative to controls (0.2% lower and 0.01% higher, respectively). Conclusions Our intervention profiling AC was feasible, but not sufficient to increase AC in our population.
    Type of Medium: Online Resource
    ISSN: 2047-9980
    URL: Article
    DOI: 10.1161/JAHA.118.009946
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 2653953-6
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  • 3
    Online Resource
    Online Resource
    Survey of confidence in use of stroke and bleeding risk calculators, knowledge of anticoagulants, and comfort with prescription of anticoagulation in challenging scenarios: SUPPORT-AF II study
    Springer Science and Business Media LLC ; 2019
    In:  Journal of Thrombosis and Thrombolysis Vol. 48, No. 4 ( 2019-11), p. 629-637
    Details
    In: Journal of Thrombosis and Thrombolysis, Springer Science and Business Media LLC, Vol. 48, No. 4 ( 2019-11), p. 629-637
    Type of Medium: Online Resource
    ISSN: 0929-5305 , 1573-742X
    URL: Article
    DOI: 10.1007/s11239-019-01950-6
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2019
    detail.hit.zdb_id: 2017305-2
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  • 4
    Online Resource
    Online Resource
    Communicating with patients about breakdowns in care: a national randomised vignette-based survey
    BMJ ; 2020
    In:  BMJ Quality & Safety Vol. 29, No. 4 ( 2020-04), p. 313-319
    Details
    In: BMJ Quality & Safety, BMJ, Vol. 29, No. 4 ( 2020-04), p. 313-319
    Abstract: Many patients are reluctant to speak up about breakdowns in care, resulting in missed opportunities to respond to individual patients and improve the system. Effective approaches to encouraging patients to speak up and responding when they do are needed. Objective To identify factors which influence speaking up, and to examine the impact of apology when problems occur. Design Randomised experiment using a vignette-based questionnaire describing 3 care breakdowns (slow response to call bell, rude aide, unanswered questions). The role of the person inquiring about concerns (doctor, nurse, patient care specialist), extent of the prompt (invitation to patient to share concerns) and level of apology were varied. Setting National online survey. Participants 1188 adults aged ≥35 years were sampled from an online panel representative of the entire US population, created and maintained by GfK, an international survey research organisation; 65.5% response rate. Main outcomes and measures Affective responses to care breakdowns, intent to speak up, willingness to recommend the hospital. Results Twice as many participants receiving an in-depth prompt about care breakdowns would (probably/definitely) recommend the hospital compared with those receiving no prompt (18.4% vs 8.8% respectively (p=0.0067)). Almost three times as many participants receiving a full apology would (probably/definitely) recommend the hospital compared with those receiving no apology (34.1% vs 13.6% respectively ((p 〈 0.0001)). Feeling upset was a strong determinant of greater intent to speak up, but a substantial number of upset participants would not ‘definitely’ speak up. A more extensive prompt did not result in greater likelihood of speaking up. The inquirer’s role influenced speaking up for two of the three breakdowns (rudeness and slow response). Conclusions Asking about possible care breakdowns in detail, and offering a full apology when breakdowns are reported substantially increases patients’ willingness to recommend the hospital.
    Type of Medium: Online Resource
    ISSN: 2044-5415 , 2044-5423
    URL: Article
    DOI: 10.1136/bmjqs-2019-009712
    Language: English
    Publisher: BMJ
    Publication Date: 2020
    detail.hit.zdb_id: 2592912-4
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  • 5
    Online Resource
    Online Resource
    Use of Electronic Health Record Access and Audit Logs to Identify Physician Actions Following Noninterruptive Alert Opening: Descriptive Study
    JMIR Publications Inc. ; 2019
    In:  JMIR Medical Informatics Vol. 7, No. 1 ( 2019-02-07), p. e12650-
    Details
    In: JMIR Medical Informatics, JMIR Publications Inc., Vol. 7, No. 1 ( 2019-02-07), p. e12650-
    Type of Medium: Online Resource
    ISSN: 2291-9694
    URL: Article
    DOI: 10.2196/12650
    Language: English
    Publisher: JMIR Publications Inc.
    Publication Date: 2019
    detail.hit.zdb_id: 2798261-0
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  • 6
    Online Resource
    Online Resource
    How Communication “Failed” or “Saved the Day”: Counterfactual Accounts of Medical Errors
    SAGE Publications ; 2020
    In:  Journal of Patient Experience Vol. 7, No. 6 ( 2020-12), p. 1247-1254
    Details
    In: Journal of Patient Experience, SAGE Publications, Vol. 7, No. 6 ( 2020-12), p. 1247-1254
    Abstract: Communication breakdowns among clinicians, patients, and family members can lead to medical errors, yet effective communication may prevent such mistakes. This investigation examined patients’ and family members’ experiences where they believed communication failures contributed to medical errors or where effective communication prevented a medical error (“close calls”). The study conducted a thematic analysis of open-ended responses to an online survey of patients’ and family members’ past experiences with medical errors or close calls. Of the 93 respondents, 56 (60%) provided stories of medical errors, and the remaining described close calls. Two predominant themes emerged in medical error stories that were attributed to health care providers—information inadequacy (eg, delayed, inaccurate) and not listening to or being dismissive of a patient’s or family member’s concerns. In stories of close calls, a patient’s or family member’s proactive communication (eg, being assertive, persistent) most often “saved the day.” The findings highlight the importance of encouraging active patient/family involvement in a patient’s medical care to prevent errors and of improving systems to provide meaningful information in a timely manner.
    Type of Medium: Online Resource
    ISSN: 2374-3735 , 2374-3743
    URL: Article
    DOI: 10.1177/2374373520925270
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2020
    detail.hit.zdb_id: 2857285-3
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  • 7
    Online Resource
    Online Resource
    SUPPORT-AF II: Supporting Use of Anticoagulants Through Provider Profiling of Oral Anticoagulant Therapy for Atrial Fibrillation : A Cluster-Randomized Study of Electronic Profiling and Messaging Combined With Academic Detailing for Providers Making Decisions About Anticoagulation in Patients With Atrial Fibrillation
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Circulation: Cardiovascular Quality and Outcomes Vol. 13, No. 2 ( 2020-02)
    Details
    In: Circulation: Cardiovascular Quality and Outcomes, Ovid Technologies (Wolters Kluwer Health), Vol. 13, No. 2 ( 2020-02)
    Abstract: Previous provider-directed electronic messaging interventions have not by themselves improved anticoagulation use in patients with atrial fibrillation. Direct engagement with providers using academic detailing coupled with electronic messaging may overcome the limitations of the prior interventions. Methods and Results: We randomized outpatient providers affiliated with our health system in a 2.5:1 ratio to our electronic profiling/messaging combined with academic detailing intervention. In the intervention, we emailed providers monthly reports of their anticoagulation percentage relative to peers for atrial fibrillation patients with elevated stroke risk (CHA 2 DS 2 -VASc ≥2). We also sent electronic medical record-based messages shortly before an appointment with an anticoagulation-eligible but untreated atrial fibrillation patient. Providers had the option to send responses with explanations for prescribing decisions. We also offered to meet with intervention providers using an academic detailing approach developed based on knowledge gaps discussed in provider focus groups. To assess feasibility, we tracked provider review of our messages. To assess effectiveness, we measured the change in anticoagulation for patients of intervention providers relative to controls. We identified 85 intervention and 34 control providers taking care of 3591 and 1908 patients, respectively; 33 intervention providers participated in academic detailing. More than 80% of intervention providers read our emails, and 98% of the time a provider reviewed our in-basket messages. Replies to messages identified patient refusal as the most common reason for patients not being on anticoagulation (11.2%). For the group of patients not on anticoagulation at baseline assigned to an intervention versus control provider, the adjusted percent increase in the use of anticoagulation over 6 months was 5.2% versus 7.4%, respectively ( P =0.21). Conclusions: Our electronic messaging and academic detailing intervention was feasible but did not increase anticoagulation use. Patient-directed interventions or provider interventions targeting patients declining anticoagulation may be necessary to raise the rate of anticoagulation. Clinical Trial Registration URL: http://www.clinicaltrials.gov . Unique identifier: NCT03583008.
    Type of Medium: Online Resource
    ISSN: 1941-7713 , 1941-7705
    URL: Article
    DOI: 10.1161/CIRCOUTCOMES.119.005871
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 2453882-6
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