Journal of evaluation in clinical practice
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Care transitions between hospitals and skilled nursing facilities (SNFs) are often associated with breakdowns in communication that may place patients at risk for adverse events. Less is known about how to address these issues in the context of busy patient care settings. We used process mapping to examine hospital discharge and SNF admission processes to identify opportunities for improvement. ⋯ Process mapping highlighted specific opportunities for improving communication between care teams. Participants advocated for earlier assessments of patients' functional status and support systems, including reliable at-home services. They also reasoned that improved communication would help patients and providers reach decisions together, coordinate work efforts, and better prepare for hospital discharge and SNF admission. This information can be used to improve patient care transitions between hospitals and SNFs.
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Patient involvement is increasingly recognized as a key component on the international health care agenda. This attention has brought a need for developing generic and standardized open-source methods, tools, and guidelines on how to systematically implement patient involvement initiatives in the clinical setting. The large-scale project the User-involving Hospital was initiated to implement two systematic methods for patient involvement at a Danish university hospital, but the required methods can only be implemented if embraced by the health professionals. This evaluation study aimed to explore the health professional perspective on the development and implementation of shared decision making (SDM) and user-led health care. Specifically, the objectives were to identify the most crucial preconditions for success and to translate the findings into practice recommendations. ⋯ The findings draw attention to several significant factors for successful implementation of large-scale patient involvement initiatives in hospitals, including the importance of having both a top-down and bottom-up approach and of active listening to the patients' perspectives. On the basis of these findings, the study outlines four recommendations incorporating the five identified key domains, which may inspire future projects on systematic development and implementation of patient-involvement initiatives based on either shared decision making or user-led health care in the clinical setting.
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Pain is a subjective experience that must be translated by clinicians into an objective assessment to guide intervention. ⋯ A persistent challenge to pain assessment and management is how clinicians reconcile a patient's subjective self-reported experience with their own clinical assessment and personal biases. Future work should explore these themes from the patient perspective.
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Few studies focus on patients' views on factors influencing implementation of patient decision aids (PDAs). This study aims to explore patients' views on the factors influencing implementation of an "insulin choice" PDA in a primary care setting. ⋯ Patients want physicians to play a major role in the implementation of the insulin PDA; physicians' communication style and commitment may influence implementation outcomes. Health care authorities need to create a conducive environment and provide patients with free access to PDA to promote effective implementation.
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The predominant assumption of doctor professionalism may be prone to unpredicted alterations in the face of "a new age of doctoring." The aim in this study is to explore one dimension in the doctor-patient dyadic relationship: the face-to-face interaction between doctors and patients and whether satisfaction of role expectations affects service outcomes as perceived by the patient-consumer. ⋯ Role expectations play a moderating role between emotions and service outcomes. The medical performance can be perceived good or bad depending on whether the doctor smiles "too much" or not. Results are discussed within the context of role expectation theory and the changing nature of service relationships in the health care sector.