Ari H. Pollack

Closing the Gap: Supporting Patients' Transition to Self-Management after Hospitalization

Patients going home after a hospitalization face many challenges. This transition period exposes patients to unnecessary risks related to inadequate preparation prior to leaving the hospital, potentially leading to errors and patient harm. Although patients engaging in self-management have better health outcomes and increased self-efficacy, little is known about the processes in place to support and develop these skills for patients leaving the hospital. Through qualitative interviews and observations of 28 patients during and after their hospitalizations, we explore the challenges they face transitioning from hospital care to self-management. We identify three key elements in this process: knowledge, resources, and self-efficacy. We describe how both system and individual factors contribute to breakdowns leading to ineffective patient management. This work expands our understanding of the unique challenges faced by patients during this difficult transition and uncovers important design opportunities for supporting crucial yet unmet patient needs.

Not Just a Receiver: Understanding Patient Behavior in the Hospital Environment

Patient engagement leads to better health outcomes and experiences of health care. However, existing patient engagement systems in the hospital environment focus on the passive receipt of information by patients rather than the active contribution of the patient or caregiver as a partner in their care. Through interviews with hospitalized patients and their caregivers, we identify ways that patients and caregivers actively participate in their care. We describe the different roles patients and caregivers assume in interacting with their hospital care team. We then discuss how systems designed to support patient engagement in the hospital setting can promote active participation and help patients achieve better outcomes.

Automated Screening of Hospitalized Children for Influenza Vaccination

BACKGROUND This study was designed to determine whether an automated hospital-based influenza vaccination screening program leveraging the electronic medical record (EMR) increases vaccination rates. METHODS We performed a retrospective cohort study of all children ≥6 months old admitted to medical, surgical, rehabilitation, or psychiatry services during influenza seasons between 2003 and 2012 at a tertiary care pediatric hospital. We compared influenza vaccination rates before (preintervention phase) and after (intervention phase) the introduction of an automated EMR intervention that utilized a nursing-based electronic screening tool to determine eligibility for influenza vaccine and facilitated vaccine ordering without requiring involvement of a physician or other provider. RESULTS Overall, 42 716 (72.8%) of the 58,648 subjects admitted during the study period met inclusion criteria. The intervention phase included 20,651 admissions, of which 11 194 (54.2%) were screened. Screening increased significantly over time in the intervention phase (19.8%-77.1%; P < .001). In-hospital influenza vaccination rates increased from a mean of 2.1% (n = 472) of all subjects preintervention phase to 8.0% (n = 1645) in the intervention phase (odds ratio = 6.8; 95% confidence interval, 6.14-7.47). Of the 11 194 screened subjects, 5505 (49.2%) were found to have already been vaccinated at the time of screening. The screening process identified 478 (4.3%) subjects who were unable to receive vaccine for medical reasons, and an additional 2865 (25.6%) whose caregiver refused the vaccine. CONCLUSIONS An automated, hospital-based influenza vaccination program integrated into the EMR can increase vaccinations of hospitalized patients and provide insight into the vaccination history and declination reasons for children not receiving the vaccine.

Opportunities and Design Considerations for Peer Support in a Hospital Setting

Although research has demonstrated improved outcomes for outpatients who receive peer support-such as through online health communities, support groups, and mentoring systems-hospitalized patients have few mechanisms to receive such valuable support. To explore the opportunities for a hospital-based peer support system, we administered a survey to 146 pediatric patients and caregivers, and conducted semi-structured interviews with twelve patients and three caregivers in a childrens hospital. Our analysis revealed that hospitalized individuals need peer support for five key purposes: (1) to ask about medical details-such as procedures, treatments, and medications; (2) to learn about healthcare providers; (3) to report and prevent medical errors; (4) to exchange emotional support; and (5) to manage their time in the hospital. In this paper, we examine these themes and describe potential barriers to using a hospital-based peer support system. We then discuss the unique opportunities and challenges that the hospital environment presents when designing for peer support in this setting.

You Can’t Treat a Problem if You Don’t Recognize It

* Abbreviations: AAP — : American Academy of Pediatrics BP — : blood pressure CDS — : clinical decision support In 2004, The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents was released by the National Institutes of Health1 with the intention of providing a clear set of guidelines to help clinicians identify and treat childhood hypertension. Despite the increased attention paid to childhood hypertension since then, most children and adolescents with elevated blood pressure (BP) still go unrecognized and undiagnosed during clinical encounters.2,3 There are likely many contributing factors that lead to the underrecognition of pediatric hypertension,3 but the fact that clinicians providing care to children and adolescents do not have a simple, single BP value to reference creates significant complexity for what should be a relatively straightforward problem. Various approaches to this problem have been proposed, ranging from creation of a simplified table of BP values to automated display of BP percentiles within the electronic health record.4,5 Most recently, in the American Academy of Pediatrics’ (AAP) 2017 “Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents,” a simplified table was … Address correspondence to Joseph T. Flynn, MD, MS, FAAP, Division of Nephrology, Seattle Children’s Hospital, Mail Stop: OC.9.820, 4800 Sand Point Way NE, Seattle, WA 98105-0371. E-mail: joseph.flynn{at}seattlechildrens.org

Aligning Pediatric Ambulatory Needs with Health IT

Primary motivations for health IT adoption, from a federal policy level, are to improve quality and reduce costs in health care. In ambulatory care, incentive alignment among stakeholders is a major obstacle. While patients and payors benefit from adoption, it is the practices and provider groups that must bear the burdens of financial investment, workflow redesign, and organizational change. Even for institutions and practices skilled in managing the necessary changes, the task of health IT adoption is risky (Table 17.1).