Carol L. Ireson

Measuring outcomes in surgical patients

The current emphasis on quality of healthcare, cost effectiveness, and consumer satisfaction demands a better understanding of the relationship between the process of care and the outcomes of care. As patients become more active in defining healthcare quality, outcome measures are becoming increasingly patient focused. To meet these new demands for understanding the process-outcomes relationship, there exists a tremendous need for physician involvement in developing outcomes assessment programs. Such programs are best designed through the cooperative efforts of clinicians and outcomes statisticians. Advances in outcomes assessment will require a combination of increased precision in measurement, greater analysis of outliers, and the development of computerized repositories of clinical and health status data.

Bridging the care continuum: patient information needs for specialist referrals

BackgroundInformation transfer is critical in the primary care to specialist referral process and has been examined extensively in the US and other countries, yet there has been little attention to the patients perspective of the information transfer process. This cross-sectional study examined the quality of the information received by patients with a chronic condition from the referring and specialist physician in the specialist referral process and the relationship of the quality of information received to trust in the physicians.MethodsStructured telephone interviews were conducted with a random sample of 250 patients who had experienced a referral to a specialist for the first visit for a chronic condition within the prior six months. The sample was selected from the patients who visited specialist physicians at any of the 500 hospitals from the National Research Corporation client base.ResultsMost patients (85%) received a good explanation about the reason for the specialist visit from the referring physician yet 26% felt unprepared about what to expect. Trust in the referring physician was highly associated with the preparatory information patients received. Specialists gave good explanations about diagnosis and treatment, but 26% of patients got no information about follow-up. Trust in the specialist correlated highly with good explanations of diagnosis, treatment, and self-management.ConclusionPreparatory information from referring physicians influences the quality of the referral process, the subsequent coordination of care, and trust in the physician. Changes in the health care system can improve the information transfer process and improve coordination of care for patients.

Defining elements of success: a critical pathway of coalition development.

In recent decades, coalitions have been established to address many public health problems, including injury prevention. A partnership among the Kentucky Injury Prevention and Research Center and four injury prevention coalitions has documented the developmental stages of successful coalitions. This developmental process was constructed through the analysis of participating coalition documents, such as each coalitions mission statement, bylaws or rules of operation, the use of committees within the organization, frequency of meetings, and additional historical documents. Themes from this analysis guided researchers in designing a critical pathway model that describes milestones in coalition formation. Critical components in coalition formation include a clear definition of the coalition structure, coalition enhancement, funding, community support, leadership, education and outreach to the community, membership, partnerships, data and evaluation, and publicity. These findings are applicable to public health professionals who work with community-based coalitions and citizens who participate in local coalitions.

The Use of Photovoice as a Method of Facilitating Deliberation

Efforts have been made in one rural Appalachian county to broaden local participation in a community health assessment. Through a series of community forums and a photovoice project, residents named community health needs and assets, framed potential solutions, and selected possible action steps to improve the local health status. Photographs and narratives from the photovoice project supplemented information from preliminary health forums to devise a framework of possible solutions to the identified health problems. Analysis of forum transcripts suggests that participants who used an issue guide that used photovoice images and stories were able to transition from broad approaches of change to specific action steps more than participants in other forums who used a more traditional forum issue guide. Community members are more easily able to identify solutions to local health issues when forum discussions are informed by local images and narratives.

Child advocacy outreach: using telehealth to expand child sexual abuse services in rural Kentucky.

We evaluated the use of videoconferencing as an educational and consultative tool for physicians and mental health staff providing services for child victims of sexual abuse in rural Kentucky. The number of counties with access to sexual abuse examinations by a qualified physician increased from 16 to 23 in the first year and to 54 in the second. The number of cases increased from 77 to 83 in the first year and to 339 in the second year. The number of consultations increased from zero to eight in the first year and to 74 in the second year. A user survey showed that the equipment supported clinical decision making, was useful and was easy to use. However, it was not as effective for case conferencing as for one-to-one interactions. Rural health professionals knowledge of child sexual abuse increased.

Public health competencies required by managed care organizations.

The authors developed a list of population-based public health competencies. They surveyed the chief executive officer, chief medical officer, and chief quality control person at a randomly selected group of managed care organizations drawn from the membership of the American Association of Health Plans. The authors asked them to rank those competencies that were essential for them in their work with their organization. The authors identified both the most commonly required competencies across all groups and the most essential for each specific job in the managed care organization. This article discusses these competencies and their implications for those who are responsible for ensuring that graduates have achieved required competencies.