Elizabeth Shuster

The impact of a group psychoeducational appointment on women with sexual dysfunction.

OBJECTIVE There is little evidence to support many treatment modalities for women with sexual dysfunction. Cognitive-behavioral therapy and bibliotherapy are associated with improved sexual outcomes. We evaluated the impact of a group psychoeducational intervention on sexual function outcome measures in women with sexual concerns. STUDY DESIGN Women with concerns of sexual function were referred to a group sexuality appointment. Before the visit, the women completed the Female Sexual Function Index (FSFI). Class participants completed the FSFI at 1-, 3-, and 6-months after the intervention to evaluate changes in sexual function. RESULTS Thirty-three women attended the group appointment between January and December 2006. Twenty-five women with an age range from 28-70 years completed a demographic and baseline FSFI questionnaire. All participants showed a baseline FSFI score indicating sexual dysfunction. At least 1 postclass FSFI was completed by 64% of participants. Significant improvement in most FSFI domain scores and the full scale score (P = .0073) was seen in these women. CONCLUSION Participating in a group sexuality appointment improved quantitative outcome measures in women with sexual dysfunction. This intervention may provide an effective means for womens health care clinicians with limited time and expertise about sexual function to meet the needs of their patients with sexual concerns.

Long-term persistence of quality improvements for an intensive care unit communication initiative using the VALUE strategy.

PURPOSE Communication in the intensive care unit (ICU) is an important component of quality ICU care. In this report, we evaluate the long-term effects of a quality improvement (QI) initiative, based on the VALUE communication strategy, designed to improve communication with family members of critically ill patients. MATERIALS AND METHODS We implemented a multifaceted intervention to improve communication in the ICU and measured processes of care. Quality improvement components included posted VALUE placards, templated progress note inclusive of communication documentation, and a daily rounding checklist prompt. We evaluated care for all patients cared for by the intensivists during three separate 3 week periods, pre, post, and 3 years following the initial intervention. RESULTS Care delivery was assessed in 38 patients and their families in the pre-intervention sample, 27 in the post-intervention period, and 41 in follow-up. Process measures of communication showed improvement across the evaluation periods, for example, daily updates increased from pre 62% to post 76% to current 84% of opportunities. CONCLUSIONS Our evaluation of this quality improvement project suggests persistence and continued improvements in the delivery of measured aspects of ICU family communication. Maintenance with point-of-care-tools may account for some of the persistence and continued improvements.

Association of patient-reported care coordination with patient satisfaction.

Little is known about the relationship between care coordination directly assessed from the patients perspective and patient satisfaction. This study applied multiple logistic regression models to examine associations between patient-reported care coordination and patient satisfaction among 1367 patients with diabetes. We found robust positive relationship between care coordination and patient satisfaction with overall chronic care (odds ratio [OR] = 1.78), ones regular doctor (OR = 1.85), and the way care was organized (OR = 1.98). Implications for health plans, providers, and future research are discussed.

Association of Dental Care with Adherence to HEDIS Measures

CONTEXT The dental setting represents an unrealized opportunity to increase adherence to preventive services and improve health outcomes. OBJECTIVE To compare adherence to a subset of Healthcare Effectiveness Data and Information Set (HEDIS) measures among a population that received dental care with a population that did not receive dental care. DESIGN Using a retrospective cohort design, we identified 5216 adults who received regular dental care and 5216 persons who did not. The groups were matched on propensity scores, were followed for 3 years, and retained medical and dental benefits. Receipt of dental care was defined as 1 or more dental visits in each 12-month period. MAIN OUTCOME MEASURES Outcome measures were assessed in a subpopulation that qualified for 1 of 5 HEDIS denominator groups (dental = 4184 patients; nondental = 3871 patients). They included 3 preventive measures (cervical, colorectal, and breast cancer screening), 4 chronic disease management services (hemoglobin A1c and low-density lipoprotein cholesterol testing, and nephropathy and retinopathy screening among the diabetes mellitus [DM] population), and 4 health outcome measures (poor glycemic control, low-density lipoprotein cholesterol control, blood pressure control in the DM population, and blood pressure control in the hypertensive population). RESULTS Dental care was associated with higher adherence to all three cancer screening measures, one of four disease management services (higher retinopathy screening), and three of four health outcomes (better glycemic control in the DM population and better blood pressure control in the DM and hypertensive populations). CONCLUSIONS Dental care was associated with improved adherence to 7 of 11 HEDIS measures.

Assessment of willingness to pay for expanded carrier screening among women and couples undergoing preconception carrier screening

Background Expanded carrier screening can provide risk information for numerous conditions. Understanding how individuals undergoing preconception expanded carrier screening value this information is important. The NextGen study evaluated the use of genome sequencing for expanded carrier screening and reporting secondary findings, and we measured participants’ willingness to pay for this approach to understand how it is valued by women and couples planning a pregnancy. Methods We assessed 277 participants’ willingness to pay for genome sequencing reporting carrier results for 728 gene/condition pairs and results for 121 secondary findings. We explored the association between attitudes and demographic factors and willingness to pay for expanded carrier screening using genome sequencing and conducted interviews with 58 of these participants to probe the reasoning behind their preferences. Results Most participants were willing to pay for expanded carrier screening using genome sequencing. Willingness to pay was associated with income level and religiosity, but not risk status for a condition in the carrier panel. Participants willing to pay nothing or a small amount cited issues around financial resources, whereas those willing to pay higher amounts were motivated by “peace of mind” from carrier results. Conclusion Women and couples planning a pregnancy value genome sequencing. The potentially high out-of-pocket cost of this service could result in healthcare disparities, since maximum amounts that participants were willing to pay were higher than a typical copay and related to income.