Laura A. Hanyok

Effects of a Focused Patient-Centered Care Curriculum on the Experiences of Internal Medicine Residents and their Patients

BACKGROUNDTraditional residency training may not promote competencies in patient-centered care.AIMTo improve residents’ competencies in delivering patient-centered care.SETTING/PARTICIPANTSInternal medicine residents at a university-based teaching hospital in Baltimore, Maryland.PROGRAM DESCRIPTIONOne inpatient team admitted half the usual census and was exposed to a multi-modal patient-centered care curriculum to promote knowledge of patients as individuals, improve patient transitions of care, and reduce barriers to medication adherence.PROGRAM EVALUATIONAnnual resident surveys (N = 40) revealed that the intervention was judged as professionally valuable (90%) and important to their training (90%) and offered experiences not available during other rotations (88%). Compared to standard inpatient rotation evaluations (n = 163), intervention rotation evaluations (n = 51) showed no differences in ratings for traditional medical learning, but higher ratings for improving how housestaff address patient medication adherence, communicate with patients about post-hospital transition of care, and know their patients as people (all p < 0.01). On post-discharge surveys, patients from the intervention team (N = 177, score 90.4, percentile ranking 97%) reported greater satisfaction with physicians than patients on standard teams (N = 924, score 86.1, percentile ranking 47%) p < 0.01).DISCUSSIONA patient-centered inpatient curriculum was associated with higher satisfaction ratings in patient-centered domains by internal medicine residents and with higher satisfaction ratings of their physicians by patients. Future research will explore the intervention’s impact on clinical outcomes.

Effects of a graduate-level interprofessional education program on adult nurse practitioner student and internal medicine resident physician attitudes towards interprofessional care

Abstract This article describes the development, implementation and evaluation of a longitudinal interprofessional education (IPE) experience for adult nurse practitioner students and internal medicine residents. This experience focused on providing care for complex community based patients during clinic and home visits, preceded by didactic learning that emphasized understanding one another’s professional roles and education, teamwork and conflict management. Evaluation demonstrated significant improvements in attitudes and beliefs associated with professional role, respect among health professions’ disciplines and conflict management. Results with regards to attitudes towards IPE and interprofessional practice, and valuing teamwork training were mixed. In particular, the curricular intervention did not change participants’self-reported skill in communication and did not affect attitudes and beliefs towards effects of interprofessional education on patient outcomes.

Practicing Patient-Centered Care

Background and ObjectivePatient-centered care, which is dependent on knowing each patient as an individual, has been identified as a critical aspect of healthcare. The most effective and efficient methods to get to know patients as individuals have not been defined. Our aim was to identify questions and phrases that can be used by physicians to get to know their patients.MethodsWe surveyed 15 physicians who have been formally recognized for their clinical excellence to determine what questions or phrases they use when interviewing patients to get to know them as individuals.ResultsA total of 28 questions or phrases were received from 13 physicians and were qualitatively analyzed and grouped into six major themes: (i) appreciation of the patient’s concerns; (ii) personal relationships; (iii) hobbies and pleasurable activities; (iv) open-ended questions to learn about the patient; (v) work; and (vi) the patient’s perspective on the patient-physician relationship.ConclusionThis work identifies questions and phrases used by clinically excellent physicians to get to know their patients as people. Future work should focus on obtaining the perspectives of patients, and on examining whether using the identified questions and phrases results in an improved patient experience as demonstrated by improved satisfaction ratings, ratings on the quality of physician-patient interaction, or patient outcomes.

Telephone calls to patients after discharge from the hospital: an important part of transitions of care

Background Teaching interns patient-centered communication skills, including making structured telephone calls to patients following discharge, may improve transitions of care. Objective To explore associations between a patient-centered care (PCC) curriculum and patients’ perspectives of the quality of transitional care. Methods We implemented a novel PCC curriculum on one of four inpatient general medicine resident teaching teams in which interns make post-discharge telephone calls to patients, contact outpatient providers, perform medication adherence reviews, and engage in patient-centered discharge planning. Between July and November of 2011, we conducted telephone surveys of patients from all four teaching teams within 30 days of discharge. In addition to asking if patients received a call from their hospital physician (intern), we administered the 3-Item Care Transitions Measure (CTM-3), which assesses patients’ perceptions of preparedness for the transition from hospital to home (possible score range 0–100). Results The CTM-3 scores (mean±SD) of PCC team patients and standard team patients were not significantly different (82.4±17.3 vs. 79.6±17.6, p=0.53). However, regardless of team assignment, patients who reported receiving a post-discharge telephone call had significantly higher CTM-3 scores than those who did not (84.7±16.0 vs. 78.2±17.4, p=0.03). Interns exposed to the PCC curriculum called their patients after discharge more often than interns never exposed (OR=2.78, 95% CI [1.25, 6.18], p=0.013). Conclusions The post-discharge telephone call, one element of PCC, was associated with higher CTM-3 scores – which, in turn, have been shown to lessen patients’ risk of emergency department visits within 30 days of discharge.

Practicing patient-centered care: the questions clinically excellent physicians use to get to know their patients as individuals.

BACKGROUND AND OBJECTIVE Patient-centered care, which is dependent on knowing each patient as an individual, has been identified as a critical aspect of healthcare. The most effective and efficient methods to get to know patients as individuals have not been defined. Our aim was to identify questions and phrases that can be used by physicians to get to know their patients. METHODS We surveyed 15 physicians who have been formally recognized for their clinical excellence to determine what questions or phrases they use when interviewing patients to get to know them as individuals. RESULTS A total of 28 questions or phrases were received from 13 physicians and were qualitatively analyzed and grouped into six major themes: (i) appreciation of the patients concerns; (ii) personal relationships; (iii) hobbies and pleasurable activities; (iv) open-ended questions to learn about the patient; (v) work; and (vi) the patients perspective on the patient-physician relationship. CONCLUSION This work identifies questions and phrases used by clinically excellent physicians to get to know their patients as people. Future work should focus on obtaining the perspectives of patients, and on examining whether using the identified questions and phrases results in an improved patient experience as demonstrated by improved satisfaction ratings, ratings on the quality of physician-patient interaction, or patient outcomes.