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Objective: To summarize the predictors and outcomes of empathy by health care personnel, methods used to study their empathy, and the effectiveness of interventions targeting their empathy, in order to advance understanding of the role of empathy in health care and facilitate additional research aimed at increasing positive patient care experiences and outcomes. Data Source: We searched MEDLINE, MEDLINE In-Process, Psyclnfo, and Business Source Complete to identify empirical studies of empathy involving health care personnel in English-language publications up until April 20, 2021, covering the first five decades of research on empathy in health care (1971-2021). Study Design: We performed a systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Data Collection/Extraction Methods: Title and abstract screening for study eligibility was followed by full-text screening of relevant citations to extract study information (e.g., study design, sample size, empathy measure used, empathy assessor, intervention type if applicable, other variables evaluated, results, and significance). We classified study predictors and outcomes into categories, calculated descriptive statistics, and produced tables to summarize findings. Principal Findings: Of the 2270 articles screened, 455 reporting on 470 analyses satisfied the inclusion criteria. We found that most studies have been survey-based, cross-sectional examinations; greater empathy is associated with better clinical outcomes and patient care experiences; and empathy predictors are many and fall into five categories (provider demographics, provider characteristics, provider behavior during interactions, target characteristics, and organizational context). Of the 128 intervention studies, 103 (80%) found a positive and significant effect. With four exceptions, interventions were educational programs focused on individual clinicians or trainees. No organizational-level interventions (e.g., empathy-specific processes or roles) were identified. Conclusions: Empirical research provides evidence of the importance of empathy to health care outcomes and identifies multiple changeable predictors of empathy. Training can improve individuals' empathy; organizational-level interventions for systematic improvement are lacking. KEYWORDS empathy, health personnel, impact, intervention, patient experience, systematic review, 1 | INTRODUCTION A good patient care experience is a core component of patient-centered care (1) and thus quality health care. (2) A positive care experience has occurred when patients [...]

Objective: To examine the feasibility of soliciting outcomes from adults who received chemotherapy treatment for cancer and describe the patterns and correlates of patient-reported toxicities. Data Sources: Patient survey data from 29 Michigan ambulatory oncology practices collected in 2017. Study Design: Secondary analysis of patient survey data. Descriptive statistics were generated at the patient and practice levels. Thematic analysis of open-text comments identified clusters of frequently reported toxicities. Data Collection Methods: Patients completed 11 items from the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events. Using a 5-point Likert scale, patients rated the frequency of nausea, vomiting, diarrhea, and pain; the severity of nausea, vomiting, constipation, numbness/tingling, and pain; and how much numbness/tingling and pain interfered with usual or daily activities. Patients could also report two toxicities in open-text comments. Finally, patients reported unplanned health care service for toxicity or side effect management. Principal Findings: Of 3565 eligible patients, 2245 participated (63%) and 457 (20%) rated at least one toxicity as severe/very severe. Across practices, the proportion of patients who reported at least one severe/very severe toxicity ranged from 8% to 50%. Troubling toxicities included pain frequency (mean 2.3, SD 1.3), pain severity (2.1, 1.1), and diarrhea frequency (1.9, 1.0). From completed assessments, 1653 (74%) reported at least one toxicity in open-text comments; fatigue (n = 182), stomach discomfort (n = 53), and skin/nail changes (n = 41) were most frequently reported. Regarding consequences, 156 patients (7%) reported unplanned health care service use: 41 (26%) visited an emergency department and 32 (21%) were admitted to a hospital. Conclusions: Querying patients on chemotherapy treatment experiences and toxicities was feasible. Toxicity rates varied across practices, which informed quality improvement. Toxicity severity and service use incidence exceed previously published trial data, particularly for pain, fatigue, and gastrointestinal issues. Open-text questions enabled exploration with newer treatment regimens. KEYWORDS ambulatory care, oncology, patient-reported outcome measures, quality of health care, 1 | INTRODUCTION Increasingly, health services researchers are soliciting patient-reported outcomes in their studies. (1) Measuring patient-reported outcomes anchors research to patient-centered research paradigms. (2) Nimble survey research platforms and [...]

Miller Fisher syndrome (MFS), a rare, self-limiting variant of Guillain-Barre syndrome (GBS), is an anti-GQ1b1gG antibody syndrome that affects the peripheral and central nervous systems. (1) An acute neuromuscular polyneuropathic [...]

In managing chronic diseases such as glaucoma, the timing of periodic examinations is crucial, as it may significantly impact patients' outcomes. We address the question of when to monitor a [...]

In this article ... Take a look at a system wide, collaborative approach led by infectious disease specialists that can significantly improve patient safety and outcomes, reduce costs, and mitigate [...]

Objectives. To model the steps involved in preparing for and carrying out propensity score analyses by providing step-by-step guidance and Stata code applied to an empirical dataset. Study Design. Guidance, Stata code, and empirical examples are given to illustrate (1) the process of choosing variables to include in the propensity score; (2) balance of propensity score across treatment and comparison groups; (3) balance of covariates across treatment and comparison groups within blocks of the propensity score; (4) choice of matching and weighting strategies; (5) balance of covariates after matching or weighting the sample; and (6) interpretation of treatment effect estimates. Empirical Application. We use data from the Palliative Care for Cancer Patients (PC4C) study, a multisite observational study of the effect of inpatient palliative care on patient health outcomes and health services use, to illustrate the development and use of a propensity score. Conclusions. Propensity scores are one useful tool for accounting for observed differences between treated and comparison groups. Careful testing of propensity scores is required before using them to estimate treatment effects. Key Words. Observational data/quasi-experiments, administrative data uses, patient outcomes/function, Recent national initiatives for comparative effectiveness research recommend harnessing the power of existing data to evaluate health-related treatment effects (Patient-Centered Outcomes Research Institute 2012). A difficulty in using observational data [...]

[PER REVIEW] Clinical trials often fail to reach desired goals due to poor recruitment outcomes, including low participant turnout, high recruitment cost, or poor representation of minorities. At present, there [...]

Background. Assessing the real-world comparative effectiveness of common interventions is challenged by unmeasured confounding. Objective. To determine whether the mortality benefit shown for drug-eluting stents (DES) over bare metal stents (BMS) in observational studies persists after controls for/ tests for confounding. Data Sources/Study Setting. Retrospective observational study involving 38,019 patients, 65 years or older admitted for an index percutaneous coronary intervention receiving DES or BMS in Pennsylvania in 2004-2005 followed up for death through 3 years. Study Design. Analysis was at the patient level. Mortality was analyzed with Cox proportional hazards models allowing for stratification by disease severity or DES use propensity, accounting for clustering of patients. Instrumental variables analysis used lagged physician stent usage to proxy for the focal stent type decision. A method originating in work by Cornfield and others in 1954 and popularized by Greenland in 1996 was used to assess robustness to confounding. Principal Findings. DES was associated with a significantly lower adjusted risk of death at 3 years in Cox and in instrumented analyses. An implausibly strong hypothetical unobserved confounder would be required to fully explain these results. Conclusions. Confounding by indication can bias observational studies. No strong evidence of such selection biases was found in the reduced risk of death among elderly patients receiving DES instead of BMS in a Pennsylvanian state-wide population. Key Words. Unmeasured confounding, confounding by indication, selection biases, Understanding the comparative effectiveness of treatments in the community requires valid approaches to control for selection biases such as confounding by indication. This can arise if characteristics of a patient [...]

Background. After total hip arthroplasty (THA), patients today (who tend to be younger and more active than those who previously underwent this surgical procedure) have high expectations regarding functional outcome. Therefore, patients need to be well informed about recovery of physical functioning after THA. Purpose. The purpose of this study was to review publications on recovery of physical functioning after THA and examine the degree of recovery with regard to 3 aspects of functioning (ie, perceived physical functioning, functional capacity to perform activities, and actual daily activity in the home situation). Data Sources. Data were obtained from the MEDLINE and EMBASE databases from inception to July 2009, and references in identified articles were tracked. Study Selection. Prospective studies with a before-after design were included. Patients included in the analysis had to have primary THA for osteoarthritis. Data Extraction and Synthesis. Two reviewers independently checked the inclusion criteria, conducted the risk of bias assessment, and extracted the results. Data were pooled in a meta-analysis using a random-effects model. Results. A total of 31 studies were included. For perceived physical functioning, patients recovered from less than 50% preoperatively to about 80% of that of controls (individuals who were healthy) 6 to 8 months postsurgery. On functional capacity, patients recovered from 70% preoperatively to about 80% of that of controls 6 to 8 months postsurgery. For actual daily activity, patients recovered from 80% preoperatively to 84% of that of controls at 6 months postsurgery. Limitations. Only a few studies were retrieved that investigated the recovery of physical functioning longer than 8 months after surgery. Conclusions. Compared with the preoperative situation, the 3 aspects of physical functioning showed varying degrees of recovery after surgery. At 6 to 8 months postoperatively, physical functioning had generally recovered to about 80% of that of controls., When conservative treatment fails to alleviate pain and dysfunction of the hip caused by osteoarthritis (OA), total hip arthroplasty (THA) is a cost-effective surgical treatment that can provide significant pain [...]

Objective. To determine whether profit status is associated with differences in hospital days per patient, an outcome that may also be influenced by provider financial goals. Data Sources. United States Renal Data System Standard Analysis Files and Centers for Medicare and Medicaid Services cost reports. Design. We compared the number of hospital days per patient per year across for-profit and nonprofit dialysis facilities during 2003. To address possible referral bias in the assignment of patients to dialysis facilities, we used an instrumental variable regression method and adjusted for selected patient-specific factors, facility characteristics such as size and chain affiliation, as well as metrics of market competition. Data Extraction Methods. All patients who received in-center hemodialysis at any time in 2003 and for whom Medicare was the primary payer were included (N= 170,130; roughly two-thirds of the U.S. hemodialysis population). Patients dialyzed at hospital-based facilities and patients with no dialysis facilities within 30 miles of their residence were excluded. Results. Overall, adjusted hospital days per patient were 17 ± 5 percent lower in nonprofit facilities. The difference between nonprofit and for-profit facilities persisted with the correction for referral bias. There was no association between hospital days per patient per year and chain affiliation, but larger facilities had inferior outcomes (facilities with 73 or more patients had a 14 ± 1.7 percent increase in hospital days relative to facilities with 35 or fewer patients). Differences in outcomes among for-profit and nonprofit facilities translated to 1,600 patient-years in hospital that could be averted each year if the hospital utilization rates in for-profit facilities were to decrease to the level of their nonprofit counterparts. Conclusions. Hospital days per patient-year were statistically and clinically significantly lower among nonprofit dialysis providers. These findings suggest that the indirect incentives in Medicare's current payment system may provide insufficient incentive for for-profit providers to achieve optimal patient outcomes. Key Words. Dialysis, end-stage renal disease, instrumental variables, for-profit, hospital days, Several studies have examined differences in mortality rates among for-profit and nonprofit dialysis facilities. These studies have been widely criticized for having insufficiently considered risk adjustment and possible referral bias. [...]

In this article ... The advent of ICD-10 and increased accountability for care outcomes have raised the importance of clinical records that are accurate and complete. CLINICAL DOCUMENTATION IMPROVEMENT (CDI) [...]

In this article ... Learn some of the tools you can use to win over an uncooperative patient. IT IS ESTIMATED THAT UP TO 30 PERCENT OF primary care visits [...]

The large and persistent differences in health outcomes between African Americans and whites have sometimes been attributed to differences in the quality of the facilities in which they receive care. A large body of literature documents systematically worse performance by facilities which serve a larger share of black patients. However, these estimates may be biased by unobserved variables which correlate with the racial profile of the clinic and also affect outcomes. This paper uses a unique dataset from the Department of Veterans' Affairs system to examine the relationship between the quality of health care and the racial profile of the patient population in an equal-access health care system. An instrumental variable is used to overcome the omitted variable bias in the Ordinary Least Squares (OLS) estimates. Both the OLS and IV estimates show that increasing the proportion of visits by African-American patients results in improved outcomes for all patients treated at the clinic. The OLS results significantly underestimate the effect of increasing the proportion of black patients. Holding the overall clinic load constant and adding one hundred outpatient visits by African Americans in a year would result in a 0.5 percentage point decrease in 1-year mortality for the average patient in the clinic. Thus, contrary to results from the private health care sector, increasing clinic racial integration in an equal access system would benefit all patients. Keywords Racial segregation. Health and health care markets. Discrimination JEL 100, Introduction Research over the last 20 years has shown persistent racial differences in health care access, utilization, and outcomes. Numerous studies have documented that minorities, particularly African Americans, experience higher [...]

Research Objective. To compare quality outcomes from surgical procedures performed at freestanding ambulatory surgery centers (ASCs) and hospital-based outpatient departments (HOPDs). Data Sources. Patient-level ambulatory surgery (1997-2004), hospital discharge (1997-2004), and vital statistics data (1997-2004) for the state of Florida were assembled and analyzed. Study Design. We used a pooled, cross-sectional design. Logistic regressions with time fixed effects were estimated separately for the 12 most common ambulatory surgical procedures. Our quality outcomes were risk-adjusted 7-day and 30-day mortality and 7-day and 30-day unexpected hospitalizations. Risk adjustment for patient demographic characteristics and severity of illness were calculated using the DCG/HCC methodology adjusting for primary diagnosis only and separately for all available diagnoses. Principal Findings. Although neither ASCs nor HOPDs performed better overall, we found some difference by procedure that varied based on the risk-adjustment approach used. Conclusions. There appear to be important variations in quality outcomes for certain procedures, which may be related to differences in organizational structure, processes, and strategies between ASCs and HOPDs. The study also confirms the importance of risk-adjustment for comorbidities when using administrative data, particularly for procedures that are sensitive to differences in severity. Key Words. Quality, mortality, hospitalization, outpatient surgery, risk adjustment, Over the past few decades, several factors including improvements in medical technology, anesthesia, and pain management have facilitated the push of surgical services to outpatient facilities (Medicare Payment Advisory Commission [...]

This study focused on evaluation of outcomes of child care health consultation services delivered to child care providers in New Jersey. Child care centers and providers of family day care who had received child care health consultation services in New Jersey participated in the study. Sixty child care health consultation service recipients from 19 of the 21 counties in the state responded to the Child Care Health Consultation Questionnaire. Positive findings were statistically significant correlations between usefulness of services, satisfaction with services, changes at the child care site, and improvement in staff caregiving. Regression analysis indicated perceived usefulness of child care health consultation services contributes most to child care center changes (R2 = .40, p < .001) and improvement in staff caregiving (R2 = .40, p < .001). Implications for nursing are tailoring services to child care community needs, following up to evaluate quality and outcomes of services, improving marketing of child care health consultation services, and creating a statewide database of quality indicators that can be used for strategic planning., Health and safety top the list of quality indicators for child care (Crowley, 2000; Crowley, 2001; Fenichel, Griffin, & Lurie-Hurvitz, n.d.). Investigators of quality child care environments have recommended that [...]

AS family practice physicians, we are challenged to investigate and apply current and emergent scientific information to improve clinical outcomes. This article seeks to establish an interactive dialogue with clinicians [...]

Thorax 2003;58:961-967 Background: The persistent airway neutrophilia observed in chronic lung disease of prematurity (CLD) may reflect inappropriate suppression of neutrophil apoptosis. Methods: 134 bronchoalveolar lavage (BAL) samples were obtained [...]

Background: Severe acute respiratory syndrome (SARS) was diagnosed in Hong Kong in over 1700 patients between March and early June 2003. Methods: 115 patients diagnosed with SARS were admitted to [...]

Evidence suggests that guidelines alone do not affect clinical practice. Feedback based on audit is useful, both as part of an implementation strategy and for longer term positive influence on [...]

* OBJECTIVES We analyzed perinatal outcomes at a rural hospital without cesarean delivery capability. * STUDY DESIGN This was a historical cohort outcomes study. * POPULATION The study population included [...]

>> The success of performance-based retail pharmacy networks for Medicare Part D is prompting some PBMs to create similar networks for their commercial and Medicaid populations. At the core of [...]

Objective. To investigate resident and facility attributes associated with long-term care health outcomes in nursing homes. Data Sources. Quarterly Management Minutes Questionnaire (MMQ) survey data for Medicaid case-mix reimbursement of nursing homes in Massachusetts from 1991 to 1994, for specification of outcomes and resident attributes. Facility attributes are specified from cost report data. Study Design. Multivariate logistic and "state-dependence" regression models are estimated for survival, ADL functional status, incontinence status, and mental status outcomes from longitudinal residence histories of Medicaid residents spanning 3 to 36 months in length. Outcomes are specified to be a function of resident demographic and diagnostic attributes and facility-level operating and nurse staffing attributes. Principal Findings. The estimated parameters for resident demographic and diagnostic attributes showed a great deal of construct validity with respect to clinical expectations regarding risk factors for adverse outcomes. Few facility attributes were associated with outcomes generally, and none was significantly associated with all four outcomes. Conclusions. The absence of uniform associations between facility attributes and the various long-term care health outcomes studied suggests that strong facility performance on one health outcome may coexist with much weaker performance on other outcomes. This has implications for the aggregation of individual facility performance measures on multiple outcomes and the development of overall outcome performance measures. Key Words. Health outcomes, nursing homes, long-term care, Researchers have advocated the use of outcome measures for measuring quality of nursing home care and for reimbursement purposes since the late 1960s (Andersen and Stone 1969). To date, only [...]

My message is simple: If you're not interested in low back pain and you're about to toss this issue aside, don't! As co-editors Chris Main and Steven George make clear, [...]

Patients who can't buy food are not going to buy medications. Patients who don't drive or have a car often can't get to doctor's appointments. Mental health problems can cause [...]

AUDIT AND OUTCOMES Audit points for asthma care in primary care and hospital respiratory clinics Organisational level * Is there a practice nurse with recognised asthma training/diploma? * How much [...]