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An adaptive approach to developing a Long COVID rehabilitation program. 以适应性方法制定长 COVID 康复计划。
Q3 Medicine Pub Date : 2024-07-01 Epub Date: 2024-04-01 DOI: 10.1177/08404704241239867
Sonya Torreiter, Peggy So

As more people became infected with the SARS-CoV-2 virus, it was anticipated that 10-20% of these individuals would develop a post-viral illness that would affect their ability to work and participate in daily activities and reduce quality of life. To support these patients, Unity Health Toronto opened the Outpatient Post-COVID Condition Rehabilitation Program in June 2021, with the aim of teaching patients how to manage their ongoing symptoms, and to maximize their independence and function. The program incorporated a multidisciplinary, patient-centred approach that leveraged group education and a virtual platform to allow patients from across Ontario to learn from one another and share experiences. Over the two years of the program, the multidisciplinary team continuously adapted to the new research on Long COVID and evolving needs of patients. This article will outline the development and evolution of the program.

随着越来越多的人感染SARS-CoV-2病毒,预计其中10-20%的人会出现病毒后遗症,影响他们的工作和日常活动能力,降低生活质量。为了帮助这些患者,多伦多 Unity Health 于 2021 年 6 月开设了门诊后 COVID 病症康复计划,旨在教导患者如何控制持续出现的症状,并最大限度地提高他们的独立性和功能。该计划采用以患者为中心的多学科方法,利用小组教育和虚拟平台,让来自安大略省各地的患者相互学习和分享经验。在该计划实施的两年中,多学科团队不断根据长COVID的新研究和患者不断变化的需求进行调整。本文将概述该计划的发展和演变。
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引用次数: 0
The benefits and opportunities: Engaging patients in identifying and reporting patient safety incidents. 好处和机会:让患者参与识别和报告患者安全事件。
Q3 Medicine Pub Date : 2024-07-01 Epub Date: 2023-10-13 DOI: 10.1177/08404704231203593
Laura Danielle Pozzobon, Thomas Rotter, Kim Sears

There is growing recognition that patients can and should be engaged in the identification of patient safety incidents arising during their experiences across health systems. In this article, we describe the benefits that can be harnessed from engaging patients in reporting patient safety incidents; identify opportunities to support patient engagement in reporting and learning from patient safety incidents; and describe the potential role of health leaders in connecting patient experience and patient safety using patient-reported patient safety incident data.

人们越来越认识到,患者可以也应该参与识别他们在整个卫生系统中经历的患者安全事件。在这篇文章中,我们描述了让患者参与报告患者安全事件可以带来的好处;确定支持患者参与报告和学习患者安全事件的机会;并使用患者报告的患者安全事件数据描述健康领导者在连接患者体验和患者安全方面的潜在作用。
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引用次数: 0
Bringing experiences of healthcare in custody into quality improvement. 将羁押期间的医疗保健经验引入质量改进。
Q3 Medicine Pub Date : 2024-07-01 Epub Date: 2024-03-01 DOI: 10.1177/08404704241235891
Yoko Murphy, Andrea Winzer, Linda Ogilvie, Melanie Mayoh, Katherine E McLeod

Patient experience is an essential component of safe and high-quality healthcare, yet rarely examined in the context of carceral settings. This article describes a project undertaken by the Ontario Ministry of the Solicitor General to collect evidence and perspectives on how to bring patient experiences of healthcare services delivered in provincial correctional facilities into ongoing quality improvement work. We first conducted a scoping review and jurisdictional scan to learn from existing processes and experiences. We then engaged frontline healthcare providers delivering services in custody and people with recent experience of incarceration regarding priority measures and processes for data collection and mechanisms for implementing evidence-based change. This article describes methods used to engage stakeholders, including a survey and focus groups, as well as key lessons learned. This work is relevant to readers experiencing barriers to patient engagement, interested in collaborative research processes, and developing services for people who have experienced incarceration.

患者体验是安全和高质量医疗保健的重要组成部分,但却很少在监狱环境中进行研究。本文介绍了安大略省副检察长部开展的一个项目,该项目旨在收集证据和观点,以了解如何将患者对省级惩教机构所提供医疗服务的体验融入到正在进行的质量改进工作中。我们首先进行了范围审查和辖区扫描,以学习现有的流程和经验。然后,我们就数据收集的优先措施和流程以及实施循证变革的机制,与在监管场所提供服务的一线医疗服务提供者和近期有过监禁经历的人员进行了交流。本文介绍了让利益相关者参与的方法,包括调查和焦点小组,以及主要的经验教训。这项工作对遇到患者参与障碍、对合作研究过程感兴趣以及为有过监禁经历的人开发服务的读者很有意义。
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引用次数: 0
Evaluating the cost of NP-led vs. GP-led primary care in British Columbia. 评估不列颠哥伦比亚省以护士为主导与以全科医生为主导的初级保健的成本。
Q3 Medicine Pub Date : 2024-07-01 Epub Date: 2024-01-30 DOI: 10.1177/08404704241229075
Damien Contandriopoulos, Katherine Bertoni, Rita McCracken, Lindsay Hedden, Ruth Lavergne, Gurprit K Randhawa

In 2020, British Columbia (BC) opened four pilot Nurse Practitioner Primary Care Clinics (NP-PCCs) to improve primary care access. The aim of this economic evaluation is to compare the average cost of care provided by Nurse Practitioners (NPs) working in BC's NP-PCCs to what it would have cost the government to have physicians provide equivalent care. Comparisons were made to both the Fee-For-Service (FFS) model and BC's new Longitudinal Family Physician (LFP) model. The analyses relied on administrative data, mostly from the Medical Services Plan (MSP) and Chronic Disease Registry (CDR) via BC's Health Data Platform. Results show the cost of NPs providing care in the NP-PCCs is slightly lower than what it would cost to provide similar care in medical clinics staffed by physicians paid through the LFP model. This suggests that the NP-PCC model is an efficient approach to increase accessibility to primary care services in BC and should be considered for expansion across the province.

2020 年,不列颠哥伦比亚省(BC)开设了四家试点执业护士初级保健诊所(NP-PCCs),以改善初级保健的可及性。本次经济评估的目的是比较在不列颠哥伦比亚省执业护士初级保健诊所(NP-PCCs)工作的执业护士提供医疗服务的平均成本,以及政府让医生提供同等医疗服务所需的成本。比较对象包括收费服务(FFS)模式和不列颠哥伦比亚省新的纵向家庭医生(LFP)模式。分析依赖于行政数据,这些数据主要来自医疗服务计划(MSP)和通过不列颠哥伦比亚省健康数据平台进行的慢性病登记(CDR)。结果显示,在 NP-PCC 中提供护理的 NP 成本略低于通过 LFP 模式支付费用的由医生组成的医疗诊所提供类似护理的成本。这表明,NP-PCC 模式是提高不列颠哥伦比亚省初级保健服务可及性的有效方法,应考虑在全省推广。
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引用次数: 0
Investigating the unique service and treatment needs of women with alcohol use disorder: Literature review and key informant perspectives in British Columbia. 调查酗酒妇女的独特服务和治疗需求:不列颠哥伦比亚省的文献综述和主要信息提供者的观点。
Q3 Medicine Pub Date : 2024-07-01 Epub Date: 2024-02-08 DOI: 10.1177/08404704241229973
Hayley Ross, Stefan Kurbatfinski, Izabela Szelest

Alcohol Use Disorder (AUD) is a medical condition uniquely affecting the female population, requiring widespread restructuring of current services to increase treatment utilization and efficacy. This review synthesizes the literature on the service and treatment needs of women with AUD. A literature search and review were conducted following PRISMA guidelines. Key informant information was collected during interviews with health leaders. Data from literature searches and interviews were analyzed to identify common themes. Results found women face more barriers when accessing and receiving AUD treatment. Major barriers include stigma, location, transportation, and childcare, which contribute to the AUD treatment gap among women. Recommendations to reduce barriers include (1) implementing universal screening, (2) improving care provider education and awareness, (3) providing childcare services, (4) establishing a strong client-clinician relationship, (5) building a community approach for Indigenous clients, (6) improving Managed Alcohol Programs, and (7) expanding virtual substance use prescribing practices.

酒精使用障碍(AUD)是一种影响女性人群的独特病症,需要对现有服务进行广泛调整,以提高治疗的利用率和有效性。本综述综合了有关女性 AUD 患者的服务和治疗需求的文献。我们按照 PRISMA 指南进行了文献检索和综述。在与医疗保健领导的访谈中收集了关键信息。对文献检索和访谈的数据进行了分析,以确定共同的主题。结果发现,女性在获得和接受 AUD 治疗时面临更多障碍。主要障碍包括污名化、地点、交通和儿童保育,这些因素造成了女性在 AUD 治疗方面的差距。减少障碍的建议包括:(1)实施普遍筛查;(2)提高护理提供者的教育和意识;(3)提供托儿服务;(4)建立牢固的客户-医生关系;(5)为土著客户建立社区方法;(6)改进酒精管理计划;以及(7)扩大虚拟药物使用处方实践。
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引用次数: 0
A Message from the Guest Editor. 特邀编辑的致辞
Q3 Medicine Pub Date : 2024-05-01 Epub Date: 2024-02-28 DOI: 10.1177/08404704241237566
Ronald R Lindstrom
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引用次数: 0
Future leaders in a learning health system: Exploring the Health System Impact Fellowship. 学习型卫生系统的未来领导者:探索卫生系统影响奖学金。
Q3 Medicine Pub Date : 2024-05-01 Epub Date: 2023-11-28 DOI: 10.1177/08404704231216951
Samuel Petrie, Ivy Cheng, Meghan McMahon, John N Lavis

The Canadian health system is reeling following the COVID-19 pandemic. Strains have become growing cracks, with long emergency department wait times, shortage of human health resources, and growing dissatisfaction from both clinicians and patients. To address long-needed health system reform in Canada, a modernization of training is required for the next generation health leaders. The Canadian Institutes of Health Research Health System Impact Fellowship (HSIF) is an example of a well-funded and connected training program which prioritizes embedded research and embedding technically trained scholars with health system partners. The program has been successful in the scope and impact of its training outcomes as well as providing health system partners with a pool of connected and capable scholars. Looking forward, integrating aspects of evidence synthesis from both domestic and international sources and adapting a general contractor approach to implementation within the HSIF could help catalyze learning health system reform in Canada.

在COVID-19大流行之后,加拿大的卫生系统陷入了困境。压力已经变成了越来越大的裂缝,急诊室等待时间长,人力卫生资源短缺,临床医生和患者越来越不满。为了解决加拿大长期需要的卫生系统改革,需要对下一代卫生领导人进行现代化培训。加拿大卫生研究院卫生系统影响奖学金是一个资金充足和相互联系的培训计划的例子,该计划优先考虑嵌入式研究,并将受过技术培训的学者与卫生系统合作伙伴联系起来。该计划在培训成果的范围和影响方面取得了成功,并为卫生系统合作伙伴提供了一批有联系和有能力的学者。展望未来,整合来自国内和国际来源的证据综合方面,并在HSIF内采用总承包商的方法来实施,可以帮助催化加拿大的学习卫生系统改革。
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引用次数: 0
Navigating the narrowing effect of public discourse for a healthier future. 驾驭公共话语的缩小效应,创造更健康的未来。
Q3 Medicine Pub Date : 2024-05-01 Epub Date: 2023-11-06 DOI: 10.1177/08404704231208597
Hugh MacLeod

This article explores the concerning phenomenon of the narrowing effect in public discourse, particularly in the context of healthcare and Medicare. It discusses the challenges posed by this narrowing effect, the impact of cognitive biases, and the ethical dilemmas faced by healthcare providers and organizations when patients take their concerns public. The article also emphasizes the importance of responsible leadership and offers navigation for overcoming the narrowing of public discourse.

本文探讨了公共话语中令人担忧的缩小效应现象,特别是在医疗保健和医疗保险的背景下。它讨论了这种缩小效应带来的挑战、认知偏见的影响,以及当患者公开他们的担忧时,医疗保健提供者和组织面临的道德困境。文章还强调了负责任领导的重要性,并为克服公共话语的狭窄提供了指导。
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引用次数: 0
The impact of cognitive biases, mental models, and mindsets on leadership and change in the health system. 认知偏见、心理模式和心态对卫生系统领导和变革的影响。
Q3 Medicine Pub Date : 2024-05-01 Epub Date: 2023-11-27 DOI: 10.1177/08404704231215750
David A Petrie, Ronald R Lindstrom, Samuel G Campbell

Understanding how cognitive biases, mental models, and mindsets impact leadership in health systems is essential. This article supports the notion of cognitive biases as flawed thinking or cognitive traps which negatively influence leadership. Mental models that do not fit with current evidence limit our ability to comprehend and respond to system issues. Resulting mindsets affect cognition, behaviour, and decision-making. Metacognition is critical. The wicked problems in today's complex health system require leaders and everyone involved to elevate their personal, organizational, and disciplinary perspectives to a systems level. Three examples of mental models/mindsets are reviewed. They do not change simply because we wish or will them to. The first step is being aware of what they are and how they impact our thinking and decision-making. Some tips for managing these traps are offered as examples of how to challenge our leadership approach in the health system.

了解认知偏见、心智模式和心态如何影响卫生系统中的领导力至关重要。这篇文章支持认知偏见是有缺陷的思维或认知陷阱的概念,对领导力产生负面影响。不符合当前证据的心智模型限制了我们理解和应对系统问题的能力。由此产生的心态会影响认知、行为和决策。元认知至关重要。当今复杂的卫生系统中的棘手问题要求领导者和所有相关人员将他们的个人、组织和学科观点提升到系统水平。本文回顾了心理模型/心态的三个例子。它们不会仅仅因为我们希望或希望它们改变而改变。第一步是了解它们是什么,以及它们如何影响我们的思维和决策。本文提供了一些管理这些陷阱的技巧,作为如何挑战我们在卫生系统中的领导方法的例子。
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引用次数: 0
How smart health leaders make intuitive decisions. 聪明的健康领导者如何做出直观的决策。
Q3 Medicine Pub Date : 2024-05-01 Epub Date: 2023-11-11 DOI: 10.1177/08404704231212781
Richard B Gasaway

A rational decision-making process enables a leader to process information clearly and logically and thus allows for accurate perception and interpretation of the event. It is believed this process prevents leaders from excessively distorting reality and being impacted by cognitive biases, both of which are possible, particularly under stressful conditions. But what happens when the decision-making environment is rapidly changing and the leader does not have time to deploy a thorough, comprehensive rational decision-making process? In time-compressed decision-making environments, leaders must often make quick, accurate decisions, with incomplete, inaccurate, or rapidly changing information, under extremely stressful conditions. To improve the ability of a leader to make high-stress, time-compressed decisions under rapidly changing conditions, we offer the intuitive decision-making process as an alternative to rational decision-making and discuss five components essential to improve intuitive decision-making outcomes.

理性的决策过程使领导者能够清晰、合乎逻辑地处理信息,从而能够准确地感知和解释事件。人们认为,这一过程可以防止领导者过度扭曲现实和受到认知偏见的影响,这两者都是可能的,尤其是在压力条件下。但是,当决策环境迅速变化,领导者没有时间部署一个彻底、全面的理性决策过程时,会发生什么?在时间压缩的决策环境中,领导者通常必须在极度紧张的条件下,利用不完整、不准确或快速变化的信息做出快速、准确的决策。为了提高领导者在快速变化的条件下做出高压力、时间压缩的决策的能力,我们提供了直观的决策过程作为理性决策的替代方案,并讨论了改善直观决策结果所必需的五个组成部分。
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引用次数: 0
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Healthcare Management Forum
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