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Optimal treatment assignment to maximize expected outcome with multiple treatments.

Optimal treatment assignment to maximize expected outcome with multiple treatments.

When there is substantial heterogeneity of treatment effectiveness, it is crucial to identify individualized treatment assignment rules for comparative treatment selection. HIP Investigator, Dr. Menggang Yu et al. propose an outcome weighted learning method that extends estimating individualized treatment rules to multi‐treatment case by using a vector hinge loss as a target function. Consistency of the resulting estimator is shown in the article.

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Inpatient Portals for Hospitalized Patients and Caregivers: A Systematic Review.

Inpatient Portals for Hospitalized Patients and Caregivers: A Systematic Review.

Patient portals, web-based personal health records linked to electronic health records (EHRs), provide patients access to their healthcare information and facilitate communication with providers. A team of authors, including HIP Investigator Dr. Ryan Coller, conducted a systematic review of the literature evaluating the design, use, and impact of inpatient portals, which are patient portals designed to give hospitalized patients and caregivers inpatient EHR clinical information for the purpose of engaging them in hospital care.

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Patient Perspectives on Smoking Cessation and Interventions in Rheumatology Clinics.

Patient Perspectives on Smoking Cessation and Interventions in Rheumatology Clinics.

Although smoking is a risk factor for cardiovascular and rheumatic disease severity, only 10% of rheumatology visits document cessation counseling. HIP Investigator, Dr. Christie Bartels et al. identified themes and categories of patient and health system-level facilitators/barriers to smoking cessation. Participant-reported barriers and facilitators to cessation involved psychological, health, and social and economic factors, and healthcare messaging, and resources.

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Scope and Influence of Electronic Health Record-Integrated Clinical Decision Support in the Emergency Department.

Scope and Influence of Electronic Health Record-Integrated Clinical Decision Support in the Emergency Department.

Widespread adoption of electronic health records offers an unprecedented opportunity to apply informatics techniques to clinical and operational data. As electronic health records evolve, integration of computerized clinical decision support offers the promise of sorting, collecting, and presenting this information to improve patient care. HIP Investigator, Dr. Brian Patterson et al. conducted a systematic review to examine the scope and influence of electronic health record-integrated clinical decision support technologies implemented in the emergency department.

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Broadening Medical Students' Exposure to the Range of Illness Experiences: A Pilot Curriculum Focused on Depression Education

Broadening Medical Students' Exposure to the Range of Illness Experiences: A Pilot Curriculum Focused on Depression Education

Exposing medical students to a broad range of illness experiences is crucial for teaching them to practice patient-centered care, but students often have limited interaction with patients with diverse illness presentations. In this pilot, Dr. Rachel Grob et. al developed, implemented, and evaluated a self-directed online curriculum followed by a small group discussion focused on depression education. The curriculum was based on a module created using the Database of Individual Patients’ Experiences methodology.

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Engaging Patients in Primary Care Quality Improvement Initiatives: Facilitators and Barriers

Engaging Patients in Primary Care Quality Improvement Initiatives: Facilitators and Barriers

Health care transformation calls for patient engagement in quality improvement (PEQI), yet practice participation remains low. This pilot study of 8 primary care clinics at 7 statewide locations sought to determine the most effective strategies for disseminating a previously successful single-system PEQI intervention. Qualitative data were obtained through site visits, interviews, observations, and journaling. The UW PATH collaborative found that five teams partially completed the intervention and 3 finished. These findings suggest that quality improvement facilitation and dedicated time can help primary care teams identify and overcome barriers to PEQI.

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Why Physicians Should Trust in Patients

Why Physicians Should Trust in Patients

Most of the existing literature on trust between patients and physicians focuses on whether patients trust their clinicians. However, the principles underlying the patient-physician relationship must shift from simply emphasizing patients’ adherence to cultivating patients’ ability to contribute to the development of care plans that reflect their own values and preferences. Physicians who wish to advance this transformation can contribute by presuming trust with each patient. Dr. Rachel Grob et al. discusses the efficacy of patient-physician partnerships and co-produced care to improve quality and safety of care, patient health outcomes, and patient experience.

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What Words Convey: The Potential for Patient Narratives to Inform Quality Improvement

What Words Convey: The Potential for Patient Narratives to Inform Quality Improvement

For the past 25 years, health care providers and health system administrators have sought to improve care by surveying patients about their experiences. More recently, policymakers have acted to promote this learning by deploying financial incentives tied to survey scores. This article explores the potential of systematically elicited narratives about experiences with outpatient care to enrich quality improvement. Dr. Rachel Grob et al. found that in a health policy environment that incentivizes attention to patient experience, rigorously elicited narratives hold substantial promise for improving quality in general and patients’ experiences with care in particular. Most narratives convey experiences that are potentially actionable by those committed to improving health care quality in outpatient settings.

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PCOR: Brave new world meets old institutional policies

PCOR: Brave new world meets old institutional policies

recent article by PROKids team member Jessica Chung, et al., discusses the tensions between the engagement of patient stakeholders in research and the institutional and legal framework governing that engagement. Patient engagement during all stages of research has become increasingly common. Yet institutional policies, often intended to protect patients and research participants, are evolving to meet this new reality.

Chung, et al. lays out these tensions using examples from trial funded by the Patient-Centered Outcomes Institute and led by Dr. Elizabeth Cox, Director of PROKids. Quandaries arose when the values or preferences of patient stakeholders conflicted with institutional policies about background checks, letters about privacy breaches, and study reminders. 

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A family-centered rounds checklist, family engagement, and patient safety

A family-centered rounds checklist, family engagement, and patient safety

In a recent randomized clinical trial led by Dr. Elizabeth Cox, implementing a checklist during family-centered rounds increased family engagement and the safety of hospitalized children from the perspective of the families. The checklist was developed with input from the hospital staff and families of hospitalized children, and two items were found to significantly increase family engagement: when hospital staff read back orders, families engaged in more decision-making and provided more information, and families were also more engaged when the team talked about goals for discharge. The materials needed to implement the family-centered rounds checklist in are available in a free toolkit here.

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