Listening to Older Adults: Elderly Patients' Experience of Care in Residency and Practicing Physician Outpatient Clinics
The population of people aged 65 and older is rapidly growing. Research has demonstrated significant quality gaps in the clinical care of older patients in the United States, especially in training programs. Little is known about how older patients' experience with care delivered in residency clinics compares with that delivered by practicing physicians. Using patient surveys from the American Board of Internal Medicine Care of the Vulnerable Elderly Practice Improvement Module, the quality of care provided to adults aged 65 and older by 52 internal medicine and family medicine residency clinics and by a group of 144 practicing physicians was studied. The residency clinics received 2,213 patient surveys, and the practicing physicians received 4,204. Controlling for age and overall health status, patients from the residency clinic sample were less likely to report receiving guidance and interventions for important aspects of care for older adults than patients from the practicing physician sample. The largest difference was observed in providing ways to help patients prevent falls or treat problems with balance or walking (42.1% vs 61.8%, P<.001). Patients from the residency clinic sample were less likely to rate their overall care as high (77.5% vs 88.8%, P<.001). Patient surveys reveal important deficiencies in processes of care that are more pronounced for patients cared for in residency clinics. Quality of patient experience and communication are vital aspects of overall quality of care, especially for older adults. Physician education at all levels, faculty development, and practice system redesign are needed to ensure that the care needs of older adults are met.
Available from: Brian John Hess
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ABSTRACT: Quality improvement (QI) activities are an important part of residency training. National studies are needed to inform best practices in QI training and experience for residents. The impact of the Institutional Review Board (IRB) process on such studies is not well described.
This observational study looked at time, length, comfort level, and overall quality of experience for 42 residency training programs in obtaining approval or exemption for a nationally based educational QI study.
For the 42 programs in the study, the time period to IRB approval/exemption was highly variable, ranging from less than 1 week to 56.5 weeks; mean and median time was approximately 18 weeks (SD, 10.8). Greater reported comfort with the IRB process was associated with less time to obtain approval ( = -.50; < .01; 95% CI, -0.70 to -0.23). A more positive overall quality of experience with the IRB process was also associated with less time to obtain IRB approval ( = -.60; < .01; 95% CI, -0.74 to -0.36).
The IRB process for residency programs initiating QI studies shows considerable variance that is not explained by attributes of the projects. New strategies are needed to assist and expedite IRB processes for QI research in educational settings and reduce interinstitutional variability and increase comfort level among educators with the IRB process.
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ABSTRACT: The aim of this study was to describe first-line managers' experiences of alternative modes of funding elderly care in two communities in western Sweden.
A growing elderly population demands alternative modes of funding elderly care for better outcomes for patients and better efficiency as it is publicly funded through taxation.
The study comprised a total of eight semi-structured interviews with first-line managers working within elderly care. The interviews were analysed using manifest qualitative content analysis. Respect for the individuals was a main concern in the study.
One category, quality improvement, and four subcategories freedom of choice, organisational structure, quality awareness and market forces effects were identified to describe first-line managers' experiences of the operation of elderly care.
Quality improvement was an important factor to deal with when elderly care was operated in different organisational perspectives, either private or public. The first-line manager is a key person for developing a learning organisation that encourages both staff, clients and their relatives to improve the organisation. Moreover, person-centred care strengthens the client's role in the organisation, which is in line with the government's goal for the quality improvement of elderly care. However, further research is needed on how quality improvement could be developed when different caregivers operate in the same market in order to improve care from the elderly perspective.
This study highlights alternative modes of funding elderly care. The economical perspectives should not dominate without taking care of quality improvement when the operation of elderly care is planned and implemented. Strategies such as a learning organisational structure built on person-centred care could create quality improvement in elderly care.
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ABSTRACT: Evidence-based practice in education requires high-quality evidence, and many in the medical education community have called for an improvement in the methodological quality of education research.
Our aim was to use a valid measure of medical education research quality to highlight the methodological quality of research publications and provide an overview of the recent internal medicine (IM) residency literature.
We searched MEDLINE and PreMEDLINE to identify English-language articles published in the United States and Canada between January 1, 2010, and December 31, 2011, focusing on IM residency education. Study quality was assessed using the Medical Education Research Study Quality Instrument (MERSQI), which has demonstrated reliability and validity. Qualitative articles were excluded. Articles were ranked by quality score, and the top 25% were examined for common themes, and 2 articles within each theme were selected for in-depth presentation.
The search identified 731 abstracts of which 223 articles met our inclusion criteria. The mean (±SD) MERSQI score of the 223 studies included in the review was 11.07 (±2.48). Quality scores were highest for data analysis (2.70) and lowest for study design (1.41) and validity (1.29). The themes identified included resident well-being, duty hours and resident workload, career decisions and gender, simulation medicine, and patient-centered outcomes.
Our review provides an overview of the IM medical education literature for 2010-2011, highlighting 5 themes of interest to the medical education community. Study design and validity are 2 areas where improvements in methodological quality are needed, and authors should consider these when designing research protocols.
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