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Narrative as Rhetoric and the Art of Medicine
Published in James Phelan, Narrative Medicine, 2023
I start by emphasizing that a rhetorical narrative approach is meant not to replace traditional clinical documentation but rather to add value to it. Clinical write-ups have evolved to efficiently convey large amounts of important clinical information in an increasingly specialized and complex health care system, and they’re grounded in the principle that such efficient information-gathering is the best means to the ends of accurate differential diagnosis and effective treatment. A rhetorical approach shares those ends, but it adds one more, and, in so doing, it also proposes to shift the means. The additional purpose is to have the clinical encounter be one in which the caregiver and patient develop a relationship that goes beyond the efficient exchange of information. Even as the relationship remains professional and guided by the other purposes of diagnosis and treatment, it is also one in which each can and should recognize the individuality and distinctiveness of the other. Furthermore, that recognition can have consequences for diagnosis and treatment.
Real-World Evidence Generation
Published in Kelly H. Zou, Lobna A. Salem, Amrit Ray, Real-World Evidence in a Patient-Centric Digital Era, 2023
Joseph S. Imperato, Joseph P. Cook, Diana Morgenstern, Kim Gilchrist, Tarek A. Hassan, Jorge Saenz, Danute Ducinskiene
An evaluation and management process is core to every patient encounter and is supplemented by Current Procedural Terminology (CPT). These elements are recorded together as an “encounter” incorporating time spent with the patient, the specific health condition, and associated comorbidities (e.g., International Classification of Diseases 10th Revision [ICD-10]). These features describe the services provided to a particular individual within the healthcare system. The recording of each healthcare encounter and the associated data elements are utilized to complete the healthcare transaction between providers, insurers, and patients. These data, in aggregate, form the elements utilized as the language between healthcare entities and the “real world” transactional experience of patients engaging in the healthcare process.
Ambulatory Systems
Published in Salvatore Volpe, Health Informatics, 2022
Curtis L. Cole, Adam D. Cheriff, J. Travis Gossey, Sameer Malhotra, Daniel M. Stein
Executives need to pay attention to the definition of the encounter itself. As with registration, terminology here is imprecise and can be confusing. Some prefer to refer to the billable event as the encounter and the face-to-face meeting with the patient as the visit. But the increasing prevalence of phone, web, and other virtual “visits” makes this topic inherently fluid. Regardless of how you refer to the event, the system must know the rules for the definitions, which are generally determined by the payer and may or may not make sense to the clinician. For example, a 9-month pregnancy may be a single encounter with multiple visits. Similarly, a visit to a doctor’s office that results in referral to the emergency room may be combined as a single encounter (the “72-hour rule” or “two-midnight rule”). A visit to different doctors on a single day may be considered a single encounter. The billing system needs to understand these rules. Again, cross-institutional reconciliation may be necessary to ensure complete accuracy in some scenarios.
Relation of satisfaction score with payer class in dermatology patients
Published in Baylor University Medical Center Proceedings, 2023
Travis S. Dowdle, Dan Hayward, Katherine G. Holder, Austin Broadhead, Meredith G. Pham, Michelle B. Tarbox
In 2015, as a response to rising Medicare costs, the US Congress passed the Medicare Access and Children’s Health Insurance Program Reauthorization Act. This law changed reimbursement for healthcare providers by shifting the traditional fee-for service system to a value-based, fee-for-performance system. In 2017, the Merit-Based Incentive Payment System was created to evaluate physicians and provide an opportunity to receive higher reimbursement for high-value care.1 Provider reimbursement is adjusted around patient experience surveys like the Hospital Consumer Assessment of Healthcare Providers and Systems survey, which is a 32-item tool administered to randomly selected patients after their healthcare encounter.2 Patient satisfaction scores are adjusted to a provider rating that goes into physician value-based reimbursement algorithms, making equitable patient grading increasingly important to physician payment.3,4 Nonmodifiable patient characteristics such as ethnicity, gender, education, travel distance, and insurance status may bias a patient’s experience score.5–7 While this has been studied in several fields, there is currently a paucity of literature in the dermatology clinic setting.
Feasibility of implementing a web-based tool built from pharmacy claims data (e-MEDRESP) to monitor adherence to respiratory medications in primary care
Published in Current Medical Research and Opinion, 2022
Alia Yousif, Catherine Lemière, Amélie Forget, Marie-France Beauchesne, Lucie Blais
The physicians’ use of e-MEDRESP was monitored following CE, using counters integrated into the tool. These counters allowed us to identify the dates each physician consulted e-MEDRESP, for each of their patients. During the follow-up, we determined the number of physicians who used e-MEDRESP at least once and the number of patients for which e-MEDRESP was consulted by the treating physician, at least once, during and outside the medical visits. The number of medical visits per patient (any cause) and the number of medical visits in which e-MEDRESP was consulted by a treating physician were calculated. We also determined the time between CE and each e-MEDRESP consultation. When available, information on the type of clinical encounter (e.g. annual checkup, emergency visit, or telehealth) was obtained.
Focusing hospitalist roles on either admitting or rounding facilitates unit-based assignment and is associated with improved discharge efficiency
Published in Hospital Practice, 2021
Evan Coates, Eli Quisenberry, Barbara Williams, Craig Blackmore
The effect of the intervention was evaluated through a retrospective time-series with primary outcomes of discharge efficiency, 30-day readmissions, and length of stay. Discharge efficiency is a recently promoted metric to determine how successful a hospitalist team is in producing discharges [8]. Monthly discharge efficiency is calculated as the number of patients discharged by hospitalist providers divided by the number of patient hospitalist encounter days (and is effectively the incidence rate for discharge). Hospitalist patient encounter days represent days in which a patient receives care from a hospitalist and therefore is eligible for discharge by the hospitalist. Patient encounter days were defined from billing data. The advantage of discharge efficiency as a metric is that it is scaled as a rate (between 0 and 1) and, unlike length of stay, is not highly influenced by long staying outliers with placement and social issues outside of the immediate control of the hospitalist provider.