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Rayfel Schneider - One of the best experts on this subject based on the ideXlab platform.
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Don't let up: implementing and sustaining change in a new post-licensure education model for developing extended role practitioners involved in Arthritis Care.
Journal of multidisciplinary healthcare, 2015Co-Authors: Katie Lundon, Rachel Shupak, Sonya Canzian, Ed Ziesmann, Rayfel SchneiderAbstract:Across a 9-year period, the Advanced Clinician Practitioner in Arthritis Care program has achieved a set of short-term "wins" giving direction and momentum to the development of new roles for health Care practitioners providing Arthritis Care. This is a viable model for post-licensure training offered to multiple allied health professionals to support the development of competent extended role practitioners (extended scope practice). Challenges at this critical juncture include: retain focus, drive, and commitment; develop academic and financial partnerships transferring short-term success to long-term sustainability; advanced, context-driven, system-level evaluation including fiscal outcome; health Care policy adaptation to new human health resource development. Success includes: completed 2-year health services research evaluating 37 graduates; leadership, innovation, educational excellence, and human health resource benefit awards; influential publications/presentations addressing post-licensure education/outcome, interprofessional collaboration, and improved patient Care.
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The patient perspective: Arthritis Care provided by Advanced Clinician Practitioner in Arthritis Care program-trained clinicians.
Open access rheumatology : research and reviews, 2015Co-Authors: Kelly Warmington, Carol A. Kennedy, Katie Lundon, Leslie J. Soever, Sydney C Brooks, Laura A. Passalent, Rachel Shupak, Rayfel SchneiderAbstract:To assess patient satisfaction with the Arthritis Care services provided by graduates of the Advanced Clinician Practitioner in Arthritis Care (ACPAC) program. This was a cross-sectional evaluation using a self-report questionnaire for data collection. Participants completed the Patient-Doctor Interaction Scale, modified to capture patient-practitioner interactions. Participants completed selected items from the Group Health Association of America's Consumer Satisfaction Survey, and items capturing quality of Care, appropriateness of wait times, and a comparison of extended-role practitioner (ERP) services with previously received Arthritis Care. A total of 325 patients seen by 27 ERPs from 15 institutions completed the questionnaire. Respondents were primarily adults (85%), female (72%), and living in urban areas (79%). The mean age of participants was 54 years (range 3-92 years), and 51% were not working. Patients with inflammatory (51%) and noninflammatory conditions (31%) were represented. Mean (standard deviation) Patient-Practitioner Interaction Scale subscale scores ranged from 4.50 (0.60) to 4.63 (0.48) (1 to 5 [greater satisfaction]). Overall satisfaction with the quality of Care was high (4.39 [0.77]), as was satisfaction with wait times (referral to appointment, 4.27 [0.86]; in clinic, 4.24 [0.91]). Ninety-eight percent of respondents felt the Arthritis Care they received was comparable to or better than that previously received from other health Care professionals. Patients were very satisfied with and amenable to Arthritis Care provided by graduates of the ACPAC program. Our findings provide early support for the deployment and integration of ACPAC ERPs into the Ontario health Care system and should inform future evaluation at the patient level.
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Evaluation of perceived collaborative behaviour amongst stakeholders and clinicians of a continuing education programme in Arthritis Care.
Journal of interprofessional care, 2013Co-Authors: Katie Lundon, Kelly Warmington, Carol A. Kennedy, Sydney C Brooks, Laura A. Passalent, Rachel Shupak, Rayfel Schneider, Linda Rozmovits, Lynne Sinclair, Leslie J. SoeverAbstract:Successful implementation of new extended practice roles which transcend conventional boundaries of practice entails strong collaboration with other healthCare providers. This study describes interprofessional collaborative behaviour perceived by advanced clinician practitioner in Arthritis Care (ACPAC) graduates at 1 year beyond training, and relevant stakeholders, across urban, community and remote clinical settings in Canada. A mixed-method approach involved a quantitative (survey) and qualitative (focus group/interview) evaluation issued across a 4-month period. ACPAC graduates work across heterogeneous settings and are on teams of diverse size and composition. Seventy per cent perceived their team as actively working in an interprofessional Care model. Mean scores on the Bruyère Clinical Team Self-Assessment on Interprofessional Practice subjective subscales were high (range: 3.66-4.26, scale: 1-5 = better perception of team's interprofessional practice), whereas the objective scale was lower (mean: 4.6, scale: 0-9 = more interprofessional team practices). Data from focus groups (ACPAC graduates) and interviews (stakeholders) provided further illumination of these results at individual, group and system levels. Issues relating to ACPAC graduate role recognition, as well as their deployment, integration and institutional support, including access to medical directives, limitation of scope of practice, remuneration conflicts and tenuous funding arrangements were barriers perceived to affect role implementation and interprofessional working. This study offers the opportunity to reflect on newly introduced roles for health professionals with expectations of collaboration that will challenge traditional healthCare delivery.
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System integration and clinical utilization of the Advanced Clinician Practitioner in Arthritis Care (ACPAC) Program-Trained Extended Role Practitioners in Ontario: a two-year, system-level evaluation.
Healthcare policy = Politiques de sante, 2013Co-Authors: Laura A. Passalent, Kelly Warmington, Carol A. Kennedy, Katie Lundon, Leslie J. Soever, Rachel Shupak, Sydney Lineker, Rayfel SchneiderAbstract:Arthritis and musculoskeletal disorders are among the most common chronic health conditions in Canada, affecting more than 4.6 million people (Bombardier et al. 2011). Together, they are a leading cause of morbidity, disability and healthCare utilization. These conditions affect people of all ages, being most prevalent among seniors but also affecting children and working-age adults. The most common Arthritis conditions, those with the greatest impact on the healthCare system, and those expected to increase to approximately 2% of the population in the next 30 years, are osteoArthritis (OA) and rheumatoid Arthritis (RA) (Bombardier et al. 2011). In order to help address the growing Arthritis burden, the Advanced Clinician Practitioner in Arthritis Care (ACPAC) program was developed in 2005 to prepare experienced physical therapists and occupational therapists for extended practice roles and to promote the development of innovative models of Arthritis Care across diverse clinical settings in Ontario, Canada. Graduates of the ACPAC program represent a new cadre of extended role practitioner (ERP), having received significant additional training with formal evaluation to establish competency in advanced assessment, diagnosis and management of select Arthritis conditions described elsewhere (Lundon et al. 2011). The ACPAC program is a unique clinical and academic training program offered in Toronto, Ontario. It focuses on the advanced assessment, diagnosis, triage and independent management of select musculoskeletal (orthopaedic) and Arthritis-related (rheumatological) disorders (Lundon et al. 2008, 2009, 2011). Between 2005 and 2011, five cohorts (37 practitioners) of trainees have successfully completed the ACPAC program. A need was identified to evaluate the impact of the ERPs as the graduates of the ACPAC program began to develop and implement new roles at their various institutions. The purpose of this study was to evaluate the system-level impact of ACPAC program–trained ERPs working within various models of Arthritis Care in diverse clinical settings across Ontario. The specific objectives were to (a) measure the extent to which ACPAC program–trained ERPs are delivering integrated and timely healthCare for patients with musculoskeletal and Arthritis-related disorders throughout the province of Ontario, (b) describe the role utilization of the ACPAC program–trained ERP and (c) describe the clinical performance of the ACPAC program–trained ERP with respect to patient volumes, referral sources and diagnoses of patients seen by the ERPs.
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SAT0477 The impact of advanced clinician practitioner in Arthritis Care (ACPAC) program-trained extended role practitioners on healthCare delivery in ontario: A two year prospective study
Annals of the Rheumatic Diseases, 2013Co-Authors: Laura A. Passalent, Kelly Warmington, Carol A. Kennedy, Katie Lundon, Rachel Shupak, L. Soever, S. Brooks, Rayfel SchneiderAbstract:Background The Advanced Clinician Practitioner in Arthritis Care (ACPAC) training program focuses on the assessment, diagnosis, triage and independent management of selected musculoskeletal and Arthritis-related disorders.It is offered to experienced physical and occupational therapists. Objectives The objectives of this study were: 1) to examine the clinical performance of ACPAC program-trained Extended Role Practitioners (ERPs) and 2) to evaluate the extent to which these ERPs are delivering integrated and timely healthCare. Methods ACPAC ERPs (n=30) from 15 healthCare institutions across Ontario (urban, rural, academic, non-academic, adult and paediatric) completed a longitudinal survey each quarter for 2009 and 2010. Indicators were developed via consensus and pilot testing. Analyses were descriptive. Results Response rate varied from 83-97% across quarters. ERPs saw 13407 and 14546 patients in 2009 and 2010, respectively. In 2009, the majority of patients were referred by a family physician (43.9%), and 35.8% by a specialist. This shifted in 2010 to 37.3% and 51.5%, respectively. Over the two-year period, combined adult and paediatric caseloads included new consults (24.9%) and follow-ups (55.6%). Remaining patients underwent triage by an ERP. Most common patient diagnoses included: osteoArthritis (51.6%), rheumatoid Arthritis (14.7%) and juvenile idiopathic Arthritis (11.1%). About 90% of respondents were working in an extended practice role. The longest median wait time from referral to initial assessment by an ERP was 22 days. Approximately half of ERPs participate in each of: education delivery, research and leadership roles, with the majority pursuing professional development. Approximately one third of patients were referred, by an ERP, for x-rays, lab tests and other services (i.e. splints, footwear), followed by referral to allied health services and specialists, and communication via dictated letters. As many as 79% of ERPs acted under the auspices of medical directives, ordering x-rays (over 80%), lab tests (over 60%) and diagnostic ultrasounds (over 40%). Approximately 70% recommended medication/dosage changes (up to 14% made these changes independently). Approximately 90% recommended joint injections (up to 18% performed them). Conclusions ACPAC program-trained therapists are primarily seeing patients with osteoArthritis or rheumatoid Arthritis in a follow-up capacity, with most patients referred by a family physician or specialist. Most ERPs are utilizing medical directives to support their extended practice roles. This new human health resource may be an effective way to address the progressive decline in Arthritis Care specialists. Future evaluations should monitor the evolution of ERPs’ extended roles and assess the impact of ERP-based Care on patient outcomes. Disclosure of Interest None Declared
Katie Lundon - One of the best experts on this subject based on the ideXlab platform.
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Measuring Advanced/Extended Practice Roles in Arthritis and Musculoskeletal Care in Canada
ACR open rheumatology, 2020Co-Authors: Katie Lundon, Carol A. Kennedy, Rachel Shupak, Taucha Inrig, Morag Paton, Mandy Mcglynn, Claire E.h. BarberAbstract:Our objective was to characterize Canadian workforce attributes of extended role practitioners (ERPs) in Arthritis Care. We used an exploratory, mixed-methods study that was based on the Canadian Rheumatology Association's Stand Up and Be Counted Rheumatologist Workforce Survey (2015). An anonymous online survey was deployed to groups of non-physician health Care professionals across Canada who potentially had post-licensure training in Arthritis Care. Demographic and practice information were elicited. Qualitative responses were analyzed using grounded theory techniques. Of 141 respondents, 91 identified as practicing in extended role capacities. The mean age of ERP respondents was 48.7; 87% were female, and 41% of ERPs planned to retire within 5 to 10 years. Respondents were largely physical or occupational therapists by profession and practiced in urban/academic (46%), community (39%), and rural settings (13%). Differences in practice patterns were noted between ERPs (64.5%) and non-ERPs (34.5%), with more ERPs working in extended role capacities while retaining activities reflective of their professional backgrounds. Most respondents (95%) agreed that formal training is necessary to work as an ERP, but only half perceived they had sufficient training opportunities. Barriers to pursuing training were varied, including personal barriers, geographic barriers, patient-Care needs, and financial/remuneration concerns. To our knowledge, no previous studies have assessed the workforce capacity or the perceived need for the training of ERPs working in Arthritis and musculoskeletal Care. Measurement is important because in these health disciplines, practitioners' scopes of practice evolve, and ERPs integrate into the Canadian health Care system. ERPs have emerged to augment provision of Arthritis Care, but funding for continuing professional development opportunities and for role implementation remains tenuous. © 2020 The Authors. ACR Open Rheumatology published by Wiley Periodicals, Inc. on behalf of American College of Rheumatology.
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An advanced clinician practitioner in Arthritis Care can improve access to rheumatology Care in community-based practice.
Journal of multidisciplinary healthcare, 2019Co-Authors: Vandana Ahluwalia, Carol A. Kennedy, Tiffany L H Larsen, Taucha Inrig, Katie LundonAbstract:Objective To facilitate access and improve wait times to a rheumatologist's consultation, this study aimed to 1) determine the ability of an advanced clinician practitioner in Arthritis Care (ACPAC)-trained extended role practitioner (ERP) to triage patients with suspected inflammatory Arthritis (IA) for priority assessment by a rheumatologist and 2) determine the impact of an ERP on access-to-Care as measured by time-to-rheumatologist-assessment and time-to-treatment-decision. Materials and methods A community-based ACPAC-trained ERP triaged new referrals for suspected IA. Patients with suspected IA were booked to see the rheumatologist on a priority basis. Diagnostic accuracy of the ERP to correctly identify priority patients; the level of agreement between ERP and rheumatologist (Kappa coefficient and percent agreement); and the time-to-treatment-decision for confirmed cases of IA were investigated. Retrospective chart review then compared time-to-rheumatologist-assessment and time-to-treatment-decision in the solo-rheumatologist versus the ERP-triage model. Results One hundred twenty-one patients were triaged. The ERP designated 54 patients for priority assessment. The rheumatologist confirmed IA in 49/54 (90.7% positive predictive value [PPV]). Of the 121 patients, 67 patients were designated as nonpriority by the ERP, and none were determined to have IA by the rheumatologist (100% negative predictive value [NPV]). Excellent agreement was found between the ERP and the rheumatologist (Kappa coefficient 0.92, 95% CI: 0.84-0.99). In the ERP-triage model, time-from-referral-to-treatment-decision for patients with IA was 73.7 days (SD 40.4, range 12-183) compared with 124.6 days (SD 61.7, range 26-359) in the solo-rheumatologist model (40% reduction in time-to-treatment-decision). Conclusion A well-trained and experienced ERP can shorten the time-to-Rheumatologist-assessment and time-to-treatment-decision for patients with suspected IA.
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Don't let up: implementing and sustaining change in a new post-licensure education model for developing extended role practitioners involved in Arthritis Care.
Journal of multidisciplinary healthcare, 2015Co-Authors: Katie Lundon, Rachel Shupak, Sonya Canzian, Ed Ziesmann, Rayfel SchneiderAbstract:Across a 9-year period, the Advanced Clinician Practitioner in Arthritis Care program has achieved a set of short-term "wins" giving direction and momentum to the development of new roles for health Care practitioners providing Arthritis Care. This is a viable model for post-licensure training offered to multiple allied health professionals to support the development of competent extended role practitioners (extended scope practice). Challenges at this critical juncture include: retain focus, drive, and commitment; develop academic and financial partnerships transferring short-term success to long-term sustainability; advanced, context-driven, system-level evaluation including fiscal outcome; health Care policy adaptation to new human health resource development. Success includes: completed 2-year health services research evaluating 37 graduates; leadership, innovation, educational excellence, and human health resource benefit awards; influential publications/presentations addressing post-licensure education/outcome, interprofessional collaboration, and improved patient Care.
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The patient perspective: Arthritis Care provided by Advanced Clinician Practitioner in Arthritis Care program-trained clinicians.
Open access rheumatology : research and reviews, 2015Co-Authors: Kelly Warmington, Carol A. Kennedy, Katie Lundon, Leslie J. Soever, Sydney C Brooks, Laura A. Passalent, Rachel Shupak, Rayfel SchneiderAbstract:To assess patient satisfaction with the Arthritis Care services provided by graduates of the Advanced Clinician Practitioner in Arthritis Care (ACPAC) program. This was a cross-sectional evaluation using a self-report questionnaire for data collection. Participants completed the Patient-Doctor Interaction Scale, modified to capture patient-practitioner interactions. Participants completed selected items from the Group Health Association of America's Consumer Satisfaction Survey, and items capturing quality of Care, appropriateness of wait times, and a comparison of extended-role practitioner (ERP) services with previously received Arthritis Care. A total of 325 patients seen by 27 ERPs from 15 institutions completed the questionnaire. Respondents were primarily adults (85%), female (72%), and living in urban areas (79%). The mean age of participants was 54 years (range 3-92 years), and 51% were not working. Patients with inflammatory (51%) and noninflammatory conditions (31%) were represented. Mean (standard deviation) Patient-Practitioner Interaction Scale subscale scores ranged from 4.50 (0.60) to 4.63 (0.48) (1 to 5 [greater satisfaction]). Overall satisfaction with the quality of Care was high (4.39 [0.77]), as was satisfaction with wait times (referral to appointment, 4.27 [0.86]; in clinic, 4.24 [0.91]). Ninety-eight percent of respondents felt the Arthritis Care they received was comparable to or better than that previously received from other health Care professionals. Patients were very satisfied with and amenable to Arthritis Care provided by graduates of the ACPAC program. Our findings provide early support for the deployment and integration of ACPAC ERPs into the Ontario health Care system and should inform future evaluation at the patient level.
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Evaluation of perceived collaborative behaviour amongst stakeholders and clinicians of a continuing education programme in Arthritis Care.
Journal of interprofessional care, 2013Co-Authors: Katie Lundon, Kelly Warmington, Carol A. Kennedy, Sydney C Brooks, Laura A. Passalent, Rachel Shupak, Rayfel Schneider, Linda Rozmovits, Lynne Sinclair, Leslie J. SoeverAbstract:Successful implementation of new extended practice roles which transcend conventional boundaries of practice entails strong collaboration with other healthCare providers. This study describes interprofessional collaborative behaviour perceived by advanced clinician practitioner in Arthritis Care (ACPAC) graduates at 1 year beyond training, and relevant stakeholders, across urban, community and remote clinical settings in Canada. A mixed-method approach involved a quantitative (survey) and qualitative (focus group/interview) evaluation issued across a 4-month period. ACPAC graduates work across heterogeneous settings and are on teams of diverse size and composition. Seventy per cent perceived their team as actively working in an interprofessional Care model. Mean scores on the Bruyère Clinical Team Self-Assessment on Interprofessional Practice subjective subscales were high (range: 3.66-4.26, scale: 1-5 = better perception of team's interprofessional practice), whereas the objective scale was lower (mean: 4.6, scale: 0-9 = more interprofessional team practices). Data from focus groups (ACPAC graduates) and interviews (stakeholders) provided further illumination of these results at individual, group and system levels. Issues relating to ACPAC graduate role recognition, as well as their deployment, integration and institutional support, including access to medical directives, limitation of scope of practice, remuneration conflicts and tenuous funding arrangements were barriers perceived to affect role implementation and interprofessional working. This study offers the opportunity to reflect on newly introduced roles for health professionals with expectations of collaboration that will challenge traditional healthCare delivery.
Catherine H. Maclean - One of the best experts on this subject based on the ideXlab platform.
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Measuring process of Arthritis Care: the Arthritis Foundation's quality indicator set for rheumatoid Arthritis.
Seminars in arthritis and rheumatism, 2006Co-Authors: Dinesh Khanna, James N. Pencharz, Erin L. Arnold, Jennifer M. Grossman, Shana Traina, Anand Lal, Catherine H. MacleanAbstract:Objective To describe the scientific evidence that supports each of the explicit process measures in the Arthritis Foundation’s Quality Indicator Set for Rheumatoid Arthritis. Methods For each of the 27 measures in the Arthritis Foundation’s Quality Indicator set, a comprehensive literature review was performed for evidence that linked the process of Care defined in the indicator with relevant clinical outcomes and to summarize practice guidelines relevant to the indicators. Results Over 7500 titles were identified and reviewed. For each of the indicators the scientific evidence to support or refute the quality indicator was summarized. We found direct evidence that supported a process–outcome link for 15 of the indicators, an indirect link for 7 of the indicators, and no evidence to support or refute a link for 5. The processes of Care described in the indicators for which no supporting/refuting data were found have been assumed to be so essential to Care that clinical trails assessing their importance have not, and probably never will be, performed. The process of Care described in all but 2 of the indicators is recommended in 1 or more practice guidelines. Conclusion There are sufficient scientific evidence and expert consensus to support the Arthritis Foundation’s Quality Indicator Set for Rheumatoid Arthritis, which defines a minimal standard of Care that can be used to assess health Care quality for patients with rheumatoid Arthritis.
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Measuring quality in Arthritis Care: the Arthritis Foundation's Quality Indicator set for osteoArthritis.
Arthritis and rheumatism, 2004Co-Authors: James N. Pencharz, Catherine H. MacleanAbstract:Objective To develop a comprehensive set of explicit process measures to assess the quality of health Care for osteoArthritis and to describe the scientific evidence that supports each measure. Methods Through a comprehensive literature review, we developed potential quality measures and a summary of existing data to support or refute the relationship between the processes of Care proposed in the indicators and relevant clinical outcomes. The proposed measures and literature summary were presented to a multidisciplinary panel of experts in Arthritis and pain. The panel rated each proposed measure for its validity as a measure of health Care quality. Results Among 22 measures proposed for osteoArthritis, the expert panel rated 14 as valid measures of health Care quality. Conclusion Sufficient scientific evidence and expert consensus exist to support a comprehensive set of measures to assess the quality of heath Care for osteoArthritis. These measures can be used to gain an understanding of the quality of Care for patients with osteoArthritis.
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Measuring quality in Arthritis Care: The Arthritis Foundation's quality indicator set for analgesics
Arthritis and rheumatism, 2004Co-Authors: Kenneth G. Saag, Jason J. Olivieri, Fausto G. Patino, Ted R. Mikuls, Jeroan J. Allison, Catherine H. MacleanAbstract:To develop systematically validated quality indicators (QIs) addressing analgesic safety. A comprehensive literature review of existing quality measures, clinical guidelines, and evidence supporting potential QIs concerning nonselective (traditional) nonsteroidal anti-inflammatory drugs (NSAIDs) and newer cyclooxygenase 2-selective NSAIDs was undertaken. An expert panel then validated or refuted potential indicators utilizing a proven methodology. Eleven potential QIs were proposed. After panel review, 8 were judged to be valid; an additional 10 were proposed by the panel, of which 7 were rated as valid. Quality indicators focused upon informing patients about risk, NSAID choice and gastrointestinal prophylaxis, and side effect monitoring. The 15 validated indicators were combined, where appropriate, to yield 10 validated processes of Care indicators for the safe use of NSAIDs. These indicators developed by literature review and finalized by our expert panel process can serve as a basis to compare the quality of analgesic use provided by health Care providers and delivery systems.
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measuring quality in Arthritis Care methods for developing the Arthritis foundation s quality indicator set
Arthritis Care and Research, 2004Co-Authors: Catherine H. Maclean, Kenneth G. Saag, Daniel H. Solomon, Sally C. Morton, Sarah Sampsel, John H. KlippelAbstract:Objective To develop a comprehensive set of explicit process measures to assess the quality of health Care for osteoArthritis, rheumatoid Arthritis, and analgesics use. Methods Potential quality measures and a summary of existing data to support or refute the relationship between the processes of Care proposed in the indicators and relevant clinical outcomes were developed through a comprehensive literature review. The proposed measures and literature summary were presented to a multidisciplinary panel of experts in Arthritis and pain. Using a modification of the RAND/UCLA Appropriateness Method, the panel rated each proposed measure for its validity as a measure of health Care quality. Results Among 66 proposed indicators, the expert panel rated 51 as valid measures of health Care including 14 for osteoArthritis, 27 for rheumatoid Arthritis, and 10 for analgesics use. Conclusions Sufficient scientific evidence and expert consensus exist to support a comprehensive set of measures to assess the quality of heath Care for osteoArthritis, rheumatoid Arthritis, and analgesics use. These measures can be used to gain an understanding of the quality of Care for patients with Arthritis.
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Measuring quality in Arthritis Care: Methods for developing the Arthritis Foundation's quality indicator set
Arthritis and rheumatism, 2004Co-Authors: Catherine H. Maclean, Kenneth G. Saag, Daniel H. Solomon, Sally C. Morton, Sarah Sampsel, John H. KlippelAbstract:To develop a comprehensive set of explicit process measures to assess the quality of health Care for osteoArthritis, rheumatoid Arthritis, and analgesics use. Potential quality measures and a summary of existing data to support or refute the relationship between the processes of Care proposed in the indicators and relevant clinical outcomes were developed through a comprehensive literature review. The proposed measures and literature summary were presented to a multidisciplinary panel of experts in Arthritis and pain. Using a modification of the RAND/UCLA Appropriateness Method, the panel rated each proposed measure for its validity as a measure of health Care quality. Among 66 proposed indicators, the expert panel rated 51 as valid measures of health Care including 14 for osteoArthritis, 27 for rheumatoid Arthritis, and 10 for analgesics use. Sufficient scientific evidence and expert consensus exist to support a comprehensive set of measures to assess the quality of heath Care for osteoArthritis, rheumatoid Arthritis, and analgesics use. These measures can be used to gain an understanding of the quality of Care for patients with Arthritis.
Kenneth G. Saag - One of the best experts on this subject based on the ideXlab platform.
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Measuring quality in Arthritis Care: The Arthritis Foundation's quality indicator set for analgesics
Arthritis and rheumatism, 2004Co-Authors: Kenneth G. Saag, Jason J. Olivieri, Fausto G. Patino, Ted R. Mikuls, Jeroan J. Allison, Catherine H. MacleanAbstract:To develop systematically validated quality indicators (QIs) addressing analgesic safety. A comprehensive literature review of existing quality measures, clinical guidelines, and evidence supporting potential QIs concerning nonselective (traditional) nonsteroidal anti-inflammatory drugs (NSAIDs) and newer cyclooxygenase 2-selective NSAIDs was undertaken. An expert panel then validated or refuted potential indicators utilizing a proven methodology. Eleven potential QIs were proposed. After panel review, 8 were judged to be valid; an additional 10 were proposed by the panel, of which 7 were rated as valid. Quality indicators focused upon informing patients about risk, NSAID choice and gastrointestinal prophylaxis, and side effect monitoring. The 15 validated indicators were combined, where appropriate, to yield 10 validated processes of Care indicators for the safe use of NSAIDs. These indicators developed by literature review and finalized by our expert panel process can serve as a basis to compare the quality of analgesic use provided by health Care providers and delivery systems.
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measuring quality in Arthritis Care methods for developing the Arthritis foundation s quality indicator set
Arthritis Care and Research, 2004Co-Authors: Catherine H. Maclean, Kenneth G. Saag, Daniel H. Solomon, Sally C. Morton, Sarah Sampsel, John H. KlippelAbstract:Objective To develop a comprehensive set of explicit process measures to assess the quality of health Care for osteoArthritis, rheumatoid Arthritis, and analgesics use. Methods Potential quality measures and a summary of existing data to support or refute the relationship between the processes of Care proposed in the indicators and relevant clinical outcomes were developed through a comprehensive literature review. The proposed measures and literature summary were presented to a multidisciplinary panel of experts in Arthritis and pain. Using a modification of the RAND/UCLA Appropriateness Method, the panel rated each proposed measure for its validity as a measure of health Care quality. Results Among 66 proposed indicators, the expert panel rated 51 as valid measures of health Care including 14 for osteoArthritis, 27 for rheumatoid Arthritis, and 10 for analgesics use. Conclusions Sufficient scientific evidence and expert consensus exist to support a comprehensive set of measures to assess the quality of heath Care for osteoArthritis, rheumatoid Arthritis, and analgesics use. These measures can be used to gain an understanding of the quality of Care for patients with Arthritis.
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Measuring quality in Arthritis Care: Methods for developing the Arthritis Foundation's quality indicator set
Arthritis and rheumatism, 2004Co-Authors: Catherine H. Maclean, Kenneth G. Saag, Daniel H. Solomon, Sally C. Morton, Sarah Sampsel, John H. KlippelAbstract:To develop a comprehensive set of explicit process measures to assess the quality of health Care for osteoArthritis, rheumatoid Arthritis, and analgesics use. Potential quality measures and a summary of existing data to support or refute the relationship between the processes of Care proposed in the indicators and relevant clinical outcomes were developed through a comprehensive literature review. The proposed measures and literature summary were presented to a multidisciplinary panel of experts in Arthritis and pain. Using a modification of the RAND/UCLA Appropriateness Method, the panel rated each proposed measure for its validity as a measure of health Care quality. Among 66 proposed indicators, the expert panel rated 51 as valid measures of health Care including 14 for osteoArthritis, 27 for rheumatoid Arthritis, and 10 for analgesics use. Sufficient scientific evidence and expert consensus exist to support a comprehensive set of measures to assess the quality of heath Care for osteoArthritis, rheumatoid Arthritis, and analgesics use. These measures can be used to gain an understanding of the quality of Care for patients with Arthritis.
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The association of race/ethnicity with the receipt of traditional and alternative Arthritis-specific health Care.
Medical care, 2003Co-Authors: Ted R. Mikuls, Amy S. Mudano, Lea Vonne Pulley, Kenneth G. SaagAbstract:The role of race/ethnicity in the receipt of Arthritis-specific health Care has not been well defined. To examine the association of race/ethnicity with the utilization of Arthritis health Care among community-dwelling older adults. We used a computer-assisted telephone interview. A population-based random sample was drawn from 6 preselected Alabama counties. Eligible respondents had self-reported Arthritis and were over 50 years of age; 1424 people responded to the survey. Logistic regression was used to examine the association of race/ethnicity with the use of conventional (including use of a rheumatologist, primary Care physician, and prescription Arthritis medicines) and complementary and alternative medicines (CAM), including the use of chiropractic Care, glucosamine and/or chondroitin, and herbals. Reflecting stratified sampling, respondents were white (n=852, 60%) or black (n=528, 37%), female (72%), and had a mean age of 65 years. After multivariable adjustment, race/ethnicity was not a significant determinant of receiving rheumatology Care or prescription Arthritis medicines. However, whites were more likely than blacks to have seen a primary Care physician for Arthritis Care (adjusted odds ratio [OR], 1.49; 95% confidence interval [CI], 1.12-1.98) or to have used CAM (OR, 1.47; 95% CI, 1.13-1.91) and twice as likely to have used glucosamine and/or chondroitin (OR, 1.99; 95% CI, 1.30-3.05). In this population of community-dwelling older adults, white race was significantly associated with CAM use and visits to primary Care physicians for Arthritis Care. In contrast, the use of specialists and prescription Arthritis medications was better explained by factors other than race/ethnicity, which included female gender, urban residence, higher educational level, and other Arthritis-specific variables.
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Arthritis health service utilization among the elderly: the role of urban-rural residence and other utilization factors.
Arthritis care and research : the official journal of the Arthritis Health Professions Association, 1998Co-Authors: Kenneth G. Saag, Bradley N. Doebbeling, James E. Rohrer, Sheela Kolluri, Theresa A. Mitchell, Robert B. WallaceAbstract:Objective. To compare the impact of urban-rural residence and other factors on the utilization of any type of Arthritis-related physician Care and on rheumatologist utilization. Methods. A population-based random sample of adults 65 years of age or older with self-reported Arthritis from 10 urban and 12 rural Iowa counties were surveyed by telephone interview. We estimated the Arthritis prevalence and health service utilization in this sample and evaluated the effects of predisposing, enabling, and need factors on utilization and satisfaction. Health Care utilization was defined as ever having visited specific types of providers for Arthritis-related Care. Results. A total of 488 individuals participated: 227 from urban counties and 261 rural respondents. Urban respondents more commonly reported having received a diagnosis of osteoArthritis from their physicians but were less likely to report rheumatoid Arthritis. A greater proportion of urban versus rural respondents had utilized any physician for Arthritis Care (50.7% versus 41.0%, P = 0.032) and had more often seen an orthopedist (18.1% versus 9.6%, P = 0.006) or general internist (18.5% versus 8.8%, P = 0.002). A diagnosis of rheumatoid Arthritis, younger age, living with another person, higher income, and further distance from an Arthritis provider were significantly associated with prior rheumatologist utilization. The strongest adjusted predictor of any physician visit for Arthritis Care was whether older adults drove themselves to their provider. For rheumatologist utilization, a diagnosis of rheumatoid Arthritis and age were independently associated. Conclusions. The most striking finding was the consistent association of need factors (such as the desire for medical advice), joint swelling, and the presence of a diagnosis of rheumatoid Arthritis with physician utilization. We identified significant urban-rural variations in factors both enabling and predisposing to Arthritis Care, although urban-rural status did not appear to independently influence Arthritis physician utilization. In a rural state with a relatively small number of rheumatologists, deleterious enabling factors such as greater distance from the doctor and lack of supplemental insurance did not provide significant obstacles to either rheumatologist or generalist utilization.
Rachel Shupak - One of the best experts on this subject based on the ideXlab platform.
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Measuring Advanced/Extended Practice Roles in Arthritis and Musculoskeletal Care in Canada
ACR open rheumatology, 2020Co-Authors: Katie Lundon, Carol A. Kennedy, Rachel Shupak, Taucha Inrig, Morag Paton, Mandy Mcglynn, Claire E.h. BarberAbstract:Our objective was to characterize Canadian workforce attributes of extended role practitioners (ERPs) in Arthritis Care. We used an exploratory, mixed-methods study that was based on the Canadian Rheumatology Association's Stand Up and Be Counted Rheumatologist Workforce Survey (2015). An anonymous online survey was deployed to groups of non-physician health Care professionals across Canada who potentially had post-licensure training in Arthritis Care. Demographic and practice information were elicited. Qualitative responses were analyzed using grounded theory techniques. Of 141 respondents, 91 identified as practicing in extended role capacities. The mean age of ERP respondents was 48.7; 87% were female, and 41% of ERPs planned to retire within 5 to 10 years. Respondents were largely physical or occupational therapists by profession and practiced in urban/academic (46%), community (39%), and rural settings (13%). Differences in practice patterns were noted between ERPs (64.5%) and non-ERPs (34.5%), with more ERPs working in extended role capacities while retaining activities reflective of their professional backgrounds. Most respondents (95%) agreed that formal training is necessary to work as an ERP, but only half perceived they had sufficient training opportunities. Barriers to pursuing training were varied, including personal barriers, geographic barriers, patient-Care needs, and financial/remuneration concerns. To our knowledge, no previous studies have assessed the workforce capacity or the perceived need for the training of ERPs working in Arthritis and musculoskeletal Care. Measurement is important because in these health disciplines, practitioners' scopes of practice evolve, and ERPs integrate into the Canadian health Care system. ERPs have emerged to augment provision of Arthritis Care, but funding for continuing professional development opportunities and for role implementation remains tenuous. © 2020 The Authors. ACR Open Rheumatology published by Wiley Periodicals, Inc. on behalf of American College of Rheumatology.
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Telemedicine delivery of patient education in remote Ontario communities: feasibility of an Advanced Clinician Practitioner in Arthritis Care (ACPAC)-led inflammatory Arthritis education program.
Open access rheumatology : research and reviews, 2017Co-Authors: Kelly Warmington, Carol A. Kennedy, Rachel Shupak, Carol Flewelling, Angelo Papachristos, Caroline Jones, Denise Linton, Dorcas E. Beaton, Sydney C. LinekerAbstract:Objective Telemedicine-based approaches to health Care service delivery improve access to Care. It was recognized that adults with inflammatory Arthritis (IA) living in remote areas had limited access to patient education and could benefit from the 1-day Prescription for Education (RxEd) program. The program was delivered by extended role practitioners with advanced training in Arthritis Care. Normally offered at one urban center, RxEd was adapted for videoconference delivery through two educator development workshops that addressed telemedicine and adult education best practices. This study explores the feasibility of and participant satisfaction with telemedicine delivery of the RxEd program in remote communities. Materials and methods Participants included adults with IA attending the RxEd program at one of six rural sites. They completed post-course program evaluations and follow-up interviews. Educators provided post-course feedback to identify program improvements that were later implemented. Results In total, 123 people (36 in-person and 87 remote, across 6 sites) participated, attending one of three RxEd sessions. Remote participants were satisfied with the quality of the video-conference (% agree/strongly agree): could hear the presenter (92.9%) and discussion between sites (82.4%); could see who was speaking at other remote sites (85.7%); could see the slides (95.3%); and interaction between sites adequately facilitated (94.0%). Educator and participant feedback were consistent. Suggested improvements included: use of two screens (speaker and slides); frontal camera angles; equal interaction with remote sites; and slide modifications to improve the readability on screen. Interview data included similar constructive feedback but highlighted the educational and social benefits of the program, which participants noted would have been inaccessible if not offered via telemedicine. Conclusion Study findings confirm the feasibility of delivering the RxEd program to remote communities by using telemedicine. Future research with a focus on the sustainability of this and other models of technology-supported patient education for adults with IA across Ontario is warranted.
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Don't let up: implementing and sustaining change in a new post-licensure education model for developing extended role practitioners involved in Arthritis Care.
Journal of multidisciplinary healthcare, 2015Co-Authors: Katie Lundon, Rachel Shupak, Sonya Canzian, Ed Ziesmann, Rayfel SchneiderAbstract:Across a 9-year period, the Advanced Clinician Practitioner in Arthritis Care program has achieved a set of short-term "wins" giving direction and momentum to the development of new roles for health Care practitioners providing Arthritis Care. This is a viable model for post-licensure training offered to multiple allied health professionals to support the development of competent extended role practitioners (extended scope practice). Challenges at this critical juncture include: retain focus, drive, and commitment; develop academic and financial partnerships transferring short-term success to long-term sustainability; advanced, context-driven, system-level evaluation including fiscal outcome; health Care policy adaptation to new human health resource development. Success includes: completed 2-year health services research evaluating 37 graduates; leadership, innovation, educational excellence, and human health resource benefit awards; influential publications/presentations addressing post-licensure education/outcome, interprofessional collaboration, and improved patient Care.
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The patient perspective: Arthritis Care provided by Advanced Clinician Practitioner in Arthritis Care program-trained clinicians.
Open access rheumatology : research and reviews, 2015Co-Authors: Kelly Warmington, Carol A. Kennedy, Katie Lundon, Leslie J. Soever, Sydney C Brooks, Laura A. Passalent, Rachel Shupak, Rayfel SchneiderAbstract:To assess patient satisfaction with the Arthritis Care services provided by graduates of the Advanced Clinician Practitioner in Arthritis Care (ACPAC) program. This was a cross-sectional evaluation using a self-report questionnaire for data collection. Participants completed the Patient-Doctor Interaction Scale, modified to capture patient-practitioner interactions. Participants completed selected items from the Group Health Association of America's Consumer Satisfaction Survey, and items capturing quality of Care, appropriateness of wait times, and a comparison of extended-role practitioner (ERP) services with previously received Arthritis Care. A total of 325 patients seen by 27 ERPs from 15 institutions completed the questionnaire. Respondents were primarily adults (85%), female (72%), and living in urban areas (79%). The mean age of participants was 54 years (range 3-92 years), and 51% were not working. Patients with inflammatory (51%) and noninflammatory conditions (31%) were represented. Mean (standard deviation) Patient-Practitioner Interaction Scale subscale scores ranged from 4.50 (0.60) to 4.63 (0.48) (1 to 5 [greater satisfaction]). Overall satisfaction with the quality of Care was high (4.39 [0.77]), as was satisfaction with wait times (referral to appointment, 4.27 [0.86]; in clinic, 4.24 [0.91]). Ninety-eight percent of respondents felt the Arthritis Care they received was comparable to or better than that previously received from other health Care professionals. Patients were very satisfied with and amenable to Arthritis Care provided by graduates of the ACPAC program. Our findings provide early support for the deployment and integration of ACPAC ERPs into the Ontario health Care system and should inform future evaluation at the patient level.
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Evaluation of perceived collaborative behaviour amongst stakeholders and clinicians of a continuing education programme in Arthritis Care.
Journal of interprofessional care, 2013Co-Authors: Katie Lundon, Kelly Warmington, Carol A. Kennedy, Sydney C Brooks, Laura A. Passalent, Rachel Shupak, Rayfel Schneider, Linda Rozmovits, Lynne Sinclair, Leslie J. SoeverAbstract:Successful implementation of new extended practice roles which transcend conventional boundaries of practice entails strong collaboration with other healthCare providers. This study describes interprofessional collaborative behaviour perceived by advanced clinician practitioner in Arthritis Care (ACPAC) graduates at 1 year beyond training, and relevant stakeholders, across urban, community and remote clinical settings in Canada. A mixed-method approach involved a quantitative (survey) and qualitative (focus group/interview) evaluation issued across a 4-month period. ACPAC graduates work across heterogeneous settings and are on teams of diverse size and composition. Seventy per cent perceived their team as actively working in an interprofessional Care model. Mean scores on the Bruyère Clinical Team Self-Assessment on Interprofessional Practice subjective subscales were high (range: 3.66-4.26, scale: 1-5 = better perception of team's interprofessional practice), whereas the objective scale was lower (mean: 4.6, scale: 0-9 = more interprofessional team practices). Data from focus groups (ACPAC graduates) and interviews (stakeholders) provided further illumination of these results at individual, group and system levels. Issues relating to ACPAC graduate role recognition, as well as their deployment, integration and institutional support, including access to medical directives, limitation of scope of practice, remuneration conflicts and tenuous funding arrangements were barriers perceived to affect role implementation and interprofessional working. This study offers the opportunity to reflect on newly introduced roles for health professionals with expectations of collaboration that will challenge traditional healthCare delivery.
