The Experts below are selected from a list of 43614 Experts worldwide ranked by ideXlab platform
Tracy Comans - One of the best experts on this subject based on the ideXlab platform.
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allied health primary contact services results of a 2 year follow up study of clinical effectiveness safety wait times and impact on Medical Specialist out patient waitlists
Australian Health Review, 2021Co-Authors: Michelle Stute, Nicole Moretto, Rebecca Waters, Maree Raymer, Sonia Sam, Marita Bhagwat, Merrilyn Banks, Tracy Comans, Peter ButtrumAbstract:Objective Long Specialist out-patient waitlists are common in public health facilities, but not all patients require consultation with a Medical Specialist. Studies of single allied health primary contact services have shown they provide timely, appropriate care and reduce demand on Medical Specialist out-patient waitlists. This study evaluated the collective benefits across multiple allied health primary contact services and models to determine their clinical effectiveness, safety, timeliness of care and impact on Medical Specialist out-patient waitlists. Method Using a prospective observational study design, data were collected and analysed for patients attending 47 allied health primary contact services in Queensland public hospitals over a 2-year period. Outcomes reported are global status, adverse events, wait times and impact on Medical Specialist out-patient waitlists. Results In all, 10634 patients were managed in and discharged from the allied health services. Most adult patients (80%) who attended at least two consultations reported an improvement in health status. No adverse events were attributed to the model of care. Approximately 68%, 44% and 90% of urgent, semi-urgent and non-urgent out-patients respectively were seen within clinically recommended time frames. Between 35% and 89% of patients were removed from out-patient waitlists without Medical Specialist consultation across the service models. Conclusions Allied health primary contact services provide safe, effective and timely care. The impact on Medical Specialist out-patient waitlists varied depending on service model and pathway characteristics. What is known about this topic? Most studies of allied health primary contact services have focused on the management of patients on orthopaedic Specialist out-patient waitlists by a physiotherapist. These studies of either individual services or groups of services with the same model cite benefits, including reduced waiting times, high levels of patient and referrer satisfaction, improved conversion to surgery, cost-effectiveness and more effective utilisation of Medical Specialists. What does this paper add? This paper highlights that, collectively, allied health primary contact services are safe, effective and provide timely care. The proportion of patients independently managed and removed from various Medical Specialist out-patient waitlists and the services involved are reported, demonstrating the variety of service models. This study reports outcomes for primary contact services for which there is a dearth of published literature, including dietician services for patients on gastroenterology waitlists, speech pathology and audiology services for patients on ear, nose and throat waitlists, occupational therapy hand services for patients on orthopaedic waitlists and physiotherapy led pelvic-health services for patients on gynaecology waitlists. Possibilities for efficiency gains are identified and discussed. What are the implications for practitioners? Health service managers should consider allied health primary contact services as a viable option to increase Specialist out-patient capacity. Service model characteristics that maximise impact on Medical Specialist out-patient waitlist management are highlighted to inform resource allocation.
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disparities in service and clinical outcomes in state wide advanced practice physiotherapist led services
Healthcare, 2021Co-Authors: Maree Raymer, Tracy Comans, Louise E Mitchell, Peter Window, Michelle A Cottrell, Shaun OlearyAbstract:This study explored variations in the primary service and clinical outcomes of a state-wide advanced practice physiotherapist-led service embedded in public Medical Specialist orthopaedic and neurosurgical outpatient services across Queensland, Australia. An audit of the service database over a six-year period was taken from 18 service facilities. The primary service and clinical outcomes were described. Variations in these outcomes between facilities were explored with a regression analysis adjusting for known patient- and service-related characteristics. The findings showed substantial positive impacts of the advanced practice model across all facilities, with 69.4% of patients discharged without a need for Medical Specialist review (primary service outcome), consistent with 68.9% of patients reporting clinically important improvements in their condition (primary clinical outcome). However, 15 facilities significantly varied from the state average for the primary service outcome (despite only three facilities varying in the primary clinical outcome). While this disparity in the primary service outcomes appears to be influenced by potentially modifiable differences in the service-related processes between facilities, these process differences only explained part of the variation. This study described the subsequent development of a new, more comprehensive set of service evaluation metrics to better inform future service planning.
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the development and practical application of a simulation model to inform musculoskeletal service delivery in an australian public health service
Operations research for health care, 2017Co-Authors: Tracy Comans, Shaun Oleary, Angela T Chang, Lachlan Standfield, Dylan Knowles, Maree RaymerAbstract:Timely access to orthopaedic and neurosurgery services in public hospitals is difficult to achieve due to constrained resources and rising demand with the result that waiting time targets are often not met. Advanced physiotherapy-led clinics can assist in managing demand by directly assessing and managing many patients without the need for consultation with a Medical Specialist. The purpose of this study was to develop and apply simulation modelling to determine the scale and mix of services required to efficiently manage demand from patients with musculoskeletal conditions in one health district.
Yuval Bitan - One of the best experts on this subject based on the ideXlab platform.
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machine learning applied to multi sensor information to reduce false alarm rate in the icu
Journal of Clinical Monitoring and Computing, 2020Co-Authors: Gal Hever, Liel Cohen, Michael Oconnor, Idit Matot, Boaz Lerner, Yuval BitanAbstract:: Studies reveal that the false alarm rate (FAR) demonstrated by intensive care unit (ICU) vital signs monitors ranges from 0.72 to 0.99. We applied machine learning (ML) to ICU multi-sensor information to imitate a Medical Specialist in diagnosing patient condition. We hypothesized that applying this data-driven approach to Medical monitors will help reduce the FAR even when data from sensors are missing. An expert-based rules algorithm identified and tagged in our dataset seven clinical alarm scenarios. We compared a random forest (RF) ML model trained using the tagged data, where parameters (e.g., heart rate or blood pressure) were (deliberately) removed, in detecting ICU signals with the full expert-based rules (FER), our ground truth, and partial expert-based rules (PER), missing these parameters. When all alarm scenarios were examined, RF and FER were almost identical. However, in the absence of one to three parameters, RF maintained its values of the Youden index (0.94-0.97) and positive predictive value (PPV) (0.98-0.99), whereas PER lost its value (0.54-0.8 and 0.76-0.88, respectively). While the FAR for PER with missing parameters was 0.17-0.39, it was only 0.01-0.02 for RF. When scenarios were examined separately, RF showed clear superiority in almost all combinations of scenarios and numbers of missing parameters. When sensor data are missing, Specialist performance worsens with the number of missing parameters, whereas the RF model attains high accuracy and low FAR due to its ability to fuse information from available sensors, compensating for missing parameters.
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Machine learning applied to multi-sensor information to reduce false alarm rate in the ICU
Journal of Clinical Monitoring and Computing, 2020Co-Authors: Gal Hever, Liel Cohen, Idit Matot, Boaz Lerner, Michael F. O’connor, Yuval BitanAbstract:Studies reveal that the false alarm rate (FAR) demonstrated by intensive care unit (ICU) vital signs monitors ranges from 0.72 to 0.99. We applied machine learning (ML) to ICU multi-sensor information to imitate a Medical Specialist in diagnosing patient condition. We hypothesized that applying this data-driven approach to Medical monitors will help reduce the FAR even when data from sensors are missing. An expert-based rules algorithm identified and tagged in our dataset seven clinical alarm scenarios. We compared a random forest (RF) ML model trained using the tagged data, where parameters (e.g., heart rate or blood pressure) were (deliberately) removed, in detecting ICU signals with the full expert-based rules (FER), our ground truth, and partial expert-based rules (PER), missing these parameters. When all alarm scenarios were examined, RF and FER were almost identical. However, in the absence of one to three parameters, RF maintained its values of the Youden index (0.94–0.97) and positive predictive value (PPV) (0.98–0.99), whereas PER lost its value (0.54–0.8 and 0.76–0.88, respectively). While the FAR for PER with missing parameters was 0.17–0.39, it was only 0.01–0.02 for RF. When scenarios were examined separately, RF showed clear superiority in almost all combinations of scenarios and numbers of missing parameters. When sensor data are missing, Specialist performance worsens with the number of missing parameters, whereas the RF model attains high accuracy and low FAR due to its ability to fuse information from available sensors, compensating for missing parameters.
Maree Raymer - One of the best experts on this subject based on the ideXlab platform.
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allied health primary contact services results of a 2 year follow up study of clinical effectiveness safety wait times and impact on Medical Specialist out patient waitlists
Australian Health Review, 2021Co-Authors: Michelle Stute, Nicole Moretto, Rebecca Waters, Maree Raymer, Sonia Sam, Marita Bhagwat, Merrilyn Banks, Tracy Comans, Peter ButtrumAbstract:Objective Long Specialist out-patient waitlists are common in public health facilities, but not all patients require consultation with a Medical Specialist. Studies of single allied health primary contact services have shown they provide timely, appropriate care and reduce demand on Medical Specialist out-patient waitlists. This study evaluated the collective benefits across multiple allied health primary contact services and models to determine their clinical effectiveness, safety, timeliness of care and impact on Medical Specialist out-patient waitlists. Method Using a prospective observational study design, data were collected and analysed for patients attending 47 allied health primary contact services in Queensland public hospitals over a 2-year period. Outcomes reported are global status, adverse events, wait times and impact on Medical Specialist out-patient waitlists. Results In all, 10634 patients were managed in and discharged from the allied health services. Most adult patients (80%) who attended at least two consultations reported an improvement in health status. No adverse events were attributed to the model of care. Approximately 68%, 44% and 90% of urgent, semi-urgent and non-urgent out-patients respectively were seen within clinically recommended time frames. Between 35% and 89% of patients were removed from out-patient waitlists without Medical Specialist consultation across the service models. Conclusions Allied health primary contact services provide safe, effective and timely care. The impact on Medical Specialist out-patient waitlists varied depending on service model and pathway characteristics. What is known about this topic? Most studies of allied health primary contact services have focused on the management of patients on orthopaedic Specialist out-patient waitlists by a physiotherapist. These studies of either individual services or groups of services with the same model cite benefits, including reduced waiting times, high levels of patient and referrer satisfaction, improved conversion to surgery, cost-effectiveness and more effective utilisation of Medical Specialists. What does this paper add? This paper highlights that, collectively, allied health primary contact services are safe, effective and provide timely care. The proportion of patients independently managed and removed from various Medical Specialist out-patient waitlists and the services involved are reported, demonstrating the variety of service models. This study reports outcomes for primary contact services for which there is a dearth of published literature, including dietician services for patients on gastroenterology waitlists, speech pathology and audiology services for patients on ear, nose and throat waitlists, occupational therapy hand services for patients on orthopaedic waitlists and physiotherapy led pelvic-health services for patients on gynaecology waitlists. Possibilities for efficiency gains are identified and discussed. What are the implications for practitioners? Health service managers should consider allied health primary contact services as a viable option to increase Specialist out-patient capacity. Service model characteristics that maximise impact on Medical Specialist out-patient waitlist management are highlighted to inform resource allocation.
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disparities in service and clinical outcomes in state wide advanced practice physiotherapist led services
Healthcare, 2021Co-Authors: Maree Raymer, Tracy Comans, Louise E Mitchell, Peter Window, Michelle A Cottrell, Shaun OlearyAbstract:This study explored variations in the primary service and clinical outcomes of a state-wide advanced practice physiotherapist-led service embedded in public Medical Specialist orthopaedic and neurosurgical outpatient services across Queensland, Australia. An audit of the service database over a six-year period was taken from 18 service facilities. The primary service and clinical outcomes were described. Variations in these outcomes between facilities were explored with a regression analysis adjusting for known patient- and service-related characteristics. The findings showed substantial positive impacts of the advanced practice model across all facilities, with 69.4% of patients discharged without a need for Medical Specialist review (primary service outcome), consistent with 68.9% of patients reporting clinically important improvements in their condition (primary clinical outcome). However, 15 facilities significantly varied from the state average for the primary service outcome (despite only three facilities varying in the primary clinical outcome). While this disparity in the primary service outcomes appears to be influenced by potentially modifiable differences in the service-related processes between facilities, these process differences only explained part of the variation. This study described the subsequent development of a new, more comprehensive set of service evaluation metrics to better inform future service planning.
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the development and practical application of a simulation model to inform musculoskeletal service delivery in an australian public health service
Operations research for health care, 2017Co-Authors: Tracy Comans, Shaun Oleary, Angela T Chang, Lachlan Standfield, Dylan Knowles, Maree RaymerAbstract:Timely access to orthopaedic and neurosurgery services in public hospitals is difficult to achieve due to constrained resources and rising demand with the result that waiting time targets are often not met. Advanced physiotherapy-led clinics can assist in managing demand by directly assessing and managing many patients without the need for consultation with a Medical Specialist. The purpose of this study was to develop and apply simulation modelling to determine the scale and mix of services required to efficiently manage demand from patients with musculoskeletal conditions in one health district.
Hanneke C J M De Haes - One of the best experts on this subject based on the ideXlab platform.
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patient participation in the Medical Specialist encounter does physicians patient centred communication matter
Patient Education and Counseling, 2007Co-Authors: Linda C Zandbelt, Ellen M A Smets, Frans J Oort, Mieke H Godfried, Hanneke C J M De HaesAbstract:Abstract Objective Physicians’ patient-centred communication is assumed to stimulate patients’ active participation, thus leading to more effective and humane exchange in the Medical consultation. We investigated the relationship between physicians’ patient-centred communication and patient participation in a Medical Specialist setting. Methods Participants were 30 residents and Specialists in internal medicine, and 323 of their patients. Participants completed a questionnaire prior to a (videotaped) follow-up consultation. Physicians’ patient-centred communication was assessed by coding behaviours that facilitate or rather inhibit patients to express their perspective. Patient participation was determined by assessing (a) their relative contribution to the conversation, and (b) their active participation behaviour. Analyses accounted for relevant background characteristics. Results Physicians’ facilitating behaviour was found to be positively associated with patients’ relative contribution to the conversation as well as patients’ active participation behaviour. Physicians’ inhibiting behaviour was not related to patients’ relative contribution, and was, unexpectedly, positively associated with patients’ active participation behaviour. Physicians’ behaviour was particularly associated with patients’ expression of concerns and cues. Conclusions Physicians in internal Specialist medicine appear to be able to facilitate patients’ active participation in the visit. The findings indicate that inhibiting behaviour may not have the expected blocking effect on patient participation: patients voiced their perspectives just the same and expressed even more concerns. Showing inhibiting behaviour may, alternatively, be a physician's response to the patient's increased participation in the encounter. Practice implications The results may give directions for future Medical education and Specialist training.
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determinants of physicians patient centred behaviour in the Medical Specialist encounter
Social Science & Medicine, 2006Co-Authors: Linda C Zandbelt, Ellen M A Smets, Frans J Oort, Mieke H Godfried, Hanneke C J M De HaesAbstract:It has been suggested that patient-centred communication does not necessarily translate into a 'one-size fits all' approach, but rather that physicians should use a flexible style and adapt to the particular needs of their patients. This paper examines variability in physicians' patient-centred behaviour in Medical Specialist encounters, and determines whether patient, visit, and physician characteristics influence this variability. Participants were 30 residents and Specialists in internal medicine at an academic teaching hospital in The Netherlands, and 323 patients having a (videotaped) outpatient follow-up appointment. Physicians and patients completed a questionnaire prior to the encounter. Consultations were coded using the Patient-centred Behaviour Coding Instrument (PBCI); physicians' patient-centred behaviour was determined by behaviours that facilitated rather than inhibited the patient's expression of his/her perspective. The results show that physicians differ in their communicative behaviour (i.e. inter-individual variability): some internists had a more 'patient-centred' communication style and others less so. At the same time, physicians show intra-individual variation; apparently they adjust their style according to the situation. Physicians displayed more facilitating behaviour when patients were older, reported more physical symptoms, when they rated patients' health condition as more severe and when the physician was a woman. Physicians also displayed more inhibiting behaviour when patients reported more physical symptoms and when the physician rated patients' health condition as more severe. Apparently, sicker patients were targets of both greater facilitation and greater inhibition. Variability in physicians' facilitating and inhibiting behaviour was explained by patient characteristics, i.e. patients' age and health condition, and-with the exception of physician gender-not by physician or visit characteristics. This indicates that physician patient-centred behaviour is related to the type of patient visiting, especially in relation to the seriousness of symptoms.
Linda C Zandbelt - One of the best experts on this subject based on the ideXlab platform.
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e consulting in a Medical Specialist setting medicine of the future
Patient Education and Counseling, 2016Co-Authors: Linda C Zandbelt, Froukje E C De Kanter, Dirk T UbbinkAbstract:Abstract Objective Today’s technology provides new ways of consulting between patients and Medical Specialists in health care, such as videoconferencing and web-messaging. In this systematic review we assessed the effects of e-consulting between Medical Specialists and patients. Methods We searched MEDLINE, EMBASE, Psychlit and Cochrane Library for randomized clinical trials assessing the use of e-consulting methods (videoconferencing (VC) or web-messaging (WM)), as compared to conventional care (face-to-face (FF) or telephone consultations (TC)) in a Medical Specialist setting. We extracted patient-related, physician-related, cost, time and follow-up outcomes. Results We included 21 trials, of which 17 addressed VC compared to FF, two compared WM with FF, one VC with TC, and one WM with TC. Physicians appeared to prefer face-to-face consultations over videoconferencing. Patients appeared to be as satisfied with videoconferencing as with face-to-face contacts, but preferred videoconferencing and web-messaging over telephone consultations. Videoconferencing was more expensive regarding equipment, but saved patient-related costs in terms of time, transportation, and missed work. Variable results were found for consult time and follow-up visits. Conclusions and practice implications We cautiously conclude that e-consulting seems a feasible alternative to Medical Specialists’ face-to-face follow-up or telephone appointments, but may be less suitable for initial consultations requiring physical examination.
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patient participation in the Medical Specialist encounter does physicians patient centred communication matter
Patient Education and Counseling, 2007Co-Authors: Linda C Zandbelt, Ellen M A Smets, Frans J Oort, Mieke H Godfried, Hanneke C J M De HaesAbstract:Abstract Objective Physicians’ patient-centred communication is assumed to stimulate patients’ active participation, thus leading to more effective and humane exchange in the Medical consultation. We investigated the relationship between physicians’ patient-centred communication and patient participation in a Medical Specialist setting. Methods Participants were 30 residents and Specialists in internal medicine, and 323 of their patients. Participants completed a questionnaire prior to a (videotaped) follow-up consultation. Physicians’ patient-centred communication was assessed by coding behaviours that facilitate or rather inhibit patients to express their perspective. Patient participation was determined by assessing (a) their relative contribution to the conversation, and (b) their active participation behaviour. Analyses accounted for relevant background characteristics. Results Physicians’ facilitating behaviour was found to be positively associated with patients’ relative contribution to the conversation as well as patients’ active participation behaviour. Physicians’ inhibiting behaviour was not related to patients’ relative contribution, and was, unexpectedly, positively associated with patients’ active participation behaviour. Physicians’ behaviour was particularly associated with patients’ expression of concerns and cues. Conclusions Physicians in internal Specialist medicine appear to be able to facilitate patients’ active participation in the visit. The findings indicate that inhibiting behaviour may not have the expected blocking effect on patient participation: patients voiced their perspectives just the same and expressed even more concerns. Showing inhibiting behaviour may, alternatively, be a physician's response to the patient's increased participation in the encounter. Practice implications The results may give directions for future Medical education and Specialist training.
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determinants of physicians patient centred behaviour in the Medical Specialist encounter
Social Science & Medicine, 2006Co-Authors: Linda C Zandbelt, Ellen M A Smets, Frans J Oort, Mieke H Godfried, Hanneke C J M De HaesAbstract:It has been suggested that patient-centred communication does not necessarily translate into a 'one-size fits all' approach, but rather that physicians should use a flexible style and adapt to the particular needs of their patients. This paper examines variability in physicians' patient-centred behaviour in Medical Specialist encounters, and determines whether patient, visit, and physician characteristics influence this variability. Participants were 30 residents and Specialists in internal medicine at an academic teaching hospital in The Netherlands, and 323 patients having a (videotaped) outpatient follow-up appointment. Physicians and patients completed a questionnaire prior to the encounter. Consultations were coded using the Patient-centred Behaviour Coding Instrument (PBCI); physicians' patient-centred behaviour was determined by behaviours that facilitated rather than inhibited the patient's expression of his/her perspective. The results show that physicians differ in their communicative behaviour (i.e. inter-individual variability): some internists had a more 'patient-centred' communication style and others less so. At the same time, physicians show intra-individual variation; apparently they adjust their style according to the situation. Physicians displayed more facilitating behaviour when patients were older, reported more physical symptoms, when they rated patients' health condition as more severe and when the physician was a woman. Physicians also displayed more inhibiting behaviour when patients reported more physical symptoms and when the physician rated patients' health condition as more severe. Apparently, sicker patients were targets of both greater facilitation and greater inhibition. Variability in physicians' facilitating and inhibiting behaviour was explained by patient characteristics, i.e. patients' age and health condition, and-with the exception of physician gender-not by physician or visit characteristics. This indicates that physician patient-centred behaviour is related to the type of patient visiting, especially in relation to the seriousness of symptoms.