Assignment: Capella University Week 7 Improvement in The Healthcare Legacy Presentation

Assignment: Capella University Week 7 Improvement in The Healthcare Legacy Presentation

Question Description
Please see attachment: Project Plan

Assignment Instructions
Goal: Demonstrate the ability to create a field of study project that uses both research-based and personal content while using presentation software to communicate with an intended audience.

Course Objective: CO3

Instructions:

During the first six-weeks you formulated a project plan, researched the content of the plan, and collected quality academic and non-academic sources. For the week 7 Field of Study Project you will create a PowerPoint presentation that builds upon the week 2 Project Plan and the week 4 Location and Access (Source Organization worksheet) that effectively communicates the knowledge you have gained during COMM110.

Please consider the following:

Presentation will include an introduction, body, conclusion, and properly formatted reference/work cited slide in the citation style of your degree program (APA, MLA, Chicago).
Clear evidence that the topic was researched and expanded upon the week 2 Project Plan.
Presentation provides audience with information to increase their knowledge of the topic presented.
Presentation engages the audience by using elements such as images, graphs, and charts. Appropriate citations must be included.
Three (3) vetted credible sources. One (1) of the sources must be scholarly and from the library.
Appropriate length 7-9 slides.
Schifferdecker, K., Yount, S., Kaiser, K., Adachi-Mejia, A., Cella, D., Carluzzo, K., … Fisher, E. (2018). A method to create a standardized generic and condition-specific patient-reported outcome measure for patient care and healthcare improvement. Quality of Life Research, 27(2), 367–378. https://doi.org/10.1007/s11136-017-1675-5

Clinton: “innovation, science and technology” are fundamental to development work. (2010). Foreign Policy Bulletin, 20(4), 72-91. doi:http://dx.doi.org.ezproxy1.apus.edu/10.1017/S10527…

Galloro V. Health Care Hall of Fame. A voice unsilenced. Bays built healthcare legacy on foundation of tireless innovation. Modern Healthcare. 2001;31(7):22-24. http://search.ebscohost.com.ezproxy1.apus.edu/login.aspx?direct=true&AuthType=ip&db=mdc&AN=11234229&site=ehost-live&scope=site. Accessed September 20, 2019.

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attachment_1

Public Health Administration
Part I
Scope and Value
The assignment scope is to examine how the knowledge and experience gained from pursuing Public Health Administration will enable one to offer services that are quality to the patients who visit the healthcare center to receive medical services. The value is to ensure that proper strategies as implemented to guarantee that patients are gratified with the medical services offered to them which will contribute to a positive influence on the future of healthcare services.
Method of Presentation
PowerPoint
Topic and Theme
Topic: Improvement in the healthcare legacy in terms of services offered.
Theme: The expertise and know-how gained from undertaking Public Health Administration as a course can be put into practice while being a health care administrator.
Questions/Statements
What can be done further in the healthcare sector to improve the face of healthcare?
What should be done to contribute to further healthcare researches?
What can be done to improve the efficiency and effectiveness of financial issues in the health sector?
Subtopics
Healthcare legacy.
Financial constraints in health care.
Strategies to improve the legacy and financial losses in healthcare.
Brainstorming
How will my expertise assist in ensuring patients are happy with the offered services in healthcare centers? Are there any possible solutions to ensure patients’ experience is top-notch services? What are some of the lessons gained from a patient who is well satisfied with the hospital services offered to them?
Part II
The best possible sources for this project plan include peer-reviewed articles on patient satisfaction in-hospital services. Undertaking an in-depth analysis of previously done researches on patient satisfaction will ensure that I get a glimpse of some of the issues patients face while getting healthcare services in hospitals. Not only will I get to learn about the main issues on patient satisfaction but also possible solutions on how to tackle the same problems.

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A method to create a standardized generic and condition-specific
patient-reported outcome measure for patient care and healthcare
improvement
Karen E. Schifferdecker1,2 • Susan E. Yount3 • Karen Kaiser3 • Anna Adachi-Mejia1,2,4 •
David Cella3 • Kathleen L. Carluzzo2 • Amy Eisenstein3,5 • Michael A. Kallen3 •
George J. Greene3 • David T. Eton6 • Elliott S. Fisher4
Accepted: 29 July 2017 / Published online: 9 August 2017
Springer International Publishing AG 2017
Abstract
Purpose Patient-reported outcome measures (PROMs),
which are generic or condition-specific, are used for a
number of reasons, including clinical care, clinical trials,
and in national-level efforts to monitor the quality of health
care delivery. Creating PROMs that meet different purposes without overburdening patients, healthcare systems,
providers, and data systems is paramount. The objective of
this study was to test a generalizable method to incorporate
condition-specific issues into generic PROM measures as a
first step to producing PROMs that efficiently provide a
standardized score. This paper outlines the method and
preliminary findings focused on a PROM for osteoarthritis
of the knee (OA-K).
Methods We used a mixed-methods approach and
PROMIS measures to test development of a combined
generic and OA-K-specific PROM. Qualitative methods
included patient focus groups and provider interviews to
identify impacts of OA-K important to patients. We then
conducted a thematic analysis and an item gap analysis:
identified areas covered by existing generic PROMIS
measures, identified ‘‘gap’’ areas not covered, compared
gap areas to legacy instruments to verify relevance, and
developed new items to address gaps. We then performed
cognitive testing on new items and drafted an OA-Kspecific instrument based on findings.
Results We identified 52 existing PROMIS items and
developed 24 new items across 14 domains.
Conclusions We developed a process for creating condition-specific instruments that bridge gaps in existing generic measures. If successful, the methodology will create
instruments that efficiently gather the patient’s perspective
while allowing health systems, researchers, and other
interested parties to monitor and compare outcomes over
time, conditions, and populations.
Keywords Patient-reported outcome measure Healthcare
quality Mixed methods Osteoarthritis of the knee
Purpose
Calls continue to mount to establish common standards for
measures of quality, including the incorporation of
patients’ health status and values via patient-reported outcome measures (PROMs) that ‘‘matter to patients’’ [1, 2].
Although PROMs have been used for a number of years in
clinical trials and some registries [3], their use is growing
in clinical care settings for patient care and shared decision
& Karen E. Schifferdecker
karen.e.schifferdecker@dartmouth.edu
1 Community and Family Medicine, Geisel School of Medicine
at Dartmouth, Lebanon, NH, USA
2 Center for Program Design and Evaluation at Dartmouth,
Geisel School of Medicine at Dartmouth, 21 Lafayette Street,
#373, Lebanon, NH 03766, USA
3 Department of Medical Social Sciences, Northwestern
University’s Feinberg School of Medicine, Chicago, IL, USA
4 The Dartmouth Institute for Health Policy and Clinical
Practice, Geisel School of Medicine at Dartmouth, Lebanon,
NH, USA
5 Leonard Schanfield Research Institute at CJE SeniorLife,
Chicago, IL, USA
6 Department of Health Sciences Research, Division of Health
Care Policy and Research, Mayo Clinic, Rochester, MN,
USA
123
Qual Life Res (2018) 27:367–378
https://doi.org/10.1007/s11136-017-1675-5
making [1] and for managing population health at a
national level [3–7]. As such, creating instruments that
meet different purposes in varying contexts without overburdening patients, healthcare systems, providers, and data
systems is paramount.
When considering current PROMs, two basic approaches exist to assess patient health: generic and conditionspecific [8]. Generic measures allow for comparability
‘‘across patients and populations,’’ while condition- or
disease-specific measures tend to provide improved relevance and responsiveness, including the potential to better
differentiate groups by clinically salient symptoms or
concerns [6, 8, 9]. Measures are identified as being condition-specific if they include items relevant for patients
with the condition and, for some measures, specifically
specify the condition (e.g., ‘‘do you have trouble walking
because of OA-K?’’) [10]. Although generic and conditionspecific measures may be more or less useful depending on
the purpose, the potential of providing ‘‘the most complete
assessment of patient-reported health’’ [11] relevant to uses
ranging from direct patient care to ‘‘driving improvement,
outcomes measurement’’ [2] increases if both types of
measures are used.
Efforts to create comprehensive instruments focus primarily on identifying [2, 12] and combining existing
measures [11, 13, 14]. Some generic measures have used
condition- or treatment-specific modules or subscales that
can be added to core items to enhance the relevance of the
measure to a specific population [15–17]. The patient-reported outcomes measurement information system
(PROMIS), which provides item banks of generic measures that are applicable across populations and chronic
conditions [18–20], serves as a prominent potential
resource in these efforts. At the same time, PROMIS has
focused on achieving more precise measures and efficiencies for individuals using item response theory (IRT) for
the development of computerized adaptive testing (CAT)
administration [21–23]. While these efforts are commendable and have their advantages, a condition-specific
assessment that builds on a generic framework may produce PROMs that offer both increased relevance for capturing the health burden imposed by specific problems and
the ability to compare across diseases, conditions, populations, and systems.
The objective of this study was to test a generalizable
method to incorporate condition-specific issues into generic PROM measures as a first step to producing PROMs
that efficiently provide a standardized score. The overall
study focuses on testing the method using PROMIS with
two high impact conditions: osteoarthritis of the knee (OAK) and heart failure (HF). Since the methods are identical,
this paper focuses on our methods and preliminary findings
for OA-K only.
Methods
We used a longitudinal transformation mixed-methods
design [24] at four sites to develop the instruments and built
upon PROMIS methods and the International Society for
Pharmacoeconomics and Outcomes Research’s task force
recommendations for developing PROM items [19, 25–27].
Steps included patient focus groups, expert interviews, item
gap analysis, new item development to address gaps, cognitive interviews, and development of the draft instruments.
The institutional review boards of Dartmouth College, Mayo
Clinic, Oregon Health and Science University Hospital, and
Northwestern University approved this study.
Qualitative data collection
Patient focus groups and provider interviews were conducted to identify potential items for inclusion in an
instrument for OA-K. Eligible patient participants were
identified via medical record review or via physician recommendation at Dartmouth-Hitchcock Medical Center,
Mayo Clinic, Northwestern Medicine, and Oregon Health
and Science University Hospital. Criteria included being
diagnosed with OA-K, being a candidate for elective total
joint arthroplasty (TJA) or having undergone TJA within
the previous 12 months, at least 18 years old, and Englishspeaking. Potential patient participants were contacted
either via phone or in clinic by a study coordinator and
received $40 in the form of a gift card for their time.
Providers were recruited based on their experience working
with patients having OA-K. Potential provider participants
were contacted either in person or by email.
Patient focus groups
Two focus groups at each of the four participating clinical
sites were conducted for a total of eight focus groups.
Focus groups were led by an experienced focus group
moderator, audio recorded, and transcribed. The semistructured focus group guide began with an open-ended
question asking participants to describe in their own words,
first on paper and then as part of the group discussion, how
their condition has impacted their life. The facilitator then
prompted participants with questions about aspects of their
lives that had changed the most since developing their
condition and since surgery for those who had surgery.
Over the course of the focus group discussion, a trained
observer took notes using a list of pre-selected and
potentially relevant domains from PROMIS (pain interference, physical function, fatigue experience, fatigue
impact, participation in social roles, satisfaction with social
roles) to note what domains participants had discussed and
to help determine if additional follow-up questions were
368 Qual Life Res (2018) 27:367–378
123
needed to clarify a particular domain or if participants had
not yet discussed a particular domain. The observer sat
next to the moderator to enable quick exchange of information so that the moderator could ask additional questions
as needed. Participants were then asked to describe the
most important impact of their condition on quality of life.
Following the group discussion, participants were given an
opportunity to individually write down any additional
comments that they wanted to expand upon or did not feel
comfortable mentioning in the group.
Provider semi-structured interviews
Healthcare provider interviews were conducted via telephone by an experienced qualitative interviewer, audio
recorded, and transcribed. The interviews focused on their
perspective on the most important impacts OA-K had on
their patients’ daily lives. Prompts included asking about
how the condition affects their patients physically, emotionally, and socially and how it impacts their ability to
function at home and at work. Providers were then asked to
identify the impacts that were most important for the
healthcare team to know about.
Qualitative data and item gap analysis
Focus group transcripts were coded in Dedoose by two
team members using a thematic analysis approach [28, 29].
A team of qualitative researchers then reviewed the coded
data results and conducted an item gap analysis to identify:
(a) codes/themes that were consistent with existing PROMIS domains (e.g., pain interference) and existing items in
the domains, and (b) codes/themes not covered by existing
PROMIS domains and items (i.e., gap items). Further
details of the process are provided below.
Provider interview data were reviewed after focus group
analyses were completed to compare and contrast with
focus group findings to identify any potential additional
domains or items. As no new domains or items were
identified, subsequent analyses only included the focus
group data.
Identifying existing PROMIS domains and items
Qualitative codes were independently reviewed by three
members of the research team (KK, AA, AE) who grouped
codes within PROMIS domains. The content of those codes
(i.e., all patient quotations for each code) was reviewed by
two members of the research team (KK, AE) in an iterative
process, whereby some items were revisited and either
eliminated or added back for reasons and criteria listed
below. For the sake of simplicity, the process is described
linearly:
1. The team matched codes to domains and potential
items in the domains. They then reviewed selected
items for subjective item quality, taking into consideration a number of factors, including item clarity,
gender or opportunity bias (e.g., not everyone has the
opportunity to climb flights of stairs), and adequate
specificity of the item. Low-quality items were
removed.
2. Next, because a larger number of items remained than
were targeted for use, psychometric item quality was
considered to help reduce item counts. PROMIS item
parameters (i.e., slopes and category thresholds) in
current use by assessment center [30] were obtained;
the slopes for all items, as determined previously from
PROMIS calibration testing [31], were added to the
item spreadsheets as a first point of focus. Any item
with a slope 2.0 was considered a potentially lesser
quality item from a psychometric perspective and
considered for elimination from the item pool if other
existing items remained to measure the item’s content.
Item slope is also known as the item discrimination
parameter. Items with steeper slopes are more helpful
in separating persons into differing ability or trait
levels than items whose slopes are less steep. Thus,
items with low discrimination (less steep slopes) are
less able to do a good job distinguishing between
persons at differing score levels of the trait (e.g.,
fatigue) being measured.
3. The items remaining after steps 1–2 were reviewed
again by the team, for the purpose of making a further
reduction in the number of items to eventually be
administered. With only vetted, good quality items
now in the pool, reduction focused on ensuring content
coverage of the domain to be measured, having a
balanced mix of easier and harder to endorse items
available in the pool, and achieving acceptable participant burden. The team reviewed and discussed these
remaining items until they reached consensus on the
final items going to quantitative testing.
Identifying gap items and new item development
Gap codes that did not appear to be covered by existing
PROMIS content were reviewed by five members of the
research team (KK, AE, SY, GG, DC). Each gap code was
entered into a spreadsheet with the following information:
code definition, the number of focus groups with the code
present, the number of excerpts (i.e., quotes) with the code,
and any closely related codes. The gap codes were first
reviewed by two qualitative researchers (KK, AE) to
develop an in-depth understanding of the code and how
participants spoke of the particular topic. The research
Qual Life Res (2018) 27:367–378 369
123
team then discussed each of the gap codes in a series of
meetings, including the relevance of the code for OA-K,
whether the code content was covered by PROMIS, and
whether the concept was covered in legacy instruments.
The review of legacy instruments during this process was
used to confirm relevance of the concept for OA-K, not to
identify questions, due to concerns regarding intellectual
property restrictions and wanting to maintain ease of distribution of PROMIS items and banks.
If the gap code was deemed relevant, not covered by
PROMIS but measurable via patient report, the team
drafted an item to measure the concept. Common reasons
that gap codes were dropped prior to writing items included: the code reflected a concept limited by geography or
season (e.g., shoveling snow), or opportunity (e.g., driving
a car), or the code was deemed to be sufficiently covered
by existing PROMIS content.
Items written to cover gap content were grouped within
existing PROMIS domains, if possible. The items were
written to be consistent with PROMIS conventions for
those domains in terms of time reference (e.g., ‘‘in the past
7 days’’), verb tense, sentence structure, and response
options. In addition, items were written to be relevant for
patients with OA-K without being attributed specifically to
OA-K to remain consistent with PROMIS conventions,
although references to the knee could be included. New
domains were created to cover items that could not be
placed within existing domains.
Cognitive interviewing
Final gap items for each condition underwent cognitive
testing. Our cognitive interviewing protocol, based on the
work of Willis [32], aims to ascertain: (a) comprehension
of the question and/or specific words in the question,
(b) the processes used by the respondent to retrieve relevant information from memory, (c) appropriateness of
response options, (d) confidence in one’s ability to answer
the question, and (e) relevance of the question to one’s
condition.
Prospective cognitive interviewees were identified from
a subsample of the focus group participants. They were
recruited by phone, at which time an interview was
scheduled for a later date. In appreciation for their time,
participants were offered a gift of $30 in the form of a
check or gift card. Cognitive interviews were conducted by
phone by two members of the study team (KS, KC).
Interviews were audio recorded for later reference and
responses recorded on a standard data form. Three members of the study team (KK, SY, GG) individually reviewed
cognitive interview data for each item and made notes
about the overall comprehension and relevance of the item.
Discrepancies in patient interpretation of the item were
noted. Next, the team members met and discussed each
item before coming to a final decision as to retain, revise,
or drop the item. A translatability review was conducted on
the final items in the event multi-lingual translations are
conducted in the future [33].
Results
Sixty-eight patients participated across the eight focus
groups. Characteristics of the focus group participants are
shown in Table 1. Six providers participated in the semistructured phone interviews.
The average age of focus groups participants was
66 years. Among the nine participants who had not had
Table 1 Focus group participant characteristics, N = 68*
N (%)
Gender
Male 27 (40)
Female 40 (60)
Race
White 60 (90)
Black or African American 6 (9)
American Indian or Alaskan native 1 (1)
Spanish, Hispanic, or Latino
No 65 (98)
Yes 1 (2)
Education
Did not complete high school 1 (1)
High school diploma or GED 6 (9)
Some college or technical school 26 (39)
Graduated college 34 (51)
Income
$10,000 5 (8)
$10,000 to $25,000 10 (15)
$25,000 to $50,000 11 (17)
$50,000 to $75,000 15 (23)
C$75,000 24 (37)
History of knee replacement
Yes, both knees 26 (39)
Yes, left or right knee 32 (48)
No surgery 9 (13)
Overall difficulty with knee(s)
None 14 (22)
Mild 21 (33)
Moderate 22 (35)
Severe 3 (5)
Extreme 3 (5)
* One focus group participant did not complete a demographics form
370 Qual Life Res (2018) 27:367–378
123
knee surgery, four had plans for surgery, two were undecided, and three did not plan to have surgery.
The thematic analysis resulted in 215 unique codes.
Figure 1 illustrates the gap analysis process.
Selection of existing PROMIS domains and items
Review of the focus group codes led to the identification of
nine PROMIS domains relevant for OAK which contained
405 items. Of these, 200 items were retained after selection
for relevance, 113 were retained after subjective review
and slope review, and 52 were retained after review for
content coverage.
Identification of gaps and new item development
During review of the 215 unique codes, 37 potential gap
codes were identified.
After review, 10 gap codes were retained and 27 were
dropped. Items were most often dropped because they were
out of the scope of a patient-reported outcome (e.g., coping, access to care), they represented an opportunity based
concept, such as driving a car, or because they were
deemed to be covered by existing PROMIS content. New
items (n = 30) were then drafted to represent the 10
retained gaps and tentatively grouped within five existing
Fig. 1 Gap analysis for
osteoarthritis of the knee
Qual Life Res (2018) 27:367–378 371
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PROMIS domains and three new domains. These 30 items
underwent cognitive testing.
Cognitive interviewing
Gap items underwent cognitive testing with 10 individuals.
Characteristics of the cognitive interview participants are
described in Table 2. The average age of participants was
70 years. They were primarily female, non-Hispanic white,
and well educated from mixed economic backgrounds.
Participants were also primarily married (80%) and retired
or on disability (70%).
After analysis of the cognitive interviews, we retained
24 new items across nine domains (six existing PROMIS
and three new domains; see Appendix for detailed listing
of all included domains and items). Fifteen of the 24 new
items (63%) include a specific reference to the knee and
10 of the new items (five each) were added to the
existing domains of pain interference and physical
function. The identified new domains were life satisfaction (ability to enjoy life), symptoms (stiffness or swelling), and independence (experience and satisfaction with
being independent), in which six new items were
retained. A readability assessment showed that new
items were interpretable at a fourth grade level while
existing PROMIS items aim to be at a sixth grade or
lower level.
Discussion
We describe and illustrate with data, a method for creating
a combined generic and disease-specific PROM using
PROMIS as our reference set of calibrated generic measures. This methodology has potential for creating efficient
measures that meet multiple purposes. Specifically, it could
enable one to enhance clinical relevance, while at the same
time maintain the ability to report on a common metric, for
purposes of comparative effectiveness research as well as
health system quality reporting.
This manuscript presents results from the application of
qualitative methods to ensure that disease-specific questions
that are conceptually related to more generic item banks can
be added to those calibrated item banks. The next step in the
process is testing in a new, larger sample, whether these
added questions fit and function within the larger general
item bank. This includes testing for unidimensionality and fit
to an IRT measurement model, and using a large sample,
preferably with longitudinal assessment, to evaluate the
unique added value of the new items. If essential unidimensionality and IRT model fit remain in the enhanced item
bank, follow-up analyses can then determine if the domain’s
measurement quality (e.g., score-level information or ‘‘reliability’’) is enhanced by the addition of condition-specific
assessment. This has been observed in previous work done
with people diagnoses with multiple sclerosis [34].
Assuming this work produces anticipated results, these
new gap items introduced into existing PROMIS domains
wi