This study underscores the need for change leaders to consider the contextual factors that surround efforts to implement Lean in primary care. As Lean redesigns are scaled across a system, special attention is warranted with respect to the implementation approach, internal clinic setting, and implications for professional roles and identities of physicians and staff.

158 HMORN 2013 -Selected Abstracts safety net population. Methods: This randomized controlled trial began in October 2011 among patients of Cambridge Health Alliance (CHA), an urban safety net health care system. We identified patients discharged from the medical service with lengths of stay 3 days or more, admission in the prior 6 months, age 60+ years, or admission for COPD or congestive heart failure. We randomized patients to the PN intervention or usual care alone. In the PN intervention, a bilingual hospital-based CHW engaged in discharge planning and made outreach phone calls to patients for 30 days after initial discharge and upon subsequent readmission. PNs assisted patients with follow-up appointments, obtaining and taking medications, transportation, financial barriers, and linkages to community resources. Sociodemographic, clinical, and utilization data were obtained from electronic medical records. Primary outcomes were the proportion of patients readmitted within 30 days, number of readmissions per patient, total number of hospital days within 180 days post-discharge, and proportion of patients with a primary care visit or an emergency department (ED) visit within 30 days. The trial will continue through spring 2013. Results: As of October 2012, 423 patients were in the PN group and 513 in the control group. Fewer PN patients (12.1%) were readmitted within 30 days of an index discharge than controls (13.6%). Readmissions per patient were lower in the PN group compared to controls (0.70 vs. 0.81), as were total hospital days (3.42 vs. 3.59). More PN patients than controls had a primary care visit within 30 days (77.1% vs. 68.6%), but similar percentages had an ED visit within 30 days (11.3% vs. 10.9%). Conclusions: Preliminary results show a trend toward a reduction in probability of 30-day readmission, number of readmissions, and total hospital days for safety net patients receiving a PN intervention, and a trend toward greater probability of a primary care visit within 30 days of discharge. Background/Aims: Implementation science (IS) is a priority topic in the renewal funding of the Cancer Research Network and encompasses a broad range of constructs and uses measures from a variety of disciplines. However, there has been little standardization of measures or agreement on definitions of constructs across different studies, fields, authors, or research groups. Moreover, many measures developed are not practical in real-world settings such as healthcare delivery systems. To further the field of IS, there is a need to both identify and evaluate IS measures on both their validity and practical relevance. Methods: We describe a collaborative, web-based activity using the National Cancer Institute's (NCI) Grid-Enabled Measures (GEM) portal that uses a wiki platform to focus discussion and engage the research community to enhance the quality and harmonization of measures for IS health-related research and practice. We present the history, process, and data from 8 months of the GEM Dissemination & Impleme...

Background: Self-management of heart failure (HF) is often a joint venture between patients and their friends and family (“framily”). However, this joint experience is often overlooked in clinical care. Objectives: The aim of this study was to understand the cognitive, emotional, and relational elements affecting the experience of patient-framily member dyads managing HF. Methods: Participants were patients with HF receiving care at a university hospital and their framily. Dyads participated in 30- to 45-minute semistructured interviews before their clinic visit. Transcribed interviews were analyzed using thematic analyses. Interviews were coded independently and checked for interrater agreement before the final coded data set was developed. Participants were recruited until thematic saturation was attained. Results: A total of 16 patient-framily member dyads and 1 triad (n = 35) participated in the study; 47.1% of patients and 77.8% of framily members were female. Patients were 66 years old (SD, 14 years) and framily members were 59 years old (SD, 12.3 years). Three aspects of the dyadic experience emerged in the themes: (1) health beliefs of dyads were characterized by acceptance and optimism, but also pessimism; (2) negative emotions influenced the dyadic experience; (3) the closeness of their interpersonal relationships influenced their contributions to managing HF. Conclusions: Our study suggests that greater attention to the experience and interpersonal relationships of dyads has the potential for improving HF self-management and facilitating patient-centered care.

As hospitals around the world increasingly face pressure to improve efficiency, “Lean” process improvement has become a popular approach to improving patient flow. In this article, we examine nurses’ perspectives on the implementation of Lean redesigns to the inpatient discharge process. We found that nurses experienced competing demands and tensions related to their time and professional roles and responsibilities as a result of Lean. Four main themes included (a) addressing the needs of individual patients, while still maintaining overall patient flow; (b) meeting discharge efficiency targets while also achieving high patient satisfaction scores; (c) “wasting time” to save time; and (d) the “real” work of providing clinical care versus the “Lean” work of process improvement. Our findings highlight the importance of soliciting hospital nurses’ perspectives when implementing Lean process improvements to improve efficiency and patient flow.

The purpose of this study was to examine the effect of training 5‐year‐olds to carry out both overt and covert rehearsal in a serial order recall task. As the superior recall for short words versus long words in adults is attributed to the use of verbal rehearsal, it was hypothesized that young children who do not normally show these effects would do so when trained to rehearse. Both overt and covert rehearsal were found to be equally effective in producing a word length effect, and these results were taken as supportive of the view that such effects are due to verbal rehearsal. It was also concluded that when instructed to do so 5‐year‐olds can make effective use of inner speech in serial order recall tasks.

The 2002, 2007, and 2012 complementary medicine questionnaires fielded on the National Health Interview Survey provide the most comprehensive data on complementary medicine available for the United States. They filled the void for large-scale, nationally representative, publicly available datasets on the out-of-pocket costs, prevalence, and reasons for use of complementary medicine in the U.S. Despite their wide use, this is the first article describing the multi-faceted and largely qualitative processes undertaken to develop the surveys. We hope this in-depth description enables policy makers and researchers to better judge the content validity and utility of the questionnaires and their resultant publications.

No abstract

No abstract