Development of a Framework and Tool to Facilitate Cost-of-Care Conversations With Patients During Prenatal Care

Erwin, Kim; Fitzpatrick, Veronica; Norell, Sarah; Gilliam, Melissa

doi:10.7326/m18-2207

Cited by 11 publications

(8 citation statements)

References 13 publications

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“…Benefit items were assessed using one of the two data collection methods, as self-selected by participants. Because benefit items were derived from patient interviews using a card sort method during the initial phase of this mixed-methods study (Erwin et al 2019), the team captured benefit item experiences using the same method in the second and final phase. Consequently, the first method of data collection was a 60-minute interview.…”

Section: Methodsmentioning

confidence: 99%

“…The cost tool’s purpose is to provide patients with a visual forecasting of their remaining prenatal care, including expected appointments, labs, scans, and tests, as well as estimated time required for each visit and other help resources that help patients navigate their care. The tool was designed to benefit patients; therefore, during the first phase of the CONTINUE study, 18 potential benefits of the cost tool (“target benefit items”) were also hypothesized (Erwin et al 2019).…”

Section: Introductionmentioning

confidence: 99%

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An exploratory factor analysis approach to identifying patient benefits of a cost-of-care conversation tool in routine prenatal care

Rivelli

Fitzpatrick

Shields

et al. 2023

Preprint

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To address the need for cost-of-care conversations in prenatal care, the CONTINUE (cost conversations inroutineprenatal care) study was conducted with prenatal patients to better understand the benefits of implementing a cost-of-care conversation “cost” tool into routine obstetrics (OB) care. This research team conducted a multi-phase, mixed-methods research study to identify 18 target benefits of a cost tool to initiate and standardize cost-of-care conversation and, subsequently, developed and validated a cost tool. The cost tool was piloted and data pertaining to cost tool benefits were collected through interviews and surveys. To comprehensively assess the cost tool’s utility, exploratory factor analysis was performed to classify the underlying factor structure of the 18 benefit item responses. Data includes patients’ self-reported experiences of benefit items, as collected from third trimester prenatal patient participants who received the tool at the beginning of their prenatal care in three midwestern-based hospital clinics within one healthcare system. The present study describes the factor analysis approach used to identify the three final factors that emerged from the data. This analysis provides a framework for exploring patient-specific predictors of experiencing the benefit-related factors of a cost tool incorporated into routine OB care.Statements and DeclarationsThis study was funded by the Robert Wood Johnson Foundation, #77290.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

An exploratory factor analysis approach to identifying patient benefits of a cost-of-care conversation tool in routine prenatal care

Rivelli

Fitzpatrick

Shields

et al. 2023

Preprint

Self Cite

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“…Prenatal patient participants completed a 60-minute semi-structured interview or 20-minute electronic survey to capture patients’ self-report of whether they had experienced the 18 previously identified benefits of CONTINUE Tool use. 36 Interview participants reviewed the benefit items during a card sort activity, which each potential benefit on a unique card, and asked to sort the benefits into three categories: benefits experienced due to the CONTINUE Tool; benefits neither experienced nor not experienced (i.e. neutral); or benefits not experienced due to the CONTINUE Tool.…”

Section: Methodsmentioning

confidence: 99%

“…The CONTINUE Tool was iteratively co-designed with low-income prenatal patients, physicians, and nurses in a prior study (COST) 36 and then integrated into routine care during a subsequent pilot study (CONTINUE), reflected in this manuscript, to determine feasibility and assess tool use-derived benefits ( Figure 1 ). The CONTINUE Tool is a trifold, paper-based tool intended to be completed by providers to reflect a patient’s personalized prenatal care plan, as decided between the patient and provider at the onset of prenatal care ( Figure 2 ).…”

Section: Introductionmentioning

confidence: 99%

The Benefits of Introducing a Pregnancy Support Tool for Low-Income Women During Routine Obstetrics Care

Rivelli

Fitzpatrick

Shields

et al. 2023

J Prim Care Community Health

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The objective of the CONTINUE (conversations in routine OB care) pilot study was to gather preliminary data on the benefits of integrating a well-designed pregnancy support tool (“CONTINUE Tool”) in low-income prenatal care. A total of 184 tools were distributed by 21 OB providers during the study implementation period. Follow-up data were collected from 71 (38.5%) prenatal patients across three community-based midwestern OB clinics serving a diverse prenatal patient population. Early-gestation prenatal patients received the strategically designed CONTINUE Tool during routine prenatal care and later completed a semi-structured interview or electronic survey to report pre-determined individual benefit items experienced due to tool usage. Factor analysis used individual benefit items to identify factors representing common underlying benefits (“factor benefits”). Logistic regression analyses were performed to describe the relative odds of participants with low income (public insurance) experiencing individual and factor benefits of tool use compared to participants of higher income (private insurance). Chi square tests (or Fisher’s exact tests) were performed to generate P values reflecting statistically significant differences by income group. More low-income prenatal participants reported experiencing individual benefits as compared to higher-income participants. Among factor benefits, low-income participants were statistically more likely to report experiencing a time-related logistics benefit (OR = 4.00; 95% CI 1.02-15.73; P = .045). Low-income participants reported experiencing an overall logistics factor benefit (OR = 4.29; 95% CI 0.47-38.75), including a cost-related logistics benefit (OR = 3.08; CI 0.59-16.00), as well as an understanding benefit (OR = 1.90; 95% CI 0.72-5.04) and a self-efficacy benefit (OR = 1.30; 95% CI 0.44-3.87). While this study is limited by sample size due to being a pilot study, the findings suggest there may be tangible benefits to introducing the CONTINUE Tool among low-income prenatal patients. Given the staggering inequity in OB care and subsequent health outcomes, any preliminary findings on ways to help combat this are necessary and should lay the groundwork for subsequent randomized trials. Our preliminary findings show that supplementing routine OB care with the CONTINUE Tool can confer benefits to both providers and patients, but particularly for low-income prenatal patients who tend to have more structural barriers to adequate care in the first place.

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“…Data was analyzed in team debrief sessions using nurse workflow mapping and a multi-level requirements framework to structure stakeholder needs into content, user and contextual levels. 27,28 Thirteen semi-structured interviews were conducted with health system stakeholders: three quality leadership, three pediatric nurses and nurse administrators, one pediatric physician, and one child life specialist with experience in the developmental needs of inpatient children. Interviews targeted current VTE prophylaxis strategies; the effectiveness and fit with UI Health's pediatric population; and opportunities to support providers and engage pediatric patients in VTE prevention.…”

Section: Methodsmentioning

confidence: 99%

Improving VTE prophylaxis adherence among hospitalized adolescents using Human-Centered Design

Kim

Klugman

Norell

et al. 2021

Journal of Patient Safety and Risk Management

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Background/problem statement Venous thromboembolism (VTE) is the leading cause of preventable hospital mortality in the United States; however, compliance with VTE prophylaxis is poor. Most materials for education about VTE prophylaxis are oriented toward adults rather than adolescents, for whom VTE risks are lower and prophylaxis indications differ. We hypothesized that educational materials for adolescents could improve compliance with VTE prophylaxis, reduce nurse burden for initiating and maintaining VTE prevention practices, and reduce practice variation by standardizing the conversation between clinicians and patients. Methods A multidisciplinary team including physicians, nurses, quality experts, communication designers, service designers, and medical students applied a human-centered design (HCD) process to define, iteratively prototype, and test education tools for nurses assigned to adolescents. We piloted a suite of six educational tools for adolescent VTE prophylaxis to fit into the existing hospital workflow. Results An in-room poster was selected after 85% of nurses responded favorably to this intervention. Adolescent adherence with Intermittent Pneumatic Compression Device increased from 69% to 79%, attaining the benchmark goal of 78%. Staff reported greater confidence in educating adolescent patients after the intervention: 62% of nurses and 72% of residents. Conclusion An HCD process helped nurses improve VTE prophylaxis for adolescents with an in-room poster and messaging strategy. Engaging staff in the design increased receptivity and adoption. The piloted materials also helped to create an environment of shared priority among the clinicians.

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Development of a Framework and Tool to Facilitate Cost-of-Care Conversations With Patients During Prenatal Care

Cited by 11 publications

References 13 publications

An exploratory factor analysis approach to identifying patient benefits of a cost-of-care conversation tool in routine prenatal care

An exploratory factor analysis approach to identifying patient benefits of a cost-of-care conversation tool in routine prenatal care

The Benefits of Introducing a Pregnancy Support Tool for Low-Income Women During Routine Obstetrics Care

Improving VTE prophylaxis adherence among hospitalized adolescents using Human-Centered Design

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