Christiana Care Value Institute

Who We Are

The Value Institute at Christiana Care is a diverse team of experts collaborating in the discovery and delivery of value-centered knowledge to improve health.

Who We Serve

To develop, deliver and evaluate innovative solutions impacting population health, patient experience, system performance and policy development.

How We Work

The Value Institute leads the way in conducting real-world research on today’s most pressing health care issues, helping to deliver better health, better care and better value for our neighbors.

Publications

Choosing Wisely in Delaware: Rationale for Evidence-Based Diagnosis & Evaluation of Low Back Pain
Choosing Wisely in Delaware: Rationale for Evidence-Based Diagnosis & Evaluation of Low Back Pain
Tanaka L, Khan OA, Jackson EV, Miller KE, Chiam TC

Del Med J 2016 Jan;88(1):14-8

PMID: 26934760

Abstract

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Patient-Centered Handovers: Ethnographic Observations of Attending and Resident Physicians: Ethnographic Observations of Attending and Resident Physicians
Patient-Centered Handovers: Ethnographic Observations of Attending and Resident Physicians: Ethnographic Observations of Attending and Resident Physicians
Mount-Campbell AF, Rayo MF, OʼBrien JJ, Allen TT, Patterson ES

Qual Manag Health Care 2016 Oct/Dec;25(4):225-230

PMID: 27749720

Abstract

Handover communication improvement initiatives typically employ a "one size fits all" approach. A human factors perspective has the potential to guide how to tailor interventions to roles, levels of experience, settings, and types of patients. We conducted ethnographic observations of sign-outs by attending and resident physicians in 2 medical intensive care units at one institution. Digitally audiotaped data were manually analyzed for content using codes and time spent using box plots for emergent categories. A total of 34 attending and 58 resident physician handovers were observed. Resident physicians spent more time for "soon to be discharged" and "higher concern" patients than attending physicians. Resident physicians spent less time discussing patients which they had provided care for within the last 3 days ("handbacks"). The study suggested differences for how handovers were conducted for attending and resident physicians for 3 categories of patients; handovers differ on the basis of role or level of expertise, patient type, and amount of prior knowledge of the patient. The findings have implications for new directions for subsequent research and for how to tailor quality improvement interventions based upon the role, level of experience, level of prior knowledge, and patient categories.
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Patient Satisfaction with Care After Coronary Revascularization
Patient Satisfaction with Care After Coronary Revascularization
Mosby DL, Manierre MJ, Martin SS, Kolm P, Abuzaid AS, Jurkovitz CT, Elliott DJ, Weintraub WS

Patient 2018 04;11(2):217-223

PMID: 28875457

Abstract

OBJECTIVE: Bridging the Divides (Bridges), a Centers for Medicare and Medicaid Services-funded program, developed a post-hospitalization care management infrastructure integrating information technology-enabled informatics with patient care for ischemic heart disease patients. The objective of this study was to assess patient satisfaction with the Bridges program and determine the patient characteristics associated with higher satisfaction.
METHODS: All adult English-speaking patients who underwent a percutaneous coronary intervention, coronary artery bypass grafting, or catheterization plus acute myocardial infarction and agreed to participate in the Bridges program were eligible. A survey instrument was administered to address patient satisfaction of care received, aspects of care that patients appreciated, and challenges faced. Descriptive statistics were calculated, and primary analyses included comparisons of overall patient satisfaction after discharge between procedure type, and according to age, sex, race, Elixhauser comorbidity count, and length of stay.
RESULTS: Four hundred and sixty-seven (46%) had complete or partial response rates. There was a statistically significant difference in the overall satisfaction among patients undergoing percutaneous coronary intervention, coronary artery bypass grafting, or catheterization plus acute myocardial infarction (p = 0.023). There were significant procedure by sex (p = 0.052) and procedure by age (p = 0.039) interactions. There were no statistically significant differences in overall satisfaction according to age, sex, race, comorbidity count, or length of stay.
CONCLUSIONS: This study identified several important components related to patient satisfaction for patients with ischemic heart disease. Results found that patients who underwent coronary artery bypass grafting were reportedly "very satisfied" when compared with patients who underwent percutaneous coronary intervention and catheterization plus acute myocardial infarction, as well as significant age and sex interactions between procedures.
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