Browsing by Author "Payne, Philip"

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    A Review of Clinical Workflow Studies and Methods
    (2019) Payne, Philip; Lopetegui, Marcelo; Yu, Sean
    It has been well established that the optimization of workflow can have substantial impact on the feasibility, efficiency, quality, safety, and outcomes of healthcare delivery. The process of studying and understanding workflow in support of such optimization has existed for some time, originally developed in the business and industrial research domains, and has been variably applied within the healthcare domain to date. In this chapter, we introduce the basic nomenclature and methods that encapsulate such workflow studies in the healthcare setting and provide a series of examples that demonstrate how such methods can be applied to solving critical problems. We conclude by reviewing open and active areas of inquiries concerning the current and future use of such workflow analysis methodologies.
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    Electronic health record-based assessment of cardiovascular health: The stroke prevention in healthcare delivery environments (SPHERE) study
    (Elsevier, 2016) Foraker, Randi; Shoben, Abigail; Kelley, Marjorie; Lai, Albert; Lopetegui, Marcelo; Jackson, Rebecca; Langan, Michael; Payne, Philip
    < 3% of Americans have ideal cardiovascular health (CVH). The primary care encounter provides a setting in which to conduct patient-provider discussions of CVH. We implemented a CVH risk assessment, visualization, and decision-making tool that automatically populates with electronic health record (EHR) data during the encounter in order to encourage patient-centered CVH discussions among at-risk, yet under-treated, populations. We quantified five of the seven CVH behaviors and factors that were available in The Ohio State University Wexner Medical Center's EHR at baseline (May–July 2013) and compared values to those ascertained at one-year (May–July 2014) among intervention (n = 109) and control (n = 42) patients. The CVH of women in the intervention clinic improved relative to the metrics of body mass index (16% to 21% ideal) and diabetes (62% to 68% ideal), but not for smoking, total cholesterol, or blood pressure. Meanwhile, the CVH of women in the control clinic either held constant or worsened slightly as measured using those same metrics. Providers need easy-to-use tools at the point-of-care to help patients improve CVH. We demonstrated that the EHR could deliver such a tool using an existing American Heart Association framework, and we noted small improvements in CVH in our patient population. Future work is needed to assess how to best harness the potential of such tools in order to have the greatest impact on the CVH of a larger patient population. Abbreviations: 95% CI, 95% confidence interval; ACC, American College of Cardiology; AHA, American Heart Association; CDS, clinical decision support; CVH, cardiovascular health; EHR, electronic health record; GEE, generalized estimation equation; OSUWMC, Ohio State University Wexner Medical Center; SD, standard deviation; SPHERE, stroke prevention in healthcare delivery environments.
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    Foundations for Studying Clinical Workflow: Development of a Composite Inter-Observer Reliability Assessment for Workflow Time Studies
    (2019) Lopetegui, Marcelo; Yen, Po-Yin; Embi, Peter; Payne, Philip
    The ability to understand and measure the complexity of clinical workflow provides hospital managers and researchers with the necessary knowledge to assess some of the most critical issues in healthcare. Given the protagonist role of workflow time studies on influencing decision makers, major efforts are being conducted to address existing methodological inconsistencies of the technique. Among major concerns, the lack of a standardized methodology to ensure the reliability of human observers stands as a priority. In this paper, we highlight the limitations of the current Inter-Observer Reliability Assessments, and propose a novel composite score to systematically conduct them. The composite score is composed of a) the overall agreement based on Kappa that evaluates the naming agreement on virtually created one-seconds tasks, providing a global assessment of the agreement over time, b) a naming agreement based on Kappa, requiring an observation pairing approach based on time-overlap, c) a duration agreement based on the concordance correlation coefficient, that provides means to evaluate the correlation concerning tasks duration, d) a timing agreement, based on descriptive statistics of the gaps between timestamps of same-task classes, and e) a sequence agreement based on the Needleman-Wunsch sequence alignment algorithm. We hereby provide a first step towards standardized reliability reporting in workflow time studies. This new composite IORA protocol is intended to empower workflow researchers with a standardized and comprehensive method for validating observers' reliability and, in turn, the validity of their data and results.

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