Publications by authors named "Jessica E Ma"
Importance: Surrogate misunderstanding of patient survival prognosis in the intensive care unit (ICU) is associated with poor patient and surrogate outcomes. Shared decision-making (SDM) may reduce misunderstanding.
Objective: To evaluate the association between SDM-aligned communication and prognostic misunderstanding.
Article Synopsis
- The study aimed to evaluate the impact of the iHI-FIVES caregiver training program on the number of days Veterans spend away from home and the well-being of their family caregivers.
- Involvement included 898 Veterans from 8 medical centers, comparing data from before and after implementing the program through a randomized trial.
- Results indicated a 42% reduction in Veteran days not at home after joining iHI-FIVES, but no significant changes were found in caregiver well-being over the same period.
Objectives: This review examines health care team-focused interventions on managing persistent or recurrent distress behaviors among older adults in long-term residential or inpatient health care settings.
Methods: We searched interventions addressing health care worker (HCW) knowledge and skills related to distress behavior management using Ovid MEDLINE, Elsevier Embase, and Ovid PsycINFO from December 2002 through December 2022.
Results: We screened 6,582 articles; 29 randomized trials met inclusion criteria.
Article Synopsis
- The purpose of documenting patient care goals is to share their wishes with other doctors and nurses.* -
- This study looked at conversations about care goals led by nurses and social workers and checked how well they were recorded in medical files.* -
- Most conversations covered all important topics, but some parts, like understanding the illness and planning for the end of life, were not fully documented in many cases.*
Rationale & Objective: Although functional impairment is common among older adults with chronic kidney disease (CKD), functional reserve before an acute health event and physical resilience after the event have not been characterized in this population. The purpose of this study was to identify distinct patterns of physical function before and after an acute health event among older veterans with stage 4 CKD.
Study Design: Prospective cohort study.
Context: Driven by concerns about care quality, patient experience, and national metrics, health systems are increasingly focusing on identifying risk factors for patients who are hospitalized in the last month of life.
Objective: To evaluate patient factors associated with hospital admission in the last month (30 days).
Methods: We analyzed a retrospective cohort of 8488 patients with a primary care visit in a tertiary health system in the last year of life using a linked electronic health record and decedent dataset.
Key Points: There are three distinct classes of symptoms, functional impairment, and medication burden among older adults with advanced kidney disease. One class with Complex Needs with pain and psychological symptoms, functional difficulties, and polypharmacy may benefit from tailored multidisciplinary care.
Background: Older adults with advanced CKD (stages 4 and 5) have significant symptoms, polypharmacy, and functional difficulties, and previous studies evaluated these burdens separately.
Background: Advance care planning (ACP) improves patient-provider communication and aligns care to patient values, preferences, and goals. Within a multisite Meta-network Learning and Research Center ACP study, one health system deployed an electronic health record (EHR) notification and algorithm to alert providers about patients potentially appropriate for ACP and the clinical study.
Objective: The aim of the study is to describe the implementation and usage of an EHR notification for referring patients to an ACP study, evaluate the association of notifications with study referrals and engagement in ACP, and assess provider interactions with and perspectives on the notifications.
Background: Goals of care (GOC) conversations can improve serious illness outcomes such as pain and symptom management and patient satisfaction.
Problem: However, we recognized that very few Duke Health patients who died had a GOC conversation documented in the designated electronic health record (EHR) tab. Therefore, in 2020, we set a target that all Duke Health patients who died should have had a GOC conversation documented in a designated EHR tab in the last 6 months of life.
Context: While professional societies and expert panels have recommended quality indicators related to advance care planning (ACP) documentation, including using structured documentation templates, it is unclear how clinicians document these conversations.
Objective: To explore how clinicians document ACP, specifically, which components of these conversations are documented.
Methods: A codebook was developed based on existing frameworks for ACP conversations and documentation.
Article Synopsis
- - Residents identified major structural barriers to Advance Care Planning (ACP) in outpatient settings, particularly citing lack of clinic time (99%) and the need to prioritize other medical issues (94%).
- - A survey conducted in 2022 revealed that many residents felt less confident in their ACP skills, especially interns, who reported a lack of knowledge about ACP processes and patient prognoses.
- - Suggested interventions to improve ACP included allowing dedicated appointment times for ACP discussions, with 96% of residents supporting this idea, indicating a need for better scheduling and training in residency programs.
Background: Most efforts to identify caregivers for research use passive approaches such as self-nomination. We describe an approach in which electronic health records (EHRs) can help identify, recruit, and increase diverse representations of family and other unpaid caregivers.
Objective: Few health systems have implemented systematic processes for identifying caregivers.
Background: The United States Veterans Health Administration National Center for Ethics in Health Care implemented the Life-Sustaining Treatment Decisions Initiative throughout the Veterans Health Administration health care system in 2017. This policy encourages goals of care conversations, referring to conversations about patient's treatment and end-of-life wishes for life-sustaining treatments, among Veterans with serious illnesses. A key component of the initiative is expanding interdisciplinary provider roles in having goals of care conversations.
View Article and Find Full Text PDFObjectives: More than 70% of infections with hepatitis C viruses (HCV) occur among people born between 1945 and 1965 (baby boomers). The US Centers for Disease Control estimate that 70% of people with chronic hepatitis are not aware that they are infected with a virus. We performed a prospective trial to determine whether people born during this time period would accept testing for chronic viral infection (hepatitis B virus (HBV) and HCV) during routine colonoscopies.
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