A Web-Based Peer Support Network to Help Care Partners of People With Serious Illness: Co-Design Study.

Background: Care partners of people with serious illness experience significant challenges and unmet needs during the patient's treatment period and after their death. Learning from others with shared experiences can be valuable, but opportunities are not consistently available.

Objective: This study aims to design and prototype a regional, facilitated, and web-based peer support network to help active and bereaved care partners of persons with serious illness be better prepared to cope with the surprises that arise during serious illness and in bereavement.

"It helps us say what's important..." Developing Serious Illness Topics: A clinical visit agenda-setting tool.

Background: Skillful communication with attention to patient and care partner priorities can help people with serious illnesses. Few patient-facing agenda-setting tools exist to facilitate such communication.

Objective: To develop a tool to facilitate prioritization of patient and care partner concerns during serious illness visits.

Harnessing the Collective Expertise of Patients, Care Partners, Clinical Teams, and Researchers Through a Coproduction Learning Health System: A Case Study of the Dartmouth Health Promise Partnership.

The coproduction learning health system (CLHS) model extends the definition of a learning health system to explicitly bring together patients and care partners, health care teams, administrators, and scientists to share the work of optimizing health outcomes, improving care value, and generating new knowledge. The CLHS model highlights a partnership for coproduction that is supported by data that can be used to support individual patient care, quality improvement, and research. We provide a case study that describes the application of this model to transform care within an oncology program at an academic medical center.

Prioritizing Measures That Matter Within a Person-Centered Oncology Learning Health System.

Background: Despite progress in developing learning health systems (LHS) and associated metrics of success, a gap remains in identifying measures to guide the implementation and assessment of the impact of an oncology LHS. Our aim was to identify a balanced set of measures to guide a person-centered oncology LHS.

Methods: A modified Delphi process and clinical value compass framework were used to prioritize measures for tracking LHS performance.

Psychometric assessment of the consideRATE questions, a new measure of serious illness experience, with an online simulation study.

Objective: To assess the psychometric properties of the consideRATE questions, a measure of serious illness experience.

Methods: We recruited people at least 50 years old via paid panels online, with US-Census-based quotas. We randomized participants to a patient experience story at two time points.

User-Centered Design of the consideRATE Questions, a Measure of People's Experiences When They Are Seriously Ill.

Context: No brief patient-reported experience measure focuses on the most significant concerns of seriously ill individuals.

Objectives: The objective of the study was to develop the consideRATE questions.

Methods: This user-centered design study had three phases.

Proportion of Decedents' Expenditures Among Recent Reductions in Medicare Expenditures.

This cohort study uses Medicare data from the Dartmouth Atlas Project to determine the source of recent changes in end-of-life Medicare expenditures.

A Person-Centered, Registry-Based Learning Health System for Palliative Care: A Path to Coproducing Better Outcomes, Experience, Value, and Science.

Background: Palliative care offers an approach to the care of people with serious illness that focuses on quality of life and aligning care with individual and family goals, and values in the context of what is medically achievable.

Objective: Measurement of the impact of palliative care is critical for determining what works for which patients in what settings, to learn, improve care, and ensure access to high value care for people with serious illness.

Methods: A learning health system that includes patients and families partnering with clinicians and care teams, is directly linked to a registry to support networks for improvement and research, and offers an ideal framework for measuring what matters to a range of stakeholders interested in improving care for this population.

Acceptability and Impact of a Required Palliative Care Rotation with Prerotation and Postrotation Observed Simulated Clinical Experience during Internal Medicine Residency Training on Primary Palliative Communication Skills.

Background: Improving communication training for primary palliative care using a required palliative care rotation for internal medicine (IM) residents has not been assessed.

Objective: To assess skills acquisition and acceptability for IM residents not selecting an elective.

Design: A consecutive, single-arm cohort underwent preobjective structured clinical examination (OSCE) with learner-centric feedback, two weeks of clinical experience, and finally a post-OSCE to crystallize learner-centric take home points.

Physician attitudes toward the use of fecal microbiota transplantation for the treatment of recurrent Clostridium difficile infection.

Background: Fecal microbiota transplantation (FMT) is a safe and effective, yet infrequently used therapy for recurrent Clostridium difficile infection (CDI).

Objective: To characterize barriers to FMT adoption by surveying physicians about their experiences and attitudes toward the use of FMT.

Methods: An electronic survey was distributed to physicians to assess their experience with CDI and attitudes toward FMT.

Effect of varying the number and location of alcohol-based hand rub dispensers on usage in a general inpatient medical unit.

We sequentially increased the number of wall-mounted alcohol-based hand rub dispensers in a small medical unit to evaluate effects on hand hygiene performance. Above a certain point, addition of more dispensers did not increase hand hygiene frequency, which appeared to be influenced more by location than by total number of dispensers.

Immune responses in infants whose mothers received Tdap vaccine during pregnancy.

Background: The effect of maternal Tdap vaccination on infant immunologic responses to routine pediatric vaccines is unknown.

Methods: This was a cohort study of infants whose mothers received or did not receive Tdap vaccine during pregnancy. Maternal and cord blood samples were collected at delivery; infant blood samples were collected before and after primary series and booster dose of diphtheria, tetanus, and acellular pertussis (DTaP) and other vaccines.

Patient attitudes toward the use of fecal microbiota transplantation in the treatment of recurrent Clostridium difficile infection.

Background: Fecal microbiota transplantation (FMT), a safe, effective alternative therapy for recurrent Clostridium difficile infection (CDI), is infrequently used, in part because of an assumption that patients are unwilling to consider FMT because of its unappealing nature.

Methods: Through a structured survey, including hypothetical case scenarios, we assessed patient perceptions of the aesthetics of FMT and their willingness to consider it as a treatment option, when presented with scenarios involving recurrent CDI.

Results: Four hundred surveys were distributed; 192 (48%) were returned complete.

Impact of a hospital-wide hand hygiene initiative on healthcare-associated infections: results of an interrupted time series.

Background: Evidence that hand hygiene (HH) reduces healthcare-associated infections has been available for almost two centuries. Yet HH compliance among healthcare professionals continues to be low, and most efforts to improve it have failed.

Objective: To improve healthcare workers' HH, and reduce healthcare-associated infections.

Does tetanus-diphtheria-acellular pertussis vaccination interfere with serodiagnosis of pertussis infection?

An anti-pertussis toxin (PT) IgG enzyme-linked immunosorbent assay (ELISA) was analytically validated for the diagnosis of pertussis at a cutoff of 94 ELISA units (EU)/ml. Little was known about the performance of this ELISA in the diagnosis of adults recently vaccinated with tetanus-diphtheria-acellular pertussis (Tdap) vaccine, which contains PT. The goal of this study was to determine when the assay can be used following Tdap vaccination.

Cost-effectiveness of preoperative nasal mupirocin treatment in preventing surgical site infection in patients undergoing total hip and knee arthroplasty: a cost-effectiveness analysis.

Objective: To perform a cost-effectiveness analysis to evaluate preoperative use of mupirocin in patients with total joint arthroplasty (TJA).

Design: Simple decision tree model.

Setting: Outpatient TJA clinical setting.

Determining next steps in a hand hygiene improvement initiative by examining variation in hand hygiene compliance rates.

Background: Health care worker hand hygiene (HH) is a major quality and safety concern since poor hand hygiene has been linked with hospital associated infections. Dartmouth-Hitchcock Medical Center has been involved in a 4-year initiative to improve hand hygiene. In 2006, HH compliance occurred 41% of the time and by 2009, it had improved to 91%.

Use of alcohol-based hand sanitizers as a risk factor for norovirus outbreaks in long-term care facilities in northern New England: December 2006 to March 2007.

Background: During December 2006 to March 2007, a substantial increase in norovirus illnesses was noted in northern New England. We sought to identify institutional risk factors for norovirus outbreaks in northern New England long-term care facilities (LTCFs).

Methods: State health departments in Maine, New Hampshire, and Vermont distributed surveys to infection preventionists at all LTCFs in their respective states.

The safety of immunizing with tetanus-diphtheria-acellular pertussis vaccine (Tdap) less than 2 years following previous tetanus vaccination: Experience during a mass vaccination campaign of healthcare personnel during a respiratory illness outbreak.

Background: Tdap is recommended for health care personnel (HCP) aged <65 years who received tetanus diphtheria or tetanus toxoid immunization (Td/TT) ≥2 years earlier. During a medical center Tdap vaccination campaign, we assessed the safety of use of a Td/TT to Tdap interval <2 years in HCP. We also describe reactogenicity in HCP who were aged ≥65 years or pregnant.