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Cook D.A.,Mayo Medical School | Cook D.A.,Knowledge Delivery Center | Sorensen K.J.,Mayo Medical School | Wilkinson J.M.,Mayo Medical School
Mayo Clinic Proceedings | Year: 2014

Objectives: To clarify the value and process of the curbside consultation and identify ways to optimize this activity. Participants and Methods: We conducted 13 focus groups at an academic medical center and outlying community sites (September 2011 to January 2013), involving a purposive sample of 54 primary care and subspecialist internal medicine and family medicine physicians. Focus group discussions were transcribed and then analyzed using a constant comparative approach to identify benefits, liabilities, mechanisms, and potential improvements related to curbside consultations. Results: We developed a model describing the role and process of the curbside consultation. Focus group participants perceived that curbside consultations add particular value in offering immediate, individualized answers with bidirectional information exchange, and this in turn expedites patient care and elevates patient confidence. Despite the uncompensated interruption and potential risks, experts provide curbside consultations because they appreciate the honor of being asked and the opportunity to help colleagues, expedite patient care, and teach. Key decisions for the initiator (each reflecting a potential barrier) include whom to contact, how to contact that expert, and how to determine availability. Experts decide to accept a request on the basis of personal expertise, physical location, and capacity to commit time and attention. Participants suggested systems-level improvements to facilitate expert selection, clarify expert availability, enhance access to clinical information, and acknowledge the expert's effort. Conclusions: Curbside consultations play an important role in enhancing communication and care coordination in clinical medicine, but the process can be further improved. Information technology solutions may play a key role. © 2014 Mayo Foundation for Medical Education and Research. Source


Cook D.A.,Rochester College | Sorensen K.J.,Rochester College | Nishimura R.A.,Rochester College | Ommen S.R.,Rochester College | Lloyd F.J.,Knowledge Delivery Center
Academic Medicine | Year: 2015

MayoExpert is a multifaceted information system integrated with the electronic medical record (EMR) across Mayo Clinic's multisite health system. It was developed as a technology-based solution to manage information, standardize clinical practice, and promote and document learning in clinical contexts. Features include urgent test result notifications; models illustrating expert-Approved care processes; concise, expert-Approved answers to frequently asked questions (FAQs); a directory of topic-specific experts; and a portfolio for provider licensure and credentialing. The authors evaluate MayoExpert's reach, effectiveness, adoption, implementation, and maintenance. Evaluation data sources included usage statistics, user surveys, and pilot studies.As of October 2013, MayoExpert was available at 94 clinical sites in 12 states and contained 1,368 clinical topics, answers to 7,640 FAQs, and 92 care process models. In 2012, MayoExpert was accessed at least once by 2,578/3,643 (71%) staff physicians, 900/1,374 (66%) midlevel providers, and 1,728/2,291 (75%) residents and fellows. In a 2013 survey of MayoExpert users with 536 respondents, all features were highly rated (=67% favorable). More providers reported using MayoExpert to answer questions before/after than during patient visits (68% versus 36%). During November 2012 to April 2013, MayoExpert sent 1,660 notifications of new-onset atrial fibrillation and 1,590 notifications of prolonged QT. MayoExpert has become part of routine clinical and educational operations, and its care process models now define Mayo Clinic best practices. MayoExpert's infrastructure and content will continue to expand with improved templates and content organization, new care process models, additional notifications, better EMR integration, and improved support for credentialing activities. Source


Cook D.A.,Mayo Medical School | Cook D.A.,Rochester College | Cook D.A.,Knowledge Delivery Center | Sorensen K.J.,Knowledge Delivery Center | And 2 more authors.
JAMA Internal Medicine | Year: 2013

IMPORTANCE: Answering clinical questions affects patient-care decisions and is important to continuous professional development. The process of point-of-care learning is incompletely understood. OBJECTIVE: To understand what barriers and enabling factors influence physician point-of-care learning and what decisions physicians face during this process. DESIGN: Focus groups with grounded theory analysis. Focus group discussions were transcribed and then analyzed using a constant comparative approach to identify barriers, enabling factors, and key decisions related to physician information-seeking activities. SETTING: Academic medical center and outlying community sites. PARTICIPANTS Purposive sample of 50 primary care and subspecialist internal medicine and family medicine physicians, interviewed in 11 focus groups. RESULTS: Insufficient time was the main barrier to point-of-care learning. Other barriers included the patient comorbidities and contexts, the volume of available information, not knowing which resource to search, doubt that the search would yield an answer, difficulty remembering questions for later study, and inconvenient access to computers. Key decisions were whether to search (reasons to search included infrequently seen conditions, practice updates, complex questions, and patient education), when to search (before, during, or after the clinical encounter), where to search (with the patient present or in a separate room), what type of resource to use (colleague or computer), what specific resource to use (influenced first by efficiency and second by credibility), and when to stop. Participants noted that key features of efficiency (completeness, brevity, and searchability) are often in conflict. CONCLUSIONS AND RELEVANCE: Physicians perceive that insufficient time is the greatest barrier to point-of-care learning, and efficiency is the most important determinant in selecting an information source. Designing knowledge resources and systems to target key decisions may improve learning and patient care. © 2013 American Medical Association. All rights reserved. Source


Cook D.A.,Mayo Medical School | Cook D.A.,Rochester College | Cook D.A.,Knowledge Delivery Center | Sorensen K.J.,Knowledge Delivery Center | And 3 more authors.
PLoS ONE | Year: 2013

Objective: Health care professionals access various information sources to quickly answer questions that arise in clinical practice. The features that favorably influence the selection and use of knowledge resources remain unclear. We sought to better understand how clinicians select among the various knowledge resources available to them, and from this to derive a model for an effective knowledge resource. Methods: We conducted 11 focus groups at an academic medical center and outlying community sites. We included a purposive sample of 50 primary care and subspecialist internal medicine and family medicine physicians. We transcribed focus group discussions and analyzed these using a constant comparative approach to inductively identify features that influence the selection of knowledge resources. Results: We identified nine features that influence users' selection of knowledge resources, namely efficiency (with subfeatures of comprehensiveness, searchability, and brevity), integration with clinical workflow, credibility, user familiarity, capacity to identify a human expert, reflection of local care processes, optimization for the clinical question (e.g., diagnosis, treatment options, drug side effect), currency, and ability to support patient education. No single existing resource exemplifies all of these features. Conclusion: The influential features identified in this study will inform the development of knowledge resources, and could serve as a framework for future research in this field. © 2013 Cook et al. Source


Cook D.A.,Knowledge Delivery Center | Cook D.A.,Rochester College | Holmboe E.S.,Accreditation Council for Graduate Medical Education | Sorensen K.J.,Knowledge Delivery Center | And 2 more authors.
JAMA Internal Medicine | Year: 2015

OBJECTIVE To identify barriers and enabling features associated with MOC and how MOC can be changed to better accomplish its intended purposes.DESIGN, SETTING, AND PARTICIPANTS Grounded theory focus group study of 50 board-certified primary care and subspecialist internal medicine and family medicine physicians in an academic medical center and outlying community sites.EXPOSURES Eleven focus groups.MAIN OUTCOMES AND MEASURES Constant comparativemethod to analyze transcripts and identify themes related to MOC perceptions and purposes and to construct a model to guide improvement.RESULTS Participants identified misalignments between the espoused purposes of MOC (eg, to promote high-quality care, commitment to the profession, lifelong learning, and the science of quality improvement) and MOC as currently implemented. At present, MOC is perceived by physicians as an inefficient and logistically difficult activity for learning or assessment, often irrelevant to practice, and of little benefit to physicians, patients, or society. To resolve these misalignments, we propose a model that invites increased support from organizations, effectiveness and relevance of learning activities, value to physicians, integration with clinical practice, and coherence across MOC tasks.CONCLUSIONS AND RELEVANCE Physicians view MOC as an unnecessarily complex process that is misaligned with its purposes. Acknowledging and correcting these misalignments will help MOC meet physicians' needs and improve patient care.IMPORTANCE Despite general support for the goals of maintenance of certification (MOC), concerns have been raised about its effectiveness, relevance, and value. Source

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