•Optimal pricing and healthcare warranty strategies of a profit maximizing healthcare provider for chronic diseases is investigated.•An intensity reduction model is introduced to model the effect of ...follow-up checkups on the patients’ risk of developing complications.•Patient heterogeneity and patient learning effects are considered.•A case study involving diabetes patients is presented to demonstrate the applicability of the proposed model.
Providing warranties for healthcare is a quality and cost-effective healthcare delivery model. Under a healthcare warranty, the patient is charged a lump-sum payment for the healthcare services administered during a prespecified period regardless of the actual cost incurred by the healthcare provider. Notably, such a fixed-price healthcare delivery model increases the risks of profit maximization among healthcare providers, thereby making pricing decisions crucial. In this paper, we establish an integration model to derive an optimal price and healthcare warranty strategy composed of periodic follow-up for patients with chronic diseases considering patient heterogeneity. This paper introduces the intensity reduction model to capture the effect of follow-up checkups on patients’ risk of developing complications, and accounts for the effect of patients’ learning effects on the risk of complications during the planning horizon. The model allows healthcare providers to make optimal pricing and follow-up decisions under different factors, including follow-up effects, patients’ learning ability, and cost parameters. A case study of diabetes is presented to illustrate the application of the proposed model and analyze the impacts of significant parameters on the optimal solutions. The model and findings form the basis in making decisions for the healthcare warranty pricing of chronic diseases.
To address health disparities, future physicians must understand the role of social determinants of health (SDH). Teaching SDH can be challenging. We created an authentic SDH curriculum using four ...real myocardial infarction (MI) patients.
During the three academic years from 2019-2020 to 2021-2022, 579 first year medical students participated in the four day curriculum. Day 1: students interviewed and learned about their patient's MI. Day 2: students met in small groups and shared their patient's history. At session end, students were familiar with four patient stories. Day 3: students explored their patient's neighborhood and then interviewed their patient again, focusing on SDH. Day 4: students gave formal patient presentations that highlighted SDH. Group discussion followed and reinforced the role of SDH. Students wrote reflections on SDH that were read and graded. End of course evaluations were reviewed.
Five hundred and seventy-nine students completed the curriculum. Course directors graded SDH reflections on a six-point rubric for the years of 2020-2021 and 2021-2022. Ninety percent and 96% of the SDH reflections during the respective years contained 5-6/6 of the rubric components. Ninety-six percent to 98% of students 'agreed' or 'strongly agreed' that the curriculum was effective for their learning.
For educators in need of an SDH curriculum that is both engaging and effective, we have found this activity to be feasible, low cost, and highly impactful for first year medical students.
Practice points
Medical education must provide social determinants of health (SDH) teaching.
Curriculum should be both engaging and interactive.
Real patient learning deepens the impact of the curriculum.
Harnessing the expertise of patients leads to feasible, low cost curricular innovation.
Clerkship education has been called a ‘black box’ because so little is known about what, how, and under which conditions students learn. Our aim was to develop a blueprint for education in ambulatory ...and inpatient settings, and in single encounters, traditional rotations, or longitudinal experiences. We identified 548 causal links between conditions, processes, and outcomes of clerkship education in 168 empirical papers published over 7 years and synthesised a theory of how students learn. They do so when they are given affective, pedagogic, and organisational support. Affective support comes from doctors’ and many other health workers’ interactions with students. Pedagogic support comes from informal interactions and modelling as well as doctors’ teaching, supervision, and precepting. Organisational support comes from every tier of a curriculum. Core learning processes of observing, rehearsing, and contributing to authentic clinical activities take place within triadic relationships between students, patients, and practitioners. The phrase ‘supported participation in practice’ best describes the educational process. Much of the learning that results is too tacit, complex, contextualised, and individual to be defined as a set of competencies. We conclude that clerkship education takes place within relationships between students, patients, and doctors, supported by informal, individual, contextualised, and affective elements of the learned curriculum, alongside formal, standardised elements of the taught and assessed curriculum. This research provides a blueprint for designing and evaluating clerkship curricula as well as helping patients, students, and practitioners collaborate in educating tomorrow’s doctors.
This paper investigates the influence of using tablet in waiting rooms and medical examinations on how physicians give information and how patients learn. It further assesses the factors that impact ...patient satisfaction.
Patients and physicians in a primary care clinic were given a tablet device to search for health information in the waiting room, and when interacting with the physician, while physicians used the tablet device to share information with patients during the medical consultation. 82 patients completed a ‘pre’ survey on using tablets to search for health related information and a ‘post’ survey after their visit. Structural equation modeling was employed to analyze patient's perceptions.
Tablet use during consultation has a negative effect on patients' perceptions of physician information giving, but using the tablet in the waiting room has a positive impact on patient learning, perceptions of physicians' information giving and patient satisfaction.
This study indicates the importance of tablet use in ensuring information giving and patient learning. It further highlights the potential for tablets to promote single-loop learning in the medical encounter by better preparing patients for the physician's information giving. Tablets also enable double-loop learning, which leads to greater patient satisfaction.
•Use of tablet computers before and during medical consultations.•Tablet use as a means of promoting single-loop and double-loop learning.•Increasing patient satisfaction during medical consultations.•Patients' perceptions of the information they receive when seeking medical advice.
Aim
The aim of this study was to explore the perceptions of surgical patients about traditional and novel methods to learn about postoperative pain management.
Background
Patient education is an ...important part of postoperative care. Contemporary technology offers new ways for patients to learn about self‐care, although face‐to‐face discussions and brochures are the most common methods of delivering education in nursing practice.
Design
A qualitative design with a vignette and semi‐structured interviews used for data collection.
Methods
A purposeful sample of 13 postsurgical patients, who had been discharged from hospital, was recruited during 2013–2014. The patients were given a vignette about anticipated hospital discharge after surgery with four different options for communication (face‐to‐face, brochure, website, serious game) to learn about postoperative pain management. They were asked to rank their preferred method of learning and thereafter to reflect on their choices. Data were analysed using an inductive content analysis approach.
Findings
Patients preferred face‐to‐face education with a nurse, followed by brochures and websites, while games were least preferred. Two categories, each with two sub‐categories, emerged from the data. These conceptualized the factors affecting patients’ perceptions: (1) ‘Trusting the source’, sub‐categorized into ‘Being familiar with the method’ and ‘Having own prejudgments’; and (2) ‘Being motivated to learn’ sub‐categorized into ‘Managing an impaired cognition’ and ‘Aspiring for increased knowledge’.
Conclusion
To implement successfully novel educational methods into postoperative care, healthcare professionals need to be aware of the factors influencing patients’ perceptions about how to learn, such as trust and motivation.
The Manchester Clinical Placement Index (MCPI) is an instrument to measure medical undergraduates' real-patient learning in communities of practice both in hospital and in GP placements. Its ...suitability to evaluate the quality of placement learning environments has been validated in an English-language context; however, there is a lack of evidence for its applicability in other languages. Our aim was to thoroughly explore the factor structure and the key psychometric properties of the Hungarian language version.
MCPI is an 8-item, mixed-method instrument which evaluates the quality of clinical placements as represented by the leadership, reception, supportiveness, facilities and organization of the placement (learning environment) as well as instruction, observation and feedback (training) on 7-point Likert scales with options for free-text comments on the strengths and weaknesses of the given placement on any of the items. We collected data online from medical students in their preclinical (1st, 2nd) as well as clinical years (4th, 5th) in a cross-sectional design in the academic years 2019-2020 and 2021-2022, by the end of their clinical placements. Our sample comprises data from 748 medical students. Exploratory and confirmatory factor analyses were performed, and higher-order factors were tested.
Although a bifactor model gave the best model fit (RMSEA = 0.024, CFI = 0.999, and TLI = 0.998), a high explained common variance (ECV = 0.82) and reliability coefficients (ωH = 0.87) for the general factor suggested that the Hungarian version of the MCPI could be considered unidimensional. Individual application of either of the subscales was not supported statistically due to their low reliabilities.
The Hungarian language version of MCPI proved to be a valid unidimensional instrument to measure the quality of undergraduate medical placements. The previously reported subscales were not robust enough, in the Hungarian context, to distinguish, statistically, the quality of learning environments from the training provided within those environments. This does not, however, preclude formative use of the subscales for quality improvement purposes.
Aims and objectives
The aim of the study was to illuminate the meanings of trigger situations experienced in everyday life when learning to live with diabetes.
Background
Adults become active ...learners when faced with situations they do not know how to manage, triggering a need to understand something in a different way than before. Knowing more about experiential learning for persons living with diabetes is important for understanding how learning can be supported by health care.
Design
A life‐world approach with a phenomenological hermeneutical method, inspired by the philosophy of Paul Ricoeur.
Methods
This method was used for interpreting transcriptions of interviews and consists of three stages: naïve understanding, structural analysis and a comprehensive understanding. Participants (n = 13), with either type I or type II diabetes, were interviewed on three different occasions over a three‐year period after being diagnosed with diabetes.
Results
When learning to live with diabetes, the meanings of trigger situations were described as ‘the unpredictable body heightens insecurity with awareness of one's own dependability’, ‘losing control in unsustainable situations’ and ‘encumbered by vulnerability and temporality in earlier familiar situations’.
Conclusion
The meanings of trigger situations were to lose the smooth, unreflected way of managing an everyday life situation, interlaced with feelings of lost control of how to live with new insights of being vulnerable. Trigger situations meant an opportunity for learning, as well as being demanding, unplanned and with limited freedom of choice. Trigger situations presented life and body as unpredictable.
Relevance to clinical practice
If healthcare professionals can identify the worries and questions raised in trigger situations, knowledge gaps can be identified and reflected on to stimulate learning.
Abstract Objective To assess the relationship between the oral literacy demand of genetic counseling sessions and the ability of low literate subjects to learn genetics-related information. Methods ...Ninety-six simulated genetic counseling sessions were videotaped and shown to 312 subjects recruited to imagine themselves as the session's client. Study measures included oral literacy demand, operationalized as: (1) use of key genetics terms; (2) informational context; (3) general language complexity; and (4) structural characteristics of dialogue interactivity. The study outcome was learning of genetics-related information. Results Subjects with restricted literacy (below 8th grade level) learned more when viewing sessions with greater dialogue interactivity and more personally contextualized information. Subjects with adequate literacy skills, however, tended to learn less in low literacy demand sessions. Conclusion The oral literacy demand of medical dialogue represents a learning obstacle to low literate subjects. However, this may not be the case for those with greater literacy skills who can understand the complex language and process the dense informational load of high demand sessions. Practice implications In order to meet the educational needs of all patients, clinicians must attend to both the informativeness and the oral literacy demand of their communication.
Scand J Caring Sci; 2011; 25: 558–566
Learning to live with illness: experiences of people recently diagnosed with diabetes
Background: The process of learning to live with an illness is complex. ...By better understanding the learning process for persons with diabetes in the early stage of the illness, the role of the health care can be shown.
Aim: To reach an understanding of how learning to live with diabetes is experienced in the first 2 months after diagnosis.
Method: A qualitative descriptive design was used, and interviews were conducted. Thirteen participants with a recent diagnosis of diabetes were included and asked to narrate about their experience of living with diabetes. Qualitative inductive content analysis was used.
Findings: Four themes emerged: ‘taken over by a new reality’, ‘the body plays a role in life’, ‘different ways of learning’ and ‘the healthcare service as a necessary partner’.
Conclusion: People with short‐term experience of the illness gained knowledge through personal resources such as their own experience and self‐reflection. The learning process includes an inner dialogue between the self, the body and the life. Participants were concerned with grasping a new reality and understanding a different self and body where lifestyle changes and uncertainty were present. When health care was accessible and sensitive to their needs, those with short‐term experience of diabetes chose the staff as key players in the early stages of their life with diabetes.
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