The National Academy of Medicine’s NAM Perspectives platform extends the National Academies’ convening and advising functions by providing a venue for leading health, medical, science, and policy experts to reflect on issues and opportunities important to the advancement of health, health care, and biomedical science. NAM Perspectives are individually-authored papers that do not reflect consensus positions of the NAM, the National Academies, or the authors’ organizations. They are not reports of the National Academies.
Below, we are pleased to present the top 10 most read NAM Perspectives papers of 2018. These manuscripts cover a wide array of issues, from clinician burnout and well-being to the social determinants of health to the future of regenerative medicine. Please enjoy revisiting these NAM Perspectives, and sign up to receive more Perspectives in 2019!
#10. Core Principles and Values of Effective Team-Based Health Care
Authors: P. Mitchell, M. Wynia, R. Golden, B. McNellis, S. Okun, C. E. Webb, V. Rohrbach, and I. Von Kohorn
“Core Principles & Values of Effective Team-Based Health Care” presents basic principles and personal values that characterize interprofessional team-based care. Developed by individual participants from the IOM’s Best Practices Innovation Collaborative, the authors identified key findings from health care literature and used interviews with 11 teams located across the United States to clarify how these factors shape effective team-based care. The principles and values reviewed are intended to help guide clinicians, patients, administrators, and other stakeholders in health care seeking high-value team-based care that focuses on the goals and priorities of patients and their families. In its conclusion, the discussion paper outlines four themes to guide the growth of team-based health care delivery. Read now.
Tweet this! Physicians caring for Medicare patients may now be connected through one patient to 229 other physicians. @theNAMedicine’s #10 most read #NAMPerspectives outlines values that underpin successful team care: https://bit.ly/2jbqgsY #NAMTop10
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#9. Manufacturing Cell Therapies: The Paradigm Shift in Health Care of This Century
Authors: R. Haddock, S. Lin-Gibson, N. Lumelsky, R. McFarland, K. Roy, K. Saha, J. Zhang, and C. Zylberberg
Recent advances in cell biology and genetic engineering have changed the way we think about medicine. Indeed, we are witnessing a potential shift from the traditional paradigm of health care to one with greater focus on the possibility of regenerative and curative treatments. Regenerative medicine can be defined as “self-healing through endogenous recruitment or exogenous delivery of appropriate cells, biomolecules and supporting structures”. Regenerative medicine products are designed to address the underlying causes of diseases rather than just their symptoms. Read now.
Tweet this! Regenerative medicine is a new realm of healing. @theNAMedicine’s #9 most read #NAMPerspectives of 2018 investigates challenges and opportunities for this growing market: http://ow.ly/9Hix30hs0o7 #NAMTop10
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#8. Harnessing Evidence and Experience to Change Culture: A Guiding Framework for Patient and Family Engaged Care
Authors: S. B. Frampton, S. Guastello, L. Hoy, M. Naylor, S. Sheridan, and M. Johnston-Fleece
Patient and family engaged care (PFEC) is care planned, delivered, managed, and continuously improved in active partnership with patients and their families (or care partners as defined by the patient) to ensure integration of their health and health care goals, preferences, and values. It includes explicit and partnered determination of goals and care options, and it requires ongoing assessment of the care match with patient goals. This vision represents a shift in the traditional role patients and families have historically played in their own health care teams, as well as in ongoing quality improvement and care delivery efforts. PFEC also represents an important shift from focusing solely on care processes to aligning those processes to best address the health outcomes that matter to patients. In a culture of PFEC, patients are not merely subjects of their care; they are active participants whose voices are honored. Family and/or care partners are not kept an arm’s length away as spectators, but participate as integral members of their loved one’s care team. Individuals’ (and their families’) expertise about their bodies, lifestyles, and priorities is incorporated into care planning and their care experience is valued and incorporated into improvement efforts. Read now.
Tweet this! Achieving better care, better health, better culture, and lower costs through patient and family engaged care is the focus of @theNAMedicine’s #8 most read #NAMPerspectives of 2018: http://ow.ly/6dTV30hs1xB #NAMTop10
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#7. Care-Centered Clinical Documentation in the Digital Environment: Solutions to Alleviate Burnout
Authors: A. K. Ommaya, P. F. Cipriano, D. B. Hoyt, K. A. Horvath, P. Tang, H. L. Paz, M. S. DeFrancesco, S. T. Hingle, S. Butler, and C. A. Sinsky
A range of factors drives clinician burnout, including workload, time pressure, clerical burden, and professional isolation. Clerical burden, especially documentation of care and order entry, is a major driver of clinician burnout. Recent studies have shown that physicians spend as much as 50 percent of their time completing clinical documentation. Nurses similarly spend up to half their time fulfilling clinical documentation requirements and data entry for other demands such as quality reporting and meeting accreditation standards. In the outpatient setting, patients will often describe clinical team members going through mundane questioning and computer documentation, often duplicative, and spending little time making eye contact and talking to them, or performing physical examination. With the exception of improving medication safety, nurses and other clinicians report dissatisfaction with the design and cumbersome processes of electronic documentation. Many clinicians feel they are compelled to first satisfy the demands of documentation in the clinical record. After caring for patients, many clinicians devote significant amounts of time to nonclinical activities, which often carry on into after-hours. This paper explores the relationship between clinical documentation, the electronic systems that support documentation, and clinician burnout, and provides recommendations for addressing these issues. Read now.
Tweet this! Electronic health records aren’t working as well as they could be. @theNAMedicine’s #7 most read #NAMPerspectives presents an opportunity to examine new ways of making clinicians more effective and patients better heard: http://ow.ly/uh1R30i1iRi #NAMTop10
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#6. Implementing Optimal Team-Based Care to Reduce Clinician Burnout
Authors: C. D. Smith, C. Balatbat, S. Corbridge, A. Legreid Dopp, J. Fried, R. Harter, S. Landefeld, C. Y. Martin, F. Opelka, L. Sandy, L. Sato, and C. Sinsky
Team-based health care has been linked to improved patient outcomes and may also be a means to improve clinician well-being. The increasingly fragmented and complex health care landscape adds urgency to the need to foster effective team-based care to improve both the patient and team’s experience of care delivery. This paper describes key features of successful health care teams, reviews existing evidence that links high-functioning teams to increased clinician well-being, and recommends strategies to overcome key environmental and organizational barriers to optimal team-based care in order to promote clinician and patient well-being. Read now.
Tweet this! Teamwork has been found to partially mitigate the relationship between work demands and burnout. @theNAMedicine’s #6 most read #NAMPerspectives of 2018 details why: https://doi.org/10.31478/201809c #NAMTop10
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#5. A Journey to Construct an All-Encompassing Conceptual Model of Factors Affecting Clinician Well-Being and Resilience
Authors: T. Brigham, C. Barden, A. Legreid Dopp, A. Hengerer, J. Kaplan, B. Malone, C. Martin, M. McHugh, and L. M. Nora
Why are so many clinicians experiencing burnout? The answer is complex but a discussion paper from the National Academy of Medicine aims to shed light on the issues contributing to of clinician burnout and well-being. Taking a holistic view of the external, systemic, and internal factors that impact clinician well-being and burnout, the authors of this discussion paper provide a first look at a comprehensive model that highlights and illustrates the interrelated factors affecting clinician burnout on a daily basis. Individuals and organizations can use this model to identify methods to increase well-being and decrease burnout for clinicians at any stage of their careers. Read now.
Tweet this! The #5 most read #NAMPerspectives of 2018 is an overview of @theNAMedicine’s Action Collaborative on Clinician Well-Being and Resilience’s Conceptual Model, which provides a holistic view of clinician burnout and well-being: http://ow.ly/dz8k30i1je4 #NAMTop10
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#4. Alternatives to Antibiotics: Why and How
Author: H.K. Allen
The antibiotic resistance problem is caused by the evolution and transfer of genes that confer resistance to medically important antibiotics into human pathogens. The acquisition of such resistance genes by pathogens complicates disease treatment, increases health care costs, and increases morbidity and mortality in humans and animals. As antibiotic resistance continues to evolve, antibiotics of so-called last resort become even more precious. Reducing or preventing the dissemination of antibiotic resistance genes into human pathogens is currently of high international importance. Read now.
Tweet this! As antibiotic resistance continues to evolve, solutions are more important than ever. @theNAMedicine’s #4 most-read #NAMPerspectives offers a look at alternatives: http://bit.ly/2uAHzZ7 #NAMTop10
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#3. Nurse Suicide: Breaking the Silence
Authors: J. Davidson, J. Mendis, A. R. Stuck, G. DeMichele, and S. Zisook
The purpose of this paper is to raise awareness of and begin to build an open dialogue regarding nurse suicide. Recent exposure to nurse suicide raised our awareness and concern, but it was disarming to find no organization-specific, local, state, or national mechanisms in place to track and report the number or context of nurse suicides in the United States. This paper describes our initial exploration as we attempted to uncover what is known about the prevalence of nurse suicide in the United States. Our goal is to break through the culture of silence regarding suicide among nurses so that realistic and accurate appraisals of risk can be established and preventive measures can be developed. Read now.
Tweet this! Real-life experiences presented in @theNAMedicine’s #3 most read #NAMPerspectives of 2018 aim to shed light on an often under-recognized threat to our health care system: nurse suicide http://ow.ly/jO9J30hBmqf #NAMTop10
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#2. Burnout Among Health Care Professionals: A Call to Explore and Address This Underrecognized Threat to Safe, High-Quality Care
Authors: L. N. Dyrbye, T. D. Shanafelt, C. A. Sinsky, P. F. Cipriano, J. Bhatt, A. Ommaya, C. P. West, and D. Meyers
The United States health care system is rapidly changing in an effort to deliver better care, improve health, and lower costs while providing care for an aging population with high rates of chronic disease and co-morbidities. Among the changes affecting clinical practice are new payment and delivery approaches, electronic health records, patient portals, and publicly reported quality metrics—all of which change the landscape of how care is provided, documented, and reimbursed. Navigating these changes are health care professionals (HCPs), whose daily work is critical to the success of health care improvement. Unfortunately, as a result of these changes and resulting added pressures, many HCPs are burned out, a syndrome characterized by a high degree of emotional exhaustion and high depersonalization (i.e., cynicism), and a low sense of personal accomplishment from work. Read now.
Tweet this! Clinician burnout affects safety, productivity, patient satisfaction and costs. @theNAMedicine’s #2 most read #NAMPerspectives of 2018 examines how further research can help: http://ow.ly/RbnJ30hs1DI #NAMTop10
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#1. Social Determinants of Health 101 for Health Care: Five Plus Five
Author: S. Magnan
As defined by the World Health Organization (WHO), the social determinants of health (SDoH) are “the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels”. The social determinants of health also determine access and quality of medical care—sometimes referred to as medical social determinants of health. Future opportunities may exist in genetics and biological determinants; however, whether modifying these will be as feasible as modifying the social determinants of health is unknown. Read now.
Tweet this! .@theNAMedicine’s #1 most read #NAMPerspectives paper of 2018 explores opportunities to address social determinants of health in health care settings. http://ow.ly/aysf30hs11j #NAMTop10
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