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" Soft skills are important but don’t save li v es ” …. Hard Evidence on So-called ‘Soft’ Skills Clinical Studies Exemplifying the Impact of the Intrinsic Roles of Physicians on Patient Mortality, Morbidity, Readmission Rate or Compliance. Communicator. Professional. Collaborator. Scholar.

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  1. "Soft skills are important but don’t save lives” … Hard Evidence on So-called ‘Soft’ Skills Clinical Studies Exemplifying the Impact of the Intrinsic Roles of Physicians on Patient Mortality, Morbidity, Readmission Rate or Compliance Communicator Professional Collaborator Scholar Leader Health Advocate Lafleur A , Gagné M, Paquin V, Michaud-Couture C.How to Convince Clinicians that ‘Soft Skills’ Save Lives? Practical Tips to Use Clinical Studies to Teach Physicians’ Roles. Submitted to MedEdPublish on May 2019 as supplementary slide kit.Design byMr Muhamy Akbar

  2. Implementation of a Medical Team Training Program in the Operating Room ANNUAL MORTALITY Collaborator Neily J, Mills PD, Young-Xu Y, Carney BT, West P, Berger DH, et al. Association between implementation of a medical team training program and surgical mortality. JAMA. 2010;304(15):1693-700.

  3. Comanagement of Hip Fracture by Geriatricians and Orthopedic Surgeons Collaborator Comanagement Usual care Friedman SM, Mendelson DA, Bingham KW, Kates SL. Impact of a comanaged Geriatric Fracture Center on short-term hip fracture outcomes. Arch Intern Med. 2009;169(18):1712-7.

  4. Multidisciplinary Strategies for the Management of Heart Failure Patients at High Risk for Admission Systematic review of 29 randomized trials (5,039 patients) 25% educed all-cause mortality by Multidisciplinary teams NNT = 17 19% educed all-cause hospitalization Collaborator NNT = 10 • Strategies : • Specialized multidisciplinary team • Telephone follow-up • Educational programs 27% All strategies educed HF hospitalization NNT = 11 McAlister FA, Stewart S, Ferrua S, McMurray JJ. Multidisciplinary strategies for the management of heart failure patients at high risk for admission: a systematic review of randomized trials. J Am Coll Cardiol. 2004;44(4):810-9.

  5. Handoff training Verbal mnemonic • Standardized • communication • New team • handoff structure Implementation of a Resident Handoff Bundle Collaborator Decreasesmedicalerrors rates from33.8 to 18.3 per 100 admissions and preventable adverse events from 3.3 to 1.5 per 100 admissions Starmer AJ, Sectish TC, Simon DW, Keohane C, McSweeney ME, Chung EY, et al. Rates of medical errors and preventable adverse events among hospitalized children following implementation of a resident handoff bundle. JAMA. 2013;310(21):2262-70.

  6. Daily Rounds by a Multidisciplinary Care Team Daily rounds by a Multidisciplinary care team in ICU 16% Collaborator 107 324 PATIENTS Significant reductions in the odds of death Kim MM, Barnato AE, Angus DC, Fleisher LF, Kahn JM. The effect of multidisciplinary care teams on intensive care unit mortality. Arch Intern Med. 2010;170(4):369-76.

  7. Physician Communication WithDiabetic Patients Who Have LowHealthLiteracy Physicians recall and comprehension assessmentand patients’ glycemic control Communicator Schillinger D, Piette J, Grumbach K, Wang F, Wilson C, Daher C, et al. Closing the loop: physician communication with diabetic patients who have low health literacy. Arch Intern Med. 2003;163(1):83-90.

  8. The Effect of Physician–patient Collaboration on Patient Adherence in Non-psychiatric Medicine Physician–patient collaboration variables Meta-analysis Quantitative relationship between physician–patient collaboration and patient adherence 34,000 participants in 48 studies. Any aspect of physician–patient communication: interaction, participation, satisfaction with level of involvement, education, decision-making, and alliance. Communicator A statistically significant weighted mean effect sizeof Md = 0.145 indicated better physician–patient collaboration is associated with better patient adherence. Arbuthnott A, Sharpe D. The effect of physician–patient collaboration on patient adherence in non-psychiatric medicine. Patient EducCouns. 2009;77(1):60-7.

  9. Perception of Care: Impact on Readmission aOR 0.68 (95% CI 0.48 to 0.97, P = 0.049) aOR 0.61 (95% CI 0.43 to 0.88, P = 0.045) Communicator Carter J, Ward C, Wexler D, Donelan K. The association between patient experience factors and likelihood of 30-day readmission: a prospective cohort study. BMJ QualSaf. 2018;27(9):683-90.

  10. Advance Care Planning on End of Life Care in Elderly Patients • Facilitated advance care planning aimed to : • assist patients to reflect on their goals, values, and beliefs • consider future medical treatment preferences • appoint a surrogate • document their wishes Communicator Detering KM, Hancock AD, Reade MC, Silvester W. The impact of advance care planning on end of life care in elderly patients: randomised controlled trial. BMJ. 2010;340:c1345.

  11. Training Program in Shared Decision-making Reduce the Overuse of Antibiotics 2-hour online tutorial followed by a 2-hour on-site interactive workshop DECISION2+ Communicator Légaré F, Labrecque M, Cauchon M, Castel J, Turcotte S, Grimshaw J. Training family physicians in shared decision-making to reduce the overuse of antibiotics in acute respiratory infections: a cluster randomized trial. CMAJ. 2012;184(13):E726-E34.

  12. Physicians’ Adherence to European Society of Cardiology Guidelines for Heart Failure Medication 1410 patients from France, Germany, Italy, Netherlands, Spain, and UK 150 cardiologists randomly selected Scholar GAI3 = adherence to first three classes of heart failure medication (angiotensin-converting enzyme (ACE)-inhibitors, beta-blockers, spironolactone) Perfect adherence (GAI3 = 100%) Moderate adherence (GAI3 = 50–67%) Low adherence (GAI3 = 0–33%) Le Pen C, van Veldhuisen DJ, Erdmann E, Gonzalez-Juanatey JR, Tavazzi L, Komajda M, et al. Adherence to guidelines is a predictor of outcome in chronic heart failure: the MAHLER survey. Eur Heart J. 2005;26(16):1653-9.

  13. Adherence to the IDSA Guidelinesfor Antibiotic Use for Community-Acquired Pneumonia in ICU 529 patients with severe CAP Scholar 13 Spanish hospitals Adherence to IDSA guidelines was the only potentially modifiable factor for improving the prognosis of patients with CAP who required ICU admission. Rodríguez A, Rello J, Gilavert MC, Bodí M, Doblas A, García F, et al. Antibiotic Prescription for Community-Acquired Pneumonia in the Intensive Care Unit: Impact of Adherence to Infectious Diseases Society of America Guidelines on Survival. Clin Infect Dis. 2005;41(12):1709-16.

  14. Adherence to guidelines for the empiric antibiotic treatment of Community-acquired Pneumonia (CAP) OR, 0.65 (95% CI, 0.5–0.9) 1 288 patients with CAP Scholar OR 0.55 (95% CI 0.3-0.9) Menéndez R, Torres A, Zalacaín R, Aspa J, Martín-Villasclaras JJ, Borderías L, et al. Guidelines for the Treatment of Community-acquired Pneumonia. Am J Respir Crit Care Med. 2005;172(6):757-62.

  15. Impact of Formal Continuing Medical Education on Practice: Making the Right Choices Interactive and mixed educational sessions were associated with a significant effecton practice. Didacticsessionsdonot appearto be effective in changingphysician performance. Interactive and mixed educational sessions Standardized effect size 0.67 (95% CI, 0.01-1.45) • Systematic review : 14 studies • 17 interventions: • Didactic • Interactive (opportunity to practice skills) • Outcomes: • Physician performance (adherence to guidelines, communications skills) • Patient behavior (eg. adherence to medication, smoking cessation) Scholar Davis D, O'Brien MAT, Freemantle N, Wolf FM, Mazmanian P, Taylor-Vaisey A. Impact of Formal Continuing Medical Education: Do Conferences, Workshops, Rounds, and Other Traditional Continuing Education Activities Change Physician Behavior or Health Care Outcomes? JAMA. 1999;282(9):867-74.

  16. Guidelines for peri-operative red cell transfusion 43% reduction in the total number of transfusions Scholar Mallett SV, Peachey TD, Sanehi O, Hazlehurst G, Mehta A. Reducing red blood cell transfusion in elective surgical patients: the role of audit and practice guidelines. Anaesthesia. 2000;55(10):1013-9.

  17. The Step Test Exercise Prescription (STEP) Project STEP included exercise counseling to physicians and prescription of an exercise training heart rate (step test: stepping up and down 2 steps 20 times) Health advocate Petrella RJ, Koval JJ, Cunningham DA, Paterson DH. Can primary care doctors prescribe exercise to improve fitness?: The step test exercise prescription (STEP) project. Am J Prev Med. 2003;24(4):316-22.

  18. Behavioral Sexual Risk-Reduction Counseling in Primary Care to Prevent Sexually Transmitted Infections • SYSTEMATIC REVIEW • Sociodemographiccaracteristics (American, African, Latina, level of study) • Riskysexualbehavior • History of STI High-Intensity interventions reduced STI incidence • High-Intensityinterventions: • > 2 hours • 1-13 sessions • Mail, computer, video, face-to-face Health advocate Odds ratio < 1 (protective effect) Adolescents 0,38 (95% CI, 0,24 to 0,60) Adults 0,70 (95% CI, 0,56 to 0,87) O'connor EA, Lin JS, Burda BU, Henderson JT, Walsh ES, Whitlock EP. Behavioral sexual risk-reduction counseling in primary care to prevent sexually transmitted infections: a systematic review for the US Preventive Services Task Force. Ann Intern Med. 2014;161(12):874-83.

  19. Vaccination Against Influenza Among Elderly Persons Living in the Community Vaccination against influenza is associated with reduced rates of hospitalization and in deaths from influenza and its complications. Health advocate Nichol K, Margolis K, Wuorenma J, Von Sternberg T. The efficacy and cost effectiveness of vaccination against influenza among elderly persons living in the community. N Engl J Med. 1994;331(12):778-84.

  20. Physician Counseling for Colorectal Cancer Screening Health advocate • Physician counseling is associated with : • Increased patient perception of CRC susceptibility • Greater screening intention • Higher completion of screening Fenton JJ, Jerant AF, von Friederichs-Fitzwater MM, Tancredi DJ, Franks P. Physician Counseling for Colorectal Cancer Screening: Impact on Patient Attitudes, Beliefs, and Behavior. J Am Board Fam Med. 2011;24(6):673-81.

  21. Why Refer to a Smoking Cessation Program? Health advocate All-cause mortality (per 1000 person-years) Anthonisen NR, Skeans MA, Wise RA, Manfreda J, Kanner RE, Connett JE, et al. The Effects of a Smoking Cessation Intervention on 14.5-Year Mortality: A Randomized Clinical Trial. Ann Intern Med. 2005;142(4):233-9.

  22. Best Practices for Managing Surgical Services • Lesspeer interaction betweenprofessional groups • None or few clinicalpathways or protocols • Absence of continuingeducation programs • Better use of peer interaction betweenprofessional groups • More feedback fromsupervisors • Supervisor positions coordinatingsurgicalschedule • Implementation of clinicalpathways and protocols • Better coordination and support of surgicalresidents Leader Young GJ, Charns MP, Daley J, Forbes MG, Henderson W, Khuri SF. Best Practices for Managing Surgical Services: The Role of Coordination. Health Care Manage Rev. 1997;22(4):72-81.

  23. Clinical and Economical Outcomes of Antimicrobial Stewardship programs An antimicrobialstewardship program (ASP) doeslimit the inappropriate use of antimicrobials. Leader Malani AN, Richards PG, Kapila S, Otto MH, Czerwinski J, Singal B. Clinical and economic outcomes from a community hospital's antimicrobial stewardship program. Am J Infect Control. 2013;41(2):145-8. Source of the image: https://pixabay.com/illustrations/influenza-flu-disease-virus-2833622

  24. Reducing Length of Stay for Hospitalized Patients when Guidelines are Endorsed by Opinion Leaders Implementation of the practice guidelines 208 patients with low-risk chest pain Leader Weingarten S, Agocs L, Tankel N, Sheng A, Ellrodt AG. Reducing lengths of stay for patients hospitalized with chest pain using medical practice guidelines and opinion leaders. Am J Cardiol. 1993;71(4):259-62. Source of the image: https://rebelem.com/heart-score-new-ed-chest-pain-risk-stratification-score/

  25. Team Functioning and Outcomes in Stroke Rehabilitation High perception of team functioning Lowertask orientation (less focus on concretetasks) High order and organization Higher utility of quality information (feedback, etc.) Leader Betterimprovement of motorfunction in stroke patients according to FIM motorscale Strasser DC, Falconer JA, Herrin JS, Bowen SE, Stevens AB, Uomoto J. Team functioning and patient outcomes in stroke rehabilitation. Arch Phys Med Rehabil. 2005;86(3):403-9.

  26. Implementing Weaning Protocols for Reduction of Duration of Mechanical Ventilation 25% in total duration of mechanical ventilation Weaningprotocol Leader 78% in weaning duration 10% in ICU lenghtof stay Blackwood B, Alderdice F, Burns K, Cardwell C, Lavery G, O’Halloran P. Use of weaning protocols for reducing duration of mechanical ventilation in critically ill adult patients: Cochrane systematic review and meta-analysis. BMJ. 2011;342:c7237.

  27. Effects of Discharge Planning and Compliance with Outpatients Appointments on Readmission Rates • 542 rehospitalized patients • 136 patients (at least one appointment) Rehospitalization rate 10% Professional • 406 patients (no appointment) • Rehospitalizationrate 15-29% Nelson EA, Maruish ME, Axler JL. Effects of discharge planning and compliance with outpatient appointments on readmission rates. Psychiatr Serv. 2000;51(7):885-9. Source of the image: https://focaia.blogspot.com/2013/03/follow-up-como-fazer-um-fup-mais-eficaz.html

  28. Effects of Failure to Follow-up Tests Results for Ambulatory Patients [ SystematicReview Professional Callen JL, Westbrook JI, Georgiou A, Li J. Failure to Follow-Up Test Results for Ambulatory Patients: A Systematic Review. J Gen Intern Med. 2012;27(10):1334-48.

  29. Physician Staffing Patterns and Clinical Outcomes in Critically ill Patients Professional Pronovost PJ, Angus DC, Dorman T, Robinson KA, Dremsizov TT, Young TL. Physician Staffing Patterns and Clinical Outcomes in Critically Ill Patients: A Systematic Review. JAMA. 2002;288(17):2151-62.

  30. Disease Complications and Physician Empathy 41% Professional Shiftingfrom a low- to a high-scoringcategory of physicianempathydecreased the odds of metabolic complications amongdiabetic patients by 41% Canale SD, Louis DZ, Maio V, Wang X, Rossi G, Hojat M, et al. The Relationship Between Physician Empathy and Disease Complications: An Empirical Study of Primary Care Physicians and Their Diabetic Patients in Parma, Italy. Acad Med. 2012;87(9):1243-9.

  31. Effects of Doctor's Attire on Patient's Confidence and Trust Positive correlation with trust and confidence to follow medical advice Professional Rehman SU, Nietert PJ, Cope DW, Kilpatrick AO. What to wear today? Effect of doctor’s attire on the trust and confidence of patients. Am J Med. 2005;118(11):1279-86.

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