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  • Fostering a Sustainable Community Care Team (CCT) Rochester, Minn.

    The purpose of this study is to create and evaluate a sustainable referral process from primary care to a Community Care Team (CCT) for patients with chronic conditions using an implementation science framework and qualitative methods. Ultimately, this referral process will be available to inform the CCT locally as well as state- and nation-wide.

  • Implementation and Assessment of the Instrument for Patient Capacity Assessment (ICAN) in Patients with Multiple Chronic Conditions Rochester, Minn.

    The purpose of this study is to implement the use of the Instrument for Patient Capacity Assessment (ICAN) discussion aid and describe its usefulness rising patients’ capacity domains of concern in comparison with a comprehensive nurse home visit capacity assessment. We also seek to explore the overall experience of physicians and patients using the Discussion Aid and the factors influencing the quantity and quality of the information obtained.  

  • Incorporating Patient Capacity into the Clinical Landscape Rochester, Minn.

    This study is designed to answer why patient capacity (i.e. patient available abilities and resources to enact self-care and access healthcare) is not regularly documented in the Electronic Medical Record (EMR) in a way that is useful for clinicians. Through the implementation of communication tools designed for patient capacity assessment and engagement of stakeholders in a process of user-centered design, the study team hypothesizes that the study can help clinicians elicit this information in conversation and regularly document it in the medical record for future healthcare discussions.

  • Learning from Our Patients, Learning from Our Practice: Implementing an Intervention to Support Patients on Dialysis Rochester, Minn.

    The purpose of this research project is to learn, alongside clinical staff and leadership, how to embed, test, and sustain patient-centered interventions to support patient capacity in the dialysis practice.  Patients on long-term dialysis are burdened by both their illness and their treatment such that the workload they face often exceeds their capacity to shoulder it.

  • My Life, My Healthcare Rochester, Minn., La Crosse, Wis.

    This study is designed to answer the following questions: "Is the My Life, My Healthcare Discussion Aid feasible for use in primary care? Does it positively impact patient and healthcare teams' care experience and communication, while reducing patient treatment burden?" Through implementation of the My Life, My Healthcare Discussion Aid for patients with chronic conditions, the study team hypothesizes that it will be feasible to implement in routine primary care practice and positively impact patient and healthcare teams experience of chronic care, while reducing patient treatment burden.

  • Patient-Centered Exploration and Innovation to Understand and Ease the Burden of Dialysis Rochester, Minn.

    The purpose of this study is to understand the navigational practices in the healthcare system and burden of work of patients undergoing dialysis in the United States.

  • The Experience of Health Care Access among Patients from Underserved Populations Rochester, Minn.

    The purpose of the study is to explore the experience of accessing health care services from the perspective of patients from groups who have historically faced barriers to accessing health care services and to assess the extent to which patient secure messages align with preferences, needs, and values identified in patient interviews.

  • The Patient Experience of Living with Undercared-for Chronic Suffering: A Mixed Methods Study Rochester, Minn.

    The purpose of this study is to better understand the patient experience of living with undercared-for chronic suffering and the clinician experience of caring for these patients.

     

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