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Yearly Archives: 2021

Preventing Contextual Errors Program in VA Diffusion Marketplace

The VA Health Care System has added information about the implementation of our work to improve contextualization of care in the VA to its Diffusion Marketplace web site for health care innovations. You can visit it at https://marketplace.va.gov/innovations/preventing-contextual-errors-pce-program

Coffee & Science interview with Saul Weiner

Institute for Health Improvement President and CEO Dr. Kedar Mate interviewed Saul about contextualizing care for the UCSF SIREN Coffee & Science Podcast.

Listen below or at https://sirenetwork.ucsf.edu/podcast/promise-and-pitfalls-adjusting-care-context

The Promise and Pitfalls of Adjusting Care to Context SIREN Coffee & Science

This episode features a conversation between Kedar Mate, MD, President and CEO of the Institute for Healthcare Improvement and Saul Weiner, MD, Professor of Medicine, Pediatrics and Medical Education, Director of the Clinical Leaders and Academic Scholars Fellowship at the University of Illinois at Chicago, and Deputy Director of the Center of Innovation for Complex Chronic Health Care at the Veterans Health Administration. This session is the third of four talks focused on health care sector efforts to Adjust clinical care based on information about patients’ social circumstances. In this conversation, Kedar and Saul explore the intersection of social care adjustment and the practice of contextualizing care and raise questions about both potential benefits and unintended consequences of implementing contextualized care.Recommended references:  https://www.contextualizingcare.org/  Weiner SJ. Contextualizing care: An essential and measurable clinical competency. Patient Educ Couns. 2021.  Weiner SJ, Schwartz A, Altman L et al. Evaluation of a Patient-Collected Audio Audit and Feedback Quality Improvement Program on Clinician Attention to Patient Life Context and Health Care Costs in the Veterans Affairs Health Care System. JAMA Netw Open. 2020.  Weiner SJ, Schwartz A. Listening for What Matters: Avoiding Contextual Errors in Health Care. Oxford Univ Press. 2016. Weiner SJ. On Becoming a Healer: The Journey from Patient Care to Caring about Your Patients. Johns Hopkins Univ Press. 2020. Gawande A. “Personal Best”. The New Yorker. 2011.

A video introduction to 4C coding

During a medical encounter, clinicians should attempt to identify and address, where feasible, patient life challenges that are complicating their care — a process called “contextualizing care.” Several studies have documented that when physicians contextualize care patients have better outcomes, there is less overuse and misuse of medical services, and hospitalization rates are reduced. Determining objectively whether a care plan has been contextualized requires analysis of audio recordings and medical record review, utilizing a process called “Content Coding for Contextualization of Care” (“4C”). This video provides an introduction to contextualizing care (Saul J. Weiner, MD) followed by a demonstration of 4C coding, utilizing REDCap (Amy Binns-Calvey). The 4C coding manual and REDCap XML file are free and accessible at http://dvn.iq.harvard.edu/dvn/dv/4C.