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better patient services and health outcomes and will lower the
are patients and their families, at the planning stage will lead to
recognizing that presenting the service to the recipients, who
patient involvement in research and the healthcare system,
Israel Endocrine Society, highlighted the importance of more
Chairman of the conference, Prof. Avi Karasik, president of the
A mean PPV of 17.8% is higher than the predictive values
pATIEnT InVOlVEMEnT: RESEARCH AnD THE HEAlTHCARE SySTEM
occur in other countries or in Israel.
ties regarding the design of services and policy changes, which
the healthcare system. Participants presented specific activi-
focused on patient involvement in various processes within
from transverse health systems attended the conference, which
Care Initiative. Clinicians, healthcare providers, and patients
The conference was organized by the OTZMA Diabetes
care systems [2].
and active also within the policy-making processes in health-
result, patients and their families are becoming more involved
and healthcare provider in determining a treatment plan. As a
approach in which there is a partnership between the patient
treatment approaches to disease, to a more patient-centered
archal conception, in which the healthcare provider dictates
Over the last 2 decades healthcare has gone from a patri-
in the design and policy in healthcare [1].
raise awareness of the expanding trend of patient involvement
Israel, on 21 March 2018. The focus of the conference was to
T cation in Diabetes was held at the Daniel Hotel in Herzliya,
Based on trigger frequency and their PPVs, a consensus
he 4th Annual Conference on Therapeutic Patient Edu-

1
2.70%
patient advocacy, patient involvement
19
19.0%
Diabetes, diabetes education program, healthcare policy,
2
15.38%
4th Annual Conference on Therapeutic Patient Education in
KEY WORDS:
5
38.46%
10
17.54%
1
11.11%
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#131118-COHANIM - 131118-COHANIM | 1 - A | 18-11-13 | 11:24:13 | SR:-- | Black
131118-COHANIM - 131118-COHANIM | 1 - A | 18-11-13 | 11:24:13 | SR:-- | Yellow
3
42.86%
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0
The most common triggers involved prescribing antiemetics
N/A
0
N/A
5
41.67%
1
4
16.67%
1
12.5%
13
11.61%
4
36.36%
Overall, 1.54 ADEs were found for every 100 days of hos-
7
50%
predictive value
found
ADEs
positive
#
Original articles 37 100 13 13 57 9 7 1 3 12 24 8 112 11 14 found Triggers < 0.001 < 0.001 0.465* 0.009 0.009 – P value Original articles ≤ 50,000mm 3 , 1 (50) T13: Thrombocytopenia ≤ 3000/mm 3 , 1 (50) T12: Leukopenia None None creatinine, 6 (24) T15: Rise in serum medication, 8 (32) T18: Abrupt cessation of administration, 7 (14) T1: Antihistamine medication, 11 (22) T18: Abrupt cessation of administrations, 13 (2
Furthermore, compared to other ADE reporting systems, the authors of this study). Study personnel underwent train- Richards also stated that the research ecosystem is prepared to Administration of the Ministry of Health, initiated a meet-
the Trigger Tool was shown to assist in identifying 10 times ing to allow for standardization and optimize reproducibility consider clinical research papers only if the authors can dem- ing with the public to investigate the gap between extensive
more ADEs in approximately one-third of all hospitalizations. in data collection. Identified ADEs were further classified by onstrate a partnership with the patients in their study. Finally, knowledge and advanced technologies compared to the
However, between-country differences in medical practices the severity of the ADE and the nature of the condition (e.g., Richards presented the role of patients on the editorial board, achievements of the Israeli healthcare system in these fields.
were shown to affect the Trigger Tool sensitivity and its positive rash, hematologic event, neurologic event). In addition, each editorial staff, and journal events and campaigns. She noted that This gap is reflected in the rising rate of those presenting with
predictive value (PPV). The latter has been reported to range event was classified as preventable or non-preventable based specific challenges included editorial collaboration, the need for chronic illness who have difficulty adhering to treatment and
between 4.0% and 21.5% in Britain and Belgium, respectively on the researcher’s clinical judgment. All disagreements in the patient guidance and support, and the value of considering the therefore endure unnecessary health deterioration and hos-
[16,17]. This finding is further reflected by variance in ADE classification of type, severity, or preventability were resolved by actions of patients, caregivers, and advocates. pitalization. The basis for this initiative is to understand that
prevalence of 3.4% in Britain and 15.6% in Brazil [17,19]. Given consensus. To prevent potential conflicts of interest, physicians In Israel, the medical field is seeing the first signs of activity the public has the knowledge and experience to approach
the relatively low PPV in the British study, along with an esti- were appointed to review charts that were not from the hospital and involvement from patients and their families within policy chronic disease treatment. The main theme that emerged
mated 40% sensitivity for preventable ADEs, the Trigger Tool at which they work. making processes, research initiatives, and healthcare education from this process was that both patients and healthcare pro-
was not adopted in British hospitals. Apart from looking for trigger-related ADEs, research programs. viders need better ongoing communication based on trust,
In Israel, the evidence is scant with estimated ADE rates nurses registered other ADEs identified through chart reviews transparency, and partnership.
of 25% and 32% in 1997 and 1998, respectively [20,21]. The in an attempt to identify ADEs not captured by the Trigger pATIEnT InVOlVEMEnT: DEVElOpMEnT Of RESEARCH AnD EVAlu-
objective of the present study was to validate the Trigger Tool Tool. Furthermore, in each of the four hospitals, we reviewed ATIOn TOOlS pATIEnT InVOlVEMEnT: ADVOCACy ORgAnIzATIOnS
in Israel and to define the ADE rates in four different hospitals. the patient safety reporting systems for any ADEs reported by Prof. Orly Manor, chairman of the board of the Israel National Giora Sherf, the general manager of the chronic myeloid
the staff during the study period, specifically those related to Institute for Health Policy Research, and former head of the leukemia (CML) patient organization (a non-governmental
the patients included in our study. Israel National Program for Quality Measures in Community organization), presented the patient’s perspective. Sherf rep-
PATIENTS AND METHODS Healthcare, presented the growing role of patients in developing resented patient advocacy groups and spoke about local and
STuDy pOpulATIOn AnD SETTIng SAMplE SIzE AnD STATISTICAl AnAlySIS research and evaluation tools, as it is reflected in the develop- international initiatives that are led by patients presenting with
The study was a retrospective descriptive correlative analysis Sample size was determined by the Trigger Tool official guide- ment of quality indicators and Patient-Reported Outcome CML and chronic lymphocytic leukemia (CLL). One of the
surveying four general hospitals in Israel located in different lines. This design required the inclusion of 20 charts per month Measures (PROMs) [7,8]. The National Program for Quality patient-driven initiatives [9] is one of the most comprehensive
geographical regions. All four hospitals are public academic for the 1 year study. Accordingly, 240 charts were randomly Measures in Community Healthcare, in cooperation with the studies conducted to date. The study showed factors that influ-
medical centers varying in size from 326 to 1517 beds. The hos- chosen from each hospital, for a total sample size of 960 hos- four Israeli health maintenance organizations, initiated a study ence non-adherence in CML. The unique study involved 2546
pitals had different levels of sophistication in electronic medical pitalizations. Comparison among groups was conducted using to develop PROMs for patients with diabetes. The process of patients from 63 countries who completed a patient-driven sur-
chart usage, with one having a full system including CPOE and ANOVA or chi-square for continuous variables and propor- determining the PROMs was conducted in collaboration with vey on ways to improve adherence, including dissemination of
the other three having a partial system. The study population tions, respectively. patient focus groups, expert groups, and consultations with an information about the disease and medication, management of
comprised patients who had been hospitalized in internal medi- To validate the research tool, sensitivity was calculated using international diabetes consortia for health outcome measure- side effects, and support from hematologists. Sherf highlighted
cine and surgical departments between January and December the ADEs identified by the Trigger Tool and those found by ments. Three patient focus groups were conducted, including many of the important roles that patient advocacy groups have,
2014 at each of the four hospitals studied. Inclusion criteria were chart reviews. In addition, the PPV of each trigger was calcu- one with Arabic speaking patients. The participants identi- including support and empowerment of patients, advocacy, and
hospitalized patients 18 years of age or older with a hospital lated by dividing the ADEs actually found with those identified fied areas that were important to them. These topics included support of advancement in research and therapy. This increased
stay between 2 days and 1 month. All hospitalizations that met by the triggers in the same cases. Based on previous studies in physical functioning, reduction of symptoms (e.g., abdominal patient involvement, according to Sherf, will lead to a better
the inclusion criteria were included. We then randomly selected which low PPV resulted in the withdrawal of the tool, PPV pain, dizziness, tiredness, sleepiness, weakness, dry mouth, diagnosis and prognosis, more effective clinical trial partici-
hospitalizations to be included in the study sample using above 10% was required to justify further use of the Trigger leg numbness), mental state, and reduction of hypoglycemia. pation, further access to therapies, and better optimization of
Microsoft Excel (version 14.0.6212.5000) software (Microsoft Tool [17]. All analyses were two-tailed and P ≤ 0.05 was con- An emphasis was also placed on the ability to manage therapy treatment selection.
Corp, Richmond, CA, USA). The study was approved by the sidered significant. and self-efficacy. For patients, important factors of treatment
institutional review board at each of the participating hospitals. successes included having interdisciplinary treatment in one pATIEnT InVOlVEMEnT: DEVElOpMEnT Of TRAInIng pROgRAMS
place and at the same visit, receiving information about the dis- Dr. Karen Hershkop, head of the Diabetes Education Program
CHART REVIEw fOR ADVERSE DRug EVEnTS RESULTS ease and treatments available, hosting patient support groups, at the OTZMA Diabetes Care Initiative, focused on patient
ADE identification and characterization was conducted using Two triggers originally present in the IHI tool were deemed maintaining a permanent framework for care, initiating routine involvement in developing training programs with specific
the methodology as set by the IHI [10]. Prior to the study initia- irrelevant to the Israeli healthcare practice and thus were follow-up care, and demonstrating care and empathy. Findings emphasis on the diabetes educators program in Israel. While
tion, all listed researchers reviewed the various ADE triggers excluded: flumazenil administration (T3) due to updated from patient focus groups, local experts, and international dia- developing this program, focus groups of patients and health-
and discussed the need for trigger adaptation. Decisions regard- guidelines for its use and prolonged PTT (T10) due to the betes consortia were included in the selection and construction care providers were involved to define the role of diabetes
ing changes were reached only by consensus. Hospitalization limited use of unfractionated heparin in internal medicine of PROMs questionnaires for diabetes and, together with the educators as well as to understand the requirements necessary
charts were initially reviewed by a research nurse to identify and general surgery departments. During the study period, a quality indicators, provided a comprehensive picture of the for their training. Follow-up interviews 1 to 3 years post-train-
triggers and potential ADEs. We reviewed physician orders, total of 421 triggers in 279 hospitalizations were identified, of treatment of diabetes in Israel. ing were conducted. All participants noted that the training
medication lists, laboratory reports, admission histories, which 75 ADEs among 72 hospitalizations (7.5%, 95% con- program was of added value to practitioners in the diabetes
progress and consultation notes, discharge summaries, and fidence interval [95%CI] 5.8–9.2) were confirmed [Table 1]. pATIEnT InVOlVEMEnT: pOlICy MAKIng field and 81% felt that the program contributes to their daily
nursing notes. For each record, the total medication dose was The calculated mean PPV was 17.81%, with between-hospital Naama Ron, a representative of the Ministry of Health, professional work (publication in process). Having the patient
manually recorded. Data were abstracted and summarized into variation of 11.83–24.21% (P = 0.128). Two ADEs were identi- explained the public involvement in policy making within the participate in the teaching process started in 1903, when Sir
electronic forms by trained research nurses. Subsequently, each fied only by chart review but were not detected by the Trigger ministry. Between 2016 and 2017, the Strategic and Financial William Osler addressed the New York Academy of Medicine
form was independently reviewed by two physicians (who were Tool (sensitivity of 97%). Compared to patients without ADEs, Planning Administration, in cooperation with the Medical saying, “In what may be called the natural method of teaching,
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