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Pre-Visit Planning Case Report: Prairie Lake Family Medicine

Pre-visit planning case report: autumn ridge family medicine, pre-visit planning case report: fairview health services, success story: pre-visit laboratory testing can improve communication with patients about test results, success story: decrease patients with poorly controlled diabetes by one-third, watch how the mayo clinic implemented a pre-visit planning process.

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Disclaimer: AMA STEPS Forward ® content is provided for informational purposes only, is believed to be current and accurate at the time of posting, and is not intended as, and should not be construed to be, legal, financial, medical, or consulting advice. Physicians and other users should seek competent legal, financial, medical, and consulting advice. AMA STEPS Forward ® content provides information on commercial products, processes, and services for informational purposes only. The AMA does not endorse or recommend any commercial products, processes, or services and mention of the same in AMA STEPS Forward ® content is not an endorsement or recommendation. The AMA hereby disclaims all express and implied warranties of any kind related to any third-party content or offering. The AMA expressly disclaims all liability for damages of any kind arising out of use, reference to, or reliance on AMA STEPS Forward ® content.

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Pre-visit Planning Saves Time

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Learn about some pre-visit planning strategies that can make office visits more efficient, productive, and meaningful for both the health care team and patient.

Marie T. Brown, MD, discusses the benefits of pre-visit planning and shares strategies to help ensure that providers and patients are prepared to assess and address diabetes management during office visits.

Q: How do health care professionals, medical practices, and patients with diabetes benefit from pre-visit planning?

A: Pre-visit planning is a process where you plan for patients’ future appointments at the conclusion of the current visit, arrange for what should happen between this visit and the next visit, and huddle with your team prior to the patient’s next visit. With pre-visit planning, everyone is prepared to make the most meaningful use of everyone's time during the office visit.

When it comes to providing care for people with diabetes, you are often caring for someone with numerous comorbidities. Your patient may be cared for by several doctors and prescribed numerous medications. A key component of pre-visit planning is making sure that everything the patient and provider need to assess diabetes management is on-hand during the office visit. This requires the patient to have lab tests a week or so before the visit so that any changes in treatment, such as medication changes, occur face-to-face to ensure optimal communication.

In many clinics, the available A1C is from 3 months prior—too long ago to make any adjustments in a treatment plan. You order an A1C, receive the results the next day, and now you need to reach your patient to adjust therapy based on the most recent A1C results. Attempting to reach them by phone or email causes delay and needless inefficiencies. If only you had the needed results during the patient visit!

Q: During a patient visit, how can health care professionals and patients plan for the next visit?

A: It’s important to have a conversation with your patient about the next visit at the end of the current visit. For instance, if your patient is not reaching his or her goals for blood glucose, you might suggest scheduling office visits every month until things start to improve. If your patient is reaching his or her blood glucose goals, he or she may only need to be seen once or twice a year. The vast majority of patients who have diabetes are seen every 3 months. It’s important that the patient understands and agrees with the plan, too.

In addition to talking about the next visit with your patient, let your patient know which lab work needs to be done before the next visit and order the necessary pre-visit lab tests . These tests can be done at a laboratory closer to the patient's home or during another visit your patient may have scheduled at your office or center for another reason. If a second visit is too much of a burden, point-of-care testing would also provide the needed lab test results.

Some doctors use a pre-visit planning checklist. Once a year, the checklist may include annual tests or referrals such as a lipid test, albumin creatinine ratio, urine test, a referral for a diabetes educator, a referral to an ophthalmologist, and so on. For the checklist, you can use order sets in electronic health records (EHRs) or use paper checklists that are handed to your team.

Q: What planning is needed in the days or hours before a patient visit?

A: The team should sit together to plan what a pre-visit planning checklist should look like. The main goal of pre-visit planning is to deliver quality efficient patient care. If you’re just beginning to do this, the process should involve the entire team so that everyone on the team understands, “What’s in it for me?” We don’t want pre-visit planning to shift the burden from one team member to another. With pre-visit planning, patients will be more likely to be seen on time, which is a much more pleasant experience for everyone. If everyone on the team understands that one of the goals of pre-visit planning is to make sure that the office stays on schedule, then the receptionist knows that they are going to have more pleasant patients in the waiting room. The team members, such as the medical assistant or nurse, will also have more time to develop a relationship with the patient, and they’ll be able to get out on time with a feeling of a “job well-done.” Care gaps such as immunizations and cancer prevention are addressed prior to the office visit and orders entered or “pended” by the team. The front desk team members can help by printing lists of patients with care gaps so that the clinical team can address them during “downtime.” 

Usually, a day or two before the patient visit, a team member will look at the notes in the EHR to make sure lab test results are up-to-date and remind patients if they still need to get their blood drawn. This review helps identify gaps in care, such as needed immunizations, annual lab tests, preventive health screenings, or referrals to a diabetes educator or other health care professional. This is time well spent because a half hour one day can save two hours the next day.

The pre-clinic care team huddle is also part of pre-visit planning. At the start of the day, huddle with the whole team to look at the schedule and get an overview of what the day is going to look like. This is an opportunity for team members to share information that could affect the day. For instance, someone might need to take a phone call or need a longer lunch break to handle a personal matter. It's also important to look at all the patients scheduled for the day and identify, for example, who may need a larger room because they use a wheelchair or have family members accompanying them. This is an opportunity to find out who might require an interpreter. You might find that there is a patient on the list who is routinely, for many reasons, always late—maybe due to public transportation delays—and planning for that disruption is important so that you minimize the effect on the schedule.

The American Medical Association (AMA) STEPSforward ™ module on pre-visit planning , authored by Dr. Christine Sinsky, is a free resource that outlines 10 steps to pre-visit planning and offers tools including checklists as well as case studies. STEPSforward™ also offers a module on developing an efficient  team-based approach to managing diabetes .

Q: How can health care professionals engage patients in pre-visit planning? What technologies can help?

A: Having patients take ownership of completing blood tests prior to the visit is important, because patients often prefer to discuss medication changes face-to-face. It also helps visits start and end on time, and helps patients achieve their goals more readily.

Organizations can use technology to develop automated reminders for patients. Patients can also use online patient portals to upload their blood glucose or blood pressure logs and review their medications before a visit. Sending educational materials also streamlines the visit.

Engaging patients in pre-visit planning continues in the waiting room. For example, before a patient visit, a receptionist may print out a list of the patient’s medications and ask the patient to review the list and provide feedback.

Asking patients to write down their priorities for the visit while they’re in the waiting room saves time, as well as ensures the patients’ needs are met. They may need a handicapped parking sticker or a referral to a podiatrist. The receptionist or medical assistant can begin addressing some of these issues while the provider can address issues that require higher decision-making skills, assess adherence, and build a trusting relationship with the patient.

Q: Are there specific examples of pre-visit planning strategies that have improved your visits with patients who have type 2 diabetes?

A: Absolutely. Many of my patients see the diabetes educator four times a year, usually a week before they see me. Recently, I saw a patient with newly diagnosed diabetes following their first visit with the diabetes educator, where they had learned how much sugar is in a 20-ounce bottle of soda. Just by cutting out soda intake, which was one soda a day, the patient began losing weight. She was excited!

At check-in, patients are handed a list of their medications and asked to circle those that need refills, cross out medications they are no longer taking, and add a question mark to medications they don’t think they need.

In our patient portal, patients can see their test results, and they know what their A1C is before I see them. So, they're prepared to hear a congratulatory message or have a conversation about adherence, diet, or the need to escalate therapy. They’re prepared to be part of the discussion about next steps and goals. Agreeing on the A1C goal and ensuring the patient understands and agrees with the goal is of paramount importance. The same is true for blood pressure goals. Often, providers assume that the patient understands the goals of therapy.

Q: Are there any other aspects of pre-visit planning that health care professionals should consider?

A: It’s important to start small so that you're successful. For instance, some organizations have done pre-visit planning for the last three or four patients of the day, since that is when the clinic is running late and staff is tired. Once the team sees that doing pre-visit planning for the last few patients of the day saved everybody time, usually one of the team members will say, “Why don’t we do this with all of our patients?” Some organizations start pre-visit planning for all patients and close all care gaps all at once. This takes planning and more resources (time for training, protected time to do the planning, and possibly more staff).

My advice is to choose a small group of patients to start with pre-visit planning. You could do this with patients over 70 years old, or just for patients with diabetes. See how successful it is, what you've learned from it, and if you're going to adopt it or adapt it.

Start with what the team values most and use the Plan-Do-Study-Act cycle : plan it; do it; study the effect; and adopt it, adapt it, or abandon it and try something else. Pre-visit planning will look different at every organization, depending on the organization's resources and the team’s level of interest.

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  • Research article
  • Open access
  • Published: 13 May 2021

Applied techniques for putting pre-visit planning in clinical practice to empower patient-centered care in the pandemic era: a systematic review and framework suggestion

  • Marsa Gholamzadeh 1 ,
  • Hamidreza Abtahi 2 &
  • Marjan Ghazisaeeidi 1  

BMC Health Services Research volume  21 , Article number:  458 ( 2021 ) Cite this article

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One of the main elements of patient-centered care is an enhancement of patient preparedness. Thus, pre-visit planning assessment tools was emerged to prepare and involve patients in their treatment process.

The main objective of this article was to review the applied tools and techniques for consideration of putting pre-visit planning into practice.

Web of Science, Scopus, IEEE, and PubMed databases were searched using keywords from January 2001 to November 2020. The review was completed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Then, qualitative analysis was done to suggest an appropriate framework by mapping the main concepts.

Out of 385 citations were retrieved in initial database searches, 49 studies from ten countries were included. Applied pre-visit techniques can be classified into eight categories. Our results showed that almost 81% of studies were related to procedures that were done between each visit, while 42% of articles were related to before visits. Accordingly, the main approach of included articles was patient preparedness. While 38 studies reported this approach is effective, three studies reported the effectiveness of such tools as moderate, only two articles believed it had a low effect on improving patient-centered care.

This survey summarized the characteristics of published studies on pre-visit planning in the proposed framework. This approach could enhance the quality of patient care alongside enhancement patient-provider communication. However, such an approach can also be helpful to control pandemic diseases by reducing unnecessary referrals.

Peer Review reports

In the information-driven care era, although the ultimate goal of health systems is still improving the quality of patient care, the patient care model has shifted from personal responsibility to participatory medical decision-making [ 1 ]. Thus, the responsibility of the patient’s health is no longer solely with the physician. On the other hand, the role of the patient in promoting his health status cannot be denied [ 2 ]. Hence, the patient-centered care (PCC) model was introduced to show the participatory role of the patient and other health care providers in the process of treatment and patient care [ 3 , 4 , 5 , 6 ]. Since the PCC idea was introduced, various definitions and models have been proposed to distinguish the main elements of this model [ 5 , 7 , 8 , 9 , 10 , 11 , 12 ]. Up to now, the best model that has been able to explain the main components of such a care model is the model presented by the Picker Institute [ 13 ]. This model consists of eight parts that outline the factors affecting the achievement of an optimal patient-centered care model [ 5 , 12 , 14 ].

One of the main elements of the PCC approach is respect for patients’ value by preparation of patients for each visit [ 6 ]. Sometimes patients have to spend more time in the waiting room than in a physician’s office [ 15 , 16 ]. Also, in each appointment, especially in the first visit, more than 5 min should be devoted to determining who the patient is, what is his problems, which drugs she/he used, what is his/her medical history, and so on [ 17 ]. This process is so complex in patients who have a chronic condition or patients with multiple chronic conditions with multiple medications [ 18 , 19 ]. It can be useful to prevent the spread of the disease. Limited time for each visit and patient complexity might have a negative impact on the patient-physician relationship.

In this context, pre-visit planning and visit preparation concepts have been suggested by American Medical Association (AMA) as a solution to address these challenges. It can help physicians when the patient checks in for the first time, he is already behind [ 20 ]. This term (pre-visit planning) was introduced by Sinsky et al. in 2014 to collect and organize patient data before a patient visit [ 21 ].

The purpose of pre-visit planning is to help the patient and physician to save time and improve care by gathering and organizing information in a structured way. Therefore, a health care provider can pay more attention to interpretation, discussion, and response to a patient during the visit. This idea is not just to plan ahead before each visit. Dr. Sinsky explains that pre-visit planning could include a broader concept that could generally refer to preparing the patient for a face-to-face visit more effectively [ 21 ]. The pre-visit planning concept is described in Fig.  1 as a conceptual model.

figure 1

The conceptual model of pre-visit planning

However, there are various methods to apply this new approach into practice, it usually includes scheduling future appointments and preparing patients before the visit [ 22 ]. These techniques are known as pre-visit assessment tools. The use of pre-visit assessment tools focuses on involving the patient and the physician through the patient care process [ 23 ]. As it is apparent in Fig. 1 , it can occur at end of each visit, arranging for the next visit, programming for the next clinical and paraclinical testing, gathering the necessary information for the subsequent visits, and take steps regarding the handoff of patients [ 24 ].

With pre-visit planning, patients and physicians are prepared to make meaningful use of their time during each visit. Furthermore, patients could have an impressive role in clinical decision-making regarding their treatment process [ 25 ]. Hence, several studies have focused on the power of patient-centered care to improve patient care, but no studies have been published to examine the applying pre-visit planning techniques in the context of patient-centered care. The main objective of this study is to review the consideration of pre-visit planning used in patient-centered care. Throughout this paper, the term pre-visit planning will refer to any intervention, care program, patient-centered planning, or even educational plan that is considered to prepare the patient for a face-to-face visit or improve the patient-provider relationship. Specific aims of this survey are as follows: 1) representing an overview of applied methods regarding pre-visit planning with their characteristics in published studies, 2) to investigate the published studies on applying pre-visit planning regarding clinical aspects such as type of disease, 3) to determine the effectiveness of putting pre-visit planning into routine practice, 3) providing an overview of the sample size, approaches, and collected information concerning applied methods and techniques, 4) suggesting a framework in this context.

A systematic search of four databases (Web of Science, Scopus, IEEE, and PubMed) was conducted from January 2001 to November 2020 using keywords alongside Mesh terms. These databases were selected for their inclusion of qualitative studies and health research. The keywords used in the search strategy were drawn from preliminary searches according to our study goals. Those keywords were validated and additional keywords added by checking the terms used in articles identified in preliminary searches. Boolean search strategies were described in Additional file 1 : Table A-1. Since no result was found in the IEEE database, it was removed from source databases in Table A- 1 . This systematic review was completed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist to ensure the inclusion of relevant studies [ 26 ].

Inclusion and exclusion criteria for study selection

Articles were included if they met the following criteria: 1) The focus of the study was on applying the pre-visit approach through the patient care process. 2) Population includes all of the patients with any type of disease, 3) This study covered all phases of the patient care process, 4) Published in recent 10 years and matched with the search query, 5) Limited to those published in the English language, 6) Only published articles and reviews in peer-reviewed journals were included, 7) All type of study designs, 8) Improve patient-centered care, 9) Studies that received an acceptable score in terms of quality based on the checklist. Articles excluded if they met the following criteria: 1) The title, abstract, or full text of the article did not relate to pre-visit planning, 2) Thesis, book chapters, letters to editors, short briefs, reports, technical reports, book reviews, review, or meta-analysis, 3) Non-English papers, 4) Publication that their full-text is not available.

Data screening phase

Based on our search strategy; articles were retrieved from databases. Additionally, related studies were added manually by a simple search in Google Scholar and reference checking. All of the citations were imported to EndNote software for better resource management. Then, duplicated articles were removed. In the first phase, all titles and abstracts of articles were examined based on our main objective to select relevant studies by one author (MG). A second reviewer (MGH) reviewed a sample of studies randomly. After that, the full texts of relevant studies were screened thoroughly by two reviewers (MG and MGH). If there was a disagreement between the authors in the selection of relevant studies, the final decision was made by HA. Lastly, some studies remained as eligible articles for qualitative analysis. The extraction forms were designed by researchers to manage and investigate the obtained information. To diminish bias, key subjects of articles summarized and entered into customized extraction forms based on specific classifications. Two authors (MG and MGH) independently extracted the study characteristics based on the classification. The information extracted by the researchers was re-examined to reach an agreement. The next reviewer (HA) assessed and verified the extracted information.

Critical quality appraisal

The methodological quality of the included articles was evaluated using the Qualitative research Critical Appraisal Program (CASP) tool by two authors. This instrument was used in systematic reviews frequently for qualitative synthesis [ 27 ]. It was employed for appraising the strengths and limitations of any qualitative research methodology. It was recommended for health-related researches and it is appropriate for novice researchers [ 28 ]. Critical appraisal was performed independently by two researchers.

To extract some necessary information, specific categories were considered to classify and analyze relevant articles. All of the articles were synthesized regarding general and specific domains. The general domain comprises the title, author, year of publication, journal name, type of study, the main objectives. Accordingly, the specific domain comprises applied pre-visit techniques, disease, clinic, sample size, country, outcome measures, effectiveness, and collected data. Analysis of the extracted information from eligible articles and framework suggestions were conducted based on these predefined categories.

In total, systematic literature searching of databases yielded 385 citations. Of which 99 articles were removed due to duplication. Next, one hundred and sixty-six papers were excluded after screening titles and abstracts. In the following, 72 papers were excluded after full-text reading. Finally, 49 papers are identified as an eligible article which met our inclusion criteria. The screening process for articles based on the PRISMA checklist is shown in Fig.  2 . All included papers had the minimum score (10 from 20) of quality assessment using the CASP tool. Only four papers were excluded based on quality appraisal assessment. Therefore, forty-nine articles were identified as eligible studies for qualitative analysis.

figure 2

PRISMA workflow for summarizing the selection of papers process

General characteristics

All included studies are published in journals from 2001 to 2020. The trend of publishing articles in this field was following an upward trend. In terms of the type of study, studies were conducted in different designs. Most of which were clinical trial studies. The descriptive analysis regarding the type of study in the included articles is represented in Table  1 . In the following, the results of the review of studies by author, year of publication, the main objectives, the sample size, type of pre-visit planning, clinic, the effectiveness of the applied method, and outcome of using the pre-visit planning are summarized in Table  2 .

Analysis of studies showed that the application of pre-visit planning is the most favorite of developed countries. Of them, the USA has the most contribution among other studies. After that Canada ranks second in the deployment plan is allocated to pre-visit intervention. The distribution of studies concerning the country is shown in Fig.  3 .

figure 3

The distribution of studies based on their conducted countries worldwide

Different techniques for putting pre-visit into practice

The investigation showed that pre-visit can apply in different ways regarding timing, main approaches, and types. The analysis showed that different types of pre-visit techniques have been employed by authors to facilitate office visits and patient care. All of these plans can be categorized into eight different categories, utilizing an electronic pre-office checklist with 12 studies (24.5%) [ 25 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 48 , 58 , 59 , 68 ], educating patients and support them before each visit in form of online and offline source of information with 12 studies (24.5%) [ 23 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 60 , 61 , 62 , 66 , 74 ], applying an EHR-linked care program with different checklists and assessment tools with nine studies (18.4%) [ 22 , 43 , 44 , 49 , 63 , 67 , 70 , 71 , 73 ], using paper-based checklists with nine studies (18.4%) [ 45 , 46 , 50 , 51 , 52 , 64 , 65 , 69 , 72 ], preparing and assess patient with the pre-visit phone-based intervention with two studies (4.1%) [ 24 , 53 ], using self-triage or self-assessment tools with two studies (4.1%) [ 54 , 55 ], using automatic reminders and sheets with one article (2%) [ 56 ], and using pre-clinic consultation by other health care team member with one article (2%) to prepare the patient for each visit [ 57 ].

According to findings, the most favorite types of pre-visit model were related to using electronic pre-office visit checklists and supporting patients by providing them with the necessary information in the form of online and offline training. In three articles, this information was provided to patients in the form of educational websites [ 37 , 39 , 40 , 60 ], while in the other six articles, the information was provided to patients in the form of training sessions before the patient’s visit and referring to the clinic [ 23 , 36 , 38 , 41 , 42 , 61 , 62 , 66 ].

The next widely applied method was the EHR-linked care program that put pre-visit planning into practice. Ten articles used pre-visit solutions such as electronic checklists, automated reminders, decision-making tools, and reviewable forms that could be implemented by connecting to electronic medical records. In third place, there are paper-based checklists used for patient preparation with nine papers. These checklists included questions about demographic information, the main problems, medical history, general symptoms, illness history, hospitalizations, medications, family history of a specific illness, level of education, location, and questions about the patient’s lifestyle. Other solutions were used in a smaller number of articles. Regarding pre-visit counseling, only one article applied the consultation of clinical pharmacists before the office visit. This approach leads to providing the physician with better information after the initial completion of the medical record.

In terms of timing, pre-visit intervention could be conducted at a different time in the patient care process. Taken together, all of these possibilities could be categorized into four situations. It can be occurred before each visit, between visits, at the end of each visit on the current visit, and in a combination of the previous three models. Our results showed that almost 81% of studies were related to procedures that were done between each visit, while 42% of articles were related to procedures that were done before each visit. Only 10 % of studies were conducted at end of the current visit.

In terms of main approaches, the analysis of studies showed that all studies can be divided into three main categories based on the main approaches. These three approaches comprise, improving the current visit and preparing the patient for the next visit, perform some procedures for patient preparedness such as sending reminders or filling pre-visit checklists, and providing more inclusively insight about the patient for the physician before they come in for an office visit. The final analysis of the studies based on the main objectives and the timing is summarized in Table  3 . Out of 49 studies, the main approach forty-eight of articles were related to patient preparedness and enhance patient adherence to their treatment.

Out of 49 studies, only one study did not report the sample size of their study. In total, the sample size ranged from 15 to 12,228 with a mean sample size of 1160.3877 (SD = ± 2613.799). In Fig.  4 , the distribution of studies based on sample size, year, and different techniques are represented.

figure 4

Distribution of studies based on sample size, year, and different techniques

The effectiveness of pre-visit planning

Articles were also reviewed regarding the effectiveness of the applied methods. Out of 49 studies, the authors of 41 articles (83.67%) considered pre-visit planning to be effective in clinical practice. While six studies (12.24%) reported the effectiveness of these tools as moderate, only two articles (4.08%) believed that using this method had very little effect on improving patient-centered care. The effectiveness of studies concerning applied methods is shown in Fig.  5 .

figure 5

Effectiveness of studies concerning applied methods

The effectiveness has been reported by researchers using various outcome measures in studies. These outcome measures reported in reviewed articles, along with their frequency and their effectiveness, are shown in Table  4 .

Different diseases and the main reason for referral

Through this survey, the referred clinic and the main reasons for the referral were also examined in reviewed articles. In terms of the reason for referral and diseases, the most common reason for referral was related to chronic disease and general problems. The frequency of disease regarding applied methods and their effectiveness are represented in Fig.  6 . Regarding the type of clinic that was considered for implementing pre-visit planning, the highest frequency was related to primary care clinics. Next, surgical clinics had the largest number of pre-visit programs.

figure 6

Frequency of disease regarding applied methods and their effectiveness

Information and collected data

To implement pre-visit planning, various types of data and information have been collected in studies. These collected data were very diverse. Hence, these different types of information can be divided into nine categories concerning their application. The different types of information regarding applied techniques are shown in Fig.  7 .

figure 7

Distribution of different kinds of collected data regarding pre-visit techniques

Determining the main categories of applied techniques regarding medical informatics

Coding of all research studies and extracted themes using thematic analysis leads to discover the main sub-themes in terms of medical informatics. Therefore, all of the employed techniques can be divided into four categories, pre-assessment forms, educational resources, decision aid tools, and reminders as the main themes. The main themes and sub-themed are shown in Fig.  8 . Different aspects of such a model were shaped by mapping the main concepts obtained through this survey. The details of applied techniques in terms of the medical informatics view are described in Table 2 .

figure 8

The main applied techniques through pre-visit planning in terms of medical informatics

Framework suggestion and IT-based solution

After a qualitative analysis of the results based on predetermined categories, the main ideas can be summarized in a proposed framework as an electronic-based advanced care program. Based on the results, this model is divided into four main parts in terms of time. This model is represented in Fig.  9 . In this model, the main focus is on the patient. The workflow is designed to improve the relationship between physician and patient in the simplest way. It is done by involving the patient in their care, which is one of the main purposes of using pre-visits in studies.

figure 9

The overall model of pre-visit planning care

In this model, it is assumed that an electronic system is available to manage patient information. To implement a pre-visit-based program, a section is also considered for patient access to his care plan in the proposed model. Based on this model, the patient can pursue the main goals of pre-visit planning through suggested workflow, such as disease management, treatment adherence, receiving the necessary advice and training, and preparing for each visit. To increase the effectiveness of the devised model, it is suggested that the proposed system should have interacted with existing databases and electronic health systems.

Summary of findings

This survey summarized the characteristics of published studies on pre-visit planning and its application in various health domains. To our knowledge, this study represents the first overview of the existing evidence about the different pre-visit planning techniques in clinical practice. Forty-nine articles from ten countries were included in this survey. As mentioned in the results, these techniques can classify into eight categories. Among them, the most widely used methods are related to using electronic pre-office visit checklists and supporting patients by providing them with the necessary information in the form of online and offline educational resources.

Consistent with the present findings, our results showed that applying pre-visit techniques was not restricted to office visits [ 75 ]. So, pre-consultation planning can employ before each patient’s consultation, between the patient’s visits, and during the current visit to facilitate complicated patient care process.

One of the remarkable results of this study is that this approach has been used more in developed countries. It may be because it is easier to take a participatory approach to patient care in developed countries due to a high level of patient literacy.

Results in the context of other researches

Our results showed that most studies have been conducted with the main goal of preparing the patient by involving them in their treatment process. Patient preparedness had the most impact on the patient’s perceptions of his disease and overall patient satisfaction [ 76 ]. Similarly, Ringdal et al. [ 77 ] indicated through their survey that patients were satisfied with their active role as a partner on the healthcare team. Also, this is exactly in line with the main goal of the patient-centered care paradigm regarding the individualized approach to the patient’s treatment [ 78 , 79 , 80 ].

However, Geraghty et al. [ 81 ] showed through their study that there is a linear relationship between patient satisfaction and visit length. Unfortunately, long waits are common at outpatient clinics [ 82 ]. Hence, our results illustrated that using a pre-visit assessment tool such as a simple checklist or questionnaire is almost effective to maximize the available time during a consultation for making the best decisions by physicians. Also, it can provide better insight for physicians to better communicate with the patient by knowing the patient’s background during the consultation [ 22 , 33 , 35 , 47 , 54 , 60 , 64 , 67 , 69 , 70 , 83 , 84 , 85 , 86 , 87 , 88 ].

Analysis of results revealed that most studies considered the pre-visit assessment tool as an independent solution that was not connected to existing electronic systems. However, in some studies, a comprehensive care plan has been taken. A pre-visit planning program could be linked to a patient’s electronic medical record as used in some reviewed studies. This approach is similar to the motivational interviewing (MI) technique that is applied to improve patient-centeredness in other studies. Motivational interviewing is a technique to help patients address their chief problems and increase their understanding of their participatory role in the treatment process [ 89 ].

Implications for research and practice

Planned and targeted care is one of the main components of the patient-centered care model [ 79 ]. Hence, implementing pre-visit tools within an advanced planned care program might be more effective in moving towards effective patient-centered care. However, pre-visit planning care is a new approach, no framework or conceptual model was introduced according to this subject. Only a planned care model was introduced by the Health Research and Quality Agency as a comprehensive patient-centered medical home (PCMH) approach in which one of its main components is pre-visit planning [ 90 , 91 ]. Hence, our findings are summarized in a conceptual model regarding applying the pre-visit assessment tool in electronic-based planned patient care (Fig. 9 ). However, the EHR-linked pre-visit type was used only in the nine studies, the suggested model is not devised in a stand-alone model. Nowadays, with the advent of the digital age, applying integrative electronic systems and medical informatics-based solutions are inevitable [ 92 ].

One of the significant gaps that were mentioned in the studies is the unnecessary referrals of patients to outpatient offices [ 93 , 94 ]. These unnecessary visits in the event of pandemics can also lead to the spread of disease [ 95 , 96 ]. In such a framework, avoiding unnecessary referrals was considered to fight the pandemic. Such an approach can be useful to prevent the spread of the COVID-19 disease too.

Limitations

Since this study is the first attempt to review and analyze the published articles regarding pre-visit planning, it encounters some limitations. The results of some studies might be published in the form of reports, letters to the editor, or other types of study. Thus, we might not have considered them based on our exclusion criteria. The results showed that most studies point out pre-visit planning conducted by large institutions and reputable organizations; their data are absurdly confounded by the fact that better-funded institutions probably produce better outcomes. Also, some researchers might put pre-visit into practice but they did not publish their attempts in form of any research article or conference paper. It could cause publication bias. Thus, further researches for specific domains in clinical practices might be done in the future.

Using a systematic review approach leads to get a comprehensive overview of literature conducted in the use of various pre-visit approaches. Our results revealed that the direct outcome of planning a pre-visit care program was enhancing the quality of patient care alongside enhancement patient-provider communication. Improving the patient-physician relationship is a key factor in moving towards a patient-centered care paradigm. The qualitative and thematic analysis of the articles also showed that pre-visit planning has the greatest impact on the relationship between physician and patient. It can account for such a useful tool to move toward patient-centered care. However, such an approach can also be helpful to control pandemic diseases by reducing unnecessary referrals. Thus, the application of pre-visit tools can be considered as one of the key components of designing a patient-centered care system. In this survey, we tried to summarize our findings and our suggestions in a complete patient care framework based on pre-visit planning techniques.

Availability of data and materials

The study involves only a review of the literature without involving any data.

Abbreviations

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

  • Patient-centered care

Thompson AGH. The meaning of patient involvement and participation in health care consultations: a taxonomy. Soc Sci Med. 2007;64(6):1297–310. https://doi.org/10.1016/j.socscimed.2006.11.002 .

Article   PubMed   Google Scholar  

Castro EM, Van Regenmortel T, Vanhaecht K, Sermeus W, Van Hecke A. Patient empowerment, patient participation and patient-centeredness in hospital care: a concept analysis based on a literature review. Patient Educ Couns. 2016;99(12):1923–39. https://doi.org/10.1016/j.pec.2016.07.026 .

Halabi IO, Scholtes B, Voz B, Gillain N, Durieux N, Odero A, et al. “Patient participation” and related concepts: a scoping review on their dimensional composition. Patient Educ Couns. 2020;103(1):5–14. https://doi.org/10.1016/j.pec.2019.08.001 .

Coulter A, Oldham J. Person-centred care: what is it and how do we get there? Future Hosp J. 2016;3(2):114–6. https://doi.org/10.7861/futurehosp.3-2-114 .

Article   PubMed   PubMed Central   Google Scholar  

Davis K, Schoenbaum SC, Audet A-M. A 2020 vision of patient-centered primary care. J Gen Intern Med. 2005;20(10):953–7. https://doi.org/10.1111/j.1525-1497.2005.0178.x .

Naughton CA. Patient-centered communication. Pharmacy (Basel). 2018;6(1):18. https://doi.org/10.3390/pharmacy6010018 .

Article   Google Scholar  

Braddock CH, Snyder L, Neubauer RL, Fischer GS. For the American College of Physicians Ethics P, human rights C, the Society of General Internal Medicine ethics C: the patient-centered medical home: an ethical analysis of principles and practice. J Gen Intern Med. 2013;28(1):141–6. https://doi.org/10.1007/s11606-012-2170-x .

Cowie MR. Person-centred care: more than just improving patient satisfaction? Eur Heart J. 2011;33(9):1037–9. https://doi.org/10.1093/eurheartj/ehr354 .

Epstein RM, Street RL Jr. The values and value of patient-centered care. Ann Fam Med. 2011;9(2):100–3. https://doi.org/10.1370/afm.1239 .

Luxford K, Safran DG, Delbanco T. Promoting patient-centered care: a qualitative study of facilitators and barriers in healthcare organizations with a reputation for improving the patient experience. Int J Qual Health Care. 2011;23(5):510–5. https://doi.org/10.1093/intqhc/mzr024 .

Ogden K, Barr J, Greenfield D. Determining requirements for patient-centred care: a participatory concept mapping study. BMC Health Serv Res. 2017;17(1):780. https://doi.org/10.1186/s12913-017-2741-y .

Shaller D. Patient-centered care: what does it take?: Commonwealth Fund New York; 2007.

Google Scholar  

Gerteis M. Through the patient’s eyes: understanding and promoting patient-centered care; 1993.

Mead N, Bower P. Patient-centred consultations and outcomes in primary care: a review of the literature. Patient Educ Couns. 2002;48(1):51–61. https://doi.org/10.1016/S0738-3991(02)00099-X .

Zakare-Fagbamila RT, Park C, Dickson W, Cheng TZ, Gottfried ON. The true penalty of the waiting room: the role of wait time in patient satisfaction in a busy spine practice. J Neurosurg. 2020;1(aop):1–11.

Anderson RT, Camacho FT, Balkrishnan R. Willing to wait?: the influence of patient wait time on satisfaction with primary care. BMC Health Serv Res. 2007;7(1):31. https://doi.org/10.1186/1472-6963-7-31 .

Oostrom T, Einav L, Finkelstein A. Outpatient office wait times and quality of care for Medicaid patients. Health Aff. 2017;36(5):826–32. https://doi.org/10.1377/hlthaff.2016.1478 .

Hewner S, Casucci S, Castner J. The roles of chronic disease complexity, health system integration, and Care Management in Post-Discharge Healthcare Utilization in a Low-income population. Res Nurs Health. 2016;39(4):215–28. https://doi.org/10.1002/nur.21731 .

Østbye T, Yarnall KS, Krause KM, Pollak KI, Gradison M, Michener JL. Is there time for management of patients with chronic diseases in primary care? Ann Family Med. 2005;3(3):209–14. https://doi.org/10.1370/afm.310 .

Grant RW, Altschuler A, Uratsu CS, Sanchez G, Schmittdiel JA, Adams AS, et al. Primary care visit preparation and communication for patients with poorly controlled diabetes: a qualitative study of patients and physicians. Prim Care Diabetes. 2017;11(2):148–53. https://doi.org/10.1016/j.pcd.2016.11.003 .

Sinsky CA, Sinsky TA, Rajcevich E. Putting pre-visit planning into practice. Fam Pract Manag. 2015;22(6):34–8.

PubMed   Google Scholar  

Grant RW, Uratsu CS, Estacio KR, Altschuler A, Kim E, Fireman B, et al. Pre-visit prioritization for complex patients with diabetes: randomized trial design and implementation within an integrated health care system. Contemp Clin Trials. 2016;47:196–201. https://doi.org/10.1016/j.cct.2016.01.012 .

Sleath B, Carpenter DM, Davis SA, Watson CH, Lee C, Loughlin CE, et al. Acceptance of a pre-visit intervention to engage teens in pediatric asthma visits. Patient Educ Couns. 2017;100(11):2005–11. https://doi.org/10.1016/j.pec.2017.05.013 .

Rivo J, Page TF, Arrieta A, Amofah SA, McCann S, Kassaye H, et al. The impact of comprehensive pre-visit preparation on patient engagement and quality of Care in a Population of underserved patients with diabetes: evidence from the care management medical home center model. Popul Health Manag. 2016;19(3):171–7. https://doi.org/10.1089/pop.2015.0063 .

Liu TC, Ohueri CW, Schryver EM, Bozic KJ, Koenig KM. Patient-Identified Barriers and Facilitators to Pre-Visit Patient-Reported Outcomes Measures Completion in Patients With Hip and Knee Pain. J Arthroplasty. 2018;33(3):643–649.e641.

Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ. 2015;349(jan02 1):g7647. https://doi.org/10.1136/bmj.g7647 .

Long HA, French DP, Brooks JM. Optimising the value of the critical appraisal skills programme (CASP) tool for quality appraisal in qualitative evidence synthesis. Res Methods Med Health Sci. 2020;1(1):31–42. https://doi.org/10.1177/2632084320947559 .

Hannes K, Lockwood C, Pearson A. A comparative analysis of three online appraisal instruments’ ability to assess validity in qualitative research. Qual Health Res. 2010;20(12):1736–43. https://doi.org/10.1177/1049732310378656 .

Albada A, van Dulmen S, Spreeuwenberg P, Ausems MG. Follow-up effects of a tailored pre-counseling website with question prompt in breast cancer genetic counseling. Patient Educ Couns. 2015;98(1):69–76. https://doi.org/10.1016/j.pec.2014.10.005 .

Albada A, van Dulmen S, Ausems MG, Bensing JM. A pre-visit website with question prompt sheet for counselees facilitates communication in the first consultation for breast cancer genetic counseling: findings from a randomized controlled trial. Genet Med. 2012;14(5):535–42. https://doi.org/10.1038/gim.2011.42 .

Frost J, Gibson A, Ukoumunne O, Vaidya B, Britten N. Does a simple web-based intervention facilitate the articulation of patients’ unvoiced agenda for a consultation with their diabetologists? A qualitative study. BMJ Open. 2019;9(6):e026588. https://doi.org/10.1136/bmjopen-2018-026588 .

O'Brien MA, Sullivan F, Carson A, Siddiqui R, Syed S, Paszat L. Piloting electronic screening forms in primary care: findings from a mixed methods study to identify patients eligible for low dose CT lung cancer screening. BMC Fam Pract. 2017;18(1):95. https://doi.org/10.1186/s12875-017-0666-5 .

Meropol NJ, Egleston BL, Buzaglo JS, Balshem A, Benson AB 3rd, Cegala DJ, et al. A web-based communication aid for patients with cancer: the CONNECT study. Cancer. 2013;119(7):1437–45. https://doi.org/10.1002/cncr.27874 .

Vo MT, Uratsu CS, Estacio KR, Altschuler A, Kim E, Alexeeff SE, et al. Prompting patients with poorly controlled diabetes to identify visit priorities before primary care visits: a pragmatic cluster randomized trial. J Gen Intern Med. 2019;34(6):831–8. https://doi.org/10.1007/s11606-018-4756-4 .

Grant RW, Lyles C, Uratsu CS, Vo MT, Bayliss EA, Heisler M. Visit planning using a waiting room health IT tool: the aligning patients and providers randomized controlled trial. The Annals of Family Medicine. 2019;17(2):141–9. https://doi.org/10.1370/afm.2352 .

Myers PL, Park RH, Sherina V, Bossert RP. Knowledge is power: providing previsit insurance coverage information of body contouring procedures to improve understanding and satisfaction in the massive weight loss patient. J Plast Reconstr Aesthet Surg. 2020;73(3):571–5. https://doi.org/10.1016/j.bjps.2019.09.052 .

Stankowski-Drengler TJ, Tucholka JL, Bruce JG, Steffens NM, Schumacher JR, Greenberg CC, et al. A randomized controlled trial evaluating the impact of pre-consultation information on Patients’ perception of information conveyed and satisfaction with the decision-making process. Ann Surg Oncol. 2019;26(10):3275–81. https://doi.org/10.1245/s10434-019-07535-0 .

Rodenbach RA, Brandes K, Fiscella K, Kravitz RL, Butow PN, Walczak A, et al. Promoting end-of-life discussions in advanced Cancer: effects of patient coaching and question prompt lists. J Clin Oncol. 2017;35(8):842–51. https://doi.org/10.1200/JCO.2016.68.5651 .

Tucholka JL, Yang DY, Bruce JG, Steffens NM, Schumacher JR, Greenberg CC, et al. A randomized controlled trial evaluating the impact of web-based information on breast Cancer Patients’ knowledge of surgical treatment options. J Am Coll Surg. 2018;226(2):126–33. https://doi.org/10.1016/j.jamcollsurg.2017.10.024 .

Krist AH, Woolf SH, Johnson RE, Kerns JW. Patient education on prostate cancer screening and involvement in decision making. Ann Fam Med. 2007;5(2):112–9. https://doi.org/10.1370/afm.623 .

Causarano N, Platt J, Baxter NN, Bagher S, Jones JM, Metcalfe KA, et al. Pre-consultation educational group intervention to improve shared decision-making for postmastectomy breast reconstruction: a pilot randomized controlled trial. Support Care Cancer. 2015;23(5):1365–75. https://doi.org/10.1007/s00520-014-2479-6 .

Albada A, van Dulmen S, Lindhout D, Bensing JM, Ausems MG. A pre-visit tailored website enhances counselees’ realistic expectations and knowledge and fulfils information needs for breast cancer genetic counselling. Familial Cancer. 2012;11(1):85–95. https://doi.org/10.1007/s10689-011-9479-1 .

Wald JS, Grant RW, Schnipper JL, Gandhi TK, Poon EG, Businger AC, et al. Survey analysis of patient experience using a practice-linked PHR for type 2 diabetes mellitus. AMIA Annu Symp Proc. 2009;2009:678–82.

PubMed   PubMed Central   Google Scholar  

Grant RW, Wald JS, Schnipper JL, Gandhi TK, Poon EG, Orav EJ, et al. Practice-linked online personal health records for type 2 diabetes mellitus: a randomized controlled trial. Arch Intern Med. 2008;168(16):1776–82. https://doi.org/10.1001/archinte.168.16.1776 .

Purkaple BA, Mold JW, Chen S. Encouraging patient-centered care by including quality-of-life questions on pre-encounter forms. Ann Fam Med. 2016;14(3):221–6. https://doi.org/10.1370/afm.1905 .

Wolff JL, Roter DL, Barron J, Boyd CM, Leff B, Finucane TE, et al. A tool to strengthen the older patient-companion partnership in primary care: results from a pilot study. J Am Geriatr Soc. 2014;62(2):312–9. https://doi.org/10.1111/jgs.12639 .

Wald JS, Businger A, Gandhi TK, Grant RW, Poon EG, Schnipper JL, et al. Implementing practice-linked pre-visit electronic journals in primary care: patient and physician use and satisfaction. J Am Med Inform Assoc. 2010;17(5):502–6. https://doi.org/10.1136/jamia.2009.001362 .

Riese A, Mello MJ, Baird J, Steele DW, Ranney ML. Prompting discussions of youth violence using electronic previsit questionnaires in primary care: a cluster randomized trial. Acad Pediatr. 2015;15(3):345–52. https://doi.org/10.1016/j.acap.2015.01.005 .

Kim-Hwang JE, Chen AH, Bell DS, Guzman D, Yee HF Jr, Kushel MB. Evaluating electronic referrals for specialty care at a public hospital. J Gen Intern Med. 2010;25(10):1123–8. https://doi.org/10.1007/s11606-010-1402-1 .

Frank O, Aylward P, Stocks N. Development of pre-consultation prevention summary and reminder sheets for patients: preliminary study of acceptability and sustainability. Aust Fam Physician. 2014;43(5):310–4.

Lewin W, Knäuper B, Roseman M, Adler P, Malus M. Detecting and addressing adolescent issues and concerns: evaluating the efficacy of a primary care previsit questionnaire. Can Fam Physician. 2009;55(7):742–3.

Walker ME, Chuang C, Moores CR, Webb ML, Buonocore SD, Grant Thomson J. The hand surgeon consultation improves patient knowledge in a hand surgery Mission to Honduras. J Hand Surg Asian Pac Vol. 2018;23(1):11–7. https://doi.org/10.1142/S2424835518500017 .

Page TF, Amofah SA, McCann S, Rivo J, Varghese A, James T, et al. Care management medical home center model: preliminary results of a patient-centered approach to improving care quality for diabetic patients. Health Promot Pract. 2015;16(4):609–16. https://doi.org/10.1177/1524839914565021 .

Hitchings S, Barter J. Effect of self-triage on waiting times at a walk-in sexual health clinic. J Fam Plann Reprod Health Care. 2009;35(4):227–31. https://doi.org/10.1783/147118909789587439 .

Judson TJ, Odisho AY, Neinstein AB, Chao J, Williams A, Miller C, et al. Rapid design and implementation of an integrated patient self-triage and self-scheduling tool for COVID-19. J Am Med Inform Assoc. 2020;27(6):860–6. https://doi.org/10.1093/jamia/ocaa051 .

Frank OR, Stocks NP, Aylward P. Patient acceptance and perceived utility of pre-consultation prevention summaries and reminders in general practice: pilot study. BMC Fam Pract. 2011;12(1):40. https://doi.org/10.1186/1471-2296-12-40 .

Cox N, Tak CR, Cochella SE, Leishman E, Gunning K. Impact of pharmacist Previsit input to providers on chronic opioid prescribing safety. J Am Board Fam Med. 2018;31(1):105–12. https://doi.org/10.3122/jabfm.2018.01.170210 .

Lee YK, Ng CJ, Low WY. Addressing unmet needs of patients with chronic diseases: impact of the VISIT website during consultations. J Eval Clin Pract. 2017;23(6):1281–8. https://doi.org/10.1111/jep.12777 .

Johansen MA, Berntsen G, Shrestha N, Bellika JG, Johnsen JA. An exploratory study of patient attitudes towards symptom reporting in a primary care setting. Benefits for medical consultation and syndromic surveillance? Methods Inf Med. 2011;50(5):479–86. https://doi.org/10.3414/ME11-02-0005 .

Article   CAS   PubMed   Google Scholar  

Bruce JG, Tucholka JL, Steffens NM, Mahoney JE, Neuman HB. Feasibility of providing web-based information to breast Cancer patients prior to a surgical consult. J Cancer Educ. 2018;33(5):1069–74. https://doi.org/10.1007/s13187-017-1207-6 .

Hu X, Bell RA, Kravitz RL, Orrange S. The prepared patient: information seeking of online support group members before their medical appointments. J Health Commun. 2012;17(8):960–78. https://doi.org/10.1080/10810730.2011.650828 .

Brackett CD, Kearing S. Use of a web-based survey to facilitate shared decision making for patients eligible for cancer screening. Patient. 2015;8(2):171–7. https://doi.org/10.1007/s40271-014-0079-7 .

Muraywid B, Butkievich LE, Myers B. Effect of a virtual pharmacy review program: a population health case study. J Manag Care Spec Pharm. 2020;26(1):24–9. https://doi.org/10.18553/jmcp.2020.26.1.24 .

Allende-Richter SH, Johnson ST, Maloyan M, Glidden P, Rice K, Epee-Bounya A. A Previsit screening checklist improves teamwork and access to preventive services in a medical home serving Low-income adolescent and young adult patients. Clin Pediatr (Phila). 2018;57(7):835–43. https://doi.org/10.1177/0009922817733698 .

Zanini C, Maino P, Möller JC, Gobbi C, Raimondi M, Rubinelli S. Enhancing clinical decisions about care through a pre-consultation sheet that captures patients’ views on their health conditions and treatments: a qualitative study in the field of chronic pain. Patient Educ Couns. 2016;99(5):747–53. https://doi.org/10.1016/j.pec.2015.11.029 .

Aboumatar HJ, Carson KA, Beach MC, Roter DL, Cooper LA. The impact of health literacy on desire for participation in healthcare, medical visit communication, and patient reported outcomes among patients with hypertension. J Gen Intern Med. 2013;28(11):1469–76. https://doi.org/10.1007/s11606-013-2466-5 .

Harrington JT, Walsh MB. Pre-appointment management of new patient referrals in rheumatology: a key strategy for improving health care delivery. Arthritis Care Res. 2001;45(3):295–300. https://doi.org/10.1002/1529-0131(200106)45:3<295::AID-ART263>3.0.CO;2-3 .

Fothergill KE, Gadomski A, Solomon BS, Olson AL, Gaffney CA, Dosreis S, et al. Assessing the impact of a web-based comprehensive somatic and mental health screening tool in pediatric primary care. Acad Pediatr. 2013;13(4):340–7. https://doi.org/10.1016/j.acap.2013.04.005 .

Savage C, Bjessmo S, Borisenko O, Larsson H, Karlsson J, Mazzocato P. Translating ‘See-and-Treat’ to primary care: opening the gates does not cause a flood. Int J Qual Health Care. 2019;31(7):30–6. https://doi.org/10.1093/intqhc/mzy244 .

Bose-Brill S, Feeney M, Prater L, Miles L, Corbett A, Koesters S. Validation of a novel electronic health record patient portal advance care planning delivery system. J Med Internet Res. 2018;20(6):e208. https://doi.org/10.2196/jmir.9203 .

Gadomski AM, Fothergill KE, Larson S, Wissow LS, Winegrad H, Nagykaldi ZJ, et al. Integrating mental health into adolescent annual visits: impact of previsit comprehensive screening on within-visit processes. J Adolesc Health. 2015;56(3):267–73. https://doi.org/10.1016/j.jadohealth.2014.11.011 .

Albertson G, Lin CT, Schilling L, Cyran E, Anderson S, Anderson RJ. Impact of a simple intervention to increase primary care provider recognition of patient referral concerns. Am J Manag Care. 2002;8(4):375–81.

Baker DW, Persell SD, Kho AN, Thompson JA, Kaiser D. The marginal value of pre-visit paper reminders when added to a multifaceted electronic health record based quality improvement system. J Am Med Informatics Assoc. 2011;18(6):805–11. https://doi.org/10.1136/amiajnl-2011-000169 .

Albada A, van Dulmen S, Bensing JM, Ausems MG. Effects of a pre-visit educational website on information recall and needs fulfilment in breast cancer genetic counselling, a randomized controlled trial. Breast Cancer Res. 2012;14(2):R37. https://doi.org/10.1186/bcr3133 .

Chwistek M. “Are you wearing your white coat?”: telemedicine in the time of pandemic. JAMA. 2020;324(2):149–50. https://doi.org/10.1001/jama.2020.10619 .

Kenton K, Pham T, Mueller E, Brubaker L. Patient preparedness: an important predictor of surgical outcome. Am J Obstetr Gynecol. 2007;197(6):654.e651–6.

Ringdal M, Chaboyer W, Ulin K, Bucknall T, Oxelmark L. Patient preferences for participation in patient care and safety activities in hospitals. BMC Nurs. 2017;16(1):69. https://doi.org/10.1186/s12912-017-0266-7 .

Niibo P, Pruunsild C, Voog-Oras Ü, Nikopensius T, Jagomägi T, Saag M. Contemporary management of TMJ involvement in JIA patients and its orofacial consequences. EPMA J. 2016;7(1):12. https://doi.org/10.1186/s13167-016-0061-7 .

Greene SM, Tuzzio L, Cherkin D. A framework for making patient-centered care front and center. Permanente J. 2012;16(3):49–53.

Vahdat S, Hamzehgardeshi L, Hessam S, Hamzehgardeshi Z. Patient involvement in health care decision making: a review. Iran Red Crescent Med J. 2014;16(1):e12454. https://doi.org/10.5812/ircmj.12454 .

Geraghty EM, Franks P, Kravitz RL. Primary care visit length, quality, and satisfaction for standardized patients with depression. J Gen Intern Med. 2007;22(12):1641–7. https://doi.org/10.1007/s11606-007-0371-5 .

Xie Z, Or C. Associations Between Waiting Times, Service Times, and Patient Satisfaction in an Endocrinology Outpatient Department: A Time Study and Questionnaire Survey. Inquiry. 2017;54:0046958017739527.

PubMed Central   Google Scholar  

Eijk ES, Bettink-Remeijer MW, Timman R, Busschbach JJ. From pen-and-paper questionnaire to a computer-assisted instrument for self-triage in the ophthalmic emergency department: process and validation. Comput Biol Med. 2015;66:258–62. https://doi.org/10.1016/j.compbiomed.2015.09.014 .

Kripalani S, Hart K, Schaninger C, Bracken S, Lindsell C, Boyington DR. Use of a tablet computer application to engage patients in updating their medication list. Am J Health Syst Pharm. 2019;76(5):293–300. https://doi.org/10.1093/ajhp/zxy047 .

Morreel S, Philips H, Verhoeven V. Self-triage at an urgent care collaboration with and without information campaign. J Emerg Manag. 2019;17(6):511–6. https://doi.org/10.5055/jem.2019.0443 .

Opel DJ, Henrikson N, Lepere K, Hawkes R, Zhou C, Dunn J, et al. Previsit Screening for Parental Vaccine Hesitancy: A Cluster Randomized Trial. Pediatrics. 2019;144(5):e20190802.

Sarkar U, Schillinger D, Bibbins-Domingo K, Nápoles A, Karliner L, Pérez-Stable EJ. Patient-physicians’ information exchange in outpatient cardiac care: time for a heart to heart? Patient Educ Couns. 2011;85(2):173–9. https://doi.org/10.1016/j.pec.2010.09.017 .

Sepucha K, Bedair H, Yu L, Dorrwachter JM, Dwyer M, Talmo CT, et al. Decision support strategies for hip and knee osteoarthritis: less is more: a randomized comparative effectiveness trial (DECIDE-OA study). J Bone Joint Surg Am. 2019;101(18):1645–53. https://doi.org/10.2106/JBJS.19.00004 .

Bosworth HB, Fortmann SP, Kuntz J, Zullig LL, Mendys P, Safford M, et al. Recommendations for providers on person-centered approaches to assess and improve medication adherence. J Gen Intern Med. 2017;32(1):93–100. https://doi.org/10.1007/s11606-016-3851-7 .

The Annals of Family Medicine, AHRQ updates on primary care research: the AHRQ Patient-Centered Medical Home Resource Center. Ann Fam Med. 2014;12(6):586. https://doi.org/10.1370/afm.1728 .

Almalki ZS, Karami NA, Almsoudi IA, Alhasoun RK, Mahdi AT, Alabsi EA, et al. Patient-centered medical home care access among adults with chronic conditions: National Estimates from the medical expenditure panel survey. BMC Health Serv Res. 2018;18(1):744. https://doi.org/10.1186/s12913-018-3554-3 .

Gholamzadeh M, Abtahi H, Safdari R. Suggesting a framework for preparedness against the pandemic outbreak based on medical informatics solutions: a thematic analysis [published online ahead of print, 2021 Jan 27]. Int J Health Plann Manage. 2021;10.1002/hpm.3106. https://doi.org/10.1002/hpm.3106 .

Ahmed S, Kelly YP, Behera TR, Zelen MH, Kuye I, Blakey R, et al. Utility, appropriateness, and content of electronic consultations across medical subspecialties: a cohort study. Ann Intern Med. 2020;172(10):641–7. https://doi.org/10.7326/M19-3852 .

Hällfors E, Saku SA, Mäkinen TJ, Madanat R. A consultation phone service for patients with total joint Arthroplasty May reduce unnecessary emergency department visits. J Arthroplast. 2018;33(3):650–4. https://doi.org/10.1016/j.arth.2017.10.040 .

Willan J, King A J, Jeffery K, Bienz N. Challenges for NHS hospitals during covid-19 epidemic. BMJ. 2020;368:m1117. https://doi.org/10.1136/bmj.m1117 .

Ross SW, Lauer CW, Miles WS, Green JM, Christmas AB, May AK, et al. Maximizing the calm before the storm: tiered surgical response plan for novel coronavirus (COVID-19). J Am Coll Surg. 2020;230(6):1080–1091.e3. https://doi.org/10.1016/j.jamcollsurg.2020.03.019 .

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Acknowledgments

We would also like to express our gratitude to Farideh Namazi for their support with us during this research.

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Marsa Gholamzadeh & Marjan Ghazisaeeidi

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Conception idea of study: Marjan Ghazisaeeidi, Hamidreza Abtahi, Marsa Gholamzadeh; Acquisition of data: Marjan Ghazisaeeidi, Hamidreza Abtahi, Marsa Gholamzadeh. Analysis and/or interpretation of data: Marsa Gholamzadeh, Marjan Ghazisaeeidi. Drafting the manuscript: Marjan Ghazisaeeidi, Marsa Gholamzadeh. Revising the manuscript critically for important intellectual content: Marjan Ghazisaeeidi, Marsa Gholamzadeh, Hamidreza Abtahi. Approval of the version of the manuscript to be published: Marjan Ghazisaeeidi, Hamidreza Abtahi, Marsa Gholamzadeh. The author(s) read and approved the final manuscript.

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Correspondence to Marjan Ghazisaeeidi .

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Additional file 1: table a-1..

Applied search strategies and their results.

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Gholamzadeh, M., Abtahi, H. & Ghazisaeeidi, M. Applied techniques for putting pre-visit planning in clinical practice to empower patient-centered care in the pandemic era: a systematic review and framework suggestion. BMC Health Serv Res 21 , 458 (2021). https://doi.org/10.1186/s12913-021-06456-7

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DOI : https://doi.org/10.1186/s12913-021-06456-7

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Healthcare IT Today

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Electronic Health Records (EHR): How to Achieve Healthcare Data Accuracy with Artificial Intelligence

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Healthcare IT Today

Patient Scheduling and Pre-Visit Intake: Let’s Give Patients What They’re Asking For

pre visit or pre visit

Several surveys about the online patient experience were recently released. It won’t surprise anyone who follows healthcare professionally—or who has used a healthcare portal—that patients are frustrated and disappointed. This article interviews a dozen experts to better understand why healthcare lags behind retail, finance, and other industries in serving customers online—and what we can do to improve the patient experience.

Surveys Show Widespread Dissatisfaction

This article was inspired by an outreach to me by the company Notable , which offers an API to interact with health records and automate routine tasks during patient interactions. The company surveyed more than a thousand people of varying genders and geographic locations (age and race weren’t tracked) to find out what they thought of the patient experience. I talked with Carle Falk, their Head of Research.

The most salient findings in the survey are listed in a short Business Wire article , but interesting details can be found in Notable’s own report . For instance, they found that 41% of patients have switched providers because of poor digital experiences.

Findings cover a lot of the patient experience, such as waiting room times—which have increased over the past few years—and time spent by doctors looking at computer screens instead of the patient, which averages 41% per visit.

Respondents made two specific requests, which reflect their expectation that a visit to the doctor should be as easy as an online restaurant reservation:

  • Patients would like to self-schedule visits online.
  • Patients would like to fill out all necessary forms before they arrive.

These requests are quite basic and can be easily satisfied with modern health care technology. Patients are not asking for remote monitoring, predictive analytics, or inspirational wellness reminders. Patients simply want incremental improvements over what they already know, just as people in Henry Ford’s early career were said to want a “faster horse.”

Wolters Kluwer’s Health division also recently commissioned a survey of 1,034 U.S. patients about their patient experience. The researchers tried to achieve a demographic balance. According to the survey, 80% of patients have follow-up questions after a health visit, and 94% of patients would like to have access to educational materials.

Finally, a survey by predictive analytics firm Carta Healthcare found that 83% of patients had to repeat information that they had previously provided at a doctor’s office. Also, 42% of respondents spent six minutes or more recounting their past medical history at every appointment. Results were provided by an online survey of 1,014 U.S. consumers. Carta Healthcare attributes the duplication to a lack of integrated medical systems at healthcare providers.

The Notable survey found, alarmingly, that 61% of patients gave up on scheduling appointments altogether because of the difficulties encountered during the process.

According to Carta Healthcare, one in five patients said the hassle of repeatedly providing their information made them less likely to return to that provider.

This article will explain how the patient experience can be improved, focusing on the two modest requests seen in the Notable survey. A follow-up article will cover the broader topic of connected care.

Why Is a Satisfying Online Experience So Hard?

Patients want to schedule a clinical visit like they schedule a restaurant reservation—so why can’t they?

Clinical visits are complex and come with many variables: insurance, patient type, provider preferences, lab requirements, etc. Scheduling patients with the right appointment therefore requires an understanding of each provider’s specific preferences and expertise.

Cynthia Davis, clinical transformation executive at Healthlink Advisors , says that many clinics are reluctant to let patients schedule visits online. The clinicians fear that the patient will choose the wrong doctor, time slot, or type of visit—or that the patient will enter critical information, such as medication names, incorrectly. Therefore, Davis advises starting small: Clinics should offer one or two slots per day for patient self-scheduling. More slots can be added as the clinic’s self-scheduling system is refined.

According to Davis, it’s also hard to offer an automated scheduling system when each doctor has specific preferences and requirements: patient type, time alloted for an initial or follow-up visit, and more. Establishing a common process is therefore important.

Davis says some of the attitudes toward self-scheduling, among both patients and doctors, are generational. Younger people are accustomed to online self-service, and therefore more likely to be comfortable self-scheduling their medical appointments.

Hari Prasad, CEO of Yosi Health , and Joseph Demmons, Application Integration Product Manager at Azalea Health , point out that patient self-scheduling portals are usually provided by the organization’s EHR vendor. For instance, MyChart was created by Epic—and Epic, notoriously, has little sensitivity and concern for the user experience. Epic’s system permits self-scheduling only for the most simple appointments.

When clinics rely on their EHR vendor for self-scheduling, they are almost always disappointed in the result. The patient portals provided by EHR vendors are difficult to use, can’t schedule complex appointments, and don’t take individual provider preferences into account.

According to Demmons, most software developers in health care are trapped in an obsolete approach. They design systems that favor the developers’ interests rather than those of the end-users.

Vendor Solutions

Stephen Dean, COO and co-founder of  Keona Health , offered a three-level taxonomy of solutions to patient problems.

  • At the lowest level, the clinician does whatever they can to bulid on the conventional patient portal, which is usually provided by the EHR vendor. Dean says this is relatively old technology that facilitates only very basic scheduling, such as a generic “new patient visit”. Everything else gets sent as a “schedule request” to the call center or front desk, who then must contact the patient to book the appointment. Typically, he says, these sites can schedule only 10-15% of all visit types online.
  • Get a third-party, automated check-in platform such as Phreesia . These AI-powered platforms digitize many paper-based processes. Because their check-in logic accounts for more variables, such as insurance and provider preferences, than EHR portals do, their scheduling algorithms allow 30-50% of visits to be self-scheduled online.
  • Work with a patient access platform such as Keona Health. These platforms operate both online and inside the call center, and they therefore allow 50-90% of all visit types to be scheduled online. These platforms maintain a database of provider preferences, use AI to capture information from the call center, and support workflows unique to the call center location.

Interestingly, although Keona Health allows more than 90% of appointment types to be scheduled online, only 30% of their patients choose to do so. This number is still much higher than the industry-wide average of 10%.

athenahealth is one of the best-known companies for EHRs and collaboration in healthcare. I talked there with Curtis Sherbo, VP of product management for the patient experience, about their services.

Their services include scheduling, self check-in, consent forms, and advance copays—all of which can be performed without going through the clinician’s portal. Providers can configure questionnaires in the EHR for patient screening, which the patient can fill out through the platform.

Branden Neish, Chief Product Officer at Weave , said their platform gives patients what they want. A widget in the clinician’s portal lets patients self-schedule. The widget pulls information from the system and offers a drop-down list that lets the patient choose the type of treatment and a specific provider.

With the appointment in the system, the patient can then receive and fill out the necessary forms. Sometimes the patient’s mobile device already has information, such as their address and phone number, that is requested by the form. In this case, Weave can populate fields in the form automatically. Communication channels supported by Weave include phone calls, text, and email.

According to Prasad of Yosi Health, 82% of patients prefer a provider who offers online scheduling, and 44% said filling out forms is the worst part of the patient experience.

Yosi Health tries to reduce this friction in several ways. It is well documented that patients find it a barrier even to sign up for an account on a portal. Yosi Health dispenses with sign-ups and allows patients to schedule and fill out forms on any smartphones, desktops and laptops, etc.

Interacting without a traditional sign-up process raises the question of how to authenticate the patient. Yosi Health’s system uses a patient matching algorithm that matches the patient information available in the EMR, reinforced by a two-factor authenticator. This enables patients to securely access the system without the need for portal signup.

Having matched the patient, the system gets as much information as it can from the patient’s record, if they are in the clinical system already. The result is that visits can be scheduled online without the need for a phone call more than 85% of the time. Canceling and rescheduling are also easy.

Yosi Health also helps patients fill in forms without having to download an app or log in through a portal. The system is fully device agnostic. Yosi Health finds that 80% of patients fill in their forms before the visit, saving 14 minutes per patient at the clinic.

Clinicians can use a no-code generator to design the questions asked of the patient during scheduling and the check-in process, such as whether they are an existing patient and whether the appointment requested is a follow-up. Such automation addresses pressures on clinicians and helps reduce staff burnout.

Let’s Talk Interactive, Inc. (LTI) hooks into the EHR’s scheduling system—which is normally used just by providers—and opens it up for self-scheduling by patients. Patients have dashboards where they can find their current provider or request a visit with the next available provider. According to Art Cooksey, Founder and CEO, patients can also update documents in the dashboard.

Thus, self-scheduling and filling out forms in advance should be available to most patients. What about more sophisticated forms of online interaction with patients? A follow-up article will cover some options.

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About the author

pre visit or pre visit

Andy is a writer and editor in the computer field. His editorial projects have ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. A correspondent for Healthcare IT Today, Andy also writes often on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM (Brussels), DebConf, and LibrePlanet. Andy participates in the Association for Computing Machinery's policy organization, named USTPC, and is on the editorial board of the Linux Professional Institute.

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Save Time & Improve Patient Experience with Pre-Visit Planning

Save Time & Improve Patient Experience with Pre-Visit Planning

A wellness visit can sometimes be a stressful experience. Patients may be taking time away from family events or using paid time off to go during the workday. While they’re aware of the importance of maintaining their health, they may view this appointment as an inconvenience due to the lengthy paperwork and intake forms required.

Physicians usually have only 15–20 minutes with each patient they see, so they need to make the most productive use of that time. Sometimes they can fall behind due to unforeseen medical situations that arise, an overbooked schedule, or administrative tasks. One study found that nearly half of a doctor’s day is consumed with desk work, while only about a quarter of the day is spent directly with patients.  

For these reasons and more, it is important to create an efficient workflow centered around the intake of new and established patients. Fortunately, there’s a solution that can help: pre-visit planning (also called “chart prep”).  

Establishing this practice within the medical office helps with patient engagement and building bidirectional trust with office staff, and it utilizes the physician’s time with each patient in the most efficient way.  

The overall goal is for patients to leave their physician’s office satisfied with the overall experience, and for providers to feel confident that all medical concerns and preventive care measures were addressed.  

What Is Pre-Visit Planning?  

Pre-visit planning is the process of methodically preparing for every single patient appointment to the greatest extent possible, with primary focus on wellness visits.  Pre-visit planning may include:  

  • New patient questionnaires that review individual and family medical history, medication reconciliation, surgical history, and social determinants of health  
  • Consideration of arranging for labs/tests to be completed prior to the planned visits  
  • A staff-wide “huddle” to get set for the current day’s workload  

According to Kate Iovinelli, Senior Director of Quality Outcomes and Process Improvement at Innovista Health, pre-visit planning incorporates a whole team within the medical practice—sometimes called the Proactive Office Encounter Team (POET) . “This team consists of everybody from the scheduler, front desk staff, medical assistant and nurse, to the individual checking the patient out at the end of the visit.”  

How Pre-Visit Planning Works  

Pre-visit planning can be time-consuming for medical and administrative staff without proper processes in place. However, t here are a few general guidelines that seem to work for many medical offices that incorporate chart prep into their workflow.  

Iovinelli says that ideally, practices should begin chart prep about a week prior to the scheduled appointment time. For patients coming in on a Monday, the practice should start planning the preceding Monday; for Tuesday, the preceding Tuesday; and so on. This creates a predictable and reliable cadence in office workflow.  

One Week Before the Visit

  • Review patient charts. The nurse or medical assistant should make sure everything is up to date, including records from other doctors or medical facilities and lab/test results.   
  • Identify care gaps. If the patient needs a referral, labs, or screenings, prepare these orders for the physician to sign, or consider using standing orders. Immunization status should also be noted so necessary vaccines can be given during the appointment, if applicable.  

Three Days Before the Visit

  • Send out appointment reminders. To reduce no-shows, email, text, and/or call patients to remind them of their upcoming visit.  
  • Call patients with more complex conditions/charts. The nurse or medical assistant should call complex-case patients to perform medication reconciliation and to pre-populate the chart with answers to some questions the doctor routinely asks.   

The Day of the Visit

  • Huddle. Every morning, the entire care team should have a 15-minute huddle to go over the day’s roster of patients. During this time, the nurse or medical assistant should share with the physician any last-minute changes to the schedule or patient charts. Just as important, the whole team can discuss how to best divide the day’s workload for maximum efficiency. If there are patients with special needs or accommodations, this should be addressed in the huddle as well.  
  • Pre-appointment goal setting. At check-in, patients should get a short questionnaire that asks them the reason for the visit and what they hope to accomplish. This improves patient experience, ensuring they leave the appointment satisfied.  
  • Hand off to the physician. Once in the exam room, patients often share updates about their personal or family history with the nurse or medical assistant. This staff member should alert the doctor to the patient’s newest concerns in a brief mini-huddle before entering the room. This allows the doctor to better understand the patient’s mental state or health goals and provide more personalized care.   
  • Midday check-ins should also be performed. Are there any add-ons that could potentially overload the physician’s schedule? Is the provider running on time?  

“If the physician is behind, staff should call the patients who are supposed to come in later in the day to see if they want to reschedule,” says Iovinelli. “It’s a courtesy, and patients are usually very thankful that their time is being respected.”  

At the End of the Visit

At the end of the patient’s appointment, it’s important to prepare for the next visit, whether it’s three months or one year away.  

  • Schedule follow-ups. The staff member handling checkout should book the next appointment. This helps keep patients compliant with follow-ups.  
  • Provide orders for labs and screenings so the patient can complete all necessary testing before the next visit or subsequent follow-up. By doing so, the physician can review results during the appointment, which is much more meaningful than calling or sending a message. That personal connection can make a real difference. I n fact, according to one study that examined this topic, o f the patients who had tests pre-ordered, 87.8% completed them and 61% said they preferred to get them done prior to the appointment. The researchers concluded that pre-ordered tests resulted in “improved office efficiency through reduced message handling,” and helped to “facilitate face-to-face discussion” that otherwise may only occur by phone.

Streamlining New Patients  

New patients create a little extra work on the part of the practice since a new file and chart need to be established. However, there are ways to streamline the process.  

If the practice has an online portal, setting up an account can allow the patient to complete all intake and medical history forms ahead of time.  

Three days before the new patient’s visit, when reaching out with the appointment reminder, be sure to remind them about filling out these forms.  

Alternatively, if the patient can’t set up an account or does not have access to a computer, having a nurse or medical assistant call to gather this information helps to kick off the practice/patient relationship on a positive note. This may help the patient to feel more comfortable for the visit, as they may be nervous about seeing a new doctor and forget to share all pertinent health information or medical history. This practice also allows the staff enough time to enter the data into the chart so the patient can go through the rest of the pre-visit planning steps seamlessly.  

Less Burden, Greater Satisfaction  

Unfortunately, the current healthcare system is causing some physicians—particularly primary care providers—a great deal of administrative stress. This may result in burnout and doctors leaving medicine well before their time.  

Research clearly shows, though, that by implementing a team-based approach that includes pre-visit planning, satisfaction among staff and patients increases dramatically . It’s a win-win all around.  

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English [ edit ]

Etymology [ edit ].

pre- +‎ visit

Adjective [ edit ]

previsit ( not comparable )

  • 1960 , Richard H. Blum, The management of the doctor-patient relationship , page 152 : The importance and nature of the patient's previsit fantasies about the kind of relationship which will develop depends upon the social background and the personality of the patient.
  • 2004 , Deborah L. Walker, Sara M. Larch, Elizabeth W. Woodcock, The Physician Billing Process , →ISBN : The previsit process is vital to ensuring accurate and timely receipt of information regarding the patient's ability to pay, yet many medical practices ignore this process.
  • 2010 , Michael D. LaGrega, Phillip L. Buckingham, Jeffrey C. Evans, Hazardous Waste Management , →ISBN , page 341 : Preaudit preparation will include obtaining previsit information from facilities targeted for auditing, preparing the audit plan, developing the audit protocol, and establishing a schedule.

Noun [ edit ]

previsit ( plural previsits )

  • 1975 , Brenda Van Zoost, Psychological Readings for the Dental Profession , page 42 : Rosengarten brought children to the dentist for a previsit .
  • 2000 , Administrative Register of Kentucky : No later than one (1) month prior to the scheduled on-site evaluation visit, the EPSB shall conduct a previsit to the institution to make a final review of the arrangements.
  • 2008 , David Amadeus Panckeri, Love Is Lust First: An Autobiography of Passion , →ISBN , page 49 : Maybe my awkward encounter in 1967 was really a previsit from Alessandra?

Verb [ edit ]

previsit ( third-person singular simple present previsits , present participle previsiting , simple past and past participle previsited )

  • 1959 , Vincent McGuire, Your student teaching in the secondary school , page 127 : In order to develop a file that will be especially helpful to you during student teaching, try to previsit your cooperating teacher and find out what specific areas you will be teaching with him.
  • 2002 , Barry Brown, Nicola Green, Richard Harper, Wireless world: social and interactional aspects of the mobile age , →ISBN : Virilio, and indeed McLuhan before him, have commented on the tendency to previsit locations, through one medium or another; to actually arrive somewhere is no longer surprising in the way that it was; and indeed Virilio suggests it is bcoming replaced by prevision.
  • 2007 , Visual Arts Research - Volumes 64-65 , page 94 : Planning a museum tour requires the art teacher to previsit the museum and become familiar with the buildings and collections, select a particular exhibit that relates to a theme the teacher wants to teach, and prepare students for a visit.

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The youngest son of Asia's richest man is getting married, and the pre-wedding event features Rihanna, a 9-page dress code, and live animals

  • Anant Ambani, the youngest son of Mukesh Ambani, is getting married.
  • He and his bride-to-be, Radhika Merchant, kicked off pre-wedding festivities this week in India.
  • Here's what we know about the lavish three-day bash.

Insider Today

Anant Ambani is getting married, and his father — Asia's richest man, Mukesh Ambani — is sparing no expense to celebrate the nuptials.

As the chair of the Fortune 500 company Reliance Industries, the elder Ambani has an estimated net worth of $111 billion, according to Bloomberg's Billionaires Index . That makes him the richest person in Asia and the 11th-richest person in the world.

The younger Ambani is set to wed Radhika Merchant, the daughter of Encore Healthcare CEO Viren Merchant, in July. The couple's three-day pre-wedding party started on Friday in Gujarat, India.

Here's everything we know about the festivities.

The couple hosted a communal dinner for 51,000 people.

pre visit or pre visit

On Wednesday, Ambani and his bride-to-be hosted a communal dinner for 51,000 local residents in Gujarat, The Hindu reported.

The event took place in the Jogwad village, near the Reliance Township in Jamnagar, The Hindu reported.

According to the outlet, serving food to the community during auspicious family occasions has long been a tradition of the Ambanis.

Rihanna performed her first full-length show in 8 years at the pre-wedding bash.

pre visit or pre visit

Rihanna took to the stage barefoot to perform in a lime green and pink local-inspired outfit at the pre-wedding event on Friday night.

She performed 19 songs, including hits such as "Umbrella," "Diamonds," and "Work," NME reported.

"I'm here tonight in honor of Anant and Radhika. Thank you for having me here. God bless your union. I wish you all the best. Congratulations," she said to the couple, who at one point joined her on stage.

As she departed from Jamnagar airport, Rihanna told reporters : "The show was the best. I haven't done a real show in eight years."

Reports estimate that the singer had been paid between $6 and $9 million for her performance.

Rihanna had previously been spotted arriving in Jamnagar with ASAP Rocky . In the clip, she can be seen exiting a building and getting onto a cart.

A fan also uploaded an Instagram video of multiple wooden crates being transported out of an airport arrival hall, with the caption, "Rihanna's luggage has arrived in India."

"What she bring with her? A folding house?" one comment under the post said, to which Rihanna responded, "The stage couldn't fit in my carryon."

The Ambanis have had megastars perform at weddings before.

In 2018 Beyoncé performed at Isha Ambani and Anand Piramal's pre-wedding ceremony. Isha Ambani is the family patriarch's only daughter.

In 2019, Coldplay's front man, Chris Martin, and The Chainsmokers entertained guests attending Akash Ambani — the soon-to-be-wed Ambani's older brother — and Shloka Mehta's pre-wedding bash in Switzerland. The couple also had Adam Levine serenade them at their post-wedding bash.

Some 1,200 guests have been invited to the celebrations.

pre visit or pre visit

Some of the world's most rich and famous have been pictured at the bash, including Ivanka Trump and Mark Zuckerberg.

The extensive guest list for the weekend includes celebrities, billionaires, and tech leaders such as Bill Gates and Sundar Pichai.

Disney CEO Bob Iger is also likely to be on the list of invitees, Reuters reported.

Reliance Industries and Disney announced an $8.5 billion merger of their India TV and streaming media assets earlier this week.

The itinerary for the weekend includes a cocktail party and a trail featuring live animals.

pre visit or pre visit

According to an event itinerary obtained by The Times , there was a cocktail party on the first day.

Video published on social media shows the ornate venue festooned in flowers and brimming full of A-list guests, who were treated to a drone show in the night sky.

On the second day, guests were taken to the Reliance animal rescue center for "a walk on the wild side," The Times said. The center is the groom's pet project .

In the evening, guests attended a "mela rouge," The Times added. "Mela" can refer to a fair or a festival.

The last day included a "tusker trails" event where guests could spend the afternoon "surrounded by the wonders of nature" — including over 200 elephants, 300 big cats, and 120 reptiles previously at risk of being sold or poached, per The Times.

Guests have been given a nine-page document detailing the dress code for the various events.

pre visit or pre visit

On top of the nine-page dress code, hair stylists and makeup artists were also available for guests, The Times reported.

The dress code includes a "jungle fever" theme and "comfortable shoes" for the visit to the animal rescue center on the second day, and "dazzling" Indian outfits for the mela, per The Times.

The Ambani family constructed 14 temples in Jamnagar ahead of the wedding.

pre visit or pre visit

At the end of February, Reliance Foundation shared a video on its official YouTube channel showcasing the construction progress of the temples.

In the video, the founder and chairperson of Reliance Foundation, Nita Ambani — the Ambani patriarch's wife and mother to his three children — can be seen speaking with various worshippers and the artists involved in designing the temples.

Around 130 flights arrived at Jamnagar airport for the celebrations, officials said.

pre visit or pre visit

In an X post on Saturday, Jamnagar airport said around 130 flights had arrived for the event.

The post said, "As the pre-wedding event of AnantAmbani & Radhika merchant begins, Jamnagar Airport today welcomed many VIP guests from across the globe including Business Leaders, Sports personalities & Actors from the Film Fraternity."

Tech bosses like Mark Zuckerberg and Bill Gates attended the pre-wedding festivities.

pre visit or pre visit

Mark Zuckerberg and his wife Priscilla Chan were among the wealthy elite and Bollywood stars who gathered in Gujarat, India, for the pre-wedding celebrations over the weekend. They wore two black outfits with a dandelion and dragonfly design, which Alexander McQueen created, Vogue reported . For the "jungle fever" themed dress-code party the next day, Zuckerberg wore a shimmering tigress-themed shirt designed by Rahul Mishra, who  shared photos  on his Instagram account. Zuckerberg was seen admiring Anant Ambani's luxury watch in a video circulating on social media. The video, reported on by several Indian news outlets, including The  Hindustan Times  and  The Indian Express , shows the Meta chief telling the groom-to-be that he never wanted a watch before then. He said, "But after seeing that, I was like, watches are cool." Bill Gates also went to the parties with his girlfriend Paula Hurd, and the couple wore Indian outfits.

Ivanka Trump and her daughter learned an Indian folk dance.

pre visit or pre visit

Ivanka Trump and her daughter Arabella Rose were taught the Gujarati folk dances garba and dandiya at the weekend. Choreographers Samir and Arsh Tanna shared a video on Instagram of them learning how to do the traditional dance, which involves decorated dandiya sticks.

pre visit or pre visit

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  • v.9; Jan-Dec 2022

Clinical Use of an Electronic Pre-Visit Questionnaire Soliciting Patient Visit Goals and Interim History: A Retrospective Comparison Between Safety-net and Non-Safety-net Clinics

Hannah shucard.

1 University of Washington, Seattle, WA, USA

Emily Muller

2 University of Washington School of Medicine, Seattle, WA, USA

Joslyn Johnson

3 University of Washington, Seattle, WA, USA

4 Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA

Joann G. Elmore

5 David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

Thomas H. Payne

Jacob berman, sara l. jackson, introduction/objectives.

We examined an initial step towards co-generation of clinic notes by inviting patients to complete a pre-visit questionnaire that could be inserted into clinic notes by providers and describe the experience in a safety-net and non-safety-net clinic.

We sent an electronic pre-visit questionnaire on visit goals and interim history to patients at a safety-net clinic and a non-safety-net clinic before clinic visits. We compared questionnaire utilization between clinics during a one-year period and performed a chart review of a sample of patients to examine demographics, content and usage of patient responses to the questionnaire.

While use was low in both clinics, it was lower in the safety-net clinic (3%) compared to the non-safety-net clinic (10%). We reviewed a sample of respondents and found they were more likely to be White compared to the overall clinic populations ( p  < 0.05). There were no statistically significant differences in patient-typed notes (word count and number of visit goals) between the safety-net and non-safety-net samples however, patients at the safety-net clinic were less likely to have all of their goals addressed within the PCP documentation, compared to the non-safety-net clinic.

Conclusions

Given potential benefits of this questionnaire as a communication tool, addressing barriers to use of technology among vulnerable patients is needed, including access to devices and internet, and support from caregivers or culturally concordant peer navigators.

Collaboration between patients and providers is a critical component of patient-centered care and is associated with improved health outcomes. 1 – 3 Open-ended questions at the start of a visit are associated with increased patient satisfaction, and in a randomized trial, pre-visit questionnaires administered via electronic portals assisted patients in preparing for visits and were viewed favorably by providers. 4 , 5 An innovative way to strengthen patient-provider collaboration is allowing patients to co-write their clinic visit notes. 6 , 7 An early study of patients and providers co-writing clinic visit notes involved patients typing their visit agendas prior to the clinic visit and inserting this text into the body of the doctor's note. 6 Patients and providers involved in these co-written notes perceived improved communication, suggesting that co-written notes could improve patient engagement, decrease the documentation burden for providers, and improve the efficiency of clinic visits. 4 Giving patients the opportunity to tell their story in their own words and including this in the clinic note is empowering, and may particularly appeal to patients who have experienced systemic oppression or disenfranchisement. 8

Historically, medical records have been easily available only to medical providers. HIPAA gave patients legal access to their medical records but in practice the records could still be difficult and costly to procure. 9 , 10 Over the last decade the OpenNotes movement has advocated making visit notes and medical records easily accessible by patients to improve transparency and collaboration. 2 This movement is supported by evidence that patients who utilize health information technology to collaborate with their provider experience greater satisfaction with care 6 , 8 , 11 , 12 and improved quality of care. 13 With implementation of the Final Rule of the 21st Century Cures Act, patients in the U.S.A now increasingly have ready electronic access to their health information. 14

 Medical record electronic patient portals may improve patient experience or outcomes, 3 , 15 , 16 however there is concern that many patients may be unable to engage with the patient portal because of limited computer and health literacy and other barriers. 17 , 18 Evidence suggests that non-white patients are less likely to access their health information online 13 , 19 – 21 and are less likely to be offered access to this information. 20 As a result, patients in some minority groups may be excluded from the potential benefits of health information technology.

Given the potential benefits of co-generated clinic notes, we wanted to understand utilization of this novel questionnaire by safety net and non-safety-net populations and had the opportunity to do so in a health system using the same technologic process and health record. We compared implementation and utilization of this novel questionnaire in two large academic clinics, one serving a safety-net population and the other a non-safety-net population. Additionally, we performed a chart review of a sample of respondents’ notes in each clinic, examining thematic content and provider use of the patient responses.

Two large academic internal medicine primary care clinics in [Seattle, WA] participated in this study between June 1, 2018 and June 30, 2019. One clinic is located at [Harborview Medical Center], a county safety-net hospital serving those with financial barriers to care and individuals from historically disenfranchised populations (the safety-net clinic). The other clinic is located at the [University of Washington Medical Center] and serves a primarily privately insured population (hereafter referred to as the non-safety-net clinic).

To be eligible, patients at these clinics had to be 18 years or older, have an active patient portal account, be able to complete the questionnaire in English, and have had three or more visits within the health system in the last 12 months. Clinic medical directors provided information about the pre-visit questionnaire to providers at clinic meetings and via email; patients did not receive any messaging beyond receiving the pre-visit questionnaire notification email. Institutional Review Board approval for the study was obtained from the University of Washington.

Eligible patients were sent an email up to seven days prior to a scheduled appointment notifying them that a new message was available on the patient portal. To answer the questionnaire, patients clicked the link in their email and logged into their patient portal account. The questionnaire asked them to type their interval histories since the most recent clinic visit, and outline their goals for the clinic visit (see Box 1 for full questionnaire). Each question had a character-limited text box for patients to type in their responses. Providers could read the responses in the patient's chart prior to and during the appointment. In the visit encounter in EpicCare (Epic Systems Corporation, Verona, WI), providers clicked a blue bar above the note labeled “Patient answers are available” to see the questions and patient-typed responses. When selected, a “Yes” button below the text titled “Do you want to add the following patient answers to your note” added the patient-entered information to the visit note at the location of the cursor in the note.

Two questions comprising the pre-visit questionnaire: interim history and goals.

Interim history. Please tell your doctor how have you been since last visit. (You may want to include changes in symptoms affecting your health, in the way you are taking medications, in your habits, or other changes in your life. To help guide what you write, we suggest you also read your doctor's last note, focusing in particular on previous plans or recommendations).

Goals . What issues would you like to focus on at your visit? (We suggest you limit what follows to the 2 or 3 things on your mind that are most important to you).

*Responses to each question were limited to 197 words due to electronic medical record functionality.

We conducted a review of a purposive sample of patient charts and associated responses to the pre-visit questionnaire from providers who had received at least three completed pre-visit questionnaires (34 providers at the safety-net clinic and 52 at the non-safety-net clinic). Using a random number generator, we randomly selected two patients from each of these providers whose charts and responses we would review, for a total of 172 patients and their visit notes.

First, four authors (HS, EM, JJ, SJ) reviewed 10% of responses to determine the main content categories in the interval history and reached consensus on the following categories: physical symptoms, medications (prescription or over the counter medications/supplements), life changes, minimal response (eg, “fine”), mental health issues (such as depression, anxiety, or panic, or medication management of mental health diagnoses), and social issues (eg housing, financial challenges, employment, disability, violence/abuse, or paperwork related to these; Table 2 ). Second, two co-authors (EM and HS) each reviewed all remaining responses to categorize the interval history by content. Agreement of the content categorization was assessed using a Kappa agreement statistic; we had good agreement for physical symptoms κ  = 0.75 (95% CI, 0.65 to 0.86), mental health issues κ  = 0.67 (95% CI, 0.48 to 0.86), social issues κ  = 0.70 (95% CI, 0.43 to 0.98), and minimal response, κ  = 0.79 (95% CI, 0.68 to 0.91), and very good agreement for medications κ  = 0.95 (95% CI, 0.90 to 1.00), and life changes κ  = 0.82 (95% CI, 0.69 to 0.94). We reached consensus for any disagreements through a consensus meeting of co-authors.

Table 2.

Characteristics of Sample of Patient Responses to the Pre-Visit Questionnaire in a Safety-net and a Non-Safety-net Clinic.

*Number of interim histories (Q1) left blank = 2 (safety-net clinic), 9 (non-safety-net clinic). Number of visit goals (Q2) left blank = 5 (safety-net clinic), 5 (non-safety-net clinic).

†Some responses were left blank by patients.

One co-author (EM) counted the number of clinical history elements in the interval history (see Table 2 ), 22 , 23 the number of unique goals, if included, and reviewed patient charts to obtain patient demographic information, identify whether the patient attended the visit, and if the pre-visit questionnaire responses were integrated into visit notes by the primary care provider. When patients typed specific goals for the visit, the note was reviewed to identify how often the provider documented addressing the patient goals.

Differences in proportions between groups were evaluated using chi-squared tests or Fisher's Exact tests when frequencies were low. Differences in continuous measures were evaluated using two-sample t tests. All tests were two-sided and statistical significance was evaluated at p  < 0.05. Statistical analyses were performed using SAS 9.4 (SAS Institute, Cary, NC).

We sent pre-visit questionnaires before 17 844 visits at the safety-net clinic and 17 590 visits at the non-safety-net clinic; three percent were completed at the safety-net clinic ( n  = 473) and 10% at the non-safety-net clinic ( n  = 1808). We sampled 172 for inclusion in the analysis.

Among 172 sampled patient respondents, a higher percentage at the safety-net clinic were white and English speaking compared to the overall safety-net clinic population ( p  < 0.0001); the same was true at the non-safety-net clinic (race, p  = 0.03 and English speaking, p  = 0.02; Table 1 ). Twelve (18%) participants in the safety-net sample were black compared to five (5%) in the non-safety-net sample; and one (1%) participant was Asian in the safety-net clinic sample compared to nine (9%) at the non-safety-net clinic. The participant samples from each clinic differed in terms of age ( ≥ 45 years, 79% at safety-net and 66% non-safety-net, p  = 0.001) and primary insurance provider type (private insurance 21% in safety-net, 47% non-safety-net, p  = 0.0001; Table 1 )

Table 1.

Demographics of Patients Attending the Safety-Net and Non-Safety-net Clinics and of Each Clinic’s Respective Sample*.

a. Race/Ethnicity groups were collapsed into White versus Other for statistical testing due to low numbers.

b. Fisher's Exact test.

* Age, sex, language, race/ethnicity, insurance from administrative data. Percentages for each demographic category may not add to 100% due to rounding.

We reviewed 172 patient responses to the pre-visit questionnaire (68 safety-net and 104 non-safety-net; Table 2 ). Of these, 10 patients answered only the history item, 11 answered only the goals question, and 151 answered both. The average length of the interval history responses was 34 words at the safety-net clinic (median: 18.50, standard deviation: 41.96) and 29 words at the non-safety-net clinic (median: 14, standard deviation: 37.71). Responses to the interval history in both clinics were most often about physical symptoms, followed by a medical history update, life changes, mental health issues, and social issues. At least half of the interim history responses included one or more history elements. For the visit goals, patients from both clinics wrote approximately 20 words in their responses (safety-net clinic: median: 6, standard deviation: 36.2; non-safety-net clinic: median: 10, standard deviation: 29.1) and had an average of two goals for the clinic visit (safety-net clinic: median: 2, standard deviation: 1.5; non-safety-net clinic: median: 1, standard deviation: 1.1). There were no statistically significant differences in the patient-typed content between the two clinics ( p  > 0.05). Tables 3 and ​ and4 4 show example patient responses to the pre-visit questionnaire.

Table 3.

Interim History Examples of Each Theme.

Table 4.

Visit Goal Examples.

Of those who both completed a pre-visit questionnaire and attended their appointment ( n  = 56 safety-net, n  = 97 non-safety-net), the majority of patient responses were added by the provider to the visit note (70% at safety-net clinic, 62% at the non-safety-net clinic) with no statically significant difference between the two clinics ( p  > 0.05). Patients at the safety-net clinic were less likely to have all of their goals addressed within the PCP documentation, compared to the non-safety-net clinic: 68% safety-net clinic, 84% non-safety net, a statistically significant difference ( p  < 0.01; Table 2 ).

Electronic health portals are increasingly utilized for communication between patients and care teams, 24 including early trials of co-generation of visit notes. 6 , 25 In this study comparing use of a novel pre-visit questionnaire asking patients to write an interim history and their goals for the upcoming visit, we found that questionnaires returned in a safety-net clinic and a non-safety net clinic had similar word counts, number of clinical history elements, and number of goals for the clinic visit, and that insurance type was not associated with whether or not a patient returned the questionnaire. However, use of the pre-visit questionnaire was very low at the safety-net clinic. Patients in the safety-net clinic also had fewer of their stated goals addressed in the provider's documentation of the visit, compared to the non-safety-net clinic; there were slightly more goals on average at the safety-net clinic compared to the non-safety-net which may have made it more difficult for all of the goals to be addressed.

Patients crafting their stories in their own words could enable them to feel “heard” by the provider, leave a permanent record of their story in the chart as they perceive it, and could improve clinic note accuracy. 26 For patients who are disenfranchised from doctors and the medical system, this could be particularly empowering. 8 More work will need to be done to determine if this tool improves trust with providers, or if non-digital engagement methods are more effective. Providers may also benefit from the pre-visit information for agenda setting and potentially more streamlined history taking and efficient visits. Our chart review of historical elements in the patient interval histories found that about half of patients submitted one or more historical elements, thus future revision of the questionnaire may be needed to gather more complete historical data. With recent changes to Medicare documentation requirements for billing to reflect medical complexity and time, 27 counting elements of history are less important for billing, but patients documenting them could still save provider time and improve documentation quality and related provider burnout.

The COVID-19 pandemic required social distancing for patients with co-morbidities and moved telehealth and remote care via technology to the forefront, with a resulting gap in access for patients from vulnerable populations. 28 Studies suggest that underserved populations are highly motivated to adopt new technology, but that access alone is not sufficient and tailoring technologies for users is needed. 29 Prior work suggests that accessing health information is more likely if patients from vulnerable populations own smartphones, and that language influences preferences related to accessing electronic data. 30 As technology becomes an increasingly important for patient engagement in health care due to the 21st Century Cares Act and the pandemic initiated telehealth options, policies will need to specifically work with vulnerable populations and address barriers to benefiting from these health care advances.

Provider access to patient responses also required technical skills in order to find the questionnaire and add them to the visit note; additional work is needed on the part of the electronic medical record system to improve providers’ ability to merge patient data into clinic notes to ensure ease of use for providers, and to create a work flow that routes the data to providers even if the patient misses the visit. Designing an interface that improves the visibility of the patient responses and ease of adding to the note may require physician training and improved user centered design. This study examined utilization at two different clinics, however, these clinics are associated with a single academic system meaning that our participants represent a small subset of patients and may not be widely generalizable. Similarly, the participant sample may not be representative of all respondents in the larger study. We did not notify patients about the study ahead of time; we simply activated it in the electronic portal and chart; this required patients to have numerous technical skills to participate, including being signed up for the portal, accessing the link from email, and knowing their password to login. We do not have information about patients who did not respond to the questionnaire. The pre-visit questionnaire was also only available in English; future electronic tools should include other languages and advances such as dictation options on smart phones to increase engagement for all populations. The patients included in this study had at least three visits to the healthcare system in the last year, and were greater utilizers of clinic services; however, even within this more engaged cohort, use of this novel communication tool was limited. Further research involving a broader spectrum of patients in varied clinical settings is needed in order to fully understand the optimal roles for co-generation of notes.

In conclusion, this novel questionnaire was utilized less by patients at the safety-net than the non-safety-net clinic. Respondents at the two clinics were more similar than different, with White patients more likely to use the tool. Developing electronic patient engagement tools that are accessible to non-English speaking patients, and investing in human resources, such as patient care partners or cultural and/or linguistic peer navigators, as well as improving provider training and access to patient responses like these, are opportunities that should be studied. As health care increasingly depends upon remote access to clinical teams and health care information via electronic portals, it is imperative that we invest in mitigating digital disparities.

Acknowledgments

The authors do not report any financial conflicts of interest. This study was supported by The Commonwealth Fund and the Gordon and Betty Moore Foundation. The authors wish to thank Megan Eguchi for her assistance with statistical testing and all of the patients and providers who participated in this study for their time and effort.

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Commonwealth Fund, Gordon and Betty Moore Foundation,

ORCID iD: Sara L. Jackson https://orcid.org/0000-0002-1278-3693

India's richest man brings Rihanna, Mark Zuckerberg and 1,200 guests to a pre-wedding celebration for his son

A man and woman dressed in red, traditional Indian wear

It might be the biggest party this small west Indian city has ever seen. 

Billionaire Mukesh Ambani is kickstarting big fat Indian wedding celebrations for his son, Anant Ambani, 28, who is set to marry his longtime girlfriend Radhika Merchant.

He's expecting billionaires from around the world, heads of state, and Hollywood and Bollywood royalty to attend a three-day bash in the family's hometown, which kicked off on Friday.

The occasion that has India transfixed is a three-day pre-wedding jamboree for his youngest son.

A family dressed in bright coloured traditional Indian clothing

The party is in Jamnagar, a city of about 600,000 in a near-desert part of Gujarat state.

It's the family’s hometown, and the home of the main oil refinery of their business empire, Reliance Industries.

There will also be traditional ceremonies in a temple complex.

On Wednesday, the Ambani family organised a community food service for 51,000 people living in nearby villages.

The wedding itself does not take place until July.

The three-day pre-wedding bash provides a glimpse of the opulence expected at the wedding itself.

Mark Zuckerberg, Bill Gates and Ivanka Trump attending

The nearly 1,200-person guest list includes Bill Gates, Mark Zuckerberg, Sunder Pichai and Ivanka Trump.

Indian billionaires Gautam Adani and Kumar Mangalam Birla are also expected to attend, along with retired cricketer Sachin Tendulkar.

Bollywood celebrities such as Deepika Padukone, Shah Rukh Khan and Rani Mukherjee will also attend. 

A crowd inside an airport

They'll be entertained by pop superstar Rihanna, magician David Blaine and famous Bollywood singers.

Rihanna holds up her arms as she performs on stage in front of backup singers

Bob Iger, CEO of Disney, is also likely to attend following an announced $8.5 billion merger of its India media assets with Reliance's on Wednesday.

The guest list also includes Mohammed Bin Jassim al Thani, the prime minister of Qatar; Stephen Harper, former Canadian prime minister; and the king and queen of Bhutan.

Guests to be pampered like royals

Guests to the couple's celebrations are set to savour 500 dishes created by about 100 chefs.

They will also be pampered, with hair styling, makeup artists and Indian wear drapists available but only on a "first come, first serve basis", according to a planning document provided to invitees and seen by Reuters.

Guests will also don jungle-themed outfits to visit an animal rescue centre run by Anant Ambani.

Known as Vantara, meaning Star Of The Forest, the 3,000 acre (1,200 hectare) centre houses abused, injured and endangered animals, especially elephants.

The invitation says guests will start each day with a new dress code, with mood boards and an army of hair stylists, makeup artists and Indian wear designers at their hotel to help them prepare.

Return charter jet flights from New Delhi and Mumbai are on offer, but guests have been asked to limit themselves to only two luggage items or three suitcases per couple.

The document cautions that "if you bring more", there's no guarantee it will arrive on the same flight.

Forbes lists Mr Ambani as the richest person in Asia.

His Reliance Industries is a massive conglomerate, with $US100 billion ($153 billion) in annual revenue and interests ranging from oil and gas to telecoms and retail.

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Intriguing CFL CB Qwan'tez Stiggers will make pre-draft visit to Detroit Lions this week

pre visit or pre visit

The Detroit Lions are hosting one of the 2024 NFL draft's most intriguing prospects, CFL rookie of the Year Qwan'tez Stiggers, on a top-30 visit on Thursday.

Stiggers is vying to become the third player in modern draft history to get drafted without playing college football. According to ESPN, defensive tackle Eric Swann (1991) and wide receiver Moritz Boehringer (2016) are the only other players with that distinction.

Stiggers signed with Lane College in Tennessee out of high school, but returned home after his father died and during the COVID-19 pandemic. He played one season in the Fan Controlled Football League, a 7-on-7 indoor league near his home in Atlanta, and led the league with five interceptions, according to ESPN .

With the help of his FCF coach, Stiggers signed with the Toronto Argonauts of the CFL, where he intercepted five passes last season and was named the league's Most Outstanding Rookie.

NFL MOCK DRAFT 2.0: Lions bolster trenches with big OL

All things Lions: Latest Detroit Lions news, schedule, roster, stats, injury updates and more.

Stiggers, 5 feet 11 and 203 pounds, played in the Shrine Bowl college all-star game in February but was not invited to the NFL combine. He has pre-draft visits with seven teams and will host a personal pro day at his old high school later this month.

The Lions, who signed last season's CFL sack leader , Mathieu Betts, earlier this offseason, are in the market for cornerback help in free agency and the draft. They re-signed veteran Emmanuel Moseley to a one-year deal Tuesday and current have just three other cornerbacks under contract: Cam Sutton, a starter last season; Steven Gilmore, who played two defensive snaps last season as an undrafted rookie; and Craig James, who signed a futures deal with the team in January.

Kindle Vildor, who finished last season as a starter, will be an unrestricted free agent next week, and the Lions do not plan to tender a contract to restricted free agent Jerry Jacobs.

Along with Stiggers, the Lions have a pre-draft visit scheduled with Northern Iowa defensive tackle Khristian Boyd, another NFL combine snub who shined at the Shrine Bowl.

Contact Dave Birkett at  [email protected] . Follow him on Twitter  @davebirkett.

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Lions hold pre-draft visit with northern iowa dt khristian boyd, share this article.

The Lions are getting a jump on the pre-draft visit process this week. The NFL Scouting Combine just ended and the Lions have already hosted the first of their 30 official pre-draft visits.

Northern Iowa defensive tackle Khristian Boyd is making the trip to Allen Park to have his official visit with the team. Boyd is making several visits as he hopes to become the highest-drafted player not invited to the combine in 2024.

Lions 2024 Draft Prospect of the Day: Kingsley Suamataia, OL, BYU

Boyd is a 6-foot-2, 317-pound interior lineman who played both 1-tech and 3-tech for the Panthers, an FCS-level power. He was a five-year contributor for Northern Iowa after a redshirt year in 2018, recording 42 tackles and 3.5 sacks as a senior.

His draft stock took off during Shrine Bowl week, where Boyd was dominant in 1-on-1 drills and disruptive in team drills, too. He fits the interior line anchor role the Lions are looking to fill next to Alim McNeill.

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Computer Science > Machine Learning

Title: decoupling weighing and selecting for integrating multiple graph pre-training tasks.

Abstract: Recent years have witnessed the great success of graph pre-training for graph representation learning. With hundreds of graph pre-training tasks proposed, integrating knowledge acquired from multiple pre-training tasks has become a popular research topic. In this paper, we identify two important collaborative processes for this topic: (1) select: how to select an optimal task combination from a given task pool based on their compatibility, and (2) weigh: how to weigh the selected tasks based on their importance. While there currently has been a lot of work focused on weighing, comparatively little effort has been devoted to selecting. This paper proposes a novel instance-level framework for integrating multiple graph pre-training tasks, Weigh And Select (WAS), where the two collaborative processes, weighing and selecting, are combined by decoupled siamese networks. Specifically, it first adaptively learns an optimal combination of tasks for each instance from a given task pool, based on which a customized instance-level task weighing strategy is learned. Extensive experiments on 16 graph datasets across node-level and graph-level downstream tasks have demonstrated that by combining a few simple but classical tasks, WAS can achieve comparable performance to other leading counterparts. The code is available at this https URL .

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IMAGES

  1. Pre-Visit Planning

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  2. Patient Journey Innovations: Pre-visit

    pre visit or pre visit

  3. Provider Toolkit Quick Reference Guide

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  4. Pre Visit Planning

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  5. Implementing A Pre-visit Planning Process

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  6. 10 steps to pre-visit planning that can produce big savings

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COMMENTS

  1. Putting Pre-Visit Planning Into Practice

    Pre-visit planning takes place in several steps: 1. Plan forward, or "The next appointment starts today." 5 The most efficient form of pre-visit planning begins near the end of the previous ...

  2. Pre-Visit Planning: Save Time, Improve Care, and Strengthen Care Team

    Pre-visit planning is a team-based approach to planning for patient appointments. Using pre-visit planning, at the end of the current visit: Patients are scheduled for follow-up appointments. Pre-visit lab testing and other diagnostics are arranged. Necessary information for upcoming visits is gathered

  3. How to use today's visit to plan for the next one

    Pre-visit planning is a way to ensure that your patients get the tests they need — and you get the test results you need — before their next visit. Then you can devote more attention during ...

  4. PDF Pre-Visit PlanningSave Time and Improve Care

    Pre-visit planning involves scheduling patients for future appointments at the conclusion of each visit, arranging for pre-visit lab testing, gathering the necessary information for upcoming visits, and spending a few minutes to huddle and handoff patients. Pre-visit planning can mean the difference between a clinic where a physician and the ...

  5. Pre-visit Planning Saves Time

    A: Pre-visit planning is a process where you plan for patients' future appointments at the conclusion of the current visit, arrange for what should happen between this visit and the next visit, and huddle with your team prior to the patient's next visit. With pre-visit planning, everyone is prepared to make the most meaningful use of ...

  6. Let's Talk Pre-Visit Planning

    The 10 Steps of Pre-visit Planning. Pre-visit planning is a strategy used to maximize the benefits of a healthcare visit with extra preparation, focusing the appointment, and creating a patient-specific care plan. Overall, pre-visit planning ensures a smoothly operating clinic and benefits both patients and healthcare providers.

  7. PDF Putting Pre-visit Planning

    PRE-VISIT PLANNING 3. Pre-visit lab testing. Pre-visit lab testing saves time, improves patient engagement in health management, and reduces the amount of work needed to report and respond to results.

  8. Applied techniques for putting pre-visit planning in clinical practice

    This term (pre-visit planning) was introduced by Sinsky et al. in 2014 to collect and organize patient data before a patient visit . The purpose of pre-visit planning is to help the patient and physician to save time and improve care by gathering and organizing information in a structured way.

  9. Applied techniques for putting pre-visit planning in clinical practice

    Background One of the main elements of patient-centered care is an enhancement of patient preparedness. Thus, pre-visit planning assessment tools was emerged to prepare and involve patients in their treatment process. Objective The main objective of this article was to review the applied tools and techniques for consideration of putting pre-visit planning into practice. Methods Web of Science ...

  10. Technology-Enabled and Artificial Intelligence Support for Pre-Visit

    Pre-visit planning is an essential element of population health management, with great potential to improve effectiveness, efficiency, and experience of care, yet there are numerous implementation barriers, many of which are human effort-related. There exist technology-enabled and AI tools for augmenting current human-driven PVP processes ...

  11. 10 steps to pre-visit planning that can produce big savings

    Pre-visit planning includes scheduling patients for future appointments at the conclusion of each visit, arranging for pre-visit lab testing, gathering the necessary information for upcoming visits and spending a few minutes to huddle and hand off patients. Pre-visit planning can increase efficiency often saving 30 minutes of both physician and ...

  12. The 10 Steps of Pre-visit Planning

    Arrange for laboratory tests to be completed before the next visit. Perform visit preparations. Use a visit prep checklist to identify gaps in care. Send patients appointment reminders. Consider a pre-visit phone call or email. Hold a pre-clinical team huddle. Use a pre-appointment questionnaire. Handoff the patient to the physician.

  13. Leveraging Interdisciplinary Teams for Pre-Visit Planning to Improve

    The pre-visit phone call was essential to this initiative. The calls, performed by registered nurses, addressed patient engagement via counseling using motivational interviewing techniques to address vaccine hesitancy. The interdisciplinary pre-visit huddle mitigated missed opportunities for vaccination. This initiative showcases that detailed ...

  14. Pre-Visit Planning

    As noted in the surgery example, a primary reason PVP is done in primary care is to improve efficiency of the visit. Pre-planning allows a practice to gather needed information for visit, like any labs or other tests done recently or records from a recent hospitalization or specialist visit. A preview also gives the opportunity to anticipate ...

  15. Enhancing patient visits through pre-visit planning

    Pre-visit planning changes that philosophy by ensuring that the patient's information is complete and current prior to the visit. This enables physicians to have quality conversations about care plans while patients are in the office, reduces the need for additional visits and improves the quality of care, according to Daniel Silver, St. Luke ...

  16. The 10 Steps of Pre-visit Planning

    Perform visit preparations. Use a visit prep checklist to identify gaps in care. Send patients appointment reminders. Consider a pre-visit phone call or email. Hold a pre-clinical team huddle. Use a pre-appointment questionnaire. Handoff the patient to the physician. Step 1: Re-appoint the patient after the visit.

  17. Patient Scheduling and Pre-Visit Intake: Let's Give Patients What They

    According to the survey, 80% of patients have follow-up questions after a health visit, and 94% of patients would like to have access to educational materials. Finally, a survey by predictive analytics firm Carta Healthcare found that 83% of patients had to repeat information that they had previously provided at a doctor's office.

  18. Save Time & Improve Patient Experience with Pre-Visit Planning

    Pre-visit planning is the process of methodically preparing for every single patient appointment to the greatest extent possible, with primary focus on wellness visits. Pre-visit planning may include: New patient questionnaires that review individual and family medical history, medication reconciliation, surgical history, and social ...

  19. PREVISIT definition and meaning

    To visit beforehand.... Click for English pronunciations, examples sentences, video.

  20. previsit

    Adjective [ edit] Prior to a visit . The importance and nature of the patient's previsit fantasies about the kind of relationship which will develop depends upon the social background and the personality of the patient. The previsit process is vital to ensuring accurate and timely receipt of information regarding the patient's ability to pay ...

  21. Do pre-visit preparation and post-visit activities improve student

    Pre-visit logistical preparation as well as both pre-visit preparation and post-visit follow-up related to the subject matter were each associated with more positive student outcomes. The study provides further evidence across a large sample of programs that pre-visit preparation and post-visit follow-up can have meaningful impacts on student ...

  22. Pre-Visit and Post-Visit Activities

    Pre-visit activities are designed to help prepare your students for a guided or self-directed tour at VMFA. Some activities are directly related to guided-tour topics while others provide a more general introduction to visiting an art museum. Post-visit activities will help your students continue to explore what they saw on their visit.

  23. Everything We Know About Anant Ambani's Pre-Wedding Party

    The couple's three-day pre-wedding party started on Friday in Gujarat, India. ... The dress code includes a "jungle fever" theme and "comfortable shoes" for the visit to the animal rescue center ...

  24. 2024 NFL Mock Draft: Pre-Combine 1st-Round Projections

    It's officially NFL Scouting Combine week, as more than 300 of this year's top prospects arrive at Lucas Oil Stadium in Indianapolis for the biggest job interview in football.

  25. Clinical Use of an Electronic Pre-Visit Questionnaire Soliciting

    Collaboration between patients and providers is a critical component of patient-centered care and is associated with improved health outcomes. 1 -3 Open-ended questions at the start of a visit are associated with increased patient satisfaction, and in a randomized trial, pre-visit questionnaires administered via electronic portals assisted patients in preparing for visits and were viewed ...

  26. India's richest man brings Rihanna, Mark Zuckerberg and more to a pre

    The occasion that has India transfixed is a three-day pre-wedding jamboree for his youngest son. ... Guests will also don jungle-themed outfits to visit an animal rescue centre run by Anant Ambani

  27. CFL CB Qwan-tez Stiggers making pre-draft visit to Detroit Lions

    The Detroit Lions are hosting one of the 2024 NFL draft's most intriguing prospects, CFL rookie of the Year Qwan'tez Stiggers, on a top-30 visit on Thursday.. Stiggers is vying to become the third ...

  28. Lions hold pre-draft visit with Northern Iowa DT Khristian Boyd

    The Lions are getting a jump on the pre-draft visit process this week. The NFL Scouting Combine just ended and the Lions have already hosted the first of their 30 official pre-draft visits. Northern Iowa defensive tackle Khristian Boyd is making the trip to Allen Park to have his official visit with the team. Boyd is making several visits as he ...

  29. Decoupling Weighing and Selecting for Integrating Multiple Graph Pre

    Recent years have witnessed the great success of graph pre-training for graph representation learning. With hundreds of graph pre-training tasks proposed, integrating knowledge acquired from multiple pre-training tasks has become a popular research topic. In this paper, we identify two important collaborative processes for this topic: (1) select: how to select an optimal task combination from ...