Medicine and Health Sciences Commons^™

Pulmonary Specialist-Supported Health Coaching Delivered By Lay Personnel Improves Receipt Of Quality Care For Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial, Rachel Willard-Grace, Danielle Hessler, Beatrice Huang, Denise Devore, Chris Chirinos, Jessica Wolf, Devon Low, Chris Garvey, Doranne Donesky, Stephanie Tsao, David H. Thom, George Su

Journal of Patient-Centered Research and Reviews

Purpose: Half of people living with chronic obstructive pulmonary disease (COPD) do not receive high-quality, evidenced-based care as described in international guidelines. We conducted secondary data analysis of a previously published study to assess the ability of a model of lay health coaching to improve provision of guideline-based care in a primary care setting.

Methods: As part of a randomized controlled trial, we recruited English- and Spanish-speaking patients with moderate to severe COPD from primary care clinics serving a low-income, predominantly African American population. Participants were randomized to receive usual care or 9 months of health coaching from primary care …

Homebound Older Adult, Caregiver, And Provider Perspectives On The Benefits Of Home-Based Primary Care: A Narrative Review, Nila N. Sabetfakhri

Journal of Patient-Centered Research and Reviews

Home-based primary care (HBPC) is a clinical practice that is being increasingly utilized for the homebound older adult population. As the age demographics in the United States shift over time, these programs will need to be expanded to accommodate the growing aging population. This narrative review aims to compile studies on the benefits of HBPC from the perspective of homebound older adult patients, caregivers, and the health care providers who practice HBPC. Studies were identified through PubMed, Web of Science, and Google Scholar, and a total of 10 papers were included in this review. Identified benefits of HBPC for homebound …

Conference Proceedings: Select Abstracts Presented At 2023 Advocate Aurora Scientific Day

Journal of Patient-Centered Research and Reviews

This abstract supplement includes findings presented at the 49th annual Advocate Aurora Scientific Day on May 24, 2023. The Scientific Day symposium provides a virtual forum for the sharing of preliminary results from research and case studies conducted by faculty, fellows, residents, and other health professionals associated with Illinois-based Advocate Health Care and Wisconsin-based Aurora Health Care.

Covid-19 Proactive Disease Management Using Covid Virtual Hospital In A Rural Community, Gandhari Loomis, Regina Rhodes, Ed Bujold, Golnosh Sharafsaleh, Ellen Collett, Mark Irwin, Elizabeth W. Staton, John M. Westfall

Journal of Patient-Centered Research and Reviews

Purpose: A community teaching hospital serving a rural population established an intensive “hospital at home” program for patients with COVID-19 utilizing disease risk stratification and pulse oximeter readings to dictate nurse and clinician contact. Herein, we report patient outcomes and provider experiences resulting from this “virtual” approach to triaging pandemic care.

Methods: COVID-19-positive patients appropriate for outpatient management were enrolled in our COVID Virtual Hospital (CVH). Patients received pulse oximeters and instructions for home monitoring of vital signs. CVH nurses contacted the patient within 12–48 hours. The primary care provider was alerted of the patient’s diagnosis and held a virtual …

Conference Proceedings: Select Abstracts Presented At Advocate Aurora Scientific Day 2022

Journal of Patient-Centered Research and Reviews

The abstracts published in this supplement were presented at the 48th annual Advocate Aurora Scientific Day on May 25, 2022. This scholarly symposium provides a closed forum for sharing preliminary results from research studies conducted by faculty physicians and nurses, fellows, residents, scientists, and other health professionals associated with U.S. Midwest-based health system Advocate Aurora Health, publisher of the Journal of Patient-Centered Research and Reviews.

Is Home Blood Pressure Monitoring Effective At Controlling Hypertension In African American Patients? A Clin-Iq, Rebecca Nye, Wilhelm Lehmann, Deborah Simpson

Journal of Patient-Centered Research and Reviews

African Americans are disproportionately affected by hypertension, a modifiable contributor to multiple chronic diseases and premature death. Primary care physicians play an important role in hypertension control. Home blood pressure monitoring (HBPM) is an evidence-based method for confirming diagnosis and monitoring hypertension over time. Some studies have found that HBPM may lead to clinically relevant reductions in blood pressure when combined with additional interventions, but few studies have focused specifically on African American populations. Evidence of effectiveness could increase clinical recommendation of HBPM. This clinical inquiry examined whether HBPM improves blood pressure control in African Americans with uncontrolled hypertension. Reviewed …

Vitamin D Level Testing In An Urban Midwest Clinic: To Test Or Not To Test?, Daniel Mundt, Marianne Klumph, Kayla Heslin, Wajih Askar

Journal of Patient-Centered Research and Reviews

Vitamin D deficiency (VDD) is significantly higher among urban populations in the U.S. Midwest, with African Americans being disproportionately affected. There is ongoing debate surrounding who and how often individuals should be screened for VDD. This study aimed to understand the prevalence of VDD, associated risk factors, and discrepancies in testing at an urban-based internal medicine residency clinic. Data were retrospectively collected on all adult patients seen by the clinic during 2018 and descriptive statistical analysis performed. Among 3976 total patients (mean age: 53 years), 18% (n = 698) had vitamin D levels analyzed, with deficiency found in 71% of …

Improving Cancer Screening Rates In Primary Care Via Practice Facilitation And Academic Detailing: A Multi-Pbrn Quality Improvement Project, Christopher P. Morley, Laura A. Schad, Laurene M. Tumiel-Berhalter, Laura A. Brady, Alexandrea Bentham, Karen Vitale, Amanda Norton, Gary Noronha, Carlos Swanger

Journal of Patient-Centered Research and Reviews

Purpose: In the United States, cancer screening rates are often below national targets. This project implemented practice facilitation and academic detailing aimed at increasing breast, cervical, and colorectal cancer screening rates in safety-net primary care practices.

Methods: Three practice-based research networks across western and central New York State partnered to provide quality improvement strategies on breast, cervical, and colorectal cancer screening. Pre/postintervention screening rates for all participating practices were collected annually, as were means across all practices over 7 years. Simple ordinary least squares linear regression was used to calculate the trend for each cancer type and test for statistical …

Impact Of Covid-19 On Screening Rates For Colorectal, Breast, And Cervical Cancer: Practice Feedback From A Quality Improvement Project In Primary Care, Laura A. Schad, Laura A. Brady, Laurene M. Tumiel-Berhalter, Alexandrea Bentham, Karen Vitale, Amanda Norton, Gary Noronha, Carlos Swanger, Christopher P. Morley

Journal of Patient-Centered Research and Reviews

Purpose: Three New York State practice-based research networks provided quality improvement strategies to improve screening rates for breast, cervical, and colorectal (BCC) cancers in safety-net primary care, over 7 years. In the final year (Y7), the United States experienced the COVID-19 pandemic. The impact of the COVID-19 pandemic on BCC cancer screening rates was assessed qualitatively.

Methods: A total of 12 primary care practices participated in Y7 of the quality improvement project. BCC cancer screening rates at year beginning and end were assessed. Practice staff were asked about how COVID-19 impacted screening. Average pre/postintervention screening rates and qualitative thematic analysis …

Patient Perceptions Of Using Clinical Decision Support For Cancer Screening And Prevention: “I Wouldn’T Have Thought About Getting Screened Without It.”, Daniel M. Saman, Melissa L. Harry, Laura A. Freitag, Clayton I. Allen, Patrick J. O'Connor, Joann M. Sperl-Hillen, Joseph A. Bianco, Anjali R. Truitt, Heidi L. Ekstrom, Thomas E. Elliott

Journal of Patient-Centered Research and Reviews

Purpose: We sought to gain an understanding of cancer prevention and screening perspectives among patients exposed to a clinical decision support (CDS) tool because they were due or overdue for certain cancer screenings or prevention.

Methods: Semi-structured qualitative interviews were conducted with 37 adult patients due or overdue for cancer prevention services in 10 primary care clinics within the same health system. Data were thematically segmented and coded using qualitative content analysis.

Results: We identified three themes: 1) The CDS tool had more strengths than weaknesses, with areas for improvement; 2) Many facilitators and barriers to cancer prevention and screening …

Conference Proceedings: Select Abstracts Presented At 2021 Advocate Aurora Health Scientific Day

Journal of Patient-Centered Research and Reviews

Abstracts published within this supplement were presented at the 47th annual Advocate Aurora Health Scientific Day, held virtually on May 26, 2021. This research symposium provides a forum for disseminating results from studies conducted by faculty, fellows, residents, and other allied health professionals associated with Midwest-based health system Advocate Aurora Health, which publishes the Journal of Patient-Centered Research and Reviews.

Heart-Healthy Integrative Nutritional Counseling Group Education Sessions Among Chinese Americans With Cardiovascular Risk Factors Or Disease: A Primary Care Quality Improvement Pilot, Jasmin Woo, Evelyn Y. Ho, Jane Jih

Journal of Patient-Centered Research and Reviews

Purpose: Current biomedical cardiovascular disease nutrition counseling does not incorporate Chinese medicine principles.

Methods: A heart-healthy integrative nutritional counseling (H2INC) curriculum consistent with Chinese medicine principles and biomedical nutrition guidelines was taught to Chinese Americans in group education sessions. Chinese-speaking patients with cardiovascular disease or risk factors from an urban general medicine practice were recruited to attend a 90-minute group session. Participants completed pre-post surveys to assess the impact of H2INC on their perceived heart-healthy nutrition knowledge and empowerment, as well as the cultural relevance of H2INC.

Results: A total of 47 participants (mean age: 74 years; 63.8% female) attended …

The Silence Of Food Insecurity: Disconnections Between Primary Care And Community Organizations, Nicole K. Runkle, David A. Nelson

Journal of Patient-Centered Research and Reviews

Purpose: Food insecurity is a prominent issue in the United States, and it is well established that food insecurity is linked to health and chronic illnesses. Studies show that screening for food insecurity is not yet part of standardized practice among all primary care physicians, nor are care providers comfortable with how to proceed with a patient who presents with this issue. Food insecurity is often handled by community-based organizations (CBOs) such as food pantries. Family medicine and pediatric clinics (FMPC) and CBOs hold unique relationships with their clients and can benefit from partnerships with each other to improve health …

A Watched Pot Never Boils: Attentive Care Needs No Timer, Dennis J. Baumgardner

Journal of Patient-Centered Research and Reviews

In this issue introduction, the editor-in-chief of Journal of Patient-Centered Research and Reviews comments on the premise that length of patient consultation time is less important than what patients perceive happened during that time. Regardless of the time allotted to a clinical visit, health care providers should make efforts to address the emotional and psychosocial needs of their patients. As always, taking a little time to express empathy can make a big difference in patient satisfaction.

Conference Proceedings: Aurora Scientific Day 2020

Journal of Patient-Centered Research and Reviews

Abstracts published in this supplement were among those presented at the 46th annual Aurora Scientific Day research symposium, held virtually on May 20, 2020. The symposium provides a forum for describing research studies conducted by faculty, fellows, residents, and allied health professionals affiliated with Wisconsin-based Aurora Health Care, a part of the Advocate Aurora Health health system, which publishes the Journal of Patient-Centered Research and Reviews.

Defining And Characterizing Frequent Attenders: Systematic Literature Review And Recommendations, Dip Shukla, Erik Faber, Brian Sick

Journal of Patient-Centered Research and Reviews

Purpose: To decrease cost and improve efficiency, health care organizations have focused on frequent attenders — patients with high health care utilization. Prior studies have investigated singular health care settings, used varying definitions of frequent attendance, and inconsistently identified factors correlated with frequent attendance. The purpose of this article is to suggest a uniform definition of frequent attenders for different health care settings and to determine factors correlated with frequent attendance.

Methods: This systematic review of three databases identified 2761 unique articles; 174 met inclusion criteria. Studies were analyzed for their definition of frequent attenders and factors associated with frequent …

Solutions To Address Frequent Hospital Attendance, Glenda Sundberg

Journal of Patient-Centered Research and Reviews

In this editorial, practical solutions and considerations in helping the most complex and at-risk patients in our health systems are discussed. These patients, sometimes referred to as health care “super-utilizers” in the literature, tend to be frequently seen and cared for in costly hospital and emergency department settings. Innovative care models that aim to bridge system gaps, achieve better health outcomes, and improve the well-being of both patients and providers are needed and should continue to be explored.

Incorporating Home Visits In A Primary Care Residency Clinic: The Patient And Physician Experience, Mary Caitlin St. Clair, Jessica J. F. Kram, Glenda Sundberg

Journal of Patient-Centered Research and Reviews

Purpose: Home visits, once a popular but now uncommon form of health care delivery, are on the rise. Few studies have focused on the value the experience brings to resident physicians and their patients.

Methods: A 6-month pilot was conducted with 11 residents who participated in 32 home visits with 11 patients. Patient and resident experiences were captured through a survey following the home visits.

Results: In all, 100% of patients and a majority of residents were very interested in being a part of and incorporating future home visits, respectively. Every patient in the survey said that the visits resulted …

House Calls Are Reaching The Tipping Point — Now We Need The Workforce, Thomas Cornwell

Journal of Patient-Centered Research and Reviews

Home-based primary care (HBPC) improves the lives of high-cost, frail, homebound patients and their caregivers while reducing costs by keeping patients at home and reducing the use of hospitals and nursing homes. Several forces are behind the resurgence of HBPC, including the rapidly aging population, advancements in portable medical technology, evidence showing the value of HBPC, and improved payments for HBPC. There are 2 million to 4 million patients who could benefit from HBPC, but only 12% are receiving it. The number of these patients is expected to double over the next two decades. This requires a larger and better …

Conference Proceedings: Aurora Scientific Day 2018

Journal of Patient-Centered Research and Reviews

This journal supplement includes selected abstracts from among the more than 50 presented at the 44th annual Aurora Scientific Day research symposium. Held May 25, 2018, in Milwaukee, Wisconsin, Aurora Scientific Day provides a forum for original research conducted by faculty, fellows, residents, and other allied health professionals affiliated with Aurora Health Care, an integrated health system with hospitals and clinics in Wisconsin and Illinois.

Patient Self-Management: Tools And Barriers, Dennis J. Baumgardner

Journal of Patient-Centered Research and Reviews

In his issue introduction, the editor-in-chief of the Journal of Patient-Centered Research and Reviews comments on the theme of patient self-management of chronic diseases and the related articles published therein. Illnesses such as cardiovascular disease, diabetes, epilepsy, arthritis, asthma, and obesity often require patients to administer their own medication daily or adhere to strict dietary restrictions. Progress is being made on the process of implementation and evaluation of patient self-management tools in primary care practices. Barriers to self-management tool implementations in clinics, as well as their use by individual patients, must be understood and addressed.

Implementing Community-Created Self-Management Support Tools In Primary Care Practices: Multimethod Analysis From The Insttepp Study, Douglas H. Fernald, Matthew J. Simpson, Donald E. Nease Jr., David L. Hahn, Amanda E. Hoffmann, Leann C. Michaels, Lyle J. Fagnan, Jeanette M. Daly, Barcey T. Levy

Journal of Patient-Centered Research and Reviews

Purpose: With one-half of Americans projected to be living with at least one chronic condition before 2020, enhancing patient self-management support (SMS) may improve health-related behaviors and clinical outcomes. Routine SMS implementation in primary care settings is difficult. Little is known about the practice conditions required for successful implementation of SMS tools.

Methods: Four primary care practice-based research networks (PBRNs) recruited 16 practices to participate in a boot camp translation process to adapt patient-centered SMS tools. Boot camp translation sessions were held over a 2-month period with 2 patients, a clinician, and a care manager from each practice. Qualitative case …

Adapting Boot Camp Translation Methods To Engage Clinician/Patient Research Teams Within Practice-Based Research Networks, Lyle J. Fagnan, Matthew J. Simpson, Jeanette M. Daly, Leann C. Michaels, David L. Hahn, Barcey T. Levy, Douglas H. Fernald, John M. Westfall, Donald E. Nease Jr.

Journal of Patient-Centered Research and Reviews

Purpose: Boot camp translation is a proven process to engage community members and health professionals in translating and disseminating evidence-based “best practices” models for health prevention and chronic illness care. Primary care practice improvement studies, particularly involving patient-driven change, as seen with self-management support (SMS), require engaged practice teams that include patients. Models of engagement such as boot camp translation may be effective.

Methods: Four geographically dispersed practice-based research networks (PBRNs) from the Meta-LARC consortium engaged 16 practices to form SMS implementation teams involving a clinician, care manager, and 2 patients in each team. Our study adapted the boot camp …

Impact Of A Boot Camp Translation Intervention On Self-Management Support In Primary Care, Donald E. Nease Jr., Jeanette M. Daly, L. Miriam Dickinson, Douglas H. Fernald, David L. Hahn, Barcey T. Levy, Leann C. Michaels, Matthew J. Simpson, John M. Westfall, Lyle J. Fagnan

Journal of Patient-Centered Research and Reviews

Purpose: Self-management support (SMS) is a pillar of the well-established chronic care model and a key component of improving outcomes for patients with chronic illnesses. The Implementing Networks’ Self-management Tools Through Engaging Patients and Practices (INSTTEPP) trial sought to determine whether a boot camp translation process could assist small to medium-sized primary care practices with care managers implement SMS tools.

Methods: INSTTEPP used a stepped-wedge design across 16 practices from 4 practice-based research networks over 12 months. Each network completed a 2-month boot camp translation for creating SMS tools with 16 participants (2 patients, a clinician, and a care manager …

Challenges Of Refugee Health Care: Perspectives Of Medical Interpreters, Case Managers, And Pharmacists, Fabiana Kotovicz, Anne Getzin, Thy Vo

Journal of Patient-Centered Research and Reviews

Purpose: Our objective was to identify perceived challenges in the provision of health care for refugees from the perspective of medical interpreters, case managers, and pharmacists working with refugee patients in Milwaukee, Wisconsin.

Methods: Two 60-minute focus groups were performed exploring challenges in refugee health care using a literature-based semi-structured protocol. Focus groups were transcribed and de-identified prior to independent analysis by two of the investigators. Using a memoing-process qualitative approach, major concepts, cross-cutting themes, and subthemes were established and ultimately developed a narrative. The project protocol was approved as not human subject research by the local institutional review board. …

Conference Proceedings: Aurora Scientific Day 2017

Journal of Patient-Centered Research and Reviews

This supplement includes select abstracts presented at the 43rd Annual Aurora Scientific Day research symposium on May 24, 2017. Aurora Scientific Day hosts a forum for original research conducted by faculty, fellows, residents, and other allied health professionals affiliated with Aurora Health Care, an integrated health system headquartered in Milwaukee, Wisconsin.

Improving Chronic Pain Management Processes In Primary Care Using Practice Facilitation And Quality Improvement: The Central Appalachia Inter-Professional Pain Education Collaborative, Roberto Cardarelli, Sarah Weatherford, Jennifer Schilling, Dana King, Sue Workman, Wade Rankin, Juanita Hughes, Jonathan Piercy, Amy Conley-Sallaz, Melissa Zook, Kendra Unger, Emma White, Barbara Astuto, Bobbi Stover

Journal of Patient-Centered Research and Reviews

Purpose: With the increasing burden of chronic pain and opioid use, provider shortages in Eastern Kentucky and West Virginia have experienced many challenges related to chronic pain management. This study tested a practice facilitator model in both academic and community clinics that selected and implemented best practice processes to better assist patients with chronic pain and increase the use of interdisciplinary health care services.

Methods: Using a quasi-experimental design, a practice facilitator was assigned to each state’s clinics and trained clinic teams in quality improvement methods to implement chronic pain tool(s) and workflow processes. Charts for 695 patients with chronic …

What Can A Primary Care Physician Discuss With Older Patients To Improve Advance Directive Completion Rates? A Clin-Iq, Judith M. Myers, Edmund Duthie Jr., Kathryn Denson, Steven Denson, Deborah Simpson

Journal of Patient-Centered Research and Reviews

Advance directives (ADs) provide patients with the opportunity to indicate their preferences for medical care while they still maintain the capacity to express their wishes, thus retaining autonomy. ADs increase the likelihood that patients will receive the care they desire, as their family members and physicians will better understand the level of care desired. Despite this, the AD completion rate by elderly patients continues to be low, especially for patients not facing serious illnesses. Primary care physicians (PCPs) are uniquely positioned to engage patients in discussions about ADs before a health crisis arises yet often do not due to time …