Medicine and Health Sciences Commons^™

Quality Improvement Of X-Ray Imaging For Unspecified Chronic Knee Pain And Suspected Knee Osteoarthritis In The Primary Care Setting, Ty E. Bever

Family Medicine Clerkship Student Projects

Although a comprehensive history and physical exam are the mainstays of initial evaluation, plain X-rays are clinically indicated for chronic knee pain of greater than 6 weeks duration and acute traumatic pain in patients who meet specific evidence-based criteria, according to the American Academy of Family Physicians (AAFP). However, there remains significant variation in what radiographic protocols are used in clinical practice, specifically in terms of what radiographic views are ordered and whether the imaging is performed with the patient weight-bearing (WB) or non-weight-bearing (NWB). In fact, several studies have shown that non-weight-bearing knee radiographs are frequently ordered by general …

Increasing Utilization Of The Delirium Prevention Protocol In Post Cardiovascular Surgery To Improve Quality And Safety Of Healthcare, Kristin Luce

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Abstract:

Background and Objectives: Post-operative delirium (POD) is the most common complication seen following surgery in older adults. Two-thirds of delirium cases are diagnosed late or missed in everyday practice across health care settings which can lead to a variety of long-term complications. POD prevalence can be reduced within inpatient practice settings by utilizing established screening tools, such as the Confusion Assessment Method (CAM). This project aimed to increase nurse screening of delirium and provide education on POD to nursing staff on the post-cardiovascular surgery unit to increase utilization of the delirium prevention protocol.

Methods: Educational sessions provided to nursing …

Care Coordination And Empowerment In People With Type 2 Diabetes, Erik M. Wilson

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

1. Background: In 2018, approximately one in seven Americans had been diagnosed with Type 2 Diabetes, a number that is projected to increase to one in three by 2050. Approximately 40% of individuals with Type 2 diabetes develop long-term complications, accounting for one-in-four healthcare dollars spent in the United States. Current initiatives supported through Accountable Care Organizations place an emphasis on improving the quality of care delivered in chronic medical problems such as diabetes to optimize patient outcomes, moving away from the traditional fee-for-service. One cornerstone of improving quality of care is care coordination and education.

1. Methods: Utilizing the Plan-Do-Study-Act methodology …

Improving Tobacco Cessation Screening And Readiness To Quit During Medication Assisted Treatment For Patients With Opioid Use Disorder, Monique Poisson Rn, Dnp-C, Jennifer Laurent Phd, Aprn

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Purpose: Tobacco use disorder is commonly comorbid in patients with Opioid Use Disorder (OUD), yet not always regularly addressed during OUD treatment. The aim of this project was to assess tobacco cessation intervention at a small outpatient medication assisted treatment (MAT) program and improve workflow to standardize care, increase knowledge and encourage tobacco cessation among patients.

Methods: The Plan Do Study Act (PDSA) method of quality improvement was used. Patient medical records were reviewed to assess documentation of tobacco use status and readiness to quit in the electronic health record (EHR). A screening, brief intervention, and referral to treatment (SBIRT) …

Community Health Interventions To Reduce The Burden Of Radon-Related Lung Cancer, Benjamin Weaver

Family Medicine Clerkship Student Projects

Exposure to radon is the second leading cause of lung cancer in the United States. One in seven homes in Vermont has elevated levels of radon, but most patients are unaware of radon as a risk factor for lung cancer or that radon testing and mitigation services are available to them. To promote increased testing and mitigation of radon we screened patients presenting to a Family Medicine practice in Vermont about whether they had had these services done in their home. We also developed a patient education resource for providers to give to patients who had more questions about radon …

Assessment Strategy For Implementation Of Evidence-Based Protocol For Antibiotics In Appendicitis, Alexa J. Golden, Alia Aunchman, Gary An

Larner College of Medicine Fourth Year Advanced Integration Teaching/Scholarly Projects

Introduction:

Evidence-based protocols (EBP) exist to guide clinicians in decision-making, however, EBP are often delayed and not optimally implemented [1]. Antibiotic stewardship is heavily guided by EBP and highly relevant to surgical practice. Antibiotic regimens for one of the most common surgical diseases, acute appendicitis (AA) can be highly variable. Post-operative antibiotic (POA) use in non-perforated AA has been largely shown to be non-beneficial and potentially harmful [2]; 4 days of POA in cases where source control is obtained has shown to be non-inferior to commonly prescribed longer courses [3]. We identified lack of consistent antibiotic usage for AA at …

Assessing Maternal Satisfaction Of Perinatal Care Provided In A Rural Ob/Gyn And Midwifery Clinic, Nadia S. Fletcher

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Purpose: Women’s childbirth experience can have long-term consequences on overall health and well-being of the parents and infant. Evaluating individual’s perspectives of maternal care received allows for appropriate assessment and improvements in the quality of care provided to ensure positive, evidence-based and respectful care. This project’s aim is to develop a formalized method of evaluating patient’s satisfaction with perinatal care delivered at a rural Ob/Gyn and Midwifery clinic with the intent of improving care.

Methods: A childbirth experience questionnaire was developed using a validated tool, the Norwegian Pregnancy and Maternity Care Patients’ Experiences Questionnaire (PreMaPEQ), and direct input from providers …

Evaluating A Hospital-Based Volunteer Doula Program In Vermont, Kiersten A. Wulff

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Background: Continuous labor support is a feature of high quality maternal healthcare, yet access to doulas is not universal. Hospital-based doula programs can minimize barriers to continuous labor support, and evaluation of hospital-based doula programs is needed. This project evaluated a pilot volunteer doula program at an academic medical center.

Methods: Sign-in process monitored volunteer activity. Likert scale surveys measured participant (RN and doula) perspectives. Likert scale surveys with a comment section measured patient experience. Survey results and sign-in sheets were analyzed using descriptive statistics. Patient comments were assessed for themes using NVivo software.

Results: Volunteer doulas (VD) (n=74) supported …

Onecare Vermont Aco Quality Metric Evaluation, Alexander Braun

Family Medicine Clerkship Student Projects

This project explores OneCare Vermont ACO quality metrics and how they can be used to improve patient care and reimbursement in a Vermont family medicine practice. Perspectives of physicians within the practice and others familiar with OneCare Vermont operations are shared. Several metrics were identified as areas for improvement within the practice by comparing ACO metrics with patient data.

How To Improve A Medication-Assisted Treatment Program For Opioid Use Disorder: First, Look At The Evidence, Collin York

Family Medicine Clerkship Student Projects

The prevalence of Opioid Use Disorder (OUD) in the United States has been described as an epidemic, and rural areas have been affected in particular. A treatment paradigm called Medication-Assisted Treatment (MAT) has been demonstrated to be effective at treating OUD, and more and more rural, primary care clinics are establishing MAT programs. One such clinic is Hudson Headwaters Health Network, a FQHC in Upstate New York. I wrote a literature review and distributed it to staff involved in MAT program design, and I also wrote a practical evidence guide for MAT providers. Providers completed a survey assessing the evidence …

Quality Improvement: Cervical Cancer Screening Rates Within Hudson Headwaters Health Network, Dylon K. Gookin

Family Medicine Clerkship Student Projects

Nearly 8 out of every 100,000 people are diagnosed with cervical cancer each year. However, powerful screening tools exist that enable us to detect and manage cervical changes before they develop into cervical cancer. In spite of this, cervical cancer screening rates remain low for many providers. This public health project sought to identify and address a cause for low cervical cancer screening rates within the Hudson Headwaters Health Network. A literature review determined that education and mailed invitation letters were proven methods for improving cervical cancer screening rates. Following a review of the local population demographics, West Mountain Health …

Using Design Thinking To Help Practitioners And Front Desk Staff Schedule Follow Up Appointments, Jhaimy Fernandez

Family Medicine Clerkship Student Projects

Due to an increase of calls at the front desk, Western Connecticut Health Network has systemized scheduling through call centers. In Newtown Family Medicine, clinical staff become responsible for helping patients navigate between two call centers in order to schedule appointments or schedule imaging. I used design thinking to create stickers that saved practitioners time explaining the process and decrease patient confusion.

Combating Diabetes In Chittenden County: A Healthcare Provider Referral Campaign To Increase Patient Participation In The Vermont Diabetes Prevention Program, Samantha Magier

Family Medicine Clerkship Student Projects

As of 2016, diabetes affects more than 29 million people in the United States and is the 7th leading cause of death nationwide. In Vermont, 1/10 people are diagnosed with either diabetes or prediabetes, with 6% of Vermonters affected by prediabetes and 5% of Chittenden Country affected by prediabetes. The public health burden of this chronic disease is immense: diabetes costs Vermont an estimated $543 million each year and is the leading cause of kidney failure, lower limb amputations, and adult-onset blindness. Prediabetes occurs when blood sugar is higher than normal but not at the diagnostic threshold of diabetes. Prediabetes …

Optimizing Transitional Care Management, Mary Katherine Lopiccolo

Family Medicine Clerkship Student Projects

Since the institution of the Transitional Care Management billing codes by the Centers for Medicare and Medicaid Services in 2013, primary care practices nationwide have worked to meet expectations and provide high-quality care to patients upon discharge from hospitalization. In St. Albans, Vermont, the complexity of preparing for successful transitions of care has challenged family medicine providers and supporting staff. Thus, this project sought to provide a structured process by which the primary care team may communicate with inpatient staff, the patients, and each other and collect information required to ensure smooth transitioning of the patient back into the setting …

Asthma, Alicia Jacobs Md

Family Medicine Scholarly Works

Improving asthma management includes improving provider education on asthma management, operational use of spirometry, provider competency in spirometry interpretation and use of a chronic disease platform in our electronic medical record to ensure adherence to current national guidelines. Key concepts in improving clinical asthma management are reviewed.