Health Information Technology Commons^™

Determinants Of Behavioral Intent To Adopt The Closed-Loop Artificial Pancreas Among Diabetes Healthcare Providers, Carolyn M. Serrano

Seton Hall University Dissertations and Theses (ETDs)

Background and Purpose of the Study: Diabetes mellitus for both children and adults are broadly defined as a group of complex diseases characterized by high blood glucose, resulting from a defect in either the production of or action of insulin, or both (National Institutes of Health, 2014). There are 29.1 million people in the US that are estimated to have diagnosed or undiagnosed diabetes (Centers for Disease Control and Prevention (CDC), 2014). Type 1 diabetes accounts for approximately 5-10% of all diabetes cases however, it has serious short term and long-term implications (Daneman, 2006).

Technology for diabetes management is rapidly …

Reducing Symptom Distress In Patients With Advanced Cancer Using An E-Alert System For Caregivers: Pooled Analysis Of Two Randomized Clinical Trials, David H. Gustafson, Lori L. Dubenske, Amy K. Atwood, Ming-Yuan Chih, Roberta A. Johnson, Fiona Mctavish, Andrew Quanbeck, Roger L. Brown, James F. Cleary, Dhavan Shah

Health and Clinical Sciences Faculty Publications

Background: Symptom distress in patients toward the end of life can change rapidly. Family caregivers have the potential to help patients manage those symptoms, as well as their own stress, if they are equipped with the proper resources. Electronic health (eHealth) systems may be able to provide those resources. Very sick patients may not be able to use such systems themselves to report their symptoms but family caregivers could.

Objective: The aim of this paper was to assess the effects on cancer patient symptom distress of an eHealth system that alerts clinicians to significant changes in the patient’s symptoms, as …

Push For Progress Inspired Improved Outcomes, Jacob L. Bidwell

Journal of Patient-Centered Research and Reviews

The author and issue editor describes the changing faces of health care as well as movements undertaken by U.S. health systems over the last two decades to improve the treatment and documented outcomes of minority or impoverished patients and to understand the impact of cultural differences on patient care. While much progress has been made, achieving health equity will require the continued efforts of many working toward this goal.

Decreasing Time To Broad Spectrum Antibiotics For Septic Patients In The Emergency Department, Joseph J. Zieminski, Emily E. Bryant

Journal of Patient-Centered Research and Reviews

Background: Timely administration of broad spectrum antibiotics has been shown to be directly correlated with decreased mortality for patients with severe sepsis and septic shock. As such, both the Surviving Sepsis Campaign and the SEP-1 CMS measure recognize timely antibiotic administration as a cornerstone of therapy for patients with severe sepsis or septic shock.

Purpose: Decrease time to broad spectrum antibiotic administration for septic patients in the emergency department (ED) of Aurora St. Luke’s Medical Center.

Methods: An alert within the electronic medical record was created to more rapidly identify potentially septic patients in the ED. After receiving the alert, …

Geo-Spatial Reporting For Monitoring Of Household Immunization Coverage Through Mobile Phones: Findings From A Feasibility Study, Abdul Momin Kazi, M. Ali, Ayub Khan, Hussain Kalimuddin, K. Zubair, A.N. Kazi, Azmina Artani, Syed Asad Ali

Department of Paediatrics and Child Health

Background: The addition of Global Positioning System (GPS) to a mobile phone makes it a very powerful tool for surveillance and monitoring coverage of health programs. This technology enables transfer of data directly into computer applications and cross-references to Geographic Information Systems (GIS) maps, which enhances assessment of coverage and trends.
Objective: Utilization of these systems in low and middle income countries is currently limited, particularly for immunization coverageassessments and polio vaccination campaigns. We piloted the use of this system and discussed its potential to improve the efficiency of field-based health providers and health managers for monitoring of the immunization …

Lung Cytokines And Systemic Inflammation In Patients With Copd., Alessandra Morello Gearhart, Rodrigo Cavallazzi, Paula Peyrani, Timothy L. Wiemken, Stephen P. Furmanek, Andrea Reyes-Vega, Umair Gauhar, Hiram Rivas-Perez, Jesse Roman, Julio A. Ramirez, Rafael Fernandez-Botran

Faculty Scholarship

Rationale: Chronic obstructive pulmonary disease (COPD) is characterized by lung and systemic inflammation. The role of cytokines in local and systemic inflammation in COPD is not well understood. This study aimed to compare plasma and bronchoalveolar lavage (BAL) fluid cytokine levels in COPD and non-COPD subjects with the intent of better understand their potential roles in driving local and systemic inflammation.

Methods: This cross-sectional study analyzed data from 65 subjects: 31 with COPD confirmed by spirometry and 34 non-COPD controls. All subjects underwent spirometry, plasma sample collection, and bronchoscopy/BAL. Levels of 21 inflammatory cytokines were measured in the plasma (systemic …

Predicting Unplanned Transfers To The Intensive Care Unit: A Machine Learning Approach Leveraging Diverse Clinical Elements, Ben Wellner, Joan Grand, Elizabeth Canzone, Matt Coarr, Patrick Brady, Nathan Dean, +Additional Authors

Pediatrics Faculty Publications

Background: Early warning scores aid in the detection of pediatric clinical deteriorations but include limited data inputs, rarely include data trends over time, and have limited validation.

Objective: Machine learning methods that make use of large numbers of predictor variables are now commonplace. This work examines how different types of predictor variables derived from the electronic health record affect the performance of predicting unplanned transfers to the intensive care unit (ICU) at three large children’s hospitals.

Methods: We trained separate models with data from three different institutions from 2011 through 2013 and evaluated models with 2014 data. Cases consisted of …

Improving Type And Screen Specimen Collection Prior To Elective Surgery, Nordx Blood Bank Staff, Haley Pelletier, Suneela Nayak, Stephen Tyzik, Ruth Hanselman

Maine Medical Center

To avoid delays in the availability of compatible blood for elective surgery patients requiring transfusion, a type and screen specimen should be completed at least 24 hours prior to surgery. Baseline metrics in an acute care inpatient blood bank demonstrated a significant number of cases with no type or screen completed.

The objective of this KPI was to prevent any delays in providing compatible blood products to scheduled surgical patients. Several internal and external system issues were identified as a result of a root cause analysis and a number of actions were initiated.

Outcomes have been positive. Data collection post …

Abstracts From The 23rd Annual Health Care Systems Research Network Conference, March 21–23, 2017, San Diego, California

Journal of Patient-Centered Research and Reviews

This proceedings supplement includes selected abstracts presented at the 23rd annual conference of the Health Care Systems Research Network (HCSRN), held March 21–23, 2017, in San Diego, California. Formerly called the HMO Research Network, HCSRN aims to improve individual and population health through research that connects the resources and capabilities of its member health care systems.

Implementation Of An Innovative Early Warning System: Evidenced-Based Strategies For Ensuring System-Wide Nursing Adoption, Shirley S. Paulson

Doctor of Nursing Practice (DNP) Projects

Early deterioration in adult medical-surgical patients is associated with increased intensive care unit and hospital mortality (Goldhill, 2001). Failure to recognize deterioration is a preventable patient safety and quality issue. To address this problem, since 2013, Kaiser Permanente Northern California (KP NCAL) has piloted Advance Alert Monitor (AAM) at two hospitals. This early warning system employs a set of predictive models developed by the KP NCAL Division of Research, which automatically predicts patient deterioration within the next 12 hours based on a complex algorithm of laboratory and clinical data points. Improvements in mortality and length of stay have been realized …

Computer Administered Safety Planning For Individuals At Risk For Suicide: Development And Usability Testing, Edwin D. Boudreaux, Gregory K. Brown, Barbara Stanley, Rajani S. Sadasivam, Carlos A. Camargo Jr, Ivan W. Miller

Rajani S. Sadasivam

BACKGROUND: Safety planning is a brief intervention that has become an accepted practice in many clinical settings to help prevent suicide. Even though it is quick compared to other approaches, it frequently requires 20 min or more to complete, which can impede adoption. A self-administered, Web-based safety planning application could potentially reduce clinician time, help promote standardization and quality, and provide enhanced ability to share the created plan. OBJECTIVE: The aim of this study was to design, build, and test the usability of a Web-based, self-administered safety planning application. METHODS: We employed a user-centered software design strategy led by a …

The Motor Cortical Representation Of A Muscle Is Not Homogeneous In Brain Connectivity, Jo Armour Smith, Alaa Albishi, Sarine Babikian, Skulpan Asavasopon, Beth E. Fisher, Jason Kutch

Physical Therapy Faculty Articles and Research

Functional connectivity patterns of the motor cortical representational area of single muscles have not been extensively mapped in humans, particularly for the axial musculature. Functional connectivity may provide a neural substrate for adaptation of muscle activity in axial muscles that have both voluntary and postural functions. The purpose of this study was to combine brain stimulation and neuroimaging to both map the cortical representation of the external oblique (EO) in primary motor cortex (M1) and supplementary motor area (SMA), and to establish the resting-state functional connectivity associated with this representation. Motor evoked potentials were elicited from the EO muscle in …

Prenatal Care Enhanced With Digital Health Tools Can Reduce Visit Frequency While Improving Patient Satisfaction, Kathryn I. Marko, Nihar Ganju, Anish Sebastian, Joshua Benham

Medicine Faculty Posters and Presentations

100 low-risk obstetric patients were enrolled to evaluate the use of digital health technology in prenatal care. 50 patients were placed on an alternate prenatal care schedule (8 visits), supplemented with an integrated technology platform of a mobile application and connected devices including a wireless weight scale and blood pressure cuff. The remaining 50 control patients received routine care, without the technology platform. Patients were evaluated for satisfaction and engagement throughout pregnancy.

When One Is Sick And Two Need Help: Caregivers’ Perspectives On The Negative Consequences Of Caring, Ilja Ormel, Susan Law, Courtney Abbott, Mark Yaffe, Marc Saint-Cyr, Kerry Kuluski, Debbie Josephson, Ann C. Macaulay

Patient Experience Journal

Informal or family caregivers contribute significantly to individual care, and to the Canadian healthcare system, yet receive limited support from governments, institutions, and healthcare professionals in recognition of their role, or in response to their health and social care needs – often due to the negative consequences of caregiving. Learning about the diversity of others’ experiences can positively influence personal decision-making, reduce feelings of isolation, as well as promote adjustment to a personal situation. For caregivers, however, few resources exist that provide reliable information on others’ experiences. We collected the narratives of caregivers’ experiences of caring for someone with a …

Removing Barriers To Care For The Underserved: Provider And Patient Perception Of Direct To Consumer Telemedicine, Robert M. Grell, Rachel Hatcliffe, Sean M. Gillen, Craig Sable, Vanessa Grant, Matthew Ledda, Mary Fuska, Shireen Atabaki

GW Research Days 2016 - 2020

Purpose of Study: Lack of access to pediatric subspecialty care is a major barrier to pediatric health for underserved populations in the Washington DC, Virginia and Maryland area. Lack of access to transportation, long office wait times, and missed school and work are barriers that prevent access to subspecialty care. Direct to consumer (DTC) telemedicine provides this service to our underserved population by bringing care into their own home through use of computers, tablets, and smart phones.

Methods Used: Structured interviews of parents and providers were performed prior to implementation of a subspecialty DTC telemedicine program for underserved children in …

Mobile Health Interventions For Adult Obesity In The United States: Analysis Of Effectiveness And Efficacy, David P. Paul Iii, Keerthi Gochipathala, Alberto Coustasse, Bezawit Wodajo, Niharika Bhardwaj

Alberto Coustasse, DrPH, MD, MBA, MPH

The Unites States continues to struggle with the negative health effects associated with increasing population obesity, a problem which has been historically difficult, if not impossible, to solve. Mobile health applications represent a potential partial solution to this problem. We examine the existing literature on the effects of mobile health applications on body weight, waist circumference, BMI, and lifestyle, examining both physical findings as well as adherence, satisfaction and cost effectiveness. The use of mobile for weight reduction looks promising, but evidence is mixed, which is not surprising given the rapidly evolving nature of the mobile application field.

Impact Of Smartphone Digital Photography, Email, And Media Communication On Emergency Room Visits Post-Hypospadias Repair., Michael E. Chua, Megan A. Saunders, Paul R. Bowlin, Jessica M. Ming, Roberto Iglesias Lopes, Walid A. Farhat, Joana Dos Santos

Manuscripts, Articles, Book Chapters and Other Papers

INTRODUCTION: Advances in communication technology are shaping our medical practice. To date, there is no clear evidence that this mode of communication will have any effect on unnecessary postoperative emergency room (ER) visits. We aim to evaluate the effect of email and media communication with application of smartphone digital photography on post-hypospadias repair ER visit rates.

METHODS: This prospective cohort study included all patients who underwent hypospadias repair performed by a single surgeon from October 2014 to November 2015. Patients were categorized into two groups: Group A consented for smartphone photography and email communication and Group B declined. Reason for …

Telemedicine Coverage For Post-Operative Icu Patients., Tara Ann Collins, Matthew P. Robertson, Corinna P. Sicoutris, Michael A. Pisa, Daniel N. Holena, Patrick M. Reilly, Benjamin A. Kohl

Department of Anesthesiology Faculty Papers

Introduction There is an increased demand for intensive care unit (ICU) beds. We sought to determine if we could create a safe surge capacity model to increase ICU capacity by treating ICU patients in the post-anaesthesia care unit (PACU) utilizing a collaborative model between an ICU service and a telemedicine service during peak ICU bed demand. Methods We evaluated patients managed by the surgical critical care service in the surgical intensive care unit (SICU) compared to patients managed in the virtual intensive care unit (VICU) located within the PACU. A retrospective review of all patients seen by the surgical critical …

Feasibility And Usability Of Tele-Interview For Medical Residency Interview, Ali Pourmand, Hayoung Lee, Malika Fair, Kaylah Maloney, Amy Caggiula

Emergency Medicine Faculty Publications

Every year in the United States, medical students and residency programs dedicate millions of dollars to the residency matching process. On-site interviews for training positions involve tremendous financial investment, and time spent detracts from educational pursuits and clinical responsibilities. Students are usually required to fund their own travel and accommodations, adding additional financial burdens to an already costly medical education. Similarly, residency programs allocate considerable funds to interview-day meals, tours, staffing, and social events. With the rapid onslaught of innovations and advancements in the field of telecommunication, technology has become ubiquitous in the practice of medicine. Internet applications have aided …

Components Of Effective Cognitive-Behavioral Therapy For Pediatric Headache: A Mixed Methods Approach., Emily F. Law, Sarah E. Beals-Erickson, Emma Fisher, Emily A. Lang, Tonya M. Palermo

Manuscripts, Articles, Book Chapters and Other Papers

Internet-delivered treatment has the potential to expand access to evidence-based cognitive-behavioral therapy (CBT) for pediatric headache, and has demonstrated efficacy in small trials for some youth with headache. We used a mixed methods approach to identify effective components of CBT for this population. In Study 1, component profile analysis identified common interventions delivered in published RCTs of effective CBT protocols for pediatric headache delivered face-to-face or via the Internet. We identified a core set of three treatment components that were common across face-to-face and Internet protocols: 1) headache education, 2) relaxation training, and 3) cognitive interventions. Biofeedback was identified as …