Internal Medicine Commons^™

Longitudinal Study On The Effects Of Implementing Continuous Glucose Monitoring For The Management Of Patients With Type-I And Type-Ii Diabetes Mellitus On Multiple Insulin Injections In An Internal Medicine Residency Clinic, Andrey Manov, Sukhjinder Chauhan, Gundip Dhillon, Athena Dhaliwal, Sabrina Antonio, Yema Jalal, Ashrita Donepudi, Jonathan Nazha, Melissa Banal, Joseph House

Far West Division GME Research Day 2023

No abstract provided.

Quiet At Night: Decreasing The Number Of Overnight Calls By Rounding At Night, Neil Gerts, Trevor Owens, Preetivi Ellis, Jasprit Takher

Far West Division GME Research Day 2023

No abstract provided.

Appeal: Advocating Polst Education And Adherence At End Of Life, Carlo Reyes, Susan Hickman, Neil Gerts, Mandeep Sablok, Jasprit Takher

Far West Division GME Research Day 2023

No abstract provided.

Improving Communication Between Nurses & Residents At Hca Florida Osceola Hospital, Juan T. Del Calvo, Mehuliben Upadhyaya, Sathvik Saineni, Minh Anh Le, Awiss Shalhoub, Olga Karasik

North Florida Division GME Research Day 2023

No abstract provided.

Improving The Blood Product Administration Process At Hca Florida Osceola Hospital, Kar Shun Constant Mak, Neha Meda, Natalia Tejada, Parasto Asnaashari, Joshua Sutarwan, Joshua Shultz, Maria Wallis-Crespo, Sarah Tinsley

North Florida Division GME Research Day 2023

No abstract provided.

Increasing Utilization Of The Fib-4 Score To Improve Appropriate Nafld Consultation, Fanny Stampfli Silva, Teayoung Kim, Omar Masarweh, Stephanie Lopez Orizondo, Mohammed Rahhal, Feras Al-Moussally

North Florida Division GME Research Day 2023

No abstract provided.

The Role Of Telehealth In Reducing Hospital Readmissions For Heart Failure Patients, Tommy Lee Bratcher

Graduate Theses, Dissertations, and Capstones

Heart failure affects over six million people annually, and is expected to increase to over eight million by 2030. Over 60 million people live in the rural United States. Telehealth is a tool to improve access to care, provide early intervention, and follow up with patients within 48 hours of a hospital discharge. Utilizing Telehealth to conduct a medication reconciliation within 48 hours of discharge to address any medication errors or admission, and reinforce adherence is a way to improve access to care to those living in rural areas.

Going From An Academic Medical Center To A Community Hospital: Patient Experiences With Transfers, Alexander Kazberouk, Nicole Boyd, Sandra Oreper, Michael Chang, James D. Harrison, Priya A. Prasad, Ari Hoffman

Patient Experience Journal

Academic medical centers (AMCs) often operate at or near full capacity, which leads to delays in care while smaller community hospitals may have excess capacity. To address this issue and to match patient needs to care acuity, patients may be transferred from an AMC emergency department for direct admission to a community hospital. We aimed to explore the experiences and perspectives of patients who were transferred. We randomly selected patients transferred between February 2019 and February 2020. We conducted structured thirty-minute interviews containing fixed response and open-ended questions focusing on the transfer rationale and experience, care quality, and patient financial …

Optimizing Oxygen Therapy, Gizam Gokalp, Ramez Massoud, Jopher Bernal, Guru Chinnaraj, Michael Delzoppo, Nicole Brenner

North Florida Division GME Research Day 2022

No abstract available.

Physician And Patient Moves In The Hospital Do Not Move Patient Satisfaction: A Single-Center Retrospective Analysis, Basil George Verghese, Nagesh Jadhav, Walter A. Polashenski, Carl H. Reynolds

Advances in Clinical Medical Research and Healthcare Delivery

Background. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a standardized survey for measuring patient's experiences at US hospitals. There is a shift towards geographically assigning patients and physicians. However, its impact on patient satisfaction scores has not been studied.

Objective: Examine the correlation between patient experience and overall hospital rating with the number of physicians seen and the number of times the patient was moved during a hospitalization.

Methods: A retrospective observational study was performed using select HCAHPS & Press Ganey survey questions to assess physician satisfaction scores and overall hospital rating and recommendation scores.

Results: There …

Implementation Of A Drive-Through Covid-19 Mass Vaccination Site: Experiences From Louvax–Broadbent In Louisville, Kentucky, Ruth Carrico, Sarah Beth Hartlage, Valenchia Brown Msn, Aprn, Fnp-C, Sarah M. Bishop, Luanne Didelot, William Hayden, Beverly Williams Coleman, Sarah Tan, Delanor Manson, Kellie Kane, Dawn Balcom, Paul Kern

The University of Louisville Journal of Respiratory Infections

Background: Response to the COVID-19 pandemic has required innovative approaches to vaccination, including methods to rapidly and safely immunize communities. A major challenge to such a response involved access to untapped healthcare worker resources. The Louisville, Kentucky, response involved the use of a large volunteer workforce to supplement local public health employees in planning and implementing a large-scale drive-through vaccination event. The objective of this manuscript was to outline processes involved in training a mass immunization workforce and implementating a large-scale COVID-19 community vaccination.

Approach: Competency-based and standardized training was provided for every volunteer before working their shift. Volunteers worked …

Catheter-Associated Urinary Tract Infections: Patient Characteristics, Treatment, And Clinical Outcomes In One South Texas Acute Care Hospital, Kimberly A. Ambrosini, Jose Campo Maldonado

MEDI 9331 Scholarly Activities Clinical Years

Background: Catheter-associated urinary tract infections (CA-UTIs) account for 40 percent of nosocomial infections worldwide. Their elimination is at the forefront of quality improvement in one South Texas acute care hospital.

Methods: Over a period of 6 months, five CA-UTIs occurred in one South Texas acute care hospital. These cases were identified via regular surveillance by Infection Prevention staff and the Laboratory Department of the hospital. This research reviews patient age, sex, length of stay, bacteria contracted, appropriate antibiotic use, patient characteristics, and overall outcomes.

Results: Between the months of July and December 2021, 5 CAUTIs were contracted. Patients …

Optimizing Secure Patient Messaging Workflow In A Vermont Primary Care Clinic, Kimberly S. Oleary

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

Optimizing Secure Patient Messaging Workflow in a Vermont Primary Care Clinic

Kim O’Leary, DNPc, RN

DNP Advisor: Margaret Aitken, DNP, AGNP, ANP-BC

Site Mentor: James Williamson, MHA, Site Supervisor, Adult Primary Care

Background: Secure patient messaging is a popular tool designed for non-urgent questions, yet patients sometimes use it to relay urgent concerns. As office workflows tend to prioritize responses to other methods of communication, this presents a potentially unsafe situation in which clinical staff may not respond to these urgent messages in a timely manner.

Purpose: To develop a methodology to improve the timeliness, effectiveness, and safety of secure …

Increasing The Rate Of Pneumococcal Vaccination In Patients Over 65 At Hca Florida Osceola Primary Care, Ubaldo Gonzalez Morales, Muna Alhusban, Chelsea Guan, Natalia Cavin, Humeyra Dogan, Allison Ferrara

North Florida Division GME Research Day 2022

No abstract available.

Improving Recombinant Zoster Vaccination Rates In Patients Receiving Biologic Therapy In The Rheumatology Clinics At The Orlando Va Healthcare System, Kathlyn Camargo Macias, Taylor Kann, Marilyn Mosquera, Ravi Shahu Khal, Ashwini Komarla

North Florida Division GME Research Day 2022

No abstract available.

Improving Code Status Discussion And Documentation For Patients 65 Years Or Older At Hca Fl Osceola Hospital, Taylor Murphy, Mark Duros, Faris Matanes, Keishla Garcia Fernandez, Raj Shah, Olga Karasik

North Florida Division GME Research Day 2022

No abstract available.

Improving Healthcare Team Recognition By Patients, Abhijit Marathe, Tin Pham, Semeon Tadesse, Franca Samoilovich, Manuel Egued, Joshua Shultz, Ashwini Komarla, Olga Karasik

North Florida Division GME Research Day 2022

No abstract available.

Perfecting The Art Of Consultation, Ana Ledo, Hannah Vansumeren, Aaron Verbeelen, Geover Virella, Anwar Alshaakh Mohd Mari, Manuel Carrazana

North Florida Division GME Research Day 2022

No abstract available.

Feasibility Of A “Network Of Champions” In Implementing A Program To Address Physician Well-Being, Kerri Palamara, Sara Poplau, Cheryl Rusten, Maria L. Walter, Cynthia D. Smith, Clare Sipler, Susan Hingle, Mark Linzer

Journal of Wellness

Introduction: Healthcare leaders have been challenged to mitigate burnout and foster well-being among physicians. Professional societies are beginning to address this in a systematic manner.

Methods: In 2014, the American College of Physicians (ACP) endeavored to improve well-being for its 160,000 members of internists and trainees through a Well-being Champion (WBC) program based in the majority of its 85 national and international chapters. The program was supported by an evidence-based curriculum, chapter volunteers who served as champions, and in-person and virtual trainings. Training included a 1-2 day program in 2018 and 2019, focused on educating champions on causes …

Self-Measured Blood Pressure Monitoring: A Patient Empowerment Project, Alison Cusmano

Doctor of Nursing Practice Final Manuscripts

Hypertension is a public health issue estimated to affect 112 million adults by 2030. Primary care patients in an outpatient clinic in Southern California with elevated blood pressure readings in the office did not have an organized system for close follow-up. The purpose of this evidence-based project (EBP) was to educate patients on self-measured blood pressure monitoring (SMBP), Dietary Approaches to Stop Hypertension (DASH), diet interventions, and healthy weight loss to improve hypertension rates. Through these interventions, patients developed an understanding of their systolic and diastolic blood pressure goals. Nurse practitioners, medical assistants, and licensed vocational nurses screened for high …

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 …

Increasing Breast, Cervical, And Colorectal Cancer Screenings: A Qualitative Assessment Of Barriers And Promoters In Safety-Net Practices, Laura A. Brady, Laurene M. Tumiel-Berhalter, Laura A. Schad, Alexandrea Bentham, Karen Vitale, Amanda Norton, Gary Noronha, Carlos Swanger, Christopher P. Morley

Journal of Patient-Centered Research and Reviews

Purpose: Breast, cervical, and colorectal cancer screening rates are suboptimal in underserved populations. A 7-year quality improvement (QI) project implemented academic detailing and practice facilitation in safety-net primary care practices to increase cancer screening rates. This manuscript assesses barriers and promoters.

Methods: Primary care practices providing care to underserved patients were recruited in New York cities Buffalo, Rochester, and Syracuse. Enrollment totaled 31 practices, with 12 practices participating throughout. Annually, each practice received 6 months of practice facilitation support for development and implementation of evidence-based interventions to increase screening rates for the three cancer types. At the end of each …

Get America Talking: Implementing Advanced Care Planning In Primary Care, Sasha Recht

Doctor of Nursing Practice Final Manuscripts

Advanced Care Planning (ACP) is an essential part of providing adequate care in the primary care setting. Discussing end of life with patients can be a tedious and uncomfortable conversation for many providers, however, its continued avoidance contributes to the stigma of end of life care and may also result in significant healthcare cost expenditure with the use of unwanted invasive treatments. All providers should engage in consistent advanced care planning in order to improve patient and provider communication, improve patient satisfaction, increase advanced directives on file, reduce the stigma of the topic, and improve quality of life.

Boosting Patient Mobility And Function On A General Medical Unit By Enhancing Interprofessional Care, Audrey M. Johnson, Janice Kuperstein, Rachel Hogg-Graham, Preetham Talari, A. Kelly, Esther E. Dupont-Versteegden

Health and Clinical Sciences Faculty Publications

Low mobility during hospitalization remains prevalent despite associated negative consequences. The goal of this quality improvement (QI) project was to increase patient mobility and function by adding a physical therapist (PT) to an existing interprofessional care team. A mobility technician assisted treatment group patients with mobility during hospitalization based on physical therapist recommendations. Change in functional status and highest level of mobility achieved by treatment group patients was measured from admission to discharge. Observed hospital length of stay (LOS), LOS index, and 30-day all cause hospital readmission comparisons between treatment group and a comparison group on the same unit, and …

Optimizing Drug Prior Authorization Procedures For Primary Care, Lydia S. Vorsteveld

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

Title and Abstract

1. 1. Title

Optimizing Drug Prior Authorization Procedures for Primary Care

1. 2. Abstract

Background:

Medication prior authorization (MPA) is a cost containment strategy utilized by health plans. The payer, or health plan requires providers to obtain prior approval for plan coverage of a drug prescription. The list of drugs requiring MPA varies among health plans and is subject to frequent change. From 2007 to 2013 Medicare Part D increased MPA requirements by 38 percent (Hoadley, Summer, Hargrave, & Cubanski, 2014).

Methods:

Pre and post interventional surveys of primary care staff were used to gather descriptions of current MPA …

Strategies To Improve Timeliness For Cleaning Inpatient Rooms Following Patient Discharge, Lora Dixon, Mark Parker, Ruth Hanselman, Suneela Nayak, Amy Sparks

Operations Transformation

STRATEGIES TO IMPROVE THE TIME FRAME FOR CLEANING INPATIENT ROOMS BY ENVIRONMENTAL SERVICES

In an inpatient rehab hospital, it was noted that Environmental Services (EVS) was delayed in cleaning rooms between patient discharges and admissions. This resulted in the frequent use of a “stat clean” order that allows only 50% of the normal cleaning time , forcing patients to wait and impacting patient flow.

A root cause analysis demonstrated lack of communication between the rehab hospital and the contracted cleaning services. A number of counter measures were initiated with the goal that cleaning would be started within 20 minutes of …