Medicine and Health Sciences Commons^™

Increasing Hpv Vaccination Rates In Residents' Primary Care Clinics, Normonique Dyer, Do, Amman Bhasin, Md, Abdul Ekiyoyo, Md, Umma Fatema, Md, Ilana Goldberg, Md, Chukwuemezie Mamanu, Md, Tamar Wolinsky, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

• The human papillomavirus (HPV) vaccine was approved in 2014 for the prevention of anogenital, cervical, and oropharyngeal cancers in female and male adolescents up to 26 years of age^1,2
• Data compiled from multiple clinical trials performed between 2006 and 2018 sought to evaluate benefit from extending the vaccination age given the implications on improving quality of life, morbidity/mortality, and reducing overall healthcare costs for preventable diseases³
• Results showed that increasing the vaccination age up to 45 in both males and females could offer additional protections against high-risk oncogenic strains of the HPV virus3
• Current recommendations from the …

Timely Ambulatory Follow Up After Emergency Department Discharge, Kevin Endersby, Jackson Weber, Marisyl De La Cruz

Health Equity and Quality Improvement (HEQI) Summit

Background

Problem Statement:

Patients over the age of 65 lack timely ambulatory follow up after discharge from the ED, leading to increased return to the ED, resource utilization, and mortality.

Project AIM:

Within 6 months of intervention, 70% of patients over the age of 65 who were recently discharged from the ED will follow up with their PCP within 7 days of the timeline recommended by the ED provider.

Improving Site-Specific Sti Screening In A Philadelphia-Based Academic Family Medicine Office, Brittany Macdonald, Md, Marie Ezran, Md, Haley Smallwood, Md, Gisel Garcia, Md, Maia Mandel, Md, Amaka Amobi, Md, Marshal Miller, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

• In the last decade, rates of sexually transmitted infections (STIs) are rising both in Philadelphia and across the United States^{1, 2}
• STIs are often asymptomatic³
• Site-specific screening for gonorrhea and chlamydia (GC/CT) infections may increase STI detection o Genitourinary (GU), pharyngeal, and rectal sites o GU is the most common site tested, but GU-only testing may lead to missed diagnoses⁴

The Association Of The G8 Questionnaire With Treatment Side Effects And Unscheduled Care Among Older Adults With Bladder Cancer, Umma Fatema, Md, Amman Bhasin, Md, Michael Zimmerman, Md, Julia Palecki, Md, Kendall Ozorowski, Kristine Swartz, Md, Kevin Zarrabi, Md, Kuang-Yi Wen, Phd

Health Equity and Quality Improvement (HEQI) Summit

Background

• The average age of people when they are diagnosed with bladder cancer is 73
• Bladder cancer in the geriatric population is often complicated by the presence of comorbidities and this population is at increased risk of experiencing short-term and long-term toxicities
• This necessitates a multimodal treatment approaches with a careful balance between efficacy and toxicity management
• The G8 questionnaire, a geriatric assessment tool, is designed to identify frailties and health risks in older patients, guiding healthcare professionals in tailoring treatment
• The aim of the study is to determine the predictive value of the G8 scores for adverse treatment outcomes …

Knowledge And Receptiveness Of Epidural Labor Analgesia By Parturients At Two Teaching Hospitals In Rwanda: A Cross-Sectional Study, Casey Fishman, Ba, Justin Do, Bs, Richita Bashyal, Mph, Fidele Hakorimana, Md

Health Equity and Quality Improvement (HEQI) Summit

Introduction

• Pain during labor can result in lasting psychological and physiological effects.¹ Although epidural analgesia is a first line pain management treatment and is used to reduce birth complications in many western countries, it is not commonly used in much of the world including Rwanda. The literature shows that African women have some of the lowest rates of pharmacological pain relief usage.
• Barriers to accessibility include; availability of equipment, staff with sufficient skills and monitoring, or myths and controversies surrounding labor.² Studies have found that some women believe that crying is a sign of weakness.³
• The aim …

Procedural Realignment To Ensure Superb Hypertension Regulation: The Presher Study, Eleni Florakis, Md, Emily Khantses, Md, Bret Mccarty, Md, Jeffrey White, Md, Jason Ojeda, Md

Health Equity and Quality Improvement (HEQI) Summit

Problem Definition

Hypertension (HTN), defined by the American Heart Association as systolic blood pressure (SBP) over 130 mm Hg or diastolic blood pressure (DBP) over 80 mm Hg, remains a major health concern worldwideas it leads tocongestive heart failure, chronic kidney disease, and stroke. Blood pressure control is an important task for the primary care physician (PCP). However, adequate management remains suboptimal as nearly half of US adults have uncontrolled high blood pressure.

After reviewing selected patients in our primary care office and discussing with our stakeholders, we found that more than two-thirds (69%) of uncontrolled hypertensive patients from a …

Incidental Coronary Artery Calcification: A Low-Hanging Fruit With Life-Prolonging Potential, Ryan Gardner, Md, Youssef Elfatatry, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

Problem Statement:

Incidental coronary artery calcium (CAC) seen on ungated computerized tomography (CT) scans obtained for various clinical reasons can serve as an excellent opportunity for screening of patients with previously undiagnosed coronary artery disease (CAD). Despite this, studies have shown that these findings are rarely reported in final impressions of radiology reports.

Project AIM:

To propose the use of a natural language processing (NLP) algorithm to identify incidental CAC noted in radiology reports and an electronic alert to notify primary care clinicians of such findings.

Addressing The Rates Of Contaminated Blood Cultures In The Tjuh Ed, Marina Gonzalez, Md, Trishya Srinivasan, Md, Bertilia Tavárez, Md, Natasa Kostic, Md, Virginia Gonzalez, Md, Kathleen Quinn, Bsn Rn-Bc, Michael Dong, Md

Health Equity and Quality Improvement (HEQI) Summit

Background & Aim

Blood culture contamination is a common, yet underrecognized, adverse event within emergency departments (ED). Through root cause analysis, this project identified barriers to using standardized blood culture collection techniques in the TJUH (Thomas Jefferson University Hospital) ED.

After incorporating our proposed interventions, we aim to reduce the percentage of contaminated blood cultures to

Improving Time To Mri In The Emergency Room For Spinal Epidural Abscesses, Karim Hafazalla, Md, Angeleah Carreras, Ms, Sean Mcgann, Md, Scott Faro, Md, Adam Flanders, Md, Richard Schmidt, Md, James Harrop, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

Magnetic resonance images (MRI) is integral in assessing pathology. This is especially true in the emergency room (ER), where delays in diagnosing emergent neurologic pathologies, including spinal epidural abscesses (EDAs), where the morbidity can be severe if not addressed in time. This study aims to implement an expedited imaging pathway for this urgent / emergent pathology.

Finding Ways To Decrease The Number Of Pediatric Type 1 Diabetes Patients With A Hba1c Over 8.5%, Abigayle Hoover, Bs, Ashley Medina, Dhsc, Kimberly Shoe Moyer, Apm, Evan G. Graber, Do, Patrick C. Hanley. Md

Health Equity and Quality Improvement (HEQI) Summit

Background

Problem Statement:

Hemoglobin A1c is the standard of care for monitoring the metabolic control of patients with Type 1 Diabetes.¹ Patients should have HbA1c checked every 3 months.

Higher HbA1cs are linked to higher morbidity and mortality in patients with diabetes.²

Project AIM:

Develop, implement, and evaluate different methods to engage patients with an

Social Needs Screenings Programs: Factors For Success, Varun Jayanti, Akshay Krishnan, Zachary Goldberg, Md, David Nash, Md, Mba

Health Equity and Quality Improvement (HEQI) Summit

Abstract

Introduction: In January 2024, the Centers for Medicare and Medicaid Services (CMS) implemented Health Quality Measure (HQM) 487, which required participating hospitals to annually screen admitted patients for the 5 domains of the Social Determinants of Health (SDOH). These requirements allowed hospitals to develop individualized, but compliant, screening programs. Previous SDOH screening research has focused on measurement tools, but not the mechanisms of screening present in various hospitals.

Research Objectives: This study will investigate the mechanism(s) for a social needs screening program (which is reflective of underlying SDOH disparity) in a large, multi-hospital academic health system in the Northeastern …

Improving Head Ct Utilization After Traumatic Intracranial Hemorrhage According To The Modified Brain Injury Guidelines (Mbig), Mathews Lan, Md, Michael Baldassari, Md, Caitlin Ritz, Md, Tyler Alexander, Bs, Richard Schmidt, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

Problem Statement: There are subsets of patients with traumatic intracranial hemorrhage who are low-risk for clinically significant hemorrhage expansion and/or neurologic deterioration requiring procedural intervention, yet these patients often undergo multiple serial head CT’s requiring an extended length of stay that may not be necessary. The Brain Injury Guidelines^1,2 (BIG) and subsequent modified Brain Injury Guidelines³ (mBIG) sought to categorize these low-risk subsets and provide an algorithm for more efficient care for these patients.

Project AIM: For low-risk patients with traumatic intracranial hemorrhage (specifically mBIG 2), we aim to reduce the number of head CT’s during admission …

Key Stakeholder Perceptions Of Doula Support For Persons With Perinatal Opioid Use Disorder, Meghan Gannon, Phd, Msph, Dennis Hand, Phd, Vanessa Short, Phd, Taylor Carrubba, Grace Thiele, Samantha Pancoe, Sarah Lawson, Nadia H-Yazdi, Phd, Scott Keith, Phd, Diane Abatemarco, Phd

Health Equity and Quality Improvement (HEQI) Summit

Background

• Maternal child health disparities are prevalent among pregnant and parenting women in treatment for opioid use disorder (OUD).
• Doulas have been utilized as a perinatal support in other vulnerable populations to increase healthcare utilization and improve birth outcomes.
• While research demonstrated that doula services can be feasibly implemented for populations experiencing poverty and trauma, there are limited studies to support that this could be true for patients with OUD as well.

Improving Provider Teach-Back Rates Among Patients With Limited English Proficiency, Bojan Lazarevic, Raghda Bchech, Md Aahivs

Health Equity and Quality Improvement (HEQI) Summit

Background and Aim

• Low personal health literacy is a social risk and is associated with worse health and health outcomes.¹
• Patients with limited English proficiency (LEP) are at greater risk for lower personal health literacy.²
• Patients with LEP also report more difficulty understanding medical situations and medication use than their English proficient counterparts.³
• Teach-back has been shown to improve post-visit comprehension of self-care after diagnosis, as well as understanding of medications and necessary follow-up, in patients with LEP.⁴
• The “5Ts” for teach back provides clinicians with an excellent counseling format for all encounter types.⁵
• Aim …

Student Pharmacists Educating Patients On Proper Disposal Of Unused Opioid Medications, Ashley Ann Uy, Jessica Cao, Anthony Esposito, Colleen Carrigan, Siddharth Pant, Ashley Kim, Kaylen Louie, Efrain Santiago, Richard Pacitti, Pharmd, Mba, Fashp, Joseph Stavish, Pharmd, Msph, Nicholas Leon, Pharmd, Bcacp, Fcpp

Health Equity and Quality Improvement (HEQI) Summit

Background

• The opioid epidemic is a public health crisis characterized by illicit drug abuse like heroin, fentanyl, and opioid medications (oxycodone and morphine)
• Improper disposal of unused opioids contribute to the opioid epidemic
• Jefferson Health places high importance on opioid stewardship to mitigate the public health risks associated with unused opioids.

Evaluating Patient Satisfaction Of Medication Education In Oncology, Christina Lew, Pharmd, Bcps, Rose Dimarco, Pharmd, Bcps, Bcop, Maria Hafez, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

• Optimization of medication education is important in promoting patient adherence, improving outcomes, and managing toxicities.
• With the increasing complexities of cancer treatments and an aging population, patient understanding is critical. In addition, chemotherapy is associated with toxicities that often require supportive care management.
• Historically, institutions and providers decide upon the type, format, and amount of information provided to patients.
• The aim of the project is to assess patient understanding of information provided in clinic, retention of information after clinic, and patient satisfaction.

Early Identification Of Hospitalized Patients Lacking Prescription Drug Insurance, Nicholas Macdonald, Md, Matthew Tucker, Md, Phoebe Chun, Md, Liam Heneghan, Md, Sawyer Kieffer, Md, Megana Murugesh, Md, Yair Lev, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

According to 2021 data from the US Department of Health and Human Services, 16% of persons in the United States under the age of 65 do not have prescription drug insurance.1Unsurprisingly, prior investigations have shown that the presence of prescription drug insurance is associated with reduced probability of hospital admission and length of stay for many common medical conditions.2A large majority of hospitalized patients are started on at least one new medication at the time of hospital discharge. Increasing the proportion of individuals with prescription drug insurance would have a substantial benefit on our population's health.

One care gap …

Lung Cancer In Immunosuppressed Patients, Garrett Melby, Andrew Bernstein, Md, Matthew Tucker, Md, Julia Palecki, Md, Zoe Begun, Md, Amman Bhasin, Md, Tingting Zhang, Phd, Ida Micaily, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

- Lung cancer is the #1 cause of cancer-related mortality in U.S. adults

- Immune evasion is a key mechanism in tumor cell proliferation

• Immunosuppressed patients have higher lung cancer incidences and worse lung cancer outcomes

- Success of immunotherapies supports the role of host immune function in host tumor response

• Studies have shown immunotherapy to be safe and effective in a variety of immunosuppressed populations
• Immunosuppressed patients are often excluded from immunotherapy trials and under-treated with immunotherapy compared to immunocompetent cohorts

- This study aimed to assess the disease course, PD-L1 expression, and utilized treatment modalities across patients …

Improving Post-Operative Educational Handouts After Spine Surgery, Arbaz A. Momin, James Harrop

Health Equity and Quality Improvement (HEQI) Summit

Background

Problem Statement: After spine surgery, patients are given take home instructions which are outdated and provide limited answers to frequently asked questions. This leads to increased office calls and overnight calls to on-call physician.

Project AIM:

• Improving educational handouts given to patients after spine surgery
• Aim is to analyze current handouts given to patients after spine surgery
• Identify frequently asked questions by patients after surgery

Bad Blood – A Patient Safety Analysis, Daniel Moylan, Md, Jonathan Colon Sanchez, Md, Tatianna Branch, Do, Ryan Gardner, Md, Taha Awan, Md, Emily Custer, Do, Tram Phung, Md, Sandy Samuel, Md, Gabrielle Mangan, Rn, Tamar Wolinsky, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

Context: In this patient safety analysis, the authors review a case in which a patient’s labs collected in a large, quaternary care hospital's ER demonstrated concerning results that significantly deviated from labs drawn only hours prior

Problem Statement: The suspected mislabeling of patient labs resulted in a near-miss for the identified patient and unknown consequences for a second patient

Project AIM: Determine the root causes of this error and identify mechanisms to improve patient safety by reducing the incidence of similar errors

Pharmacist-Assisted Insulin Titration In Primary Care To Improve Diabetes Outcomes, Megana Murugesh, Md, Alisha Goyal, Michael Kelly, Pharmd, Emily Scopelliti, Pharmd, Barbara Simon, Md, Aparna Sarin, Md, Mph

Health Equity and Quality Improvement (HEQI) Summit

Background

Problem Statement: Approximately, 90% of patients with Type 2 Diabetes (T2DM) are treated by primary care providers (PCPs) and with a growing aging population, and a shrinking primary care workforce, the demand for PCPs to provide care to diabetics is only expected to further worsen.

Despite novel therapies in T2DM, insulin remains a mainstay in treatment. Titrating insulin is a tedious and time-consuming task, requiring frequent follow-ups and lengthy conversations, increasing the burden of care on PCPs.

Project AIM:

1. Assess efficacy of pharmacy–assisted insulin titration in T2DM in achieving glycemic control by monitoring blood glucose and A1c changes
2. Evaluate …

Interprofessional Pilot Approach To Standardizing Nursing-Provider Driven Postpartum Urinary Retention Protocol, Mymy Nguyen, Mary Van Schaick, Md, Charlette E. Williams, Md, Anne Bocage, Md, Julia Switzer, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

Problem Statement: Postpartum urinary retention is a frequent cause of distress to new mothers, affecting 1 in 500 patients¹. It is imperative that patients receive prompt diagnosis and management to avoid long term sequelae of urogenital tract morbidity, including detrusor damage and bladder rupture². Although hospital protocols for urinary retention in the non-obstetric setting exist, management of urinary retention in the postpartum setting often varies by nursing-provider preference.

Project AIM: In this QI project, we developed a standardized protocol for postpartum urinary retention, and a comprehensive training model for provider and nursing teams. We assessed …

Viral Hepatitis And Hiv Screening Amongst Inpatients With Substance Use Disorder, Christine Papastamelos, Md, Elizabeth Novick, Md, Carolyn Kramer, Md, John Zurlo,Md, Nikhil Seval, Md, Daniel Taupin, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

• ~67,000 individuals in Philadelphia county are estimated to be living with opioid use disorder (OUD).¹
• Persons who inject drugs (PWID) are at disproportionately greater risk of acquiring HIV and viral hepatitis compared to the general public.²
• PWID are less likely to receive timely HIV and viral hepatitis screening in the outpatient setting given complex biopsychosocial barriers, including homelessness, mental illness, lack of insurance, incarceration, and stigma.^3,4

Developing A Taskforce To Improve Digital Health Equity, Samuel Wilson, Natalia Queenan, Julianna Lenoir, Alexzandra Gentsch, Jay Trivedi, Rohith Tudi, Nikita Nair, Akshay Krishnan, Andrew Vanichkachorn,, Tien Vu, Alexandra Cohen, Eleanor Jenkins, Marissa Witmer, David Rigas, Jeffrey Ndubisi, Isabella Muti, Kristin Rising, Md

Health Equity and Quality Improvement (HEQI) Summit

Our Population

• Thomas Jefferson University Hospital (TJUH) is a tertiary care center and L1 trauma center, and we serve patients from all areas in Philadelphia for acute health crises
• In Philadelphia, major disparities exist regarding health factors and health outcomes
• When stratifying by neighborhood or zip code, these disparities become even more apparent
• Several studies have also shown that these geographic demarcations coincide with racial disparities for access to health resources, like primary care physicians, COVID-19 vaccinations, and public health interventions
• Accessibility of health resources for our inpatients is thus highly variable.

Medication Access Barriers To Hepatitis C Anti-Viral Therapy Following Transplantation Of Hepatitis C Positive Donors Into Hepatitis C Negative Recipients, Harry Rockower, Md, Sarah Yeager, Pharmd, Jami Schulte, Pharmd, Dagan Coppock, Md, Jonathan Fenkel, Md, Katherine Belden, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

• Over the past decade there has been a paradigm shift in solid organ transplantation with the use of Hepatitis C (HCV) positive donor organs for HCV negative recipients.
• This evaluation looks through the lens of insurance approval for direct acting antivirals (DAA) and the process needed for obtaining and ensuring affordability of these medications.
• While the AASLD/IDSA guidelines recommend early initiation of pangenotypic DAA therapy after organ transplant without the need to confirm recipient viral replication many centers often initiate the DAA approval process after viremia is detected due to insurance barriers.¹
• The process for obtaining insurance approval …

The Road To Equity: A Look At Medical School Interview Scores, Priyanga Selvakumar, Bs, Anjali Upadhyaya, Bs, Ashley B. Zhang, Bs, Ms, Alix Masters, Md, Bernard Lopez, Md, Alisa Losasso, Md

Health Equity and Quality Improvement (HEQI) Summit

Introduction and Objectives

• African Americans and other racial minorities remain underrepresented in medicine (UIM)¹, as do LGBTQ+ individuals.²
• Lack of physician diversity likely contributes to and exacerbates existing healthcare disparities.³
• Addressing medical school admissions is an appropriate target to improve overall physician diversity as the U.S. medical school populations critically lacks diversity which further perpetuates the problem.
• Few studies have focused on the medical school interview process as a potential site of bias, and there are no studies to date discussing the bias that may stem from faculty interview reports.

Objective

To investigate the medical school …

Resumption Of Anti-Platelet/Anticoagulation Therapy Following Lumbar Spine Surgery, Stephanie Serva, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

Problem Statement:

• No current guideline or protocol for AC/AP resumption in neurosurgical spine patients at TJUH
• There is difficulty in providing consistent perioperative anticoagulation recommendations to patients, as there remains no widely accepted, definitive literature of evidence or guidelines (Louie et al, 2020)

Project Aims:

• To determine standardized protocol for resuming antiplatelet/anticoagulation therapy following lumbar surgery
• To reduce combined postoperative cardiac/cerebrovascular/thrombotic events, and post-operative hematomas

Cardiology Referrals For African-American Basketball Players Falls Below Expectation, Vacha Shah, Blaise O'Malley, Douglas Corsi, Avinash Saraiya, Margaret Doyle, I. Masood, Brian Osler, A. Hajduczok, David Shipon

Health Equity and Quality Improvement (HEQI) Summit

Background

Problem Statement:

• Rates of sudden cardiac death due to hypertrophic cardiomyopathy are higher in male African American basketball players compared with White players (Maron, 2003)
• Male African American NCAA Division I basketball players have the highest incidence of sudden cardiac arrest and death between the ages of 11 and 29 (Peterson, 2020)
• Retrospective analysis of the HeartBytes Registry collected by Simon’s Heart Organization identified multiple risk factors, such as asthma and sickle cell anemia, higher in this population than in the general population
• Increased murmurs and EKG abnormalities such as ST-segment depressions and other nonspecific changes are present in …

Early Non-Invasive Monitoring Of Fatty Liver Disease Using Emr Software, Franklin L. Thelmo, Do Jr., Eric J. Shiffrin, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

• Problem: Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD) and Metabolic Dysfunction-Associated Steatohepatitis (MASH) are liver diseases that have rapidly increased in the population over the last few years and are becoming an evercommon cause of liver failure and the need for liver transplant. Disease presence long predates concerning symptoms and many individuals will not be made aware until after the diseased has progressed in severity. Earlier intervention is often inhibited due to the need of invasive biopsy or specific lab testing not easily available leading to significant underdiagnosis of patients with early disease
• Project AIM: We sought to add a …

Streamlined Pre-Authorization Expedites Patient Discharges From Stroke Units To Rehabilitation Centers, Michael Vo, William Nguyen, Matthew Trotter, Jeffrey Zhou, Glenn A. Gonzalez, Eric Mong, Rene Daniel, Ross-Jordan Elliott, James Harrop

Health Equity and Quality Improvement (HEQI) Summit

Background

Problem statement: Patient discharge from neurosurgical stroke units to rehabilitation centers is a complex administrative and clinical endeavor involving a population often with cognitive and motor morbidity that can be intensified with extensive hospital length of stay (LOS).

Project aim: This project aims to analyze the change in LOS due to the introduction of liaisons, who advocate for and expedite pre-authorization, rounds, and plan of care establishment for patients with strokes.