Medicine and Health Sciences Commons^™

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.

Providing A Latch Key: Increasing Lactation Education For Medical Students, Elizabeth Wagman, Bs, Santosh Coorg, Md, Cheryl Godcharles, Md, Nabblem-C

Health Equity and Quality Improvement (HEQI) Summit

Background

• Problem Statement: Current Healthy People 2030 data suggests that only up to 25% of infants are exclusively breastfed at six months of life, but target rates are upwards of 40%. Though this trend is multifactorial, an actionable solution is to increase lactation education for residents and medical students to better equip them to counsel patients.
• Project AIM: We aim to increase provider comfort in lactation counseling by implementing lactation education, resources, hands-on training, and postpartum follow-up strategies for Thomas Jefferson University pre-clerkship/ rotating medical students and OB/GYN residents.

Socioeconomic Status And Comorbidity Burden Influence On Mortality Index In Spinal Neurological Surgery Operations, Carey Preston, Bs, Pious Patel, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

• Pre-existing comorbidities are generally thought to increase risk of undergoing surgical procedures
• Low socioeconomic status (SES) has been correlated with increased comorbidity burden previously
• Patients with low SES undergoing spinal neurological surgery operations may have existing comorbidities that impact expected surgical outcomes
• Vizient Inpatient Mortality uses pre-existing comorbidities during an inpatient stay to estimate post-operative expected mortality
• With increased comorbidity burden, expected mortality in low SES patients may not be accurately represented by

Protection Or Punishment? Reimagining The Hospital Care Environment For People Who Use Drugs, Natalina Contoreggi, Md, Jillian Zavodnick, Md, Kathleen Mechler, Md, Helene Dailey, Dnp, Rn, Ccrn, Ccctm, Rebecca Jaffe, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

Problem: Jefferson serves a large population of patients who use drugs (PWUD). As the opioid epidemic has evolved, our practice has adapted. Examples of Jefferson's dynamic response include hospital-wide guidelines for withdrawal management and medications for opioid use disorder, establishment of a bridge clinic, and the JAMS service. However, there is little consensus on how to best support this population in the hospital, particularly if they are using or suspected of using non-prescribed substances during their admission.

Aim: Development of accessible guidelines to manage and support PWUD in thehospital.

Racial Disparities In Transcatheter And Surgical Aortic Valve Replacement, Maggie Doyle, Svenja Schneider, Md, Kashka Mallari, Md, Nicholas Ruggiero, Md, Rebecca Marcantuono, Crnp, Alec Vishnevsky, Md, Yevgeniy Brailovsky, Do

Health Equity and Quality Improvement (HEQI) Summit

Background

• Transcatheter and surgical aortic valve replacement (TAVR, SAVR) is disproportionately distributed across racial and ethnicity groups.^{1, 2}
• Nationally, 87-91% of individuals undergoing AVR are White, despite making up approximately 60% of the US population.^1-4
• Jefferson’s AVR demographic data is consistent with national trends.
• Further studies have found that zip codes associated with lower socioeconomic status (SES) have lower rates of TAVR.⁵
• Although this disparity is widely recognized, there lacks understanding of contributing factors and potential interventions.

Project Aim:

• Investigate additional demographic data of Thomas Jefferson University Hospital (TJUH) patients undergoing TAVR to isolate targets for future …

Importance Of The Assessment Of Left Ventricular Function Following A Diagnosis Of Left Bundle Branch Block, Samuel Dyer, Bs, Benjamin Mass, Bs, Alyson Owen, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

• Left bundle branch block (LBBB) is a diagnosis often encountered in clinical practice.
• It can be seen as a harbinger of decreased left ventricular function in the future. LBBB has been associated with new onset congestive heart failure (CHF) and death from cardiovascular diseases.¹

Problem Statement

• LBBB in and of itself is given inadequate follow-up and attention by clinicians. Project AIM: bring to light the delay in follow-up after diagnosis of LBBB.

Patient Safety Case Review: Inpatient Use Of Recreational Opiates, Duncan Kilpatrick, Md, Tammy Tran, Md, Hayley Barker, Md, Gine Urban, Rn, Timothy Kuchera, Md

Health Equity and Quality Improvement (HEQI) Summit

Background of Case

• Patient with active substance use (reported snorting 8-10 bags of fentanyl/day) not initially interested in MOUD admitted to TJUH for severe sepsis due to empyema
• Placed on hydromorphone PCA with scheduled oxycodone for pain control and withdrawal, found to have diverted prescribed opiates and used recreational fentanyl while inpatient

Project Aim

1. Perform root cause analysis of safety event
2. Develop solutions to prevent similar instances in future given growing opiate epidemic in Philadelphia

Ventilation Method During Intensive Care Unit Transport After Cardiac Surgeries; When Should We Use A Ventilator?, Francis Anderson, Do, Kent Berg, Md, Marc Torjman, Phd, Yoshihisa Morita, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

Problem Statement: Manual ventilation with AMBU bag is utilized mostly for transporting post cardiac surgery patients to the intensive care unit, but some patients need mechanical ventilation due to concern for oxygenation, ventilation, and cardiac function.

Also, transport can be a critical moment because of limited hemodynamic information and suboptimal environment for therapeutic intervention.

Thus, risk stratification for appropriate ventilation is necessary for safe transport. •

Project AIM: We assessed biventricular function (with a hand-held echocardiography), arterial blood gas, and hemodynamics pre and post transport in manual and mechanical ventilation groups.

Patient Perceptions Of Screening For Social Determinants Of Health In A Primary Care Setting, Blaise O'Malley, Zarin Mohsenin, Olivia George, Geoffrey Mills

Health Equity and Quality Improvement (HEQI) Summit

Background

• Social determinants of health (SDOH) screenings have become increasingly common in healthcare settings over the past decade (Berkowitz et al., 2021; Rogers et al., 2020)
• These screenings can help healthcare providers direct care and provide resources to patients with social needs (Bleacher et al., 2019)
• The sensitive nature of the screening questions may cause patients to feel uncomfortable (Broaddus- Shea et al., 2022)
• Many related studies focus on the perspective of adult caregivers of pediatric patients, less on the perspective of adult patients (Emengo et al., 2020)

Project Aims

1. To further our understanding of adult patient perceptions of the …

Your Role In Communicating With Deaf Patients: Lessons Learned From A Virtual Patient Panel, Natalie M. Perlov, Bs, Benedicta O. Olonilua, Bs, Rosemary Frasso, Phd, Dimitrios Papanagnou, Md, Julia Croce, Aud

Health Equity and Quality Improvement (HEQI) Summit

Background

• Communication and cultural differences predispose Deaf patients to suboptimal healthcare¹
• Health professionals have historically received little to no training in caring for Deaf patients²
• Patient panels are an effective medical education tool to model communication strategies³

Do Large Language Models Adhere To Clinical Guidelines For Cervical Fusion? A Comparison Of Chatbotgenerated Responses With Nass Coverage Recommendations, Advith Sarikonda, Ba, Bs, Emily Self, Md, Dwight Mitchell Self, Md, Abhijeet Sambangi, Bs, Angeleah Carreras, Md, Jack Jallo, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

Introduction:

• Cervical fusion is a widely performed procedure with rapidly increasing usage.
• Despite this surge in utilization, there has been limited exploration into whether cervical fusion procedures align with evidence-based guidelines.
• To address these issues, the North American Spine Society (NASS) has developed EBM coverage recommendations for various diagnostic procedures and therapeutic treatments in the field of spine surgery

Project AIM:

• To assess the efficacy of chatbots in adhering to official guidelines for indications for cervical spine surgery

Utilizing Inpatient Opportunities To Increase Comprehensive Advanced Care Planning In Oncology Patients, Alexandros Grivas, Md, Brian Schonewald, Md, Sawan Dutta, Md, Matt Bierowski, Md, Chioma Nwonu, Do, Evan Nardone, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

- Advanced Care Planning (ACP) is a high-value intervention that significantly improves end-of-life (EOL) care.

- ACP includes discussion between the patient and a qualified healthcare provider in an appropriate healthcare setting aiming: o To recognize patient’s wishes at end-of-life situations.

• To identify surrogates to act in the patient’s best wishes if they become unable to make such decisions.
• ACPs provide comfort on patients and their families during stressful end-of-life situations and facilitates appropriate use of resources.
• Absence of ACP leads to non-beneficial care, higher financial burden, and family distress.
• Ideal locations to form and document ACP are outpatient …

Measuring Standard Of Care Physical Parameters In An Academic Psychiatric Practice During The Covid Pandemic – A Trainee Driven Quality Improvement Study, Himangshu Rathinakumar, Md, James Luebbert, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

• Outpatient Psychiatric services need to monitor certain evidence-based quality indicators that promote patient safety and guide standards of care.
• Our Child and Adolescent Psychiatry (CAP) fellow outpatient clinic provides psychotherapy and pharmacological management to a population in a major metropolitan city, who belong to various minority predominantly African American and reduced socio-economic at-risk groups.
• The COVID pandemic has brought about a lot of changes in psychiatric practice which includes Telepsychiatry.
• This study aims to determine if greater use of telepsychiatry has resulted in changes in compliance with the evaluation of basic vital sign parameters of our patients during the …

Optimizing Resource Allocation Of A Covid-19 Prophylactic In Immunocompromised Hosts, Julianna Tolotta, Abigail Hoover, Michael Joseph, Angelinia Liddy, Anshel Kenkare, Dagan Coppock

Health Equity and Quality Improvement (HEQI) Summit

Introduction

• COVID-19 presented unique challenges for the care of immunocompromised individuals.
• Patients with suppressed immune systems lack the ability to mount a robust response to vaccines, leading to an increased likelihood of developing severe COVID-19 responses and increased mortality.
• Astra-Zeneca developed Evusheld, a monoclonal antibody (Tixagevimab/cilgavimab) as a COVID-19 prophylaxis to target the SARS-CoV-2 spike protein.¹
• In December 2023, the FDA enacted an Emergency Use Authorization (EUA) for Evusheld in immunocompromised individuals and TJUH developed a roll-out plan.²
• Thomas Jefferson University Health (TJUH) distributed the drug using a tiering system that ranked the degrees of immunocompromising conditions for …

Limited Education And Training For Inpatient Nurses Caring For Pregnant Women With Opioid Use Disorder, Jaime Tsao, Bs, Stephen Didonato, Phd, Lpc, Abby Adamczyk, Mlis, Ahip, Meghan Gannon, Phd Msph

Health Equity and Quality Improvement (HEQI) Summit

Background

• The opioid epidemic continues as a public health emergency
• Pregnant women with OUD face multiple forms of marginalization and stigma based on the complex interplay of their various social identities
• OUD education and training among healthcare providers, particularly nurses, who are frontline clinicians in treating perinatal OUD, are lacking and leave the workforce unprepared and under-resourced to effectively support pregnant persons with OUD

Oncology Infusion Center Hyperglycemia Protocol, Franklin L. Thelmo, Do Jr., Eric J. Shiffrin, Md, Rose Dimarco, Pharmd, Bcps, Bcop, Emily Brand, Pharmd, Daniel Lin, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

• Problem: Patients receiving chemotherapy for their cancer are often overwhelmed with the stresses of their new diagnoses and other coexistent medical issues may be forgotten or ignored. In the event dysglycemia or diabetes appears during the course of chemotherapy it may difficult for these patients to obtain care in a timely fashion and early literature suggests that dysglycemia may decrease the efficacy of chemotherapy
• Aim: Our goal was a protocol designed to ensure adequate euglycemia in patients at the Oncology Infusion Center (OIC) to eliminate insulin treatment guesswork for hyperglycemia, allow timely care with endocrinology specialists, and create a …

Identifying Inappropriate Dual Anti-Platelet Therapy (Dapt) Utilization In The Outpatient Setting, Youssef Elfatatry, Julia Palecki, Nevin Varghese, Amry Majeed, Alexis Wickersham

Health Equity and Quality Improvement (HEQI) Summit

Background

Problem Statement:

• Dual anti-platelet therapy (DAPT) is a cornerstone in management of many cardiovascular and cerebrovascular conditions; however, inappropriate and prolonged use can lead to increased bleeding risk. Despite guidelines on optimal DAPT duration for various clinical scenarios, a proportion of patients receive inappropriately extended courses of therapy, exposing them to unnecessary risk.

Project AIM:

• We aim to (1) identify inappropriate DAPT use using established clinical guidelines at two academic primary care clinics and (2) develop and implement a targeted best practice advisory (BPA) in EPIC to address gaps in adherence to DAPT guidelines to enhance patient safety and …

Patient-Provider Communication About Cognition And The Role Of Memory Concerns: A Descriptive Study, Justin Do, Bs, Casey Fishman, Ma, Emily Bratlee-Whitaker, Phd, Rn, Heejung Jang, Phd, Sakshi Bhargava, Phd, Jennifer R. Turner, Phd, Andrea Yevchak Sillner, Phd, Rn, Jacqueline Mogle, Phd, Ms, Nikki L. Hill, Phd, Rn

Health Equity and Quality Improvement (HEQI) Summit

Introduction

• 40% of Alzheimer’s disease cases could be delayed or prevented with early intervention¹
• Early detection remains challenging due to lack of consensus regarding screening, time constraints
• Subjective memory decline (SMD): “the perception of a decline in memory ability when objective cognitive testing indicates normal performance.”²
• Linked to early stages of Alzheimer’s Disease and mild cognitive impairment (MCI)
• Older adults with SCD up to 4 times more likely to develop MCI or dementia³
• Older adults consider severity of problems, potential benefits or consequences of disclosing concerns, as well as past interactions with healthcare providers when discussing cognition …

Enhancing Quality Of Life: Addressing Care Gaps In Lung Cancer Survivorship Through Comprehensive Needs Assessment, Umma Fatema, Md, Ida Micaily, Md, Ms

Health Equity and Quality Improvement (HEQI) Summit

Background

• The growing population of lung cancer survivors in the United States underscores the importance of addressing their multifaceted needs beyond treatment completion.
• There's a pressing need to understand and address the ongoing challenges of lung cancer survivors at Jefferson Health, being a major treatment center.
• Given the shifting demographics of lung cancer patients, with a growing proportion being younger individuals, the necessity for lung cancer survivorship programs has become increasingly evident
• A survivorship survey enables comprehensive assessment of survivors' physical, psychological, and practical needs
• By gathering data on the interests and needs of lung cancer survivors can guide tailored …

Implementation Of Pediatric Behavioral And Developmental Health Screening Tools At Student-Run Free Clinics In Philadelphia Shelters, Renee Li, Jasmine Miller, Martin Henry, Do, Bob Motley, Md, David Beckmann, Md, Mph

Health Equity and Quality Improvement (HEQI) Summit

Background & Project Aims

• Children experiencing homelessness (CEH) are at increased risk for behavioral health problems: 78% show behavioral problems, academic delays, or depression.¹

• Recent research suggests an increased prevalence of Autism Spectrum Disorder (ASD) among people experiencing homelessness.^2,3

• Psychosocial challenges are exacerbated by limited access to behavioral health and developmental disability screening, which is essential for early intervention.^4-6

• Recent studies have found that behavioral health screening in shelters is feasible, can generate a large number of referrals, and can be carried out by a student-run clinic without significantly disrupting workflow.^7,8

Public And Community Perceptions Of Safe Injection Sites, Bahram Pashaee, Mph, Gary Kaplan, Mslis, Amy Leader, Drph, Mph

Health Equity and Quality Improvement (HEQI) Summit

Background

• The opioid epidemic began in 1999 and the number of deaths from overdoses has since quadrupled by 2019
• 50,000 deaths in the US in 2019 from opioid overdoses and the numbers increase each year
• Research Question: What are the public’s and communities' perceptions of safe injection sites?

Correlation Of Neck Circumference With Bmi And Waist Circumference In A High-Risk Urban Cohort, Jay Satasiya, Bs, Meera Patel, Bs, Antoinette Portnoy, Bs, Noel Tharakan, Bs, Brian D. Fedgchin, Md, Glenn S. Cooper, Md, Cindy Cheng, Md, Phd

Health Equity and Quality Improvement (HEQI) Summit

Background

Problem Statement:

• Obesity is a global epidemic requiring accurate ongoing clinical assessment, as it increases risk of multiple health conditions, such as CVD.
• Body mass index (BMI) is the most widely used anthropometric measure.
• Waist circumference (WC) is an accurate measure of visceral fat.
• Neck circumference (NC) is a newer, simple assessment tool positively correlated with percent body fat, BMI and WC.
• NC is easier to measure than WC, and unaffected by external factors like lean muscle mass for BMI, and abdominal distension, respiration, and patient discomfort for WC.

Hypothesis:

• NC, less studied in black patients, who are at …

Unplanned Pregnancy As An Independent Risk Factor For Antepartum Si In A Post Roe Vs. Wade World, Rianna Mcnamee

Rowan-Virtua Research Day

Abstract: The objective of this literature review is to determine whether unplanned pregnancy is an independent risk factor for developing antepartum SI. Background: The Supreme Court of the United States of America recently ruled that the constitution of the United States does not confer a right to abortion to its citizens. As of October 2023, twenty-one states had developed full or partial bans on abortion, resulting in millions of Americans residing in areas where terminating unplanned pregnancy is not a viable option. There is evidence that indicates antepartum suicidal ideation (SI) is higher than that of the general population, however …

Chronic Schizophrenia Presenting With Psychogenic Polydipsia Masking Stage Iv Uterine Adenocarcinoma, Dakota B. Pastore, Kamayel Jaludi, Angelo Sica

Rowan-Virtua Research Day

Background: Psychogenic polydipsia (PPD) is a condition of excessive water intake and seeking behavior with a 6-20% prevalence among patients with psychiatric illnesses, commonly Schizophrenia. It remains unknown how often concomitant disease can mask other, more serious conditions in psychiatric patients.

Case Description: The patient is a 58-year-old Hispanic, white female with chronic schizophrenia complicated by multiple hospitalizations for hyponatremia secondary to PPD. The patient initially presented to the emergency department (ED) in 2016 with abdominal pain, was treated symptomatically and discharged. From 2020 to 2023, the patient was readmitted seven more times, with two suspected aspirin overdoses, an Ambien …

An Unexpected Finding During A Breast Excisional Biopsy: A Case Report, Emily Forester, Anjeanette Brown

Rowan-Virtua Research Day

Background: Pacemaker leads within the breast are rare. Although it is infrequent, there are some reports of implanted cardiac devices or wires migrating into breast tissue or through the chest wall. To the best of our knowledge, there are no current reports of pacemaker leads within the breast tissue of a patient with concurrent breast cancer. This case aims to detail the surgical management of this rare phenomenon.

Case Presentation: A pacemaker-dependent, female patient presented to the operating room for a left breast excisional biopsy. Intraoperatively, two epicardial leads were unexpectedly found within the center of the patient’s breast tissue. …