Medicine and Health Sciences Commons^™

Improving Practice Accessibility Through Mychart Utilization, G. Bires, M. Taskier, P. Padgaonkar, L. Flink, R. Wiley, S. Newsom, J. Mitchell, S. Cokenakes, J. Schutzman, A. Nwaobasi, T. Huang

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

• Increase patient portal MyChart activation for a cohort of approximately 2,000 patients at JFMA by 1% from February to April 2021.
• Demonstrate evidence of utilization including appointment scheduling, results review, and communication with providers through MyChart after activation.

Addressing Health Disparities And Access In The Department Of Neurology Outpatient Setting In The Era Of The Covid-19 Pandemic: A Quality Improvement Initiative, V. Wang, M. Rehman, K. Burda, L. Liao, M. Braslavsky, T. Chuang, J. Diep, Md, E. Isaac, E. Wong

Health Equity and Quality Improvement (HEQI) Summit

Neurology, a largely outpatient specialty, has joined many other fields in the endeavor of incorporating telemedicine.^4,6,7 We present the results of analysis of the Epic Electronic Medical Record (EMR) of all outpatient visits from the Thomas Jefferson University Hospital Department of Neurology from 2019 to 2020 in order to identify areas of ethnic minority and geographic disparities with regards to usage of telemedicine. For our analyses, we have included Neurology patients across the General Neurology (JUP Neurology 909 Walnut NEU), Headache Center (HA), and Multiple Sclerosis Center (MS). Additionally, based on patient surveys from a subset of our outpatient …

Improving The Use Of Asthma Action Plans, Pooja Pandit, Md, Aaron B. Kaye, Md, Hassan Shahid, Md, Colin Peters, Do, Jessica Most, Md

Health Equity and Quality Improvement (HEQI) Summit

Objectives

• Identify the percentage of asthmatics in Friday fellows’ clinic with an AAP in place.
• Determine if clinician education can increase the number of AAP created for patients.

Addressing Catheter Associated Uti In The Neuro Icu, Aria Mahtabfar, Md, Giuliana Labella, Msn, Caitlin Harley, Msn, Omar Shah, Md, Mba

Health Equity and Quality Improvement (HEQI) Summit

Increasing systemic pressures have forced clinicians to identify and address a variety of metrics to provide better “quality” care. Catheter associated UTIs (CAUTI) are a common health careassociated infection in the Neuro ICU and are associated with increased LOS and overall mortality.

Aims for Improvement: Improving the incidence of CAUTI at the Gibbon and JHN ICUs on an annual basis after incremental interventions.

Evaluating The Reliability Of The Problem List For Comorbidity, Joseph W. Schaefer, Alan A. Kubey, Md, Michael Li, Phd, Novel Covid Learning Group

Health Equity and Quality Improvement (HEQI) Summit

The problem list in EPIC provides a centralized source of patient medical conditions that informs medical decision making. This is especially important for COVID- 19 patients where risk scores such as the “4C score” inform care.

The goal of this study was to identify the accuracy of the problem list and identify areas for future improvement.

Improving Serial Imaging Protocols In Spontaneous Intracerebral Hemorrhage, Kevin Hines, Md, Nikolaos Mouchtouris, Md, Fadi Al-Saiegh, Md, Karim Hafazalla, Jacob Mazza, Giuliana Labella, Muhammad K. Athar, Md, Adam Flanders, Md, M. Reid Gooch, Md, Stavropoula Tjoumakaris, Md, Robert H. Rosenwasswer, Md, Pascal Jabbour, Md

Health Equity and Quality Improvement (HEQI) Summit

There is no universally agreed upon protocol to image patient presenting with intra-parenchymal hemorrhage of non-traumatic etiology (sICH). At our institution, it is common practice for a patient to have 3 CT’s done within 24 hours. They are often at onset of symptoms or presentation, 6 hours post onset of symptoms, and finally 24 hours post bleed onset.

The goal of this project will be to assess the safety and efficacy of obtaining this repeat imaging in our patients in the hopes that limiting unnecessary CT head studies will decrease resource utilization, decrease patient radiation, expedite movement of stable patients …

Evaluating Advance Care Planning In Patients With Amyotrophic Lateral Sclerosis: A Retrospective Chart Review, Zachary Klock, Md, Stephanie Dobak, Rd, Gail Houseman, Rn, Margaret Kreher, Md, Facp

Health Equity and Quality Improvement (HEQI) Summit

• ALS is a progressive, degenerative neurologic disorder with inevitable decline in function and ultimately death.
• Most patients and families will be faced with decisions regarding mechanical ventilation and artificial nutrition.
• Prior studies have showed low rates of ACP completion in this population (<50%) and high rates of opt out in programs to aid ACP (nearly 40%).
• By reviewing charts of patients with ALS, we can analyze the impact of ACP on care utilization including artificial nutrition, mechanical ventilation and hospice utilization to help to guide efforts regarding ACP in the outpatient setting.

Addressing The Limitations Of Neurosurgical Care Via Telemedicine, Nikolaos Mouchtouris, Md, Robert Sergott, Md, Mark Moster, Md, Michael Karsy, Md, Laura Sweeney, Crnp, Christopher Farrell, Md, James Evans, Md

Health Equity and Quality Improvement (HEQI) Summit

Novel telemedicine software successfully automates cranial nerve assessment of patients from the comfort of their home

Alteplase Administration For Acute Ischemic Stroke (Ais) In Er - A 5-Year Review, Ali A. Saherwala, Md, Diana Tzeng, Md, Robin Dharia, Md

Health Equity and Quality Improvement (HEQI) Summit

• ER visits for AIS grown in last 10 years by 25%
• Ongoing effort by AHA/ASA to improve access to care with early stroke recognition and awareness
• Time is brain; rate of thrombolysis with alteplase (ALT) should increase with better EMS systems, awareness, and education

Increasing The Rate Of Excisional Lymph Node Biopsies At Easily Accessible Sites When Ruling Out Lymphoma, Catherine M. Tucker, Md, Xiangyun Ye, Christopher Gardner, Austin Redilla, Guldeep K. Uppal, Md, Adam F. Binder, Md

Health Equity and Quality Improvement (HEQI) Summit

The aim of this study is to increase the rate of excisional lymph node biopsies from 78% to 95% in patients presenting to the Center City campus with lymphadenopathy at easily accessible sites by September 2021.

Provider Use Of Risk Stratification Tools For Pe And Cta Ordering Practices, Christy Johnson, Do, Daniel I. Shpigel, Md, Nicole Caltabiano, Do, Benjamin Slovis, Md, Ma, Facep

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

Quantify utilization of clinical decision tools, D-dimer and CTA-PE at TJUH and compare to benchmark and implement the logic seen in the adjacent QR code to an EPIC pop-up

The “Ok” Guideline: Implementing An Electronic Electrolyte Repletion Guideline For Improving Rates Of Oral Potassium And Magnesium Delivery, Joshua M. Riley, Jeffrey M. Riggio, Md, Alan A. Kubey, Md

Health Equity and Quality Improvement (HEQI) Summit

Nearly 500,000 doses of potassium (K) and magnesium (Mg) are given at Thomas Jefferson University Hospital (TJUH) each year. More than 80% of these doses are given intravenously.

Guidelines that encourage both intravenous and oral (PO) repletion options increase rates of PO dosing and more successfully attain goal levels than standard care.

Our goal was to increase the percent of K and Mg doses delivered by oral route to >50% of total doses distributed at TJUH within one year of implementation of an Epic-based electronic order set.

Quality Of Post-Discharge Follow-Up In Patients Admitted To Tjuh With Intermediate High Risk Pulmonary Embolism, D. Kramer, P. Kirupaharan, M. Flamenbaum, M. Scharf

Health Equity and Quality Improvement (HEQI) Summit

• Our institution has developed a multidisciplinary pulmonary embolism response team (PERT) to help in the management of patients with intermediate high risk pulmonary embolism
• While the PERT focus is on acute inpatient management, it is important that PERT patients have close follow-up to monitor for known future complications including thromboembolic pulmonary hypertension (CTEPH) and chronic pulmonary embolism syndrome
• CTEPH, in particular, is a potentially treatable disease with significant morbidity if left untreated
• Therefore, an underappreciated and important aspect of the PERT team should be the coordinated follow-up and long term care of these patients
• We wanted to better understand how …

Increasing Depression Screening And Treatment, Emma De Louw, Md, Michael Danielewicz, Md, Michael Haines, Md, Molly Allanoff, Md, Elizabeth Clark, Md, Michael Bozzi, Md, Natalie Antosh, Md, Catherine Guariglia, Md, Yael Horvath, Md

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

• Increase response to depression advisory in EHR from 39% (January 2021) to 60% or greater (March 2021)
• Increase referrals to behavioral health from baseline of 39/month (January 2021) by 25% (March 2021)

Improving Understanding Of And Compliance With Anti-Shivering Protocols During Therapeutic Hypothermia With Just-In-Time Training, Brittany Heckel, Md, Eunice Lee, Md, Courtney Curran, Md, Kasun Navarathna, Md, Henry Lee, Md, Lucy Maguire, Md, Phd, Malissa Pynes, Md, Shyam Majmundar, Md, Alexander Buslov, Md, Syed Shah, Md, Mba, Matthew Vibbert, Md

Health Equity and Quality Improvement (HEQI) Summit

• Therapeutic hypothermia after cardiac arrest has been demonstrated to improve neurologic outcomes and survival rates following cardiac arrest.
• Shivering during hypothermia increases metabolic demand, increases oxygen consumption and increases difficulty maintaining desired temperatures.
• Gaps in knowledge can lead to inadequate management of shivering, leading

Aims for Improvement

To improve understanding of and compliance with anti-shivering protocols during therapeutic hypothermia post-cardiac arrest.

Postoperative Aspiration Pneumonia (Popna) Prevention Protocol, R. Lamm, Md, D. Pace, Md, B. Till, Md, B. Creisher, J. Curran, E. Foecke Munden, J. Williamson, Iii, S. Cowan, Md, C. Costanzo, Md, Harish Lavu, Md

Health Equity and Quality Improvement (HEQI) Summit

• Postoperative pneumonia increases morbidity, mortality, length of stay, and hospital costs up to $12,000-$40,000 per patient
• TJUH Center City ranked in the top 3rd - 4th quartile of pulmonary complications on the 2020 National Surgical Quality Improvement Program perioperative review
• ICOUGH protocol: widely accepted, standardized set of post-operative interventions to reduce pneumonia incidence
• Survey design: measure ICOUGH compliance before and after implementation of resident note checklist in EPIC

Improving Advanced Care Planning Discussion And Documentation, Justin Robbins, Md, Bharaniabirami Rajaram, Md, Patrick Kukulich, Md, Danielle Verghese, Md, Dianna Cheney-Peters, Md

Health Equity and Quality Improvement (HEQI) Summit

Our goal is to improve ACP discussion and documentation in patients above the age of 65 in our Jefferson Hospital Ambulatory Practice (JHAP) resident clinic. By instituting procedural changes within the EMR and the clinic, as well as improving provider education, we hope that residents can carry out a comprehensive and streamlined discussion regarding advanced care planning. We will institute these changes over the next 3 months, and we predict that there will be an increase in ACP discussion and uploading of appropriate documentation to 50% and 25%, respectively.

Improving Colon Cancer Screening Rates In An Ambulatory Resident Clinic, Ashima Oza, Md, Tina Boortalary, Md, Elizabeth Chin, Md, Tudor Sturzoiu, Md, John Wallis, Md, Sonia Bharel, Md

Health Equity and Quality Improvement (HEQI) Summit

In the US, colorectal cancer (CRC) is the third leading cause of cancer-related deaths. According to the 2018 CDC Behavioral Risk Factor Surveillance System survey, 68.8% of US adults between 50 and 75 were up to date on colorectal screening (CRCS) across all screening modalities. In light of the COVID-19 pandemic, screening has dropped even further and is still 50% below pre-pandemic levels. At Jefferson, our CRCS rate is below the national average at 55.4%. Given the importance of regular screening for CRC prevention, this is clearly inadequate. There are several barriers to completing an invasive screening modality like a …

A Safety Assessment Of The Re-Opening Of An Academic Medical Center Outpatient Endoscopy Unit During The Covid-19 Pandemic, Scott Manski, Christopher Schmoyer, Alice Pang, Richard Denicola, Amy Javia, Melissa Vitolo, Linda Yan, Christopher Cao, Brianna Shinn, Divya Chalikonda, Giselle Mahoro, Ritu Nahar, Joshua Lieberman, Micaela Gernhardt, Neveda Murugesan, Alexandra Leto, Ryan Erwin, Taylor Kavanagh, Stephanie Moleski, Robert Coben, Mitchell Conn

Health Equity and Quality Improvement (HEQI) Summit

• This study aimed to assess outcomes and satisfaction among patients undergoing outpatient endoscopic procedures during the COVID-19 pandemic
• Identifying the rates of COVID-19 symptom development and post procedure testing would provide critical information on patient safety
• Assessment of patient experiences would serve as a guide for potential areas of improvement
• We predicted that with proper protocols in place, outpatient endoscopy was a safe and positive experience

Improving The Virtual Neurosurgery Residency Interview Experience, Ellina Hattar, Md, Omaditya Khanna, Md, Ritam Ghosh, Md, Nikolaos Mouchtouris, Md, Kevin Hines, Md, Daniel Franco, Md, Michelle Hoffman, James S. Harrop, Md, Ashwini D. Sharan, Md

Health Equity and Quality Improvement (HEQI) Summit

The residency selection process has proven a challenge in the face of the Covid-19 pandemic. In the neurosurgery match, residents are chosen based on objective metrics as well as their ability to effectively work as part of a team tasked with caring for medically complex patients faced with neurosurgical conditions. As there remain limitations on the number of externships students could participate in and the Step 1 examination is expected to be reported as either pass or fail in years to come, we will have fewer objective metrics to review in the student application. We conducted a study to best …

Introduction Of Gi Wellness Committee To Reduce Gi Fellow Burnout And Improve Wellness., Richard P. Denicola, Md, Melissa A. Vitolo, Md, Ritu Nahar, Md, Jorge Prieto, Md, Stephanie Moleski, Md

Health Equity and Quality Improvement (HEQI) Summit

Gastroenterology (GI) fellowship is an arduous process which predisposes fellows to fatigue and burnout.

Our baseline survey showed a large number of our fellows to be in danger of burnout.

Aims for Improvement

• To improve the overall wellness of GI fellows, identify stressors and reduce incidence of burnout.
• The goal for the first 6 months of operation is to demonstrate improvement in Mini ReZ survey scores by 25% at starting from Sept 1st, 2020.

Improving Follow Up Compliance For Patients With Sleep Disordered Breathing At Jefferson Sleep Center, E. Fares, Md, A. Ananth, Md, Z. Fast, Md

Health Equity and Quality Improvement (HEQI) Summit

Despite the high effectiveness of CPAP therapy, patient adherence remains variable and a hurdle towards appropriate treatment of their sleep-disordered breathing.

Patients often stop using their CPAP and are then lost to follow-up, which increases their risk of previously mentioned complications that are associated with OSA.

Goals for Improvement

To increase the follow-up rate for patients with OSA.

Improving Sensitivity To And Inclusivity Of Lgbt Older Adults In An Urban Geriatric Practice, Elizabeth Spina, Do, Brooke Salzman, Md, Michael Danielewicz, Md, David Grifith, John Liantonio, Md, Mba, Hmdc

Health Equity and Quality Improvement (HEQI) Summit

CHA’s overall goal is to improve the care delivered to LGBT older adults.

Step 1: Needs assessment with provider and staff survey (Fall 2020)
Step 2: Implementation of SAGE training and provider education (Fall/Winter 2020) Step 3 (this study): Needs assessment with community-dwelling LGBT older adults (Spring 2021)

Improving Rates Of Nephrology Referral For Patients With Chronic Kidney Disease In Resident Clinic, Akanksha Arya, Md, Rabia Iqbal, Md, Rahed Mohammed, Md, Neveda Murugesan, Md, Jillian Zavodnick, Md

Health Equity and Quality Improvement (HEQI) Summit

• According to the KDIGO (Kidney Disease Improving Global Outcomes), evaluation by a nephrologist is recommended for patients with CKD stage 4 or higher (corresponding to a GFR of 30 or lower).
• Studies have shown that patients who are not referred to a nephrologist or referred later suffer from increased complications of renal disease, accelerated progression to ESRD, and have an increased overall mortality rate.
• At Jefferson Hospital Ambulatory Practice (JHAP), we noted decreased rates of nephrology follow-up in our patients with chronic kidney disease stage 4 and 5.
• We identified that the most prevalent reason for the decreased referral rates …

They Used Expressive Writing With Their Therapist, Lindsay Mccue

School of Psychology, Family, and Community Research Conference

This study aims to explore the effect that expressive writing could have as an intervention for improving self-compassion, anxiety, depression, and stress associated with relational distress in a therapeutic environment. Participants will be split into two groups, and both will attend therapy with a focus on a relational problem in their life. The control group will receive 8 talk therapy sessions, while the intervention group will receive 5 talk therapy sessions and 3 sessions focusing on an expressive writing assignment. Participants will be screened for recent traumatic events, will need to be over the age of 18, and will need …

Narrative Therapy Effectiveness In Adult Patients Undergoing Chemotherapy Cancer Treatment, Gretchen Hoyum

School of Psychology, Family, and Community Research Conference

It is very common for cancer patients to experience depression while undergoing treatment (Vega et al., 2014). Previous studies have tested the effectiveness of several types of therapeutic interventions for depression in cancer patients. However, few studies have focused on the use of narrative therapy specifically in this population. This study seeks to test the effectiveness of narrative therapy for cancer patients currently undergoing chemotherapy treatment using the PHQ-9 and White's maps of narrative therapy (Kroenke et al. 2001; 2007).

How Effective Is Polyvagal Theory On The Long-Term Reduction Of Ptsd Symptoms In Adolescents?, Kristyna Richards

School of Psychology, Family, and Community Research Conference

This longitudinal study is focused on using the Polyvagal theory and identifying its efficiency in reducing PTSD symptoms in adolescents between the ages of 13-18. Launching into early adulthood with a dysregulated nervous system presents challenges for the client both physiologically and psychologically. While talk-therapy is effective in helping a client psychologically process the trauma, it often does not address the clients physiological state of the stored trauma. Without intervention to the clients physiological system, symptoms of the PTSD can persist and increase risk for psychological and physical comorbidities as well as increase the likelihood of intergenerational trauma within relational …

Exploring The Therapeutic Alliance In Eft When Addressing Race And Cultural Differences., Ashley Kortman, Deyja Kauffman

School of Psychology, Family, and Community Research Conference

This study aims to explore the therapeutic alliance in EFT when addressing race and cultural difference between a non-white client and a white therapist. This quantitative study will survey 100 non-white clients receiving therapy from a white therapist. Subjects will participate in 10 sessions of therapy with a white therapist practicing EFT. Half of the clients will see a traditional EFT therapist, while the other half will see an EFT therapist who has gone through specialized training in cultural attunement. Using a modified Helping Alliance Questionnaire (Luborsky, et al. 1996), with additional questions concerning race and culture, we will measure …

Implications Of Cultural Awareness On Healthcare Access In Marginalized Communities, Allison Davis, Diana Melman

School of Psychology, Family, and Community Research Conference

While the Covid-19 pandemic has had global effects, community inequalities have led to a diversity of specific impacts. Covid-19 has specifically impacted marginalized communities at a higher rate, and a common theme has emerged highlighting a disparity in healthcare access, leading to these communities being left behind. As current literature is being released during the pandemic, data has uncovered some technical details of new challenges in healthcare access. In addition, individuals from marginalized communities may place a higher importance of cultural competency in their health care. This proposal aims to identify the ways in which access to telehealth has impacted …

Integration Of Systemic Family Therapy And Attachment-Focused Approach With Adoptive Families: Impacts On Attachment In Child-Parent Interactions, Julianne Park

School of Psychology, Family, and Community Research Conference

Attachment deficits are prevalent among adoptive children especially after their first year in adoption (van den Dries, 2009). While treatment with the focus on the attachment needs of adopted children and adoptive parents’ attunement has been increasingly discussed, not much has been researched on the effectiveness of the family systems approach, including the exploration of the parents’ emotional experiences around adoption. In addition, more studies that strictly focus on treating adoptive children’s attachment issues after their first year of adoption are needed. By incorporating the Taking Care of Adoption (TCA) model, which is based on the integration of a family …