Health and Medical Administration Commons^™

Quality Improvement Protocol: Improving The Use Of Nonpharmacological Pain Management Strategies Within The Inpatient Hospital Setting, Katherine Salamon, Christina Russell, Dara Devinney, Catherine M Soprano

Department of Medicine Faculty Papers

Background: There are many nonpharmacological pain management services available to hospitalized youth; however, not all youth are offered these services. Lack of knowledge about resources, difficulty with the referral process, and lack of understanding about nonpharmacological pain management services and when to refer patients are among the main reasons for lack of utilization. Quality improvement (QI) initiatives have grown within hospital settings and can serve to create change in fast-paced environments. Methods: The current QI project aimed to pilot an educational program to increase the use of nonpharmacological pain management interventions. Staff located on one floor of a pediatric hospital …

Quality Improvement In Public-Private Partnerships In Low- And Middle-Income Countries: A Systematic Review, Cassandra Iroz, Rohit Ramaswamy, Zulfiqar Bhutta, Paul Barach

College of Population Health Faculty Papers

BACKGROUND: Public-private partnerships (PPP) are often how health improvement programs are implemented in low-and-middle-income countries (LMICs). We therefore aimed to systematically review the literature about the aim and impacts of quality improvement (QI) approaches in PPP in LMICs.

METHODS: We searched SCOPUS and grey literature for studies published before March 2022. One reviewer screened abstracts and full-text studies for inclusion. The study characteristics, setting, design, outcomes, and lessons learned were abstracted using a standard tool and reviewed in detail by a second author.

RESULTS: We identified 9,457 citations, of which 144 met the inclusion criteria and underwent full-text abstraction. We …

Postoperative Discharge Destination Impacts 30-Day Outcomes: A National Surgical Quality Improvement Program Multi-Specialty Surgical Cohort Analysis, Carlos Riveros, Sanjana Ranganathan, Yash Shah, Emily Huang, Jiaqiong Xu, Michael Geng, Zachary Melchiode, Siqi Hu, Brian Miles, Nestor Esnaola, Dharam Kaushik, Angela Jerath, Christopher Wallis, Raj Satkunasivam

Student Papers, Posters & Projects

Surgical patients can be discharged to a variety of facilities which vary widely in intensity of care. Postoperative readmissions have been found to be more strongly associated with post-discharge events than pre-discharge complications, indicating the importance of discharge destination. We sought to evaluate the association between discharge destination and 30-day outcomes. A retrospective cohort study was conducted using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Patients were dichotomized based on discharge destination: home versus non-home. The main outcome of interest was 30-day unplanned readmission. The secondary outcomes included post-discharge pulmonary, infectious, thromboembolic, and bleeding complications, …

An Integrated Process For Co-Developing And Implementing Written And Computable Clinical Practice Guidelines, Dyann M. Matson-Koffman, Susan J. Robinson, Priya Jakhmola, Laura J. Fochtmann, Duwayne Willett, Ira M. Lubin, Matthew M. Burton, Amrita Tailor, Dana L. Pitts, Donald E. Casey, Frank G. Opelka, Ryan Mullins, Randy Elder, Maria Michaels

College of Population Health Faculty Papers

The goal of this article is to describe an integrated parallel process for the co-development of written and computable clinical practice guidelines (CPGs) to accelerate adoption and increase the impact of guideline recommendations in clinical practice. From February 2018 through December 2021, interdisciplinary work groups were formed after an initial Kaizen event and using expert consensus and available literature, produced a 12-phase integrated process (IP). The IP includes activities, resources, and iterative feedback loops for developing, implementing, disseminating, communicating, and evaluating CPGs. The IP incorporates guideline standards and informatics practices and clarifies how informaticians, implementers, health communicators, evaluators, and clinicians …

Implementation Of A Virtual Interprofessional Icu Learning Collaborative: Successes, Challenges, And Initial Reactions From The Structured Team- Based Optimal Patient-Centered Care For Virus Covid-19 Collaborators, Simon Zec, Nika Zorko Garbajs, Yue Dong, Ognjen Gajic, Christina Kordik, Lori Harmon, Marija Bogojevic, Romil Singh, Yuqiang Sun, Vikas Bansal, Linh Vu, Kelly Cawcutt, John M. Litell, Sarah Redmond, Elly Fitzpatrick, Kirstin J. Kooda, Michelle Biehl, Neha S. Dangayach, Viren Kaul, June M. Chae, Aaron Leppin, Mathew Siuba, Rahul Kashyap, Allan J. Walkey, Alexander S. Niven

Jefferson Hospital Staff Papers and Presentations

IMPORTANCE: Initial Society of Critical Care Medicine Discovery Viral Infection and Respiratory illness Universal Study (VIRUS) Registry analysis suggested that improvements in critical care processes offered the greatest modifiable opportunity to improve critically ill COVID-19 patient outcomes. OBJECTIVES: The Structured Team-based Optimal Patient-Centered Care for Virus COVID-19 ICU Collaborative was created to identify and speed implementation of best evidence based COVID-19 practices. DESIGN, SETTING, AND PARTICIPANTS: This 6-month project included volunteer interprofessional teams from VIRUS Registry sites, who received online training on the Checklist for Early Recognition and Treatment of Acute Illness and iNjury approach, a structured and systematic method …

Medication Reconciliation: Defining The Standard Of Care, Jenna Mandel, Matthew Matthew Piechnik, Rahul Muchintala

Physician Executive Leadership-Plus (PEL-Plus)

No abstract provided.

Colonoscopy Standardization: Insurance Verification And Direct Access, Connor Crutchfield, Jacqueline Chen, Kiernan Mcnelis, Luke Kelly

Physician Executive Leadership-Plus (PEL-Plus)

Outline

• Background
• Problem Scope
• Approach
• Progress
• Recommendations

To Improve Quality, Leverage Design, Byron Crowe, Jessica Gaulton, Noah Minor, David A Asch, Jeff Eyet, Erin Rainosek, Kristen Flint, Joseph Joo, Chip Chambers, Sherry Bright, Julius J Yang, Gene Beyt, Read Pierce, James M Moses

Department of Medicine Faculty Papers

No abstract provided.

Acute Care Patient Transfer Patterns From Community Hospital Emergency Departments, Dylan Selbst, Michael Knapp, Vasil Mico

Physician Executive Leadership-Plus (PEL-Plus)

No abstract provided.

Cost Savings And Patient Satisfaction Following Implementation Of An Online Blockchain-Based Healthcare Payment Portal, Zubin Hussain, Meghan Gannon, Phd, Constantine Daskalakis, Scd

Phase 1

Introduction. Although most patients prefer e-billing, many providers use paper. On average, over three paper bills are sent before payment is received. This means wasted time, money, energy, and decreased patient satisfaction. Could the implementation of an online, blockchain-based healthcare payment portal increase cost savings and patient satisfaction while maintaining confidentiality?

Methods. Transaction data was collected by MAPay through their portal system from about 100 providers in 50 locations in the NYC area, all through IntegraConnect. This study analyzes trends in how patients pay their medical bills and how much they pay.

Results. From March through September, all electronic methods …

What Are The Characteristics That Explain Hospital Quality? A Longitudinal Pridit Approach, Robert D. Lieberthal, Dominique M. Comer

College of Population Health Faculty Papers

Health outcomes vary substantially between high and low quality institutions, meaning the difference between life and death in some cases. Prior literature has identified a number of variables that can be used to determine hospital quality, but methodologies for combining variables into an overall measure of hospital quality are not well developed. This analysis builds on the prior investigation of hospital quality by evaluating a method originally developed for the detection of healthcare fraud, Pridit, in the context of determining hospital quality. We developed a theoretical model to justify the application of Pridit to the hospital quality setting and then …

Utilization Of Ct Scans And Mris In An Insured Population With Migraine, Neil I. Goldfarb, Valerie Pracilio, Mph, Daisy Ng-Mak, Phd, Joe Couto, Pharmd, Mba, Cary Sennett, Md, Phd, Mary Hopkins, Rn, Jon Bumbaugh, Stephen Silberstein, Md

College of Population Health Lectures, Presentations, Workshops

Background:

• Neuroimaging is a diagnostic tool that may be used to rule out a serious condition when a patient presents with head pain. It is not typically warranted for patients who have a normal neurologic exam, and may be over utilized despite established practice parameters set by the American Academy of Neurology.

•A decision to use neuroimaging should consider the type of headache and presence of any clinical features that suggest a serious condition.

Over-utilization of neuroimaging has cost and safety implications.

The United States Headache Consortium, a panel of experts on migraine, set the guidelines for diagnosis and …

Association Between Triptanuse And Cardiac Contraindications In An Insured Migraine Population, Daisy Ng-Mak, Phd, Valerie P. Pracilio, Mph, Stephen Silberstein, Md, Joseph Couto, Pharmd, Mba, Cary Sennett, Md, Phd, Mary Hopkins, Rn, Jon Bumbaugh, Neil I. Goldfarb

College of Population Health Lectures, Presentations, Workshops

Background

Safety concerns exist when using triptansto treat patients with cardiac contraindications.

–Triptans cause vasoconstriction, a safety concern for migraineurswith cardiovascular (CV) disease or other cardiac risk factors.

–All triptans contain contraindications in their package inserts to avoid use in patients with cardiac conditions.

•Previous research indicates that clinicians are less likely to prescribe triptansin patients with CV disease or CV risk factors.

Limited research has examined the proportion of migraine patients with cardiovascular disease or those individuals who were concurrently treated with triptans.

Teaching Cultural Humility And Competence: A Multi-Disciplinary Course For Public Health And Health Services Students, Rob Simmons Drph,Mph,Ches, Nancy L. Chernett, Mph, Elaine Yuen, Phd, Susan Toth-Cohen, Phd, Otr/L

College of Population Health Lectures, Presentations, Workshops

Poster on the interdisciplinary Cultural Humility and Competence course taught at the Jefferson School of Population Health for the past several years.

Overall Course Aim:

Why a multi-disciplinary cultural humility competence course?

An in-depth and advanced understanding of cultural diversity, health inequities and cultural competence in inter-professional health and human service delivery and administration. Facilitate development of cultural competence and humility in one's self, colleagues and the work environment and its application to practice.

International Evidence On Medical Spending., Robert D. Lieberthal, Phd

College of Population Health Lectures, Presentations, Workshops

The 46th Actuarial Research Conference, Poster session I, University of Connecticut, Storrs, CT. August 11, 2011.

Poster conclusions:

• U.S. spending is high.
• Long tailed medical linked insurance may be easier to write in the U.S.
• U.S. healthcare cost curve is not outrageous.
• Average spending
• Low volatility

Poster is associated with this paper: http://jdc.jefferson.edu/healthpolicyfaculty/45/

International Evidence On Medical Spending., Robert D. Lieberthal, Phd

College of Population Health Lectures, Presentations, Workshops

Presented for the American Statistical Association Health Policy Statistics Section.9th International Conference on Health Policy Statistics, Cleveland, OH.

14 PowerPoint slides

Presentation associated with this paper: http://jdc.jefferson.edu/healthpolicyfaculty/45/.

Strategies For Financing Healthcare Costs Over The Long Term., Robert D. Lieberthal, Phd

College of Population Health Lectures, Presentations, Workshops

Presented for the American Statistical Association Health Policy Statistics Section. 9th International Conference on Health Policy Statistics, Poster session I, Cleveland, OH.

Funding to support this work came from AHRQ grant R36 HS018835-01.

Policy Implications:

-Health insurance companies should use a broad, diversified investment portfolio as their optimal investment strategy -Insurance regulators should be focused on longer term lines of health insurance

High Frequency Evidence On Variation In Spending Growth., Robert D. Lieberthal, Phd

College of Population Health Lectures, Presentations, Workshops

Presented for the American Statistical Association Health Policy Statistics Section. 9th International Conference on Health Policy Statistics, Poster session I, Cleveland, OH.

Policy Implications:

• Health insurance regulation should include compensation for taking on riskier groups.
• Health programs should focus on changing needs for risk management versus health management throughout the life cycle.

Funding to support this work came from AHRQ grant R36 HS018835-01.

Validating The Pridit Method For Determining Hospital Quality With Outcomes Data., Robert D. Lieberthal, Phd, Dominique Comer, Pharmd, Katherine O’Connell, Bs

College of Population Health Lectures, Presentations, Workshops

Presented for The 46th Actuarial Research Conference, University of Connecticut, Storrs, CT.

15 PowerPoint slides

International Evidence On Medical Spending Risk., Robert D. Lieberthal, Phd

College of Population Health Lectures, Presentations, Workshops

Presented for the American Risk and Insurance Association. 2011 ARIA Annual Meeting, San Diego, CA.

20 PowerPoint slides.

Presentation is associated with the paper: http://jdc.jefferson.edu/healthpolicyfaculty/45/

Knowledge And Perceived Barriers About Diabetic Retinopathy And Dilated Eye Exam In Patients With Diabetes, Manisha Verma, Md, Mph, Mona Sarfaty, Robert Simmons, Drph, Mph, Albert G. Crawford

College of Population Health Lectures, Presentations, Workshops

Conclusions:

• The results of this study suggest that 68% of the population from this primary care practice got a dilated eye exam within a year. Facilitators were awareness/knowledge about the DR and DFE, eye problems and information from their doctors.
• Almost 20% of the patients did not get an eye exam as recommended. Various barriers included cost, transportation issues, time constraint issues, lack of symptoms of the disease, and fear of the exam.
• There is a significance difference in getting an eye exam by the type of insurance with a smaller percentage of Medicaid recipients (60%) meeting the guidelines compared …

International Evidence On Medical Spending., Robert D. Lieberthal, Phd

College of Population Health Lectures, Presentations, Workshops

Presented for the Casualty Actuarial Society 2011 Seminar on Reinsurance, Philadelphia, PA.

Handouts are also available at: http://www.casact.org/education/reinsure/2011/handouts/C17-Lieberthal.pdf

the audio is available at: http://www.casact.org/education/reinsure/2011/audio/C17.mp3

and it is associated with the paper: http://jdc.jefferson.edu/healthpolicyfaculty/45/

23 PowerPoint slides.

Detecting Hospital Quality With Pridit., Robert D. Lieberthal, Phd

College of Population Health Lectures, Presentations, Workshops

Presented for the Temple University, Fox School of Business Department of Risk, Insurance & Healthcare Management. Robert A. Hedges Research Seminar Series, Philadelphia, PA.

25 PowerPoint slides

Associated papers available at: http://onlinelibrary.wiley.com/doi/10.1111/j.1475-6773.2007.00821.x/abstract

and the 2008 Proceedings of the Joint Statistical Meeting.

Finding High Quality Hospitals In Philadelphia., Robert D. Lieberthal, Phd

College of Population Health Lectures, Presentations, Workshops

Guest lecture for PBH609 GIS Mapping. Fall, 2010 session. Philadelphia, PA.

15 PowerPoint slides.

Prevention, Intervention And Evaluation Of Maternal Child Health Programs And Practices, Diane J. Abatemarco, Phd, Msw

College of Population Health Lectures, Presentations, Workshops

PowerPoint presentation given by Diane Abatemarco, PhD, MSW.

Office Based Prevention Of Child Abuse And Neglect: Lessons Learned From The Practicing Safety Quiin Project, Diane Abatemarco, Phd, Msw, Ruth Gubernick, Mph, Steve Kairys, Md, Mph, Faap

College of Population Health Lectures, Presentations, Workshops

Parental behavior effects child psychosocial development. Parents who once had the benefits and supports of extended families and communities are now more isolated in their parenting. The isolation of families increases stress. New parents receive little education and support to deal with stress and the added stress of a newborn or their very young children. This poster presentation will describe a quality improvement project based in pediatric practices. The study was designed to test methods to increase anticipatory guidance, screening, and referral for psychosocial development. The project included physician use of chart data to identify outcomes of their enhanced care. …

Fitwits Md: An Intervention To Prevent Childhood Obesity, Diane J. Abatemarco, Phd, Msw, Ann Mcgaffey, Md, Ilene Katz Jewell, Mshyg, Susan K. Fidler, Md, Kristin Hughes, Mfa

College of Population Health Lectures, Presentations, Workshops

Objectives: The purpose of this presentation is to describe a comprehensive evaluation undertaken to study the feasibility of Fitwits MD, an intervention designed to assist primary care physicians to increase health fluency and affect wellness choices of children and their families. Childhood obesity is a growing epidemic but there are few if any successful interventions to alter the course of childhood obesity. The intervention was created through the use of participatory design.

Ferric Gluconate Yields Cost-Savings In Hemodialysis Patients With High Ferritin And Low Tsat: Results From The Drive Studies, Laura T. Pizzi, Thomas J. Bunz, David S. Goldfarb, Daniel W. Coyne, Ajay K. Singh

College of Population Health Lectures, Presentations, Workshops

Purpose: One third of hemodialysis patients have high serum ferritin levels and low transferrin saturation (TSAT). The purpose of this analysis was to determine the cost effectiveness of administering 1g of sodium ferric gluconate complex (SFGC: also referred to as ferric gluconate) to patients with serum ferritin >500ng/mL and TSAT ≤25% based on the Dialysis Patients Response to IV Iron with Elevated Ferritin (DRIVE) study and its 6-week observational extension (DRIVE-II). In these studies, IV iron administration resulted in reduced epoetin requirements.

Methods: Decision analysis was performed using a time horizon of 12 weeks, consistent with the combined duration of …

Resource Utilization Due To Breakthrough Pain In Patients With Chronic Painful Conditions, L. T. Pizzi, S. P. Lee, D. Richardson, N. Cobb, B. Leas, R. Toner, V. Pracilio, S. K. Ballas, A. Ashkenazi, C. T. Derk, D. Wang, E. Desousa

College of Population Health Lectures, Presentations, Workshops

Objectives
Primary: To capture healthcare resource consumption and work loss in a population of patients with chronic pain who have pain flares from one or more non-cancer conditions.

Secondary: To explore the relationship between anxiety, depression, and pain in this population.

Perception Of Breakthrough Pain In Patients With Chronic Painful Conditions, L. T. Pizzi, S. P. Lee, D. Richardson, N. Cobb, B. Leas, R. Toner, V. Pracilio, S. K. Ballas, A. Ashkenazi, C. T. Derk, D. Wang, E. Desousa

College of Population Health Lectures, Presentations, Workshops

Objective: To understand how patients with chronic non-cancer pain define and describe pain flares.