Quality Improvement Commons^™

A Cancer Education Needs Assessment: Informing Middle-Aged Female Patients About The Relationships Between Obesity And Women’S Health Concerns In The Reproductive System, Breast, And Endometrial Health, Batul Mirza

MUSC Theses and Dissertations

Obesity significantly impacts women’s health, particularly among middle-aged women, by increasing the risk of hormone-sensitive cancers such as breast, endometrial, and reproductive system cancers. This study examines the educational needs of this demographic group regarding obesity-related cancer risks and explores effective intervention strategies. Obesity-induced mechanisms – hormonal imbalances, chronic inflammation, and insulin resistance – drive cancer susceptibility, emphasizing the need for targeted health education. The study employs a qualitative design, which includes interviews with subject matter experts (SMEs) and surveys of middle-aged women. The goal is to assess awareness, perceived barriers, and preferred learning methods. Findings suggest that with many …

Care Coordination In Pediatric Primary Care, Alyssa K. Durzo

Dissertations

No central documentation of care plans exists for children with special healthcare needs (CSHCN) in the electronic health record (EHR). Providers of a large pediatric primary care office in St. Louis Missouri were asked to identify CSHCN in the practice. Clinic nurses completed a comprehensive chart review of the patients identified and constructed care coordination documents using a pre-established smart-text phrase. Subsequently, these were documented centrally in the EHR under the Problem List.

Likert score data was obtained from providers on the acceptability, appropriateness, and feasibility of the intervention through the verified tools: Acceptability of Intervention Measure (AIM), Intervention Appropriateness …

Educating Healthcare Providers To Prevent And Mitigate The Effects Of Zoom Fatigue, Andrea Lima

Doctor of Nursing Practice Scholarly Projects

Zoom Fatigue (ZF), or physical and neuropsychological responses to excessive videoconferencing (VC), increased during the COVID-19 pandemic. Like burnout, ZF can compromise patient safety by causing decreased job satisfaction, social isolation, disrupted focus, and difficulty empathizing with patients. This Plan-Do-Study-Act quality improvement project aimed to assess feelings about VC, raise awareness of the adverse effects of overuse, and empower primary care providers (PCPs) to improve their work experiences. A group of on-site PCPs at a tertiary care medical center in the Southwest, who continued holding exclusive virtual team meetings after the pandemic, was asked to complete the 15-question Zoom Exhaustion …

Unsuitable Underlying Cause-Of-Death Statements: Implementation And Evaluation Of A Structured Process For Healthcare Providers Certifying Natural Causes Of Death In An Outpatient Setting, Naida Rutherford

Doctor of Nursing Practice Projects

Background: Accuracy in death certification is crucial for effective public health initiatives. Inaccuracies in unsuitable Underlying Cause-of-Death (UCOD) statements can distort mortality statistics, influence health policy, and impact resource allocation. In South Carolina, changes in the death registration process and the introduction of an unsuitable cause-of-death list highlighted an urgent need for structured training among certifiers to enhance accuracy in death documentation.

Purpose: The purpose of this project was to implement a standardized training program for healthcare providers certifying natural causes of death and assessing the impact of reducing the unsuitable underlying cause-of-death inaccuracies in an outpatient hospice setting.

Project …

Increasing Colorectal Cancer Screening Rates For Patients Without Insurance, Andrea F. Day

Doctor of Nursing Practice Projects

Background: Colorectal cancer is a leading cause of cancer-related death in the United States (U.S.), ranking as second most prevalent overall. Despite many initiatives, screening rates remain low, especially among clinic patients without insurance. The lack of an evidence-based screening protocol exacerbates these issues and increases the risk of advanced cancer and death. Initial data showed that 0% of patients were screened according to recommended guidelines.

Purpose: The project implemented a standard screening protocol to increase colorectal cancer screening rates in a rural Alabama free clinic for patients ages 45-64 lacking insurance.

Project Design: This quality improvement …

Transforming Primary Care: Innovative Post Graduate Pa Training For Real-World Solutions, Kenneth Botelho, James Ali

Lynchburg Journal of Medical Science

The ongoing crisis in primary care demands innovative and scalable strategies to prepare and retain advanced practice providers. This article introduces the Primary Care Practitioner (PCP) Program, a conceptual postgraduate training model designed for certified physician associates/assistants (PAs) who aim to serve in underserved and rural communities. The program integrates advanced clinical training, leadership development, telehealth competencies, VR-enhanced simulation, and evidence-based strategies to promote provider resilience. Rooted in systems-based thinking and real-world applicability, the PCP Program culminates in capstone projects that encourage innovation in care delivery and population health.

Aligned with national frameworks such as the HRSA Primary Care Training …

Healthy Moms/Healthy Babies Of Mississippi Initial Provider Engagement And Student Feedback Loop Project, Corban Jackson Mph, Jillian Harper-Peavy Lmsw, Imh-E, Starica Harper, Vernesia Wilson Phd, Mph

Journal of Public Health in the Deep South

Background Between 2017 and 2022, 83% of maternal deaths in Mississippi were preventable. Unfortunately, there is a persistent shortage of OB-GYNs in Mississippi, feeding the rise of maternal care deserts and the lapse in collaboration between providers and state maternal health organizations. Purpose Healthy Moms/Healthy Babies of Mississippi, a care management program for high-risk mothers and infants, has partnered with the Mississippi Alliance for Innovation on Maternal Health initiative (AIM) to improve maternal health outcomes through building healthcare networks with existing providers. Methods 33 medical students from the University of Mississippi Medical Center School of Medicine and William Carey University …

Development Of Recommendations For The Future Of Telehealth Use Among Sexual And Gender Minorities (Sgm), Jeffrey A. Wilhite

Dissertations and Theses

It is now well-documented that sexual and gender minoritized individuals (SGMs) face consistent stigmatization from not just the health care system, but also from overarching community, federal, and societal entities. Subsections of the SGM community, like gay men for example, face higher rates of eating disorders, certain cancers, alcoholism, mental illness and even obesity, when compared to heterosexual counterparts. Many of these challenges could be exacerbated by current political administration efforts to silence the community. Ensuring access to clinical care is one way of preserving the health and livelihood of the community. Telehealth, or synchronous, remote based clinical care, can …

Cultivating Workplace Wellness: An Evaluation Of Gratitude Card Interventions Among University Faculty, Jeffrey Druck, Patrick Ockerse, Jamal Jones

Journal of Wellness

Introduction: There has been a growing interest in understanding the role of gratitude in promoting well-being. Gratitude, defined as a feeling of thankfulness and appreciation in response to receiving a benefit from someone else, has been shown to improve mood, increase social support, and decrease symptoms of depression and anxiety. This research paper explores an innovative intervention using gratitude cards for faculty members and measures the emotional impact of this intervention.

Methods: The study involved 32 clinical physicians from the Department of Emergency Medicine at the University of Utah. Participants were invited to write a gratitude card to …

Decreasing Time To Antibiotics In Febrile Oncology Patients With Central Line In The Pediatric Emergency Department; A Quality Improvement Initiative, Abbigayle Carlson, Leslie Hueschen, Stephanie Clark, Christopher Kaberline, Joel Thompson

Research Days

Background: Oncology patients are at a high risk for sepsis, due to chemotherapy-induced immunosuppression and neutropenia as well as presence of a central venous catheter. Due to the high risk of sepsis, these patients require antibiotics within 60 minutes of Emergency Department (ED) arrival. During our baseline period, Sept 2022-May 2023, we only achieved this 38% of the time at Children’s Mercy ED.

Aim: By April 30th, 2024, we will increase the percentage of ED febrile oncology patients receiving antibiotics < 60 min of arrival from 36.6% to 80%, stratifying by race and ethnicity, to monitor for inequities.

Methods: Our outcome measures were the percentage of ED febrile oncology patients with antibiotics given < 60 min of arrival and the median time to antibiotic administration. Our process measures were the percentage of standard order-set usage and percentage of patients with critical information notes. Our balance measure was time from arrival to ED triage. We created a process map and fishbone diagram and identified several delays in antibiotics administration. We performed interventions with Plan-Do-Study-Act methodology. First, we implemented standing nursing orders to decrease the time spent waiting for a provider to order antibiotics (June 2024). Next, the outpatient oncology providers created a Critical Information Note, which directed prompt antibiotic administration prior to labs or consultation (August 2024). To engage physicians, we made this a Maintenance of Certification (MOC) project, with monthly review of run charts (Oct 2024). Next, we prioritized timely access of the patients’ central line, with a nursing script to communicate with families the importance of accessing their child’s central line as soon as possible (Oct 2024). We created a Central Line Note, identifying the type of central line and needle size required to access the line (March 2024).

Results: With the implementation of …

Observed And Reported Outcomes Following Experiential Cultural Capability And Clinical Yarning Training For Clinicians Treating Aboriginal And Torres Strait Islander People With Persistent Pain, Stuart Ekberg, Renata F. I Meuter, Ivan Lin, Roslyn Rowen, Angela Kinnell, Eva Malacova, Tania Waring, Kushla Houkamau, Marayah Taylor, Matthew Bryant, Jermaine Isua, Andrew Claus, Paul Gray, Joseph Kluver, Christina M. Bernardes, Greg Pratt

Journal of the Australian Indigenous HealthInfoNet

Communication is recognised as crucial to culturally safe healthcare, and poor communication remains a major reason that Aboriginal and Torres Strait Islander people do not access healthcare. This pragmatic, pre-post comparison study employed mixed methods to evaluate cultural capability and clinical yarning training delivered to 57 clinicians supporting Aboriginal and Torres Strait Islander people at three persistent pain management services in Queensland, Australia. Observable outcomes of the training were evaluated by video recording clinicians’ training experiences and seven consultations with patients that occurred either pre- or post-training. Reported outcomes were evaluated by using a modified Cultural Safety Survey (CSS), which …

Pcsk-9 Inhibitors Treatment: The Cardiovascular Disparity, Julia Lees, Seana-Pierre Williams, Tahir Razzaq, Michael B. Roberts

The Journal of Integrated Primary Care

Introduction: According to the Center for Disease Control and Prevention (CDC) and American Heart Association (AHA), cardiovascular disease is the leading cause of death in the United States. This phenomenon disproportionally affects the African American population, who have a 31% higher mortality rate than non-Hispanic Caucasian individuals. A retrospective review of PCSK-9 medication use, specifically in a patient population that had minimal representation in the large, landmark clinical trials, can lead to better understanding about the therapeutic potential in cardiovascular disease reduction and patient outcomes attributed to medication use. Education regarding this novel drug class, medication access and patient support, …

5x-Multiplier Vs 3-Tier Model For Discharge Opioid Prescriptions After Intra-Abdominal Cancer Surgery: Randomized Clinical Trial Protocol, Brittany C. Fields, Timothy E. Newhook, Heather A. Lillemoe, Wei Qiao, Jose A. Karam, Surena F. Matin, Larissa A. Meyer, Ching-Wei D. Tzeng

Advances in Cancer Education and Quality Improvement

Background

Surgeons provide up to 10% of total opioid prescriptions across all specialties, and more than one-third of surgeon-prescribed medications are opioids. Patient-reported opioid consumption and risk of persistent opioid use beyond the postoperative recovery period correlate with the initial opioid quantity prescribed at discharge. Interventions to reduce postoperative opioid prescribing have demonstrated no adverse effects on pain control or increased need for prescription refill; however, in the absence of standardized prescription protocols, opioid prescribing practices vary widely.

Objective

The study objective is to identify the opioid prescribing model that provides the lowest oral morphine equivalents (OME) volume prescribed at …

Reducing The Percentage Of Intubation Time On Continuous Infusion Midazolam, Arsemen Brown, Emily Highsmith, Michelle Horng

Advances in Cancer Education and Quality Improvement

This quality improvement study was conducted at a comprehensive cancer care center with the aim to decrease the percentage of on continuous infusion (CI) midazolam by 30% by May 5, 2023. The pre-intervention and post-intervention data collection phases occurred from January 1, 2022, to October 31, 2022, and March 7, 2023, to May 5, 2023, respectively. Sedation was assessed utilizing the Richmond Agitation and Sedation Scale (RASS), and delirium was assessed utilizing the Intensive Care Delirium Screening Checklist (ICDSC). A sedation pathway and associated educational materials were developed by a multidisciplinary team and frontline staff. Interventions in the sedation pathway …

Impact Of A Goal Of Care Communication Training Program For Oncology Clinical Staff, Gary Martinez

Advances in Cancer Education and Quality Improvement

Abstract

Goals of care (GoC) refers to medical care decisions made by patients and families that are consistent with their personal values and preference choices. However, the oncology health care system does not always align with the patient’s GoC values and preferences. Clinical experts suggest formalized GoC education to improve this practice gap. Accordingly, MD Anderson Cancer Center implemented GoC training for front-line clinical staff using the evidence-based COMFORT Model to enhance the participants’ ability to have connected GoC conversations and enhance their comfort levels in responding to patients’ emotions. Our institution’s GoC education team compared the pretest and posttest …

Persistent Improvement In Opioid Perceptions And Prescribing For Cancer Surgery: 5-Year Follow-Up, Brittany C. Fields, Timothy E. Newhook, Heather A. Lillemoe, Jessica E. Maxwell, Jose M. Soliz, Keyuri U. Popat, Christina L. Roland, Jean-Nicolas Vauthey, Matthew H. G. Katz, Ching-Wei D. Tzeng

Advances in Cancer Education and Quality Improvement

Background and Objectives

We previously reported that implementation of a department-wide opioid education program led to post-education improvements in opioid perceptions and prescription recommendations, with one-month and one-year retention. With ongoing programmatic and quality improvement efforts, we sought to re-evaluate the retention of these improvements five years after initial efforts.

Methods

Attending surgeons, clinical fellows, and advanced practice providers were surveyed five years after implementation of a comprehensive, departmental opioid reduction framework in August 2018. This framework initially consisted of dedicated opioid education sessions and retrospective assessment of prescribing practices, and subsequently expanded over time to include prospective quality improvement …

Making Training Stick: Transferring Learning Back To The Job, Amanda Woods Herron, Phoebe Hessen, Katelyn J. Cavanaugh, Wykesha C. Hayes, Victor Hassid, Courtney L. Holladay

Advances in Cancer Education and Quality Improvement

Communication remains a central priority in healthcare, making it a key component of many training efforts. The positive impacts of communication training in healthcare settings have been well-established; however, the linkage of communication training to key organizational outcomes (e.g., engagement, performance, retention) remains underexplored. The present study investigated a training program targeting interpersonal communication within a large academic oncology center. We drew from Cognitive Load Theory and Social Cognitive Theory to evaluate the impact of the training on participant learning (retention and utilization), transfer (communication, decision-making, performance), and results-level outcomes (engagement and turnover). The program centered around a personality framework …

Announcing The Inaugural Issue Of Advances In Cancer Education And Quality Improvement (Ace-Qi): A Foreword By Dr. Peter Pisters, Peter Pisters

Advances in Cancer Education and Quality Improvement

No abstract provided.

The Power In Patient Education: A Collaborative Approach To Cancer Care, Eric Singhi, Aurora Lucas

Advances in Cancer Education and Quality Improvement

A viewpoint on patient education

Professional Alliance For Learning And Support (Pals): A Pilot Career Development Educational Program For Administrative Support Personnel In Healthcare Research, Ebonie R. Hatfield, Humberto Shaw, David P. Farris, Ronald Abraham, Dzifa Duose, Chad M. Middleton, Veronica Garza, Celia Garcia-Prieto, Ignacio I. Wistuba, Rama Soundararajan

Advances in Cancer Education and Quality Improvement

The COVID-19 pandemic has profoundly transformed the healthcare research landscape, staging unprecedented challenges for administrative research-support personnel. While career programs and retention benefits have emerged to support frontline healthcare workers facing health concerns, burnout and employee-turnover, many “classified”/administrative support staff in research departments who experience similar challenges remain without adequate structured support. This lack of structure has impacted job satisfaction, career-progression and talent retention within this crucial sector.

Recognizing the critical importance of addressing this training gap for the benefit of the broader research enterprise, the Interdisciplinary Translational Education and Research Training (ITERT) Core at UT MD Anderson Cancer Center …

Post-Discharge Telephone Intervention With A Clinical Pharmacy Specialist For Gastrointestinal Medical Oncology Patients, Jane E. Rogers, Michael Leung, Amanda Sirisaengtaksin, Jennifer Zadlo, Van Nguyen, Morgan Mace, Wendy Covert, Makenna Smack, Stacy Diao, Zhou Fang, Andrea Landgraf, Mariela Blum Murphy

Advances in Cancer Education and Quality Improvement

Background: Oncology patients are a vulnerable population with medication-related problems spanning across care settings. Gastrointestinal medical oncology (GIMO) patients often have unique medication challenges due to extensive treatment history. High-quality medication reconciliation aids in preventing medication discrepancies and potential adverse events during transitions of care. We conducted a pilot post-hospital discharge intervention with clinical pharmacy specialists for GIMO patients.

Objective: The primary objective was to identify the frequency of medication discrepancies.

Methods: GIMO patients discharged from our hospital were identified and called within 7 days of discharge. Clinical pharmacy specialist telephone encounters occurred between December 2021 and February 2022.

Results: …

Factors Associated With Emergency Difficult Tracheal Intubation And Difficult Airway Management In A Non–Operating Room Setting At A Cancer Treatment Center, Jackson Su, Neil Bailard, Jens Tan, Jeffrey Lim, Catherine Vu, Wenli Dong, Gang Zheng

Advances in Cancer Education and Quality Improvement

Difficult tracheal intubations are reported more often in the emergency non−operating room setting than in the operating setting. To identify the factors associated with emergency difficult intubation (DI) and difficult airway (DA) management in hospitalized patients with cancer, we conducted a single-center retrospective study in hospitalized patients who underwent emergency intubations in a non−operating setting from 2016 to 2019 at a cancer treatment center. Cases of DI (inability to visualize the vocal cords and/or >2 intubation attempts) and DA (DI, advanced airway device use, and/or need for a surgical airway) were included. We reviewed 763 cases; the DI and DA …

Evaluating The Impact Of A Renal Dosing Refreshable Sidebar Report On Appropriateness Of Antimicrobial Dosing At A Large Acute Care Cancer Hospital, Emily Fox, Jovan Borjan, Nancy Vuong, Hannah Aune, Claire Marten, Joshua Hendrickson

Advances in Cancer Education and Quality Improvement

Background: Appropriate antimicrobial dosing is vital in the treatment of patients with infectious diseases, though adherence to guideline recommended doses is often suboptimal.

Outcomes: This study was conducted to evaluate the impact of a renal dosing refreshable sidebar report, which displayed recommendations from a previously developed institutional antimicrobial dosing guide at the time of antimicrobial order entry. The primary outcome was adherence to daptomycin dosing guideline recommendations before and after implementation.

Methods: This was a pre- and post-quasi-experimental study at a 600-bed acute care cancer hospital. Adult patients (≥18 years old) that received daptomycin from February-April 2021 (pre-intervention phase) and …

A Tobacco Treatment Training Program Expands The Number Of Healthcare Providers Trained To Use Evidence-Based Practices And Methods, Alex Hurst, Maher Karam-Hage, Jennifer Cofer, Mehwish Javaid, Diane Beneventi, Janice Blalock, Tiffany Winter, Paul M. Cinciripini, Ernest Hawk

Advances in Cancer Education and Quality Improvement

Tobacco-use disorder remains a global health challenge, despite declining rates, and is a leading cause of morbidity and mortality, especially among special populations that disproportionally do not have access to comprehensive treatment services. The lack of trained providers and slow dissemination of new tobacco treatment knowledge are obstacles to accessing comprehensive evidence-based treatments. Less is known about the impact of specialized training programs on healthcare professionals' ability to effectively treat tobacco use. This paper reports on the evaluation of the tobacco treatment training program, training methodology, and the demographics of the specialists trained.

MD Anderson’s Tobacco Treatment Training Program (TTTP) …

Evaluating Surge Capacity In The Emergency Department: A Comprehensive Literature Review On Preparedness And Response Frameworks, Tanner J. Riscoe

Capstone Experience: Master of Public Health

Medical surge capacity in emergency departments is influenced by four critical factors: staff, stuff, space, and systems. Understanding these factors and the interplay between them is critical. Emergency departments are increasingly encountering issues with overcrowding, patient boarding, and medical surge events causing interruptions in care and depleting critical resources. Coordination of medical surge is challenging during normal operations but is intensified during times of crisis. This comprehensive literature review seeks to better understand the current state of the literature surrounding surge preparedness and response in emergency departments across the United States, identify gaps in the current literature, and ultimately recommend …

Understanding The Care Experiences And Support Needs Of Uk Adults Treated In Hospital For Meningitis, Harriet Hay, Amy Tallett Dr, Bec Aeddi, Beverley Corbett, Claire Donovan, Jane Blewitt, Juan Abad Madroñero

Patient Experience Journal

Background: Meningitis often results in ongoing and multifaceted after-effects, which can impact many aspects of people's lives, yet relatively little support and follow-up is offered. This study explored post-treatment care experiences of UK adults aged 16 and over following a recent stay in hospital for meningitis. Methods: A survey was designed to ask about hospital discharge, recovery, information provision and aftercare support. The research involved 5 semi-structured, in-depth interviews and a 15-participant online asynchronous focus group. The themes arising from this qualitative stage informed the development of a quantitative 32-item questionnaire which was hosted and promoted online between September 2022 …

Improving Handoffs Between Outpatient Clinics And Acute Cancer Care Centers At A Tertiary Oncology Hospital Using A Quality Improvement Methodology, Mini George, Mohamed Ait Aiss, Gabriele Urschel, Maria Franco Vega, Susan Gaeta, Diane Bodurka

Advances in Cancer Education and Quality Improvement

Accrediting agencies recommend safe and accurate transfer of clinical information during care transitions. At our institution, a tertiary care cancer hospital, ambulatory clinic providers use multiple methods for communicating essential information to emergency care providers. Therefore, we initiated a quality improvement project using a standardized electronic handoff during the transfer of care between providers at outpatient clinics and acute cancer care centers. The project was launched in May 2023 and aimed to achieve electronic handoff for 70% or more of ambulatory care patients transferred to emergency care by October 2023. A multidisciplinary team developed an electronic handoff, provided training, and …

Decreasing Extubation Times Using Adaptive Support Ventilation: A Scoping Review, Daphne Thomas, Cole Vest, Luke Wilson, Shannon Witcher, Bobby Bellflower Dnsc, Nnp-Bc, Faanp

Doctor of Nursing Practice Projects

Purpose/Background:This scoping review explores the effectiveness of adaptive support ventilation (ASV) compared to conventional ventilation modes in reducing postoperative extubation times in adults undergoing general anesthesia with ventilatory support. Ventilator weaning is a critical determinant of recovery and outcomes in intensive care settings. ASV, a closed-loop ventilation mode, automatically adjusts ventilator parameters based on patient-specific respiratory mechanics and demand to optimize the weaning process. Although promising, evidence regarding ASV’s effectiveness remains inconsistent across different patient populations and surgical contexts.

Methods: A systematic literature search was conducted from August 2023 to December 2024 across PubMed, CINAHL, Medline, JAMA, and Google …

Effectiveness Of The Use Of An Opt-Out Script To Increase Hiv Screening In Adolescent Clients In Pediatric Primary Care Clinics In West Tennessee: A Scoping Review, Julie Cupples Msn, Rn, Allison Johnson Ms, Bsn, Rn, Sally Humphrey Dnp, Aprn, Cpnp-Pc

Doctor of Nursing Practice Projects

Purpose/Background

The American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC) recommend one-time human immunodeficiency virus (HIV) screening for all adolescents. Pediatric primary care providers are on the front lines of adolescent healthcare and can provide testing that is adolescent-friendly, confidential, and easily accessible. This scoping review aims to synthesize the evidence and assess the literature on the efficacy of using an opt-out script to increase HIV testing in adolescent well-child checks.

Methods

A literature review was conducted between October 2022 and August 2024 to collect studies assessing adolescents aged 12-18, provider-led sex education, and …

Challenging Race-Based Health Care Discrimination: A New Private Right Of Action, Aaron Pinkett

Northwestern University Law Review

The Hippocratic Oath calls on doctors to “do no harm.” Yet we know from extensive public health research that clinicians repeatedly cause harm to Black patients by dismissing their medical concerns, misdiagnosing them, and undertreating their pain. These practices of differential treatment for Black patients have led to steadily increasing racial disparities in health care outcomes throughout the United States. Title VI of the Civil Rights Act of 1964 prohibits this type of disparate impact, but modern Supreme Court jurisprudence forecloses opportunities for affected parties to seek legal relief—despite the clearly established legislative intent of Title VI. However, another legal …