Quality Improvement Commons^™

Reducing Food Scarcity: The Benefits Of Urban Farming, S.A. Claudell, Emilio Mejia

Journal of Nonprofit Innovation

Urban farming can enhance the lives of communities and help reduce food scarcity. This paper presents a conceptual prototype of an efficient urban farming community that can be scaled for a single apartment building or an entire community across all global geoeconomics regions, including densely populated cities and rural, developing towns and communities. When deployed in coordination with smart crop choices, local farm support, and efficient transportation then the result isn’t just sustainability, but also increasing fresh produce accessibility, optimizing nutritional value, eliminating the use of ‘forever chemicals’, reducing transportation costs, and fostering global environmental benefits.

Imagine Doris, who is …

Evaluation Of A Community Based Teaching Hospital’S Geriatric Emergency Medicine Initiative, Josette Hartnett, Isabel Muronzi-Belfon, Suzanne J. Rose

Journal of Geriatric Emergency Medicine

INTRODUCTION: To accommodate the complex healthcare needs of the rising geriatric population, Stamford Hospital’s (SH) emergency department (ED) began a Geriatric Emergency Medicine Initiative (GEMI) in 2018 to improve our ED environment, practices, and focused assessments for our community-dwelling older adults.

METHODS: This retrospective program evaluation describes SH’s novel ED processes for at-risk older adults and compares GEMI and non-GEMI assessed patient outcomes using aggregate frequencies on throughput metrics such as length of stay (LOS), 72 hour and 30-day re-admission rates, and other outcomes of interest. Chi-square tests and group t-tests were used for all analyses with a p-value of …

Assessing Social Determinants Of Health In Primary Care, Vicki Carpenter

Doctoral Projects

The social determinants of health encompass the various circumstances and environments in which individuals reside, develop, labor, and experience aging (Social Determinants of Health, 2022). These variables significantly contribute to the existence of health inequities and disparities within populations. In order to effectively mitigate health disparities, it is imperative to consider the various determinants that influence health outcomes, as this consideration is crucial for advancing the goal of achieving health equity. This public health concern encompasses multiple sectors within our society, necessitating the collaboration of various organizations and communities to effectively address and mitigate its impact.

The fundamental …

Providing Optimal Resident Sleep Hygiene In Assisted Living Communities; Opportunities For Design And Operation Teams To Collaborate And Share Their Unique Knowledge, Beverly B. J. Miller

Architecture Masters of Science Program: Theses

Research is emerging relating sleep hygiene to disease pathogenesis including Parkinson's, dementia, Alzheimer’s disease and increased cardiovascular risk. The application of circadian science as it relates to human wellness has intensified as a result. The quality of sleep significantly impacts the wellness of residents living in long term care, however sleep hygiene research is lacking in assisted living (AL) communities.

The thesis question inquires; How can operation and design teams collaborate to optimize sleep health for residents in assisted living communities? The research methodology utilized a two-phase process. Phase I identified three AL communities as test sites, providing case studies …

Quality & Patient Safety Gazette : Volume 2, Issue 4 - 2023, The Aga Khan University Hospital, Karachi

Quality and Patient Safety Archives

• World Quality Day 2023
• Workshop on How to conduct a Root Cause Analysis
• Blast from the Past
• Learn with Fun!
• Stay Tuned with Us…..

A Case Study Of The Political Determinant Of Health On The Public Health Crisis Of Malaria In Nigeria, Bisola M. Olumegbon

Electronic Theses and Dissertations

Abstract

Globally, there were about 229 million cases of malaria in 2022. The sub-Saharan African region accounted for 92% of the reported cases and 94% of deaths. Nigeria had the highest number of malaria cases and deaths, representing 27% of global cases. This scholarly project was a case study guided by the political determinants of health. Triangulation of data using thematic analysis was used to identify the political determinants of malaria in Nigeria and to understand how the concept of interaction contributes to the persistence of the disease. The analysis involved a deductive and inductive approach based on the literature …

Case Sampling Vs Universal Review For Evaluating Hospital Postoperative Mortality In Us Surgical Quality Improvement Programs, Vivi W Chen, Alexis P Chidi, Tracey Rosen, Yongquan Dong, Peter A Richardson, Jennifer Kramer, David A Axelrod, Laura A Petersen, Nader N Massarweh

Faculty, Staff and Students Publications

IMPORTANCE: Representative surgical case sampling, rather than universal review, is used by US Department of Veterans Affairs (VA) and private-sector national surgical quality improvement (QI) programs to assess program performance and to inform local QI and performance improvement efforts. However, it is unclear whether case sampling is robust for identifying hospitals with safety or quality concerns.

OBJECTIVE: To evaluate whether the sampling strategy used by several national surgical QI programs provides hospitals with data that are representative of their overall quality and safety, as measured by 30-day mortality.

DESIGN, SETTING, AND PARTICIPANTS: This comparative effectiveness study was a national, hospital-level …

Assessing Virtual Versus In-Person Experiential Learning And Medical High-Fidelity Simulation In Medical Student Pediatric Clerkship Training, Andrew Mitchell Berry

Electronic Theses and Dissertations

Simulation and experiential training have been incorporated into medical school training for decades. The utilization of medical simulations has become an invaluable tool in healthcare education and training. However, circumstances such as limited resources, geographical constraints, or global health crises may hinder the feasibility of conducting in-person medical simulations. In these scenarios, virtual medical simulations emerge as a compelling alternative. While there are many ways to accomplish experiential-based learning, many faculty and students feel Socratic learning styles provide the best learning experience.

As medical students had just finished a predominantly virtual preclinical year due to the COVID-19 pandemic, the research …

Nurse Initiated Standing Orders: A Process Improvement At An Emergency Department In Interior Alaska, Justin D. Melberg

Capstone Experience: Master of Public Health

Emergency Departments (EDs) are a valuable and limited public health resource. In addition to treating acute medical emergencies, EDs bridge the gaps in urgent care and primary care accessibility, operating twenty-four hours a day, seven days a week, providing care regardless of an individual’s ability to pay. EDs across the country operate at or above capacity regularly, and overcrowding is projected to increase due to decreased facilities and available inpatient beds. Innovative measures are necessary to increase patient throughput and decrease length of stay while maintaining quality care. Nurse initiated standing orders, also known as nurse driven protocols, standing orders, …

Exploration Of The Implementation Of An Integrated Electronic Laboratory Information Management System On Quality Diagnostics Service Indicators At A County Level Public Hospital In Western Kenya., Kelly Allen

Capstone Collection

Underinvestment in pathology and laboratory capacity caused by low visibility in research and in prioritization by public health leaders results in limited effective healthcare coverage and an estimated 1.1 million premature deaths annually in Low-and-Middle-Income Countries. Kenya’s public health laboratories provide a median 41% of the Essential Diagnostic List to their patients and in Kisumu County, as much as 44.2% of the population has little to no access to essential diagnostics. The government of Kisumu implemented the county Health Laboratory Strategic Plan 2018-2022 to address this public health challenge. Little information exists on the effectiveness of these initiatives and the …

A Quality Improvement Initiative For Hiv Prevention In Underserved Communities, Meredith E. Clement, Angie D. Settle, Claudia T. Martorell, Jeffrey D. Carter, Melissa Rodriguez, Chelsie Anderson Chadha, Bonnie Douglas, Laura Simone, Leah Molloy

School of Medicine Faculty Publications

Infectious Diseases Week, IDWeek 2023, October 11 - 15, 2023, Boston, MA

A Helping Hand Out Of The River: Refugee Perspectives For Provider Engagement, Brian L. Isakson, Elizabeth R. Stein, Alexandra Olson, Destiny Waggoner, Jill Holtz, Sara Ali, Suha Amer, Martin Ndayisenga

Journal of Patient-Centered Research and Reviews

Purpose: A growing number of refugee groups are seeking care within the U.S. health care system for medical, psychological, and social needs. Research is limited in understanding refugee-specific conceptualizations of helping relationships and provider characteristics that improve interactions in health systems. This study aimed to identify provider characteristics that facilitate engagement and helpfulness in a refugee-specific population from refugee participant voices to inform future practices of health care clinics.

Methods: Semi-structured interviews with refugee participants were conducted to assess 1) experiences moving on from difficult experiences, 2) engagement with the health system, and 3) provider characteristics that facilitated engagement and …

A Clear, Succinct Research Question Portends The Rest Of The Story, Jessica J. F. Kram, Lisa Sullivan Vedder, Brenda Fay, Deborah Simpson

Journal of Patient-Centered Research and Reviews

The goal of any research manuscript is to convey the story of a systematic answer to an important question in the field. A clear, succinct research or study question is what provides the storyline that connects all the sections of a manuscript. One of the most common strategies to developing a meaningful research question is the FINER approach, which encompasses five standards to determine the quality of a question: feasible, interesting, novel, ethical, and relevant. Using the FINER approach can provide the guidepost for all design and reporting decisions. This editorial recommends creating a study protocol aimed at answering your …

Pulmonary Specialist-Supported Health Coaching Delivered By Lay Personnel Improves Receipt Of Quality Care For Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial, Rachel Willard-Grace, Danielle Hessler, Beatrice Huang, Denise Devore, Chris Chirinos, Jessica Wolf, Devon Low, Chris Garvey, Doranne Donesky, Stephanie Tsao, David H. Thom, George Su

Journal of Patient-Centered Research and Reviews

Purpose: Half of people living with chronic obstructive pulmonary disease (COPD) do not receive high-quality, evidenced-based care as described in international guidelines. We conducted secondary data analysis of a previously published study to assess the ability of a model of lay health coaching to improve provision of guideline-based care in a primary care setting.

Methods: As part of a randomized controlled trial, we recruited English- and Spanish-speaking patients with moderate to severe COPD from primary care clinics serving a low-income, predominantly African American population. Participants were randomized to receive usual care or 9 months of health coaching from primary care …

The Implications Of Ferroptosis In Antibiotic Resistance, Marysol Hohl

Senior Honors Theses

Bacterial infections in the United States are becoming increasingly resistant to existing antibiotic treatments. Due to projected increases in resistance and the recent decrease in novel antibacterials, experts have determined that the United States is in the “post-antibiotic era.” The scientific community has failed to resolve resistance despite the continual discovery of new antibiotic compounds. In the past decade, a novel form of cell death called ferroptosis has been implicated in antibiotic treatment by employing the use of nanotechnology. This literature review will describe the problem of bacterial resistance and demonstrate how current research is pioneering a new age of …

Improving Access To Cardiac Catheterization, Sunitha Dharman

Student Scholarly Projects

The American Heart Association lists cardiovascular disease as the underlying cause of death for 874,613 people who lost their lives in 2019 (Tsao et al., 2022). On average, someone in the United States has a myocardial infarction every 40 seconds, and someone dies of a stroke every 3 minutes and 30 seconds. Studies support coronary artery disease as a significant contributor to cardiac arrest in a non-hospital setting (Yannopoulos et al., 2019). The authors provide evidence supporting the importance of early cardiac catheterization. There is a 10-15% survival rate with a higher level of functioning compared to delayed or no …

The Impact Of Telehealth In Urgent Care Settings, Annie Dong

Applied Research Projects

Telehealth is an emerging modality of patient care and has since expanded to urgent care facilities. Urgent care facilities have been around for decades; however, along with telehealth, it has only grown in popularity in recent years due to the COVID-19 pandemic. However, the implementation and usage of telehealth in urgent care facilities is dependent on the provider being able to use it. This study aimed at looking at the perspective of the provider on the implementation and usage of telehealth in the urgent care setting.

J Mich Dent Assoc November 2023

The Journal of the Michigan Dental Association

Every month, The Journal of the Michigan Dental Association brings news, information, and features about Michigan dentistry to our state's oral health community and the MDA's 6,200+ members. No publication reaches more Michigan dentists!

In this issue, the reader will find the following original content:

• A cover story on The University of Michigan's Gordon H. Sindecuse Museum of Dentistry.
• News you need, Editorial and regular department articles on MDA Foundation activities, Dentistry and the Law, Staff Matters, and component news.

This issue also includes two articles reprinted with permission.

• A feature from Ontario Dentist on The Challenge of False Belief: …

Risk-Adjusted Cumulative Sum For Early Detection Of Hospitals With Excess Perioperative Mortality, Vivi W Chen, Alexis P Chidi, Yongquan Dong, Peter A Richardson, David A Axelrod, Laura A Petersen, Nader N Massarweh

Faculty, Staff and Students Publications

IMPORTANCE: National surgical quality improvement programs lack tools for early detection of quality or safety concerns, which risks patient safety because of delayed recognition of poor performance.

OBJECTIVE: To compare the risk-adjusted cumulative sum (CUSUM) with episodic evaluation for early detection of hospitals with excess perioperative mortality.

DESIGN, SETTING, AND PARTICIPANTS: National, observational, hospital-level, comparative effectiveness study of 697 566 patients. Identification of hospitals with excess, risk-adjusted, quarterly 30-day mortality using observed to expected ratios (ie, current criterion standard in the Veterans Affairs Surgical Quality Improvement Program) was compared with the risk-adjusted CUSUM. Patients included in the study underwent a …

A 3- And 6- Month Follow-Up To A Student-Led Approach To Patient Safety In Pre-Clinical Curriculum, Nelson D. Gonzalez, Sahar Panjwani, Daniel Nwosuocha, Lauren Bayliss, Ayleen Godreau

Research Colloquium

Introduction: Preventable medical errors are currently the third leading cause of death in the United States following heart disease and cancer. In light of this, integration of formal patient safety education into undergraduate medical education has been encouraged by the World Health Organization. This study aimed to assess the change in patient safety knowledge, attitudes, and beliefs in students after early exposure to patient safety during pre-clinical years.

Methods: First and second-year medical students participated in the training and responses were assessed through a pre-test, immediate post-test, 3-month post-test, and 6-month post-test. The survey assessed student knowledge on aspects …

Quality Improvement Initiative To Improve Time And Adherence To Revaccination After Hematopoietic Cell Transplantation: Implementation Of A Revaccination Clinic Within The Transplantation Program, Caitlin Elgarten, Anne Wohlschlaeger, Ellen Levy, Katharine Tadley, Lei Wang, Megan Atkinson, Houston Roberson, Timothy Olson, Nancy Bunin, Jennifer Heimall, Brian Fisher, Stephan Grupp, Jason Freedman

Faculty, Staff and Students Publications

Background:

Revaccination after hematopoietic cell transplantation (HCT) is critical to prevent morbidity and mortality from vaccine preventable illnesses. While earlier re-vaccination after HCT is desirable, they may be ineffective if deployed before partial reconstitution of adaptive immunity. Increasingly, personalized approaches to re-vaccination after HCT have replaced time-based protocols in order to minimize unvaccinated time and enhance vaccine effectiveness. Furthermore, for revaccination to be maximally beneficial, compliance with, and timely delivery of the complete revaccination schedule is imperative, but rare, and there is little data on strategies to optimize vaccine delivery.

Objectives:

The global aim of our quality improvement initiative was …

Quality Improvement Project To Increase Hepatitis C Virus Screening For Ambulatory Gme Internal Medicine Clinic Patients, Nghia Nguyen, Karrar Al Gburi, Arturo Suplee, Jarrad Mcadams, Serag Fares, Carol Soler, Ans Albustamy, Jorge Alejandro Bernal, Sumandeep Brar, J. Paredes

Research Symposium

Background: In 2020, CDC established new guideline expanding Hepatitis C virus (HCV) screening to all adults aged 18 to 79 years. Our QI project objective is to enhance HCV screening amongst the UTRGV-DHR IM department by establishing suitable reminders and educational sessions.

Methods: We reviewed HCV screening status of all adult patients 18 to 79 years old from June 1^st 2020 to December 1^st 2020. We then provided one lecture on the new screening recommendation from CDC 2020 guideline. We also encouraged residents to educate patients on the importance of HCV screening, and to identify and overcome barriers …

The Fortify Resilience Initiative, Nausheen Jamal, Deepu George, Maria Hernandez, Evan Garcia, Myrna Ruiz, Salvador Arellano Iii

Research Symposium

Purpose: The Fortify Resilience Initiative focuses on building and sustaining a culture of wellbeing for Residents and Fellows (R/Fs) at The University of Texas Rio Grande Valley (UTRGV) School of Medicine’s (SOM) Graduate Medical Education (GME) residency and fellowship programs. In order to address the multitude of threats to physician wellness and to mitigate the silent, but pernicious effects of burnout on these physician learners serving in the RGV, this Initiative from the Office of GME will strengthen existing wellbeing pathways while expanding additional solutions that will work to sustain wellbeing. Utilizing a combination of prevention, promotion, and intervention strategies …

Interdisciplinary Integrated Primary And Behavioral Healthcare (I2pbh) Initiative, John Ronnau, Deepu George, Maria Hernandez, Evan Garcia, Myrna Ruiz

Research Symposium

Purpose: The Interdisciplinary Integrated Primary and Behavioral Healthcare (I²PBH) initiative will train University of Texas Rio Grande Valley (UTRGV) mental health graduates to deliver high quality, evidence-based Integrated Behavioral Health (IBH) services in the Rio Grande Valley (RGV) – a high-need, high-demand, medically underserved Hispanic region along the US-Mexico border. Specifically, the I²PBH initiative will train 24 UTRGV mental health graduates annually to deliver high-quality Integrated Behavioral Health (IBH) clinical services through the evidence based Primary Care Behavioral Health (PCBH) model. With a training emphasis on basic/advanced theory and clinical skills in the PCBH model, students …

Primary Care Behavioral Health Partnerships Advancing & Transforming Health Sciences (Pcbh Paths), Kristan Diaz-Rios, Deepu George, Maria Hernandez, Evan Garcia, Myrna Ruiz, Salvador Arellano Iii

Research Symposium

Purpose: Primary Care Behavioral Health Partnerships Advancing & Transforming Health Sciences (PCBH PATHS) is a workforce development pipeline project aimed at permanently augmenting UTRGV’s institutional capacity to address shortage of an Integrated Behavioral Health (IBH) competent workforce locally, regionally and nationally. Our initiative, aligned with UTRGV strategic priorities and key initiatives, will integrate basic(model specific strategy and operational elements), mid-level (role identity and profession specific behavioral competencies specific to each health profession), and advanced (behavioral medicine clinical skills) applications of the evidence based PCBH model of delivery. A PCBH focused delivery system (clinical and educational), in which primary care providers …

A Logistics Approach To Improve Medication Reconciliation In The Outpatient Clinic Setting, Aysha Khan, Demetra Antimisiaris, Madison Perkins, Luz Fernandez

The Cardinal Edge

Medication reconciliation (MR) is the process of determining the most accurate account of medication the patient is taking. Although MR seems simple, research has shown that 25% of medical errors are related to lack of medication reconciliation [1]. In the community clinic setting, the task of medication reconciliation falls on the Medical Assistants (MAs). A preliminary study of MR accuracy in an outpatient clinic found an average of 5.8 discrepancies in the chart medication list [2]. The most notable were incomplete directions, wrong directions, or wrong frequency of dosing. Unoptimized medication use is estimated to result in 275,869 deaths per …

From Awareness To Action: Understanding And Addressing Health Disparities, Aamira Shah

The Cardinal Edge

In the United States, marginalized groups consistently face barriers to healthcare services necessary for maintaining quality of life and achieving positive health outcomes. Health disparities can be defined as “preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by populations that have been disadvantaged by their social or economic status, geographic location, or environment” (CDC, 2008). With input from insightful interviews, this article seeks to investigate specific challenges faced by marginalized groups in the healthcare setting and provide potential solutions to reduce health disparities.

Anti-Inflammatory And Antioxidant Effects Of Sea Urchin Spine Extract, Dina Magdy El Gamal

The Undergraduate Research Journal

Diadema savignyi spine extract in an experimental setup using L929 cell line in vitro. The cell metabolic activity of L929 cells is tested through an MTT assay. The sea urchin spine extract is applied to the cells in two concentrations: 100 μg/ml (136% viability) and 200 μg/ml (95% viability). The bioactive components of the sea urchin spine are identified via GC-MS, and the antioxidant and anti-inflammatory activities are evaluated using catalase assay (CAT), glutathione (GSH), and nitric oxide (NO) tests. Results show that the GC-MS identified bioactive components including the anti-inflammatory and anti-irritant bisabolol oxide and the pro-inflammatory oleic acid. …

Retrospective Evaluation Of The Covid-19 Contact Tracing Program At The Maine Center For Disease Control And Prevention, Elisabeth Brewington Mha, Mph, Ben K. Greenfield Phd, Jessica Purser Phd

Journal of Maine Medical Center

Introduction: Despite the widespread use of contact tracing efforts throughout the COVID-19 pandemic, there are limited findings available about best practices and recommendations. The Maine Center for Disease Control and Prevention contracted staff to conduct COVID-19 contact tracing from August 2020 through February 2022. A retrospective evaluation of this program was conducted to share lessons learned with public health and health care leaders for future use.

Methods: Contracted contact tracing staff participated in facilitated discussions structured by the Strengths, Weaknesses, Opportunities, and Threats analysis framework. Three sessions were recorded and transcribed, and qualitative analysis through thematic review and evaluation coding …

Who Left The Hospital Against Medical Advice During The Early Covid-19 Pandemic?, Bryan Werner, Se Won Lee

HCA Healthcare Journal of Medicine

Background

Patients leaving against medical advice (AMA) presents a challenge to hospitals as they try to manage costs and improve patient outcomes in an ever-increasing competitive market. Investigating AMA discharges that occurred during the early COVID-19 pandemic presents a unique opportunity to better understand this phenomenon and be better prepared for the future.

Methods

This retrospective analysis of 34 379 patients from a nationwide private healthcare system across 20 states analyzed patients during the early stages of the pandemic who chose to leave against medical advice (AMA) after being admitted with COVID-19 infection and identified several patient characteristics associated with …