Quality Improvement Commons^™

Cutaneous Adverse Effects From Diabetes Devices In Pediatric Patients With Type 1 Diabetes Mellitus: Systematic Review, Alicia Podwojniak, Joseph Flemming, Isabella J Tan, Hira Ghani, Zachary Neubauer, Anne Jones

Rowan-Virtua School of Osteopathic Medicine Departmental Research

BACKGROUND: Continuous glucose monitoring (CGM) and continuous subcutaneous insulin infusions (CSIIs) are the current standard treatment devices for type 1 diabetes (T1D) management. With a high prevalence of T1D beginning in pediatrics and carrying into adulthood, insufficient glycemic control leads to poor patient outcomes. Dermatologic complications such as contact dermatitis, lipodystrophies, and inflammatory lesions are among those associated with CGM and CSII, which reduce glycemic control and patient compliance.

OBJECTIVE: This systematic review aims to explore the current literature surrounding dermatologic complications of CGM and CSII as well as the impact on patient outcomes.

METHODS: A systematic review of the …

Insurance Coverage During Transitions: Evidence From Medicaid Automatic Enrollment For Children Receiving Supplemental Security Income, Stephanie Rennane, Danielle Sobol, Bradley D Stein, Andrew Dick

Faculty, Staff and Student Publications

OBJECTIVES: To analyze relationships between Medicaid automatic enrollment for child Supplemental Security Income (SSI) recipients and health insurance coverage during transitions.

DATA SOURCES AND STUDY SETTING: Medical Expenditure Panel Study, 2000-2020 and National Survey for Children with Special Health Care Needs, 2001-2010.

STUDY DESIGN: Leveraging variation in SSI-Medicaid automatic enrollment status across regions and over time, we estimate a regression model to quantify associations between automatic enrollment and insurance coverage. We validate our findings in the NS-CSHCN.

DATA COLLECTION: Our sample includes children receiving SSI for a disability. We also analyze a subsample of children newly enrolled in SSI.

PRINCIPAL …

Risk Evaluation In Occupational Safety And Health Research: Results From A Benchmarking Exercise Of Federal And Academic Irbs, Sarah A Felknor, Jessica M K Streit, Angela M Morley, John D Piacentino

Faculty, Staff and Student Publications

OBJECTIVE: Research involving working populations can pose unique ethical and risk evaluation challenges. The purpose of this benchmarking project was to assess how federal agencies and academic institutions approach the interpretation and application of key risk evaluation concepts in research involving workers in their places of employment.

METHODS: Key informant interviews were conducted to ascertain current practices related to assessing soundness of research design, determining risk reasonableness and research relatedness of risks, and evaluating the risk of noninvasive clinical tests in occupational settings.

RESULTS: There were noteworthy commonalities among the approaches described to review and address critical aspects of risk …

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 …

Screening For Food And Nutrition Insecurity In The Healthcare Setting: A Cross-Sectional Survey Of Non-Medicaid Insured Adults In An Integrated Healthcare Delivery System, Carmen Byker Shanks, Nancy P Gordon

Faculty, Staff and Student Publications

OBJECTIVES: Healthcare screening identifies factors that impact patient health and well-being. Hunger as a Vital Sign (HVS) is widely applied as a screening tool to assess food security. However, there are no common practice screening questions to identify patients who are nutrition insecure or acquire free food from community-based organizations. This study used self-reported survey data from a non-Medicaid insured adult population approximately one year after the start of the COVID-19 pandemic (2021). The survey examined the extent to which the HVS measure might have under-estimated population-level food insecurity and/or nutrition insecurity, as well as under-identified food and nutrition insecurity …

Institutional Strategies To Maintain And Grow Imaging Research During The Covid-19 Pandemic, Mai-Lan Ho, Corey W Arnold, Summer J Decker, John D Hazle, Elizabeth A Krupinski, David A Mankoff

Faculty, Staff and Student Publications

Understanding imaging research experiences, challenges, and strategies for academic radiology departments during and after COVID-19 is critical to prepare for future disruptive events. We summarize key insights and programmatic initiatives at major academic hospitals across the world, based on literature review and meetings of the Radiological Society of North America Vice Chairs of Research (RSNA VCR) group. Through expert discussion and case studies, we provide suggested guidelines to maintain and grow radiology research in the postpandemic era.

A Scoping Review Of Digital Health Interventions For Combating Covid-19 Misinformation And Disinformation, Katarzyna Czerniak, Raji Pillai, Abhi Parmar, Kavita Ramnath, Joseph Krocker, Sahiti Myneni

Faculty, Staff and Student Publications

OBJECTIVE: We provide a scoping review of Digital Health Interventions (DHIs) that mitigate COVID-19 misinformation and disinformation seeding and spread.

MATERIALS AND METHODS: We applied our search protocol to PubMed, PsychINFO, and Web of Science to screen 1666 articles. The 17 articles included in this paper are experimental and interventional studies that developed and tested public consumer-facing DHIs. We examined these DHIs to understand digital features, incorporation of theory, the role of healthcare professionals, end-user experience, and implementation issues.

RESULTS: The majority of studies (n = 11) used social media in DHIs, but there was a lack of platform-agnostic generalizability. …

Multisite Evaluation Of Prediction Models For Emergency Department Crowding Before And During The Covid-19 Pandemic, Ari J Smith, Brian W Patterson, Michael S Pulia, John Mayer, Rebecca J Schwei, Radha Nagarajan, Frank Liao, Manish N Shah, Justin J Boutilier

Faculty, Staff and Student Publications

OBJECTIVE: To develop a machine learning framework to forecast emergency department (ED) crowding and to evaluate model performance under spatial and temporal data drift.

MATERIALS AND METHODS: We obtained 4 datasets, identified by the location: 1-large academic hospital and 2-rural hospital, and time period: pre-coronavirus disease (COVID) (January 1, 2019-February 1, 2020) and COVID-era (May 15, 2020-February 1, 2021). Our primary target was a binary outcome that is equal to 1 if the number of patients with acute respiratory illness that were ED boarding for more than 4 h was above a prescribed historical percentile. We trained a random forest …

Multimethod Process Evaluation Of A Community Paramedic Delivered Care Transitions Intervention For Older Emergency Department Patients, Gwen Costa Jacobsohn, Apoorva P Maru, Rebecca K Green, Angela N Gifford, Matthew D Lukasik, Tikiri Bandara, Thomas V Caprio, Amy L Cochran, Jeremy T Cushman, Courtney M C Jones, Amy J H Kind, Michael Lohmeier, Manish N Shah

Faculty, Staff and Student Publications

OBJECTIVE: We assessed fidelity of delivery and participant engagement in the implementation of a community paramedic coach-led Care Transitions Intervention (CTI) program adapted for use following emergency department (ED) visits.

METHODS: The adapted CTI for ED-to-home transitions was implemented at three university-affiliated hospitals in two cities from 2016 to 2019. Participants were aged ≥60 years old and discharged from the ED within 24 hours of arrival. In the current analysis, participants had to have received the CTI. Community paramedic coaches collected data on program delivery and participant characteristics at each transition contact via inventories and assessments. Participants provided commentary on …

Fostering A High-Functioning Team In Cancer Care Using The 4r Oncology Model: Assessment In A Large Health System And A Blueprint For Other Institutions, Raymond Liu, Christine B Weldon, Elizabeth Linehan, Nancy Gordon, Thea Abbe, Marti Hennings, Henie James, Jed Katzel, Chun Ng, Megumi Tomita, Jeffrey B Velotta, Stephanie Ossowski, Lori C Sakoda, Sharon Likely Sprague, Anna Dowling, Kimberly Beringer, Arliene Ravelo, Elaine Yu, Julia R Trosman

Faculty, Staff and Student Publications

PURPOSE: Delivering cancer care by high-functioning multidisciplinary teams promises to address care fragmentation, which threatens care quality, affects patient outcomes, and strains the oncology workforce. We assessed whether the 4R Oncology model for team-based interdependent care delivery and patient self-management affected team functioning in a large community-based health system.

METHODS: 4R was deployed at four locations in breast and lung cancers and assessed along four characteristics of high-functioning teams: recognition as a team internally and externally; commitment to an explicit shared goal; enablement of interdependent work to achieve the goal; and engagement in regular reflection to adapt objectives and processes. …

Low Rates Of Structured Advance Care Planning Documentation In Electronic Health Records: Results Of A Single-Center Observational Study, Adela Wu, Robert J Huang, Gabriela Ruiz Colón, Chris Zembrzuski, Chirag B Patel

Faculty, Staff and Student Publications

BACKGROUND: Proper advance care planning (ACP) documentation both improves patient care and is increasingly seen as a marker of high quality by governmental payers. The transition of most medical documentation to electronic health records (EHR) allows for ACP documents to be rapidly disseminated across diverse ambulatory practice settings. At the same time, the complexity and heterogeneity of the EHR, as well as the multiple potential storage locations for documentation, may lead to confusion and inaccessibility. There has been movement to promote structured ACP (S-ACP) documentation within the EHR.

METHODS: We performed a retrospective cohort study at a single, large university …

How Did The Dietary Habits Of Patients With Chronic Medical Conditions Change During Covid-19?, Sahil K. Patel, Adarsh Gupta

Rowan-Virtua School of Osteopathic Medicine Departmental Research

CONTEXT: Previous studies have examined the changes in the dietary habits of general populations during the COVID-19 pandemic but have not focused on specific populations such as those with chronic medical conditions (CMCs). Prior to major vaccination efforts, 96.1% of deaths were attributed to patients with preexisting CMCs, thus it is important to examine how this population has endured changes.

OBJECTIVES: The purpose of this study was to identify differences in dietary habits, lifestyle habits, and food attitudes between those with CMCs compared to the populations without chronic medical conditions (non-CMCs) since the beginning of the COVID-19 pandemic.

METHODS: An …

Real-World Matching Performance Of Deidentified Record-Linking Tokens, Elmer V Bernstam, Reuben Joseph Applegate, Alvin Yu, Deepa Chaudhari, Tian Liu, Alex Coda, Jonah Leshin

Faculty, Staff and Student Publications

OBJECTIVE: Our objective was to evaluate tokens commonly used by clinical research consortia to aggregate clinical data across institutions.

METHODS: This study compares tokens alone and token-based matching algorithms against manual annotation for 20,002 record pairs extracted from the University of Texas Houston's clinical data warehouse (CDW) in terms of entity resolution.

RESULTS: The highest precision achieved was 99.9% with a token derived from the first name, last name, gender, and date-of-birth. The highest recall achieved was 95.5% with an algorithm involving tokens that reflected combinations of first name, last name, gender, date-of-birth, and social security number.

DISCUSSION: To protect …

Assessment Of Electronic Health Record For Cancer Research And Patient Care Through A Scoping Review Of Cancer Natural Language Processing, Liwei Wang, Sunyang Fu, Andrew Wen, Xiaoyang Ruan, Huan He, Sijia Liu, Sungrim Moon, Michelle Mai, Irbaz B Riaz, Nan Wang, Ping Yang, Hua Xu, Jeremy L Warner, Hongfang Liu

Faculty, Staff and Student Publications

Purpose: The advancement of natural language processing (NLP) has promoted the use of detailed textual data in electronic health records (EHRs) to support cancer research and to facilitate patient care. In this review, we aim to assess EHR for cancer research and patient care by using the Minimal Common Oncology Data Elements (mCODE), which is a community-driven effort to define a minimal set of data elements for cancer research and practice. Specifically, we aim to assess the alignment of NLP-extracted data elements with mCODE and review existing NLP methodologies for extracting said data elements.

Methods: Published literature studies were searched …

The Technical Landscape For Patient-Centered Cds: Progress, Gaps, And Challenges, Prashila Dullabh, Krysta Heaney-Huls, David F Lobach, Lauren S Hovey, Shana F Sandberg, Priyanka J Desai, Edwin Lomotan, James Swiger, Michael I Harrison, Chris Dymek, Dean F Sittig, Aziz Boxwala

Faculty, Staff and Student Publications

Supporting healthcare decision-making that is patient-centered and evidence-based requires investments in the development of tools and techniques for dissemination of patient-centered outcomes research findings via methods such as clinical decision support (CDS). This article explores the technical landscape for patient-centered CDS (PC CDS) and the gaps in making PC CDS more shareable, standards-based, and publicly available, with the goal of improving patient care and clinical outcomes. This landscape assessment used: (1) a technical expert panel; (2) a literature review; and (3) interviews with 18 CDS stakeholders. We identified 7 salient technical considerations that span 5 phases of PC CDS development. …

A Qualitative Investigation Of Organizational Challenges And Facilitators To Screening Individuals Experiencing Homelessness For Hepatitis C Virus (Hcv) In Houston, Texas, Alane Celeste-Villalvir, J Michael Wilkerson, Christine Markham, Lourdes Rodriguez, Vanessa Schick

Faculty, Staff and Student Publications

BACKGROUND: Individuals experiencing homelessness may be at a disproportionately high risk for hepatitis C (HCV) because they may be more likely to engage in HCV risk behaviors. Community organizations that provide services to these vulnerable individuals can effectively screen, diagnose, and navigate them into HCV care. However, screening people experiencing homelessness for HCV at such organizations is limited by various challenges that remain understudied, including budgetary considerations and strategies to improve teamwork and communication. Accordingly, this study investigated the organizational challenges and facilitators to HCV screening of individuals experiencing homelessness as reported by homeless services providers.

METHODS: Staff (N = …

Characterizing Cancer And Covid-19 Outcomes Using Electronic Health Records, Youngran Kim, Liang Zhu, Huili Zhu, Xiaojin Li, Yan Huang, Chunhui Gu, Heather Bush, Caroline Chung, Guo-Qiang Zhang

Faculty, Staff and Student Publications

PURPOSE: Patients with cancer often have compromised immune system which can lead to worse COVID-19 outcomes. The purpose of this study is to assess the association between COVID-19 outcomes and existing cancer-specific characteristics.

PATIENTS AND METHODS: Patients aged 18 or older with laboratory-confirmed COVID-19 between June 1, 2020, and December 31, 2020, were identified (n = 314 004) from the Optum® de-identified COVID-19 Electronic Health Record (EHR) derived from more than 700 hospitals and 7000 clinics in the United States. To allow sufficient observational time, patients with less than one year of medical history in the EHR dataset before their …

Patient Satisfaction With Noise, Robert W. Kentner Ii

Student Scholarly Projects

Practice Problem: Noise on hospital units can interfere with patient rest, timely recovery, and statisfacton with care. Improvements in the reduction of hospital noise levels lead to improved patient satisfaction and improved rest. Patients were surveyed on their satisfaction with noise during the day and at night.

PICOT: In Acute Care Patients (P), does the implementation of a noise reduction program (I) compared to no noise reduction program (C), affect patient satisfaction with noise (O) over a six-week period (T)?

Evidence: Studies show that many hospitals have noise levels that exceed the World Health Organization’s recommended standards for noise …

Reaching Consensus On A Home Infusion Central Line-Associated Bloodstream Infection Surveillance Definition Via A Modified Delphi Approach., Sara Keller, Alejandra Salinas, Deborah Williams, Mary Mcgoldrick, Lisa Gorski, Mary Alexander, Anne Norris, Jennifer Charron, R. Scott Stienecker Md, Catherine Passaretti, Lisa Maragakis, Sara E Cosgrove

Infection Control

BACKGROUND: A consensus on a central line-associated bloodstream infection (CLABSI) surveillance definition in home infusion is needed to standardize measurement and benchmark CLABSI to provide data to drive improvement initiatives METHODS: Experts across fields including home infusion therapy, infectious diseases, and healthcare epidemiology convened to perform a 3-step modified Delphi approach to obtain input and achieve consensus on a candidate home infusion CLABSI definition.

RESULTS: The numerator criterion was identified by participants as involving one of the 2 following: (1) recognized pathogen isolated from blood culture and pathogen is not related to infection at another site, or (2) one of …