Family Medicine Commons^™

Getting To The Source: Safety Findings In Cervical Cancer Screening Using External Lab Databases, Miranda Aragon, Md, Sunny Lai, Md, Mph, Geoffrey Mills, Md, Phd

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Objective

To investigate the feasibility of using external lab databases to locate Pap smear results completed at outside clinics.

Eliciting Patient-Important Outcomes Through Group Brainstorming: When Is Saturation Reached?, Marianna Lanoue, Alexzandra Gentsch, Amy Cunningham, Geoffrey Mills, Amanda M.B. Doty, Judd E. Hollander, Brendan G. Carr, Larry Loebell, Gail Weingarten, Kristin L. Rising

Department of Emergency Medicine Faculty Papers

PURPOSE: Group brainstorming is a technique for the elicitation of patient input that has many potential uses, however no data demonstrate concept saturation. In this study we explore concept saturation in group brainstorming performed in a single session as compared to two or three sessions.

METHODS: Fifty-two predominately African American adults patients with moderately to poorly controlled Diabetes Mellitus participated in three separate group brainstorming sessions as part of a PCORI-funded group concept mapping study examining comparing methods for the elicitation of patient important outcomes (PIOs). Brainstorming was unstructured, in response to a prompt designed to elicit PIOs in diabetes …

A Learning Community Approach To Identifying Interventions In Health Systems To Reduce Colorectal Cancer Screening Disparities., Lillian C. Man, Melissa Dicarlo, Emily Lambert, Randa Sifri, Martha Romney, Linda Fleisher, Ronald Myers

Department of Medical Oncology Faculty Papers

Although colorectal cancer (CRC) screening in the United States has been increasing, screening rates are not optimal, and there are persistent disparities in CRC screening and mortality, particularly among minority patients. As most CRC screening takes place in primary care, health systems are well-positioned to address this important population health problem. However, most health systems have not actively engaged in identifying and implementing effective evidence-based intervention strategies that can raise CRC screening rates and reduce disparities. Drawing on the Collective Impact Model and the Interactive Systems Framework for Dissemination and Implementation, our project team applied a learning community strategy to …

Effective Hepatitis C Screening In High Risk Populations, Aekata Shah, Do, Jennifer Seymour, Do

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Purpose

The purpose of our study was to demonstrate how various quality improvement initiatives activated in selected Jefferson Northeast family medicine teaching offices have enabled effective HCV screening. Given the cost effectiveness of screening and early treatment versus treatment of the disease in the later stages of progression,8 we hope to encourage other primary care offices to implement quality initiatives to encourage appropriate HCV screening. This is especially important for the baby boomer generation, as well as for high risk individuals with a history for and/or current IV drug abuse or other high risk behaviors.

Implementation Of A Volunteer-Based Hospital Program For Older Adults, Elizabeth Collins, Md, Kristine Swartz, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Background

• A multi-faceted, volunteer-led, hospital-based program1has been shown to: •Reduce the incidence of delirium •Decrease hospital length of stay •Reduce hospital costs.
• Implementation of such a program requires upfront investment.
• A smaller, volunteer-based visitation program for older adults may provide support for the allocation of more hospital resources in delirium prevention and establishment of a formal Hospital Elder Life Program1in this institution.
• This research aims to investigate: •If the implementation of a visitation program is feasible at this hospital •Volunteer experience with the program.

The Effects Of Office-Based Interventions To Increase Patient Enrollment In An Online Electronic Medical Record Portal, Lionel Mcintosh, Md, Allison Rague, Md, Claire Thesing, Md, Amy Lachewitz, Md, Gillian Love, Md, Daniel Sizemore, Md, Zachary Klock, Md, Aimee Mcmullin, Md, Zeynep Uzumcu, Md, Patrick Mcmanus, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

We aimed to increase the number of JFMA patients signed up with MyChart by 50% over a 5 month time frame by educating providers and staff on ways to implement patient portal sign up into the office visit as well raising awareness of the portal for both providers and patients

Improving Follow-Up For Family Medicine Patients After Hospital Discharge, Erica Li, Md, Rebecca Simon, Md, Michael Weissberger, Md, Angela Silverman, Md, Mpg, Bryan Botti, Md, Laura Emerson, Md, Zoe Agoos, Md, Rachel Ehrman-Dupre, Md, Jennifer Moyer, Md, Andrew Rabovsky, Md, Geoffrey Mills, Md, Phd

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Aims

• Increase percentage of JFMA patients with follow-up appointment scheduled after discharge to 100% by March 2018
• Increase percentage of JFMA patients who show up to their follow up appointments after discharge to 80% by March 2018

The Effect Of Diabetes Self-Management Education On Hba1c And Quality Of Life In African-Americans: A Systematic Review And Meta-Analysis., Amy T. Cunningham, Denine R. Crittendon, Neva White, Geoffrey D. Mills, Victor Diaz, Marianna Lanoue

Department of Family & Community Medicine Faculty Papers

BACKGROUND: Type 2 diabetes presents a major morbidity and mortality burden in the United States. Diabetes self-management education (DSME) is an intervention associated with improved hemoglobin A1c(HbA1c) and quality of life(QOL), and is recommended for all individuals with type 2 diabetes. African-Americans have disproportionate type 2 diabetes morbidity and mortality, yet no prior meta-analyses have examined DSME outcomes exclusively in this population. This systematic review and meta-analysis examined the impact of DSME on HbA1c and QOL in African-Americans compared to usual care.

METHODS: Randomized controlled trials, cluster-randomized trials, and quasi-experimental interventions were included. 352 citations were retrieved; 279 abstracts were …

Sports Medicine Potpourri, Marc I. Harwood, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Objectives:

At the conclusion of this talk, the learner will be:

• Thoroughly confused by the whirlwind of information presented
• But...able to delve into any of the topics at greater length when time permits.

Presentation: 52:03

Audio for PowerPoint slides.

Transgender Care, Nyasha George, Md, Pgy 3

Department of Family & Community Medicine Presentations and Grand Rounds

Outline:

Objectives

Review of trans epidemiology

Healthcare and the Transcommunity

Cases 1&2

• Taking a transgender history
• CSH indications

Case 3

• Mental Health and Transpersons

Case 4

• Cardiovascular Risks and Estrogen in Transwomen
• Provider Resources

Objectives

My goals for you at the end of this lecture:

Comfort in determining which transgender patients meet criteria for initiating CSH

Appreciation of the overlap between transgender identity and psychiatric disease as mediated primarily by trauma

Improved self efficacy in weighing risks/benefits of CSH therapy

Familiarity with resources available to help support primary care providers take care of transgender patients.

Presentation: 58:36

Promoting Family Resilience As A Population Health Strategy, Barry J. Jacobs, Psy.D.

Department of Family & Community Medicine Presentations and Grand Rounds

Today's Talk:

• Why family matters to population health
• Research from two movements
• Steps toward patient and family resilience
• Barriers to integrating family caregivers into healthcare
• Healthcare-based family caregiver support programs: Baylor Scott & White, Concord Hospital

No audio, just PowerPoint slides

An Interprofessional Clinical Integrations Pilot Program: Integrating Third-Year Pharmd Students Into Family Medicine Clinics, Eric Gilliam, Pharmd, Arian Hilsendager, Fnp, Erin Hagerman, Pa, Benjamin Kirkley, Md, Benjamin Chavez, Pharmd, Kari Franson, Pharmd

JCIPE Conference

Purpose: Pilot an interprofessional student placement model by entrusting Doctor of Pharmacy students to deliver value-added patient engagement within interprofessional clinical environments.

Background: Beginning in January 2016, pharmacy education standards mandate students actively engage in early patient care experiences with interprofessional teams, thus necessitating new models by which students collaborate with providers in the provision of patient care.

Intervention: Between May and August 2016, two family medicine clinics are incorporating 65 third-year pharmacy students into shared medical patient care visits during an interprofessional-provider introductory pharmacy practice experience (IP Provider IPPE) pilot program. Students engage with patients and …

The Core Of Care Management: The Role Of Authentic Relationships In Caring For Patients With Frequent Hospitalizations., Charlotte Grinberg, Margaret Hawthorne, Marianna Lanoue, Jeffrey Brenner, Dawn B Mautner

Department of Family & Community Medicine Faculty Papers

In the movement to improve the health of patients with multiple chronic conditions and vulnerabilities, while reducing the need for hospitalizations, care management programs have garnered wide attention and support. The qualitative data presented in this paper sheds new light on key components of successful chronic care management programs. By going beyond a task- and temporal-based framework, this analysis identifies and defines the importance of "authentic healing relationships" in driving individual and systemic change. Drawing on the voices of 30 former clients of the Camden Coalition of Healthcare Providers, the investigators use qualitative methods to identify and elaborate the core …

Comprehensive Refugee Health Surveillance In Philadelphia: A Combined Resettlement And Clinical Patient Registry, Colleen Payton, Mph, Ches, Brittany Divito, Mph, Bsn, Rn, Gretchen Shanfeld, Mph, Zoe Agoos, Md, Kevin Scott, Md, Marc Altshuler, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Oral presentation at the 6^th Annual North American Refugee Health Conference, Niagara Falls, New York.

Goal:

To improve the success of refugee resettlement and health outcomes in Philadelphia by establishing a multi-agency registry with social services and clinical measures.

Barriers And Facilitators To Cervical Cancer Screening Among Iraqi Refugees Resettled In Philadelphia: A Qualitative Analysis Of Patient And Provider Perceptions, Colleen Payton, Mph, Ches, Laura Parente, Md, Dalea Al-Hawarri, Md, Philip Manasseh, Mph, Kevin Scott, Md, Marc Altshuler, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Oral presentation at the 6^th Annual North American Refugee Health Conference, Niagara Falls, New York.

Research Questions:

1. What is the prevalence of cervical cancer and cervical cancer screening among recently resettled refugees seen at Jefferson's Center for Refugee Health?

2. Are patient-and provider-identified barriers to cervical cancer screening at CRH consistent with those identified in previous research efforts?

3. What are patient-and provider identified facilitators to cervical cancer screening for Iraqi refugee women?

Utilization Of Exercise Prescriptions For Older Adults, David Jeong, Md, Caqsm, Cep, Rmsk, Brooke Salzman, Md, Jeremy Close, Md

Department of Family & Community Medicine Posters

Objective

This study was conducted to investigate

1) Providers` knowledge and physician attitude about Exercise and Physical activity (PA) recommendations for Older Adults (OA)

2) Frequency of utilizing written exercise prescriptions

3) Barriers to using exercise prescriptions in primary care practice

4) Providers’ interest in learning about and utilizing exercise prescriptions

Recurrent Siadh After Switching Citalopram To Very Low Dose Duloxetine In The Elderly, David Jeong, Md, Caqsm, Cep, Rmsk, Patrick Doggett, Md, Kristine Swartz, Md, Lauren Hersh, Md, Brooke Salzman, Md

Department of Family & Community Medicine Posters

Objective

• Duloxetine-induced SIADH has been seldom reported
• This case study emphasizes the importance of suspecting rare adverse effects of recurrent SIADH after switching an SSRI to duloxetine in older adults

The Pennsylvania Emergency Department Geriatric Readiness Project, Adam Perry, Md, Alyssa Sipes, Bs

College of Population Health Posters

BE THE ED DOC – Illustrating Geriatric Readiness

An independent, right handed 81 year old who lives alone trips and falls while walking with her walker. A thorough evaluation at her local ED reveals only a nonoperative right proximal humeral fracture. Her pain is well controlled with immobilization and oral analgesics.

What is her disposition?

• Discharge home with shoulder immobilizer and instructions to call orthopedics in the morning.
• Admit to Telemetry Bed for “Syncope” with orthopedics and cardiology consultations, with subsequent SubAcute Rehabilitation stay.
• Admit to Observation Status for “Ambulatory Dysfunction”.
• Discharge home with her daughter, who lives locally, with …

Sonographic Findings Of A Semi-Professional Football Player With 1st Mtp Joint Pain: Gout Or Turf Toe?, David Jeong, Md, Caqsm, Cep, Rmsk, Danielle Snyderman, Md, Lauren Hersh, Md, Jeremy Close, Md

Department of Family & Community Medicine Posters

Purpose

Aim : To review the applications and indications of sonography for forefoot disorders, especially gout and plantar plate injury of 1^st MTP joint.

Introduction

• Forefoot disorders are common but forefoot ultrasound is underutilized.
• Point-of-Care Ultrasound was utilized in initial workup evaluating acute on chronic 1^st MTP joint pain in our case study.

Association Between Knowledge And Performance In Clerkships And Usmle Step 2 Ck Scores: Implications For Counseling And Academic Decision-Making, Abigail Kay, Md, Kristin Desimone, Md, Jon Veloski, Ms, Steven Herrine, Md

Department of Family & Community Medicine Posters

Background

Step 2 CK scores are of increasing importance in medical student career planning. In the National Resident Matching Program 2014 Program Director Survey, Step 1 scores were the highest-rated among 33 factors used in screening applicants to be interviewed (94% cited it with a mean rating of 4.1 on a 5 point Likert scale); Step 2 scores were rated fourth in importance (80% cited it, mean rating of 4.1). When citing factors for ranking a given applicant, Step 1 scores ranked 5^th (80% cited, with mean rating of 4.1) and Step 2 CK scores ranked 7^th (71% …

Exercise Beliefs During Pregnancy In A Predominantly Low-Income, Urban Minority Population, Lindsay S. Mcalpine, Msiii, Christine A. Marschilok, Pgy-3, Amber S. Maratas, Md, Jeremy D. Close, Md

CwiC Posters

In 2002, and reaffirmed in 2009, The American College of Obstetricians and Gynecologists recommended that healthy pregnant women exercise for at least thirty minutes most days of the week. Exercise during a healthy pregnancy is safe and has many maternal and fetal benefits. Identified benefits include management of weight gain, improvement in mood, and preparation for labor. Previous research has evaluated women’s beliefs and practices of exercise in pregnancy, but it has focused on affluent, ethnic majority populations. This survey study was performed to assess beliefs about exercise in pregnancy in a predominantly low-income, urban minority population.

Recurrence Of Ganglion Cysts Following Re-Excision, Lindsay S. Mcalpine, Msiii, Juana Medina, Md, Nayoung Kim, Bs, Michael Rivlin, Md

CwiC Posters

Previous studies have examined the recurrence of ganglion cysts after surgical excision at a rate of 4 to 40%. However, recurrence after revision surgical excision is unknown. The purpose of this study was to define the incidence of recurrent ganglion cysts in patients who underwent a 2nd excisional procedure.

Confirmatory Factor Analysis And Invariance Testing Between Blacks And Whites Of The Multidimensional Health Locus Of Control Scale., Marianna Lanoue, Abby Harvey, Dawn B. Mautner, Bon Ku, Kevin Scott

Department of Family & Community Medicine Faculty Papers

The factor structure of the Multidimensional Health Locus of Control scale remains in question. Additionally, research on health belief differences between Black and White respondents suggests that the Multidimensional Health Locus of Control scale may not be invariant. We reviewed the literature regarding the latent variable structure of the Multidimensional Health Locus of Control scale, used confirmatory factor analysis to confirm the three-factor structure of the Multidimensional Health Locus of Control, and analyzed between-group differences in the Multidimensional Health Locus of Control structure and means across Black and White respondents. Our results indicate differences in means and structure, indicating more …

Obsessive-Compulsive Disorder, Elizabeth Collins, Md

Department of Family & Community Medicine Presentations and Grand Rounds

PowerPoint only, no audio.

Presentation includes:

• Definitions
• Epidemiology and Pathology
• Diagnosis
• Dermatologic Manifestations
• Management

Can Doctors Change? Attempts To Improve Adherence To The 2013 Statin Guidelines For Diabetic Patients At An Urban Academic Family Medicine Clinic, Marshall Miller, Md, Victoria Rose, Md, Jill Kropa, Md, Rina Edi, Md, Margaret Crenshaw, Md, Emily Levy, Md, Christopher Hwang, Md, Elizabeth Collins, Md, Danielle Dang, Md, Lori Atkinson, Md

Department of Family & Community Medicine Presentations and Grand Rounds

In November 2013 new statin guidelines were released. Generally, physicians are slow to adopt new guidelines and adherence to new guidelines often remains low even years after they have been issued. In this study, multiple interventions, including patient handouts, email reminders, and education sessions were implemented to increase adherence with new statin prescribing guidelines in a large urban practice. The numbers of prescriptions were analyzed for 6 weeks prior to and 6 weeks after the interventions. Statin prescribing in diabetic patients not already on a statin pre-intervention was 11.7% and post-intervention was 13.0% (p-value 0.5936). There was a small increase …

Characterization Of The Older Adult Refugee Population At Thomas Jefferson University’S Center For Refugee Health (Crh), Kathryn Beldowski, Md, Neesha Patel, Md, Brooke Salzman, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Background

• Established in 2007, the CRH has served over 1,000 refugees of all ages as they resettle in Philadelphia, PA.
• Research about refugee populations generally focuses on infectious disease, women’s health, pediatrics and mental health, with minimal research on the older adult refugee population.
• The objective of this study was to describe the characteristics of the older refugee population served by the CRH, focusing on chronic disease, smoking status, immunization and cancer screening rates, and presence of geriatric syndromes.

Unique Interdisciplinary Public Health Model Doubles Latent Tuberculosis Infection Treatment Completion Of Refugee Patients In A Large Metropolitan Area, Christine O'Leary, Pharmd, Kevin Scott, Md, Marc Altshuler, Md, Karen Kitagawa-James, Rn, Bsn, Maria Hervada-Paige, Mss

Department of Family & Community Medicine Presentations and Grand Rounds

Background and Purpose:

The Jefferson Center for Refugee Health (JCRH), a component of Jefferson Family Medicine Associates (JFMA), is the first and largest single provider of refugee health in Philadelphia; over 1,000 refugee primary care visits are provided annually. Refugee patients are disproportionately affected by latent tuberculosis infection (LTBI) compared to the general population of the United States; and though treatment of LTBI is highly effective at reducing conversion to active tuberculosis (TB), completion rates among the foreign-born are reported to be less than 50%. To establish baseline LTBI incidence and treatment completion rates for our refugee population, the JCRH …

An Update On Breast Cancer Screening And Prevention., Maria Syl D. De La Cruz, Mona Sarfaty, Richard C Wender

Department of Family & Community Medicine Faculty Papers

The goal of this article is to provide clinical guidance on breast cancer screening and prevention in primary care. The discussion highlights the importance of risk assessment, including screening options and risk-reduction strategies, for women at average and high risk. We review recommendations for breast cancer screening, evaluate current evidence on primary prevention, examine current practice patterns, and consider the impact of recent changes within health care.

Cancer Screening 2014, Richard C. Wender, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Presentation celebrating 40th reunion symposium for the Department of Family and Community Medicine at Thomas Jefferson University Hospital.

Presentation outline includes:

Breast, Colon, Lung and Prostate Cancer

Learning objective: Apply new cancer screening guidelines to primary care physicians

Jfma Street Outreach: A Resident-Run Street Medicine Program A Retrospective Chart Review Examining The Needs Of A Vulnerable Population And Services Provided, Kenneth E. Hemba, Md, Rebecca Simon, Bs, Lara Carson Weinstein, Md

Department of Family & Community Medicine Presentations and Grand Rounds

In Philadelphia it is estimated that over 12,000 people experience homelessness annually, and up to 500 individuals live on the street on any given day.¹

Project HOME coordinates the City of Philadelphia’s outreach effort aimed at forming relationships with unsheltered individuals, identifying their barriers to entering permanent supportive housing and assisting them in overcoming these barriers.

Having identified this population’s need for medical services, in 2007 faculty in Jefferson Family Medicine Associates (JFMA) reached out to Project HOME and extended an ongoing community-academic partnership.

Since then Family Medicine residents and students have been traveling with the outreach team, meeting …