Public Health Commons^™

A New Era For Real-World Evidence, Neal J. Meropol, Md

College of Population Health Forum

This presentation will use cancer therapeutic development as a use case for exploring the emerging role of real-world evidence. The current availability of electronic health records with rich information about patients gathered during their routine care is rapidly changing the landscape of evidence generation in medicine. Recent advances have accelerated the introduction of new diagnostics and treatments into clinical practice.

Learning Objectives:

1. Understand potential sources of real-world data for use in evidence generation to guide drug development and patient care.
2. Describe the opportunities and limitations of observational research using real-world data derived from electronic health records.
3. Review examples of real-world …

A Prospective, Population-Based Study Of Trends In Operative Vaginal Delivery Compared To Cesarean Delivery Rates In Low- And Middle-Income Countries, 2010-2016., Margo S. Harrison, Sarah Saleem, Sumera Ali, Omrana Pasha, Elwyn Chomba, Waldemar A. Carlo, Ana L. Garces, Nancy F. Krebs, K. Michael Hambidge, Shivaprasad S. Goudar, S. M. Dhaded, Bhala Kodkany, Richard J. Derman, Archana Patel, Patricia L. Hibberd, Fabian Esamai, Edward A. Liechty, Antoinette Tshefu, Adrien Lokangaka, Melissa Bauserman, Carl L. Bose, Fernando Althabe, Jose M. Belizan, Pierre Buekens, Janet L. Moore, Dennis D. Wallace, Menachem Miodovnik, Marion Koso-Thomas, Elizabeth M. Mcclure, Robert L. Goldenberg

Global Health Articles

OBJECTIVE: Few data are available on cesarean delivery and operative vaginal delivery trends in low- and middle-income countries. Our objective was to analyze a prospective population-based registry including eight sites in seven low- and middle-income countries to observe trends in operative vaginal delivery versus cesarean delivery rates over time, across sites.

STUDY DESIGN: A prospective population-based study, including home and facility births among women enrolled from 2010 to 2016, was performed in communities in Argentina, Democratic Republic of Congo, Guatemala, India, Kenya, Pakistan, and Zambia. Women were enrolled during pregnancy and delivery outcome data were collected.

RESULTS: We analyzed 354,287 …

Optimizing Clinical And Cost Outcomes For Patients On Enteral Nutrition Support For Treatment Of Exocrine Pancreatic Insufficiency: Proceedings From An Expert Advisory Board Meeting, Joseph I. Boullata, Janice L. Clarke, Archie Stone, Alexis Skoufalos, David B. Nash

College of Population Health Faculty Papers

No abstract provided.

Rural Hospital Nursing Skill Mix And Work Environment Associated With Frequency Of Adverse Events., Jessica G. Smith, Colin M. Plover, Moira C. Mcchesney, Eileen T. Lake

College of Population Health Faculty Papers

Introduction: Though rural hospitals serve about one fifth of the United States (U.S.), few studies have investigated relationships among nursing resources and rural hospital adverse events.

Objectives: The purpose was to determine relationships among nursing skill mix (proportion of Registered Nurses (RNs) to all nursing staff), the work environment and adverse events (medication errors, patient falls with injury, pressure ulcers, and urinary tract infections) in rural hospitals.

Methods: Using a cross-sectional design, nurse survey data from a large study examining nurse organizational factors, patient safety, and quality from four U.S. states were linked to the 2006 American Hospital Association data. …

Medicaid Spending Burden Among Beneficiaries With Treatment-Resistant Depression., Dominic Pilon, John J. Sheehan, Holly Szukis, David Singer, Philippe Jacques, Dominique Lejeune, Patrick Lefebvre, Paul E. Greenberg

College of Population Health Faculty Papers

AIM: To evaluate Medicaid spending and healthcare resource utilization (HRU) in treatment-resistant depression (TRD).

MATERIALS & METHODS: TRD beneficiaries were identified from Medicaid claims databases (January 2010-March 2017) and matched 1:1 with major depressive disorder (MDD) beneficiaries without TRD (non-TRD-MDD) and randomly selected patients without MDD (non-MDD). Differences in HRU and per-patient-per-year costs were reported in incidence rate ratios (IRRs) and cost differences (CDs), respectively.

RESULTS: TRD beneficiaries had higher HRU than 1:1 matched non-TRD-MDD (e.g., inpatient visits: IRR = 1.41) and non-MDD beneficiaries (N = 14,710 per cohort; e.g., inpatient visits: IRR = 3.42, p < 0.01). TRD beneficiaries incurred greater costs versus non-TRD-MDD (CD = US$4382) and non-MDD beneficiaries (CD = US$8294; p < 0.05).

CONCLUSION: TRD is associated …

New Synthetic Cannabinoids Metabolism And Strategies To Best Identify Optimal Marker Metabolites., Xingxing Diao, Marilyn A. Huestis

Institute of Emerging Health Professions Faculty Papers

Synthetic cannabinoids (SCs) were initially developed as pharmacological tools to probe the endocannabinoid system and as novel pharmacotherapies, but are now highly abused. This is a serious public health and social problem throughout the world and it is highly challenging to identify which SC was consumed by the drug abusers, a necessary step to tie adverse health effects to the new drug's toxicity. Two intrinsic properties complicate SC identification, their often rapid and extensive metabolism, and their generally high potency relative to the natural psychoactive Δ ⁹ -tetrahydrocannabinol in cannabis. Additional challenges are the lack of reference standards for the …

Improving The Quality Of Patient-Provider Interactions And Promoting Equitable, Accessible And Patient-Centered Cancer Care, C. Vaughan-Briggs, Lcsw, A. Petok, Lcsw, Mph, T. Dejesse, Amy Leader, Drph, Mph

Department of Medical Oncology Posters

• Philadelphia is among the top 10 cities in the US with populations over 500,000 with a high Community Need Index score (CNI- severity of Health disparity)
• Data from 2015 County Health Ranking, had Philadelphia last of all 67 counties in the state for social economic factors. (unemployment, income inequality, injury deaths, etc. )
• Cancer is a leading cause of mortality in the US
• The SKCC participated in a year-long, externally supported self study to improve the quality of patientprovider interactions and promote more equitable, accessible and patient- centered cancer care. This program aligned with internal initiatives.
• SKCC at Jefferson is …

The Population Health Template: A Roadmap For Successful Health Improvement Initiatives, Michael Kobernick, Md, Ms-Hsa, Ms-Poph, Faafp

Population Health Leadership Series: PopTalk Webinars

Learning Objectives

• Describe the population health template as a tool to achieve and report on Quintuple Aim objectives of health improvement initiatives
• Identify gaps in current health initiatives illustrating the needs for the template's more organized approach
• Apply the template to health improvement opportunities in health improvement initiatives
• Understand the role of social determinants of health in health improvement initiatives

Presentation: 50:31

The Impact Of Student Hotspotting On Patients & The Jefferson Health System, Mishael Khan, Bs, Lauren Collins, Md, Shoshana Sicks, Edm, Richard Hass, Phd, Tracey Vause Earland, Phd, Otr/L, Courtney Newsome, Ba, Sara Cohen, Ots

Phase 1

Introduction

“Super-utilizers”, patients with five or more hospital admissions in the past year, account for half of all healthcare expenditures and present a significant financial burden to our healthcare system. In Pennsylvania “super-utilizers” result in $1.25 billion of healthcare spending and Philadelphia has the highest number of “super-utilizers” in the state. To address this crisis, Jefferson University serves as one of four new national hubs for student hotspotting. Teams of interprofessional health professions students along with faculty and staff advisors enroll “super-utilizers” and provide targeted interventions to address social determinants of health, reduce hospitalizations and improve patient outcomes.

Methods

To …

Adaptive Statistical Iterative Reconstruction-V For Lung Nodule Analysis, Cherry Au, Zhenteng Li, Md, Eric Gingold, Md, Ethan Halpern, Md, Baskaran Sundaram, Md

Phase 1

Introduction: Low-dose CT in lung cancer screening has demonstrated benefits in select patients. As the traditional filtered back projection (FBP) technique is limited by poor image quality, adaptive statistical iterative reconstruction-V (ASIR-V) algorithm has been developed to achieve higher image quality with processing efficiency.

Objective: To investigate the impact of various CT scan parameters on the semi-automated measurement of lung nodules using a Computer Aided Detection (CAD) program.

Methods: This IRB-exempt phantom experiment was conducted with a CT scanner capable of ASIR-V algorithm. Eight lung nodules sized 5-12 mm, of solid or ground glass type, were placed inside a multipurpose …

Diagnostic Accuracy Of Home Sleep Apnea Testing (Hsat) Based On Recording Duration, Angela Alnemri, Theodora Fynn, Prakash Vasudevan, Ritu Grewa, Karl Doghramji

Phase 1

Introduction: Obstructive Sleep Apnea (OSA) is a chronic sleeping disorder with serious health consequences. Currently, standard diagnosis is through in-lab polysomnography; however, there has been a shift to greater use of Home Sleep Apnea Testing (HSAT) for patients with a high pre-test probability of having OSA.

Objective: To investigate the minimum recording time needed during HSAT to accurately diagnose the presence and severity of OSA.

Methods: A retrospective review was conducted of HSATs done from January-October 2017. Each study was divided into 1-, 2-,3-,4-,5-, 6-, and 7 hour intervals beginning at the recording start time. The respiratory event index (REI) …

Effect Of Tort Reform On Diagnostic Imaging Rates, Israel Ojalva, Ba, Arthur Hong, Md, Mph

Phase 1

Introduction: Defensive medicine, is defined as “order[ing] tests, procedures, or visits, or avoid certain high-risk patients or procedures, primarily (but not solely) because of concern about malpractice liability.” Nearly all physician who fear malpractice litigation have admitted to practicing some degree of defensive medicine. In response, many states have enacted policy reforms to lighten the threat of malpractice on physicians.

Objective: The most common defensive medicine behavior is ordering diagnostic imaging tests when it is potentially unwarranted. Many states have enacted non-economic damage caps from 2000-2010. We explored if these laws had an impact on the rates of diagnostic imaging …

Identifying The Causes Of Cancer Readmissions: A Patient Centered Approach, Katie Holland, Emily Wei, Allison Zibelli

Phase 1

While there are large efforts to decrease readmission rates in the United States, cancer patients represent a population that has been overlooked. Cancer patients are a vulnerable population who make up a large portion of hospital readmissions. Most of the current research on the causes of readmissions in cancer patients focuses on medical chart reviews and insurance claims. Many of these studies fail to incorporate patient input which could further the understanding of the complete burden associated with cancer readmissions. The goal of this study is to understand the personal reasons behind the decision of cancer patients to return to …

Enhancing Services For Homeless Populations: Impact Of A Virtual-Reality Training Tool On Health Professional Students’ Self-Efficacy In Working With Homeless Populations, Madeline Russell, Susan Toth-Cohen, Phd, Otr/L

Phase 1

INTRODUCTION

Despite the rising prevalence and unmet healthcare needs of homeless populations, most healthcare providers do not receive specific training on working with this population. The growth of simulation-based technology in the medical classroom offers new opportunities for such training. Virtual-reality tools have been shown to facilitate learning and minimize restraints such as time and travel. The Enhancing Service to Homeless Populations (ESHP) program was designed to provide health professions students at Thomas Jefferson University with training on how to interact with homeless populations using an interprofessional virtual-reality setting, with the ultimate goal of improving students’ self-efficacy.

METHODS

Participants (n=15) …

A Multicountry Randomized Controlled Trial Of Comprehensive Maternal Nutrition Supplementation Initiated Before Conception: The Women First Trial., K. Michael Hambidge, Jamie E. Westcott, Ana Garcés, Lester Figueroa, Shivaprasad S. Goudar, Sangappa M. Dhaded, Omrana Pasha, Sumera A. Ali, Antoinette Tshefu, Adrien Lokangaka, Richard J. Derman, Robert L. Goldenberg, Carl L. Bose, Melissa Bauserman, Marion Koso-Thomas, Vanessa R. Thorsten, Amaanti Sridhar, Kristen Stolka, Abhik Das, Elizabeth M. Mcclure, Nancy F. Krebs

Global Health Articles

Background: Reported benefits of maternal nutrition supplements commenced during pregnancy in low-resource populations have typically been quite limited.

Objectives: This study tested the effects on newborn size, especially length, of commencing nutrition supplements for women in low-resource populations ≥3 mo before conception (Arm 1), compared with the same supplement commenced late in the first trimester of pregnancy (Arm 2) or not at all (control Arm 3).

Methods: Women First was a 3-arm individualized randomized controlled trial (RCT). The intervention was a lipid-based micronutrient supplement; a protein-energy supplement was also provided if maternal body mass index (kg/m2) was(DRC), Guatemala, India, and …

A Multicomponent Quality Improvement Project To Improve Sleep In Hospitalized Patients: A Single Center Pilot Experience, Michelle Konkoly, Alan Kubey, Md

Phase 1

No abstract provided.

A Qualitative Evaluation Of The Interprofessional Student Hotspotting Learning Collaborative: Perceptions Of Student And Faculty Advisor Participants, Ashley Traczuk, Bsn, Rn, Angela Gerolamo, Phd, Rn, Elena Umland, Pharmd

Phase 1

Introduction: Student participation in interprofessional education has proven beneficial in regards to students’ understanding of professional roles, team situational awareness¹,and appreciating the need for collaboration². The interprofessional student hotspotting learning collaborative enables students to work in teams to help serve patients categorized as health-system “super-users”, defined as those who overuse inpatient and/or emergency hospital services, over a period of six months’ time. This model will allow students to have real patient encounters and to begin utilizing their own roles within interdisciplinary teams.

Objective: This study aims to evaluate the impact of the interprofessional student hotspotting learning …

Total Body Skin Exam And Number Needed To Screen, Audra Hugo, Michael Bui, Alexander Sherban, Shayan Waseh, Elizabeth Jones, Md

Phase 1

Introduction/Background: Skin cancer screening could impact mortality and morbidity in US adults; however, the effectiveness of widespread screening remains unclear. Further research is necessary to determine what age groups, with what risk factors, might benefit from routine total body skin exams (TBSE) in the US.

Objective: This study sought to determine, on average, the number of patients, per decade, needed to screen via TBSE to identify one person with skin cancer.

Methods: A retrospective review of Jefferson Dermatology outpatient data in Epic was conducted. All patient charts from 1/1/2017 - 1/1/2018 were reviewed if they received a TBSE. The type …

Outcomes Reporting In Regional Anesthesia Patients: A Comparison Of Manual Phone Calls Versus Automated Phone App Messaging, Gavyn Ooi, Mba, Eric Schwenk, Md, Fasa, Jeffrey Mojica, Do, Alexander Grant, Md, Max Shilling, Md, David Barnabei, Md, Jennifer Lessin, Ba, Rn, Ccrc, Marc Torjman, Phd, Kent Berg, Md, Mba

Phase 1

Automation of patient follow-up via mobile phone apps have the potential to save time for physicians, standardize responses from patients, and increase the patient response rate. Studies that assess the effectiveness of mobile phone-based surveys have been favorable, with completion rates of about 60% in the surgical population. The impact of mobile phone-based patient management in anesthesia deserves further study. This study examines the follow-up success rates of (1) manual phone calls (the current standard of care) vs. (2) automated patient outreach (APO) in patients who receive a regional anesthesia block procedure.

As part of normal follow up, anesthesia team …

Mindfulness-Based Stress Reduction Intervention For The Treatment Of Chronic Pain In The Elderly, Austin Roadarmel, Diane Reibel, Phd, Aleeze Moss, Phd, Andrew Newberg, Md

Phase 1

One of the most common complaints of adults in their 80s and above, a growing portion of our population, is chronic pain and it is often inadequately treated. A secular mindfulness-based stress reduction (MBSR) program was developed by Jon Kabat-Zinn in 1979 and has since shown measurable benefits to individuals in decreasing depression, pain, and anxiety. Considering the significant risk of side effects and age-associated changes of pharmacodynamics and pharmacokinetics in the traditional pharmacologic approach to chronic pain in the elderly, non-pharmacologic intervention such as MBSR may be particularly effective for the elderly population.

Methods: We conducted a 6 week, …

An Evaluation Of Ultrasound-Guided Regional Block Anesthesia In Outpatient Hand Surgery, Daniel Calem, Armen C. Voskeridjian, Md, Michael Rivlin, Md, Pedro Beredjiklian, Md, Mark L. Wang, Md, Phd

Phase 1

Introduction: The utilization of ultrasound-guided peripheral nerve blocks in orthopedic surgery has increased in popularity as the anesthesia of choice for the management of perioperative pain. Peripheral nerve blockade has been shown to increase overall surgical efficiency, improve patient satisfaction, reduce postoperative narcotic use, and decrease the duration of facility admissions, while increasing overall cost-effectiveness. To date, scant literature exists regarding the safety and efficacy of ultrasound-guided supraclavicular blocks used in common hand surgery procedures, and the rate of neurologic and vascular complications remains unknown.

Objective: The purpose of this study was to examine the effectiveness and complication rate of …

Improving Bedside Procedural Safety Through Optimizing Timeout Documentation And A Pre-Procedure Checklist, Jennifer Harris, Md, R. Benson Jones, Md, Kristin Lohr, Md, Grant Turner, Md, Drew Kotler, Md, Justine Blum, Md, Megan Margiotta, Md, Matthew Bokhari, Md, Erica Li, Md, Riti Kanesa-Thasan, Md, Bracken Babula, Md, Rebecca Jaffe, Md

Department of Medicine Posters

Aim

GOAL: Improve the safety of patients undergoing bedside procedures while maintaining the full spectrum of graduated autonomy in procedure training for residents.

SMART Aim: Increase the rate of timeouts documented for bedside procedures from 29% to 50% by June 2018.

A Mixed-Methods Refugee Community Health Needs And Assets Assessment, Eleni Florakis, Rickie Brawer, Phd, Mph, Mches, Abby Cabrera, Kaushal Desai, Saya Bery

Phase 1

Introduction:

Many factors may negatively affect the experience of refugees navigating the healthcare system in Philadelphia. These factors include, but are not limited to, lack of familiarity with the healthcare system, language and cultural barriers, limited health literacy, physical and transportation barriers, and fear and/or distrust of the healthcare system. In addition, there are a large proportion of United States refugees in Pennsylvania. According to usnews.com, Pennsylvania was ranked the top 6th state for taking in the most refugees in the year 2017.

Objective:

The primary objective is to assess the experiences of refugees within the healthcare system since resettlement …

Mental Health And Resilience In Adolescent Refugees Resettled In Philadelphia, Saya Bery, Pia Ghosh, Mph, Ellen Plumb, Md

Phase 1

Introduction: Mental health in adolescents has a large impact on physical health, academic achievement, and overall well-being; moreover, refugee youth are at an increased risk for mental health disorders. While growing evidence shows that positive youth development interventions can prevent health risk behaviors, there is need for further evaluation that shows how to tailor interventions to meet population-specific needs.

Objective: The aim is to assess how targeted interventions can enhance protective factors and reduce negative adult outcomes in vulnerable refugee adolescents. The goals are to understand the current status of mental health and access to resources among resettled adolescents in …

Gene Therapy Reimbursement Models – A Stakeholder Assessment, Aaron Bholé, Matthew Luminais, Msc, B. A. Sillah, Md, Mba

Phase 1

Introduction: The first one-time curative gene therapy was approved in December 2017 with a list price of $850,000, and there is a historic increase in gene therapy clinical trials with 89 having reached phase III as of May 2018. Gene therapy’s high upfront cost will challenge the traditional reimbursement models which are well suited for common, chronic conditions.

Objective: This stakeholder assessment surveys groups to identify existing opinions and generate insights regarding gene therapies and their reimbursement models.

Methods: A 12 question survey was sent to 200 stakeholders with the list generated from author’s contacts. Stakeholder groups targeted were providers, …

Normalized Healthcare Utilization Among Refugees Resettled In Philadelphia, 2007-2016, Kaushal Desai, Mph, Colleen Payton, Phd, Mph, Ches, Kevin Scott, Md, Brandon George, Phd, Ms, Marc Altshuler, Md

Phase 1

Background/Purpose: About 70,000 new refugees are resettled in the United States each year, of which approximately 600 are resettled in Philadelphia. This project seeks to better understand the patterns of healthcare utilization, including primary care, emergency, and hospitalization, among refugees resettled in Philadelphia, PA, between 2007 and 2016.

Methods: Demographic and healthcare utilization data for 1,144 refugees seen at Jefferson Family Medical Associates were compiled from the Jefferson Longitudinal Refugee Health Registry. Descriptive statistics were used to describe the demographic characteristics of the refugee population. Negative binomial count regressions were used to test for significant correlations between major demographic variables …

Medication Assisted Treatment In The Primary Care Setting: A Prospective Review, Bridget M. Smith, Lara Weinstein, Md

Phase 1

Introduction: Project HOME Health Services (PHHS) initiated a Medication Assisted Treatment program for Opioid Use Disorder in a primary care setting that is the first of its kind in the city of Philadelphia. This study assesses the MAT program by evaluating the Quality of Life (QoL) of the participants as well as their perception of the program.

Objective: The purpose of this study is to assess the QoL of the participants in the MAT program at PHHS and to evaluate the participants’ satisfaction with the program.

Methods: The population includes patients enrolled in the MAT program at PHHS who consented …

Housing First For People With Opioid Use Disorder (Oud), Ashley Katzenstein, Lara C. Weinstein, Md, Mph, Drph

Phase 1

Introduction

Philadelphia’s opioid crisis has subsequently resulted in an increase in unsheltered individuals. Significant barriers in healthcare access exist for individuals experiencing homelessness and substance use disorders, often leading to poor health outcomes and significant disease burden.

Objective

This study’s purpose is to determine the prevalence of physical and mental illness among individuals with experiences of homelessness and OUD upon entry to a permanent supportive housing program through Pathways to Housing PA (PTHPA).

Methods:

This study is a cross-sectional analysis of physical and mental health conditions of individuals who entered PTHPA’s housing program by July 2018. All individuals included had …

Rethinking Emergency Response To Mass Casualty Incidents: Disaster Medicine Education And The Role Of Medical Students, Claire Zurlo, Edward Jasper, Md, Mph

Phase 1

Introduction: The threat of a mass casualty incident (MCI) is one that must be taken seriously and for which hospitals must be prepared. In the wake of a disaster, emergency departments are often taxed beyond their ability to handle the demands of incoming traumas. In response to this, Dr. Edward Jasper, an emergency physician at Thomas Jefferson Hospital, designed the Hospital Emergency Response Team (HERT) to alleviate the pressure on the ED during a MCI. The HERT is a team of nursing and medical students who are FEMA trained to respond in the event of a MCI.

Objective: The primary …

Signs Of Humanity: A Qualitative Exploration Of Panhandling In Philadelphia, Alyssa Tate, Rosemary Frasso, Phd, Msc, Cph, Willie Baronet, Mfa, Katherine Brierly, Steven Buffer, Kaela Edwards, Zach Fusfeld, Jenna Garret, Nisha George, Nichole Holmes, Emily Wei

Phase 1

People who participate in panhandling are those who ask for financial or other assistance on the street. In Philadelphia, it is known that a large portion of people who panhandle also experience housing insecurity or other hardship. Panhandlers are a very visible fraction of a city’s homeless population and their experiences are of particular interest because their cardboard signs can give insight into common hardships such as housing and food insecurity and substance abuse disorders. While panhandlers in Philadelphia have been surveyed in the past, there is not recent literature on their lived experiences and perspectives and information was not …