Quality Improvement Commons^™

Dosimetric Effects Of Pinnacle³ Version 18.0 Advanced Auto-Planning Settings In Oropharyngeal Vmat Optimization, Emily Sanden

Masters Projects

This study evaluated the impact of Pinnacle³ version 18.0 auto-planning advanced settings modulation amount, monitor unit (MU) level, and dose fall-off priority on volumetric modulated arc therapy (VMAT) plan quality for bilateral oropharyngeal cancer. A total of 64 plans were generated using all possible combinations of low, medium, high, and very high settings for each parameter. A standardized base of tongue case was optimized once per plan using a single-time point approach, with planned target volume 1 (PTV1) (6996 cGy) and planned target volume 2 (PTV2) (5412 cGy) coverage evaluated. Each parotid gland, the spinal cord, brainstem, and the oral …

New Patient Onboarding, Jennifer Fournier, Sarah Flagg, Alletta Roberts Dzik, Lyndsay Stevens, Shannon Smith, Karen Waterhouse

Operations Transformation

Currently there are barriers to establish a new patient with a primary care. The workflow for patients who self-refer currently requires 10 steps and is performed by 7 care team members.

• 4 PSR at the front desk complete paper intake forms that are then manually entered into a spreadsheet by 3 other care team members.

The step in the workflow, to obtain the release of information for patient records to be requested and submit the form, is inconsistently followed internally and externally and results in very long process time of 40+ days. This step is frequently overlooked due to the …

Enhancing Medication Communication In The Acute Care Setting To Strengthen Patient Comprehension And Retention, Ashleigh C. Christensen

Student Scholarly Projects

Practice Problem: Research has shown that breakdowns in communication, especially in the context of medication education, play a critical role in the delivery of safe and effective patient care. These findings underscore the need to prioritize effective communication in medication education. In the acute care setting, effective communication is essential for ensuring patient safety, adherence, and improved patient-centered outcomes.

PICOT: In clinical staff providing direct patient care in the acute care setting (P), does the implementation of the evidence-based teach-back method (I), as compared to current practice (C), improve patient knowledge, understanding, and self-management upon discharge (O), over ten weeks …

Implementation Of Artificial Intelligence For Scribing In An Outpatient Mental Health Clinic, Elissa A. Moore

Student Scholarly Projects

Practice Problem: Traditional documentation practices place a significant burden on psychiatric mental health nurse practitioners (PMHNP) in outpatient mental health clinics (MHC), contributing to provider burnout and negatively impacting the patient-provider relationship. Preserving practicing PMHNPs is essential across the United States, but imperative in medically underserved areas where mental health services are limited.

PICOT: In PMHNPs (Population), does the use of AI scribing software (Intervention) compared to traditional documentation methods (Comparison) reduce documentation time and increase provider satisfaction (Outcome) over a ten-week period (Time)?

Evidence: This Doctor of Nursing Practice (DNP) scholarly project was informed by evidence obtained from 15 …

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

MUSC Theses and Dissertations

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

Care Coordination In Pediatric Primary Care, Alyssa K. Durzo

Dissertations

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

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

Patient Information Needs During Ambulatory Medication Changes: A Qualitative Study, Elaine Giletta, Vanessa B. Hurley, Yushi Yang, Jessica L. Schwartz, Rabia Jalalzai, Nicole L. Mollenkopf, Raquel Mayne, Samantha I. Pitts

Journal of Patient-Centered Research and Reviews

Purpose: We performed interviews with patients and caregivers to explore whole-person, whole-regimen information needs at times of routine outpatient medication changes. We categorized information needs in this relatively unstudied context and identified which needs were commonly recognized as insufficiently met.

Methods: We explored the content of the semi-structured interviews, which involved nine patients and two caregivers of pediatric patients, all of whom experienced a recent medication change in the outpatient setting of a large urban academic healthcare system. We used inductive thematic analysis to organize information needs into categories to identify key information gaps.

Results: We identified five categories of …

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

Doctor of Nursing Practice Scholarly Projects

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

Impact Of Race On Admission, Clinical Outcomes, And Disposition In Cholangiocarcinoma: Insights From The National Inpatient Database, Tijin A. Mathew, Teresa M. Varghese, Nithya Krishnakumaran, George M. Varghese, Khwaja S. Haq, Akshita Khosla, Rojymon Jacob, Gina Vaccaro

School of Medicine Faculty Publications

BACKGROUND: Cholangiocarcinoma, malignancies arising from the intrahepatic and extrahepatic bile ducts, has increased in incidence in the United States over the past few decades. The reported incidence of cholangiocarcinomas is high, particularly in specific racial groups such as Asian and Pacific Islander patients. Race also significantly impacts disparities in healthcare utilization and clinical outcomes. Our study focused on the impact of race on admission, clinical outcomes, and disposition of cholangiocarcinoma. METHODS: We performed a retrospective analysis of cholangiocarcinoma-related hospital admissions, using the National Inpatient Sample for the year 2022. Patients were stratified according to race into the following groups: White, …

Implementing A Team-Based Approach To Reduce Blood Culture Contamination Rates In The Emergency Department: A Quality Improvement Initiative, Melissa Lockhart

Doctor of Nursing Practice Projects

Background: Blood culture contaminations (BCC) present significant risks to patients, including adverse drug reactions and the exacerbation of antibiotic resistance. BCC can also result in millions of dollars in financial burdens for hospitals due to the need for follow-up testing, treatment complications, and antibiotic stewardship efforts. At this facility, the contamination rate in the emergency department (ED) consistently exceeds the national benchmark of 3%. Contributing factors include high patient turnover and increased nursing workloads, which can lead to shortcuts in essential practices such as hand hygiene and skin disinfection before collection.

Purpose: This project aimed to evaluate whether implementing a …

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

Doctor of Nursing Practice Projects

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

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

Project …

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

Doctor of Nursing Practice Projects

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

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

Project Design: This quality improvement …

Reporting And Tracking Of Occupational Bloodborne Pathogen Exposures, Olivia Smith

Doctor of Nursing Practice Final Project Abstract

Purpose/Background: Underreporting of occupational bloodborne pathogen (BBP) exposures remains a significant patient and employee safety issue. At UT Health, outdated paper-based systems hindered accurate tracking, timely follow-up, and reporting compliance. The aim of this quality improvement (QI) project was to achieve a 30% increase in quarterly BBP exposure reports, from 30 to 39, by implementing an electronic reporting system between January 1 and March 31, 2025.

Methodology: Guided by the Health Belief Model and using the Implementation and Improvement Science (IIS) Framework, the project replaced the existing paper form with an external, user-friendly digital system. Staff received structured training, and …

Care Alert Program In Chronic Emergency Department Using Patients: Expanded Study, Jonathan Leggett, Kaitlyn Phelps, David Nuñez, Brent Wright, Erica Gibbons, Jonathan Bryan, Brian Griggs

HCA Healthcare Journal of Medicine

Introduction

The Care Alert Program (CAP) is designed to help navigate encounters with patients who are high utilizers of Emergency Department (ED) resources. The CAP intends to address the needs of this challenging patient population by designing individualized care plans that are approved by a multidisciplinary committee. The patient populations that frequently use ED resources often have chronic medical conditions, a poor understanding of their conditions, unrealistic expectations regarding treatment, a lack of outpatient resources, and present with multiple complaints when using ED resources.

Methods

The CAP was adopted by our facility in the spring of 2020. The present study …

Age-Friendly Care And Mobility In Hospitalized Older Adults With Cognitive Impairment: A Feasibility Quality Improvement Initiative, Jasmine K. Vickers, Richard E. Kennedy, Shari Harrell, David H. James, Katrina Booth, Emily Simmons, Cynthia J. Brown, Kellie L. Flood

School of Medicine Faculty Publications

BACKGROUND: Hospitalized older adults with cognitive impairment (CI) have an increased risk for adverse outcomes. Acute Care for Elders (ACE) Units were developed to reduce functional decline in hospitalized older adults. INTERVENTION: We developed a quality improvement (QI) initiative to disseminate ACE care processes to non-ACE units, converting them into "Virtual ACE" units. The aim of this evaluation is to examine the impact of this intervention on the mobilization of patients with CI. POPULATION: Older adults with CI admitted to a study unit (ACE Unit or seven Virtual ACE units). METHODS: We conducted a pre/post-intervention evaluation of the proportion of …

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

Lynchburg Journal of Medical Science

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

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

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

Journal of Public Health in the Deep South

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

How Do Montessori-Based Activities Affect Behaviors For Older People With Dementia: A Literature Review, Isabel Quigley

University Honors Theses

Objectives: This literature review is meant to analyze the development on the research on Montessori-based activities for adults with dementia.

Introduction: Baby Boomers are the largest generation to enter senior age (65+) in history due to the advancement in medicine to increase life expectancy. Dementia is a neurocognitive disease that affects parts of the brain related to memory and signs typically surface around 65 years old. Dementia is not considered healthy aging. Montessori-based activities have been recently developed as an intervention to encourage a feeling of accomplishment and success for adults with dementia.

Methods: Two electronic databases …

Development Of Preventive Dental Guidelines In The Primary Healthcare Setting In Egypt: A Delphi Method, Basant Mehriz

Theses and Dissertations

This study addresses the critical need for standardized preventive dental care guidelines within Egypt's primary healthcare system amid the rising burden of oral diseases. Through a systematic two-phase methodology combining a comprehensive literature review and a Delphi consensus-building process engaging 35 dental professionals, the research established priorities for contextually appropriate preventive measures. The consensus framework revealed strong support for clinical interventions (mean of 83% agreement), particularly fluoride-based prevention; community initiatives (mean of 83%), especially school-based programs; policy measures (mean of 77%) such as workforce and educational development, though with variable support for taxation and social determinants approaches. Statistical analysis demonstrated …

Why Acromegaly Dies: A Systematic Review, Isam Noori Salman, Safaa Ehssan Atta, Baydaa Ahmed Abed, Noor Ulhuda G. Mohammed

Maaen Journal for Medical Sciences

Acromegaly is a rare endocrine clinical syndrome characterized by long-term elevated production of growth hormone (GH) due to a pituitary adenoma tumor. The main problem of acromegaly patients (AC-PTs) is prolonged elevated GH concentration, which leads to increased insulin-like growth factor 1 (IGF-1) production, causing the characteristic tissue and bone overgrowth. The appearance of diabetes in AC-PTs was linked with the high risks of cardiovascular morbidity, indicating that individuals with both conditions face heightened health challenges. Acromegaly typically has a higher cancer incidence rather than the general population. Without early diagnosis and effective treatment, excess GH can have widespread systemic …