Quality Improvement Commons^™

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 …

Development Of Recommendations For The Future Of Telehealth Use Among Sexual And Gender Minorities (Sgm), Jeffrey A. Wilhite

Dissertations and Theses

It is now well-documented that sexual and gender minoritized individuals (SGMs) face consistent stigmatization from not just the health care system, but also from overarching community, federal, and societal entities. Subsections of the SGM community, like gay men for example, face higher rates of eating disorders, certain cancers, alcoholism, mental illness and even obesity, when compared to heterosexual counterparts. Many of these challenges could be exacerbated by current political administration efforts to silence the community. Ensuring access to clinical care is one way of preserving the health and livelihood of the community. Telehealth, or synchronous, remote based clinical care, can …

Spy Quest: Gamifying Quality And Patient Safety Education, Shauna Szyszkowski

2025 Swedish FISH (Fostering Interdisciplinary Solutions in Healthcare) Conference

No abstract provided.

Implementation Of A Health Care Transition Pathway For Children And Adults With Inborn Errors Of Metabolism: A Pilot Project, Brittany M. Murray

Doctor of Nursing Practice Scholarly Projects

Background: Children with medically complex diseases require highly specialized care by a highly specialized team. Those with rare disease, including inborn errors of metabolism (IEMs), are a medically complex population and face significant challenges undergoing the health care transition from a child/family-centered model to an adult/patient-centered model of care. The project site follows patients with IEMs in the Metabolism Program, but previously did not have a coordinated process and had insufficient resources for patients/families for the health care transition.

Methods: The Plan-Do-Study-Act (PDSA) method was utilized as the model for improvement. Due to the complexity of the population and time …

Cultivating Workplace Wellness: An Evaluation Of Gratitude Card Interventions Among University Faculty, Jeffrey Druck, Patrick Ockerse, Jamal Jones

Journal of Wellness

Introduction: There has been a growing interest in understanding the role of gratitude in promoting well-being. Gratitude, defined as a feeling of thankfulness and appreciation in response to receiving a benefit from someone else, has been shown to improve mood, increase social support, and decrease symptoms of depression and anxiety. This research paper explores an innovative intervention using gratitude cards for faculty members and measures the emotional impact of this intervention.

Methods: The study involved 32 clinical physicians from the Department of Emergency Medicine at the University of Utah. Participants were invited to write a gratitude card to …

2024 Health Equity Impact Report, Children's Health, Stormee Williams

Publications

The Health Equity Impact Report from Children’s Health outlines the organization’s strategy and progress in advancing equitable pediatric care. The report highlights efforts to identify and address social determinants of health—such as food insecurity, housing instability, and access to transportation—through systemwide screening and targeted interventions.