Quality Improvement Commons^™

Using Preliminary Data And Prospective Power Analyses For Mid-Stream Revision Of Projected Group And Subgroup Sizes In Pragmatic Patient-Centered Outcomes Research, Elizabeth A. Tolley Md, Satya Surbhi Md, James E. Bailey Md

Faculty Publications and Presentations

Pragmatic clinical trials are commonly used in patient-centered outcomes research to assess heterogeneity of treatment effects. Patient-Centered Outcomes Research Institute (PCORI) methodology standards for assessing heterogeneity of treatment effects are extremely rigorous, but their implementation in real-world settings can be difficult. Predicting recruitment effectiveness and subgroup characteristics is often challenging and may require mid-stream revision of projected group and subgroup sizes. Yet, little real-world data are available to demonstrate methodologically valid approaches to address situations where such revisions are necessary. These data were used for mid-stream revision of group and subgroup sizes in the Management of Diabetes in Everyday Life …

Improving Colorectal Cancer Screening And Testing In A Primary Care Clinic, Leslie Michelle Dubois

Doctor of Nursing Practice

Colorectal cancer (CRC) is the third most common cancer and the second most common cause of cancer-related deaths worldwide (World Health Organization, 2019a). In the United States, CRC was the fourth most common cancer in 2016 (Centers for Disease Control and Prevention, 2019a). The American Cancer Society (2020a) estimated that there will be 147,950 estimated new cases and 53,200 estimated deaths of CRC in the U.S. in 2020. The purpose of the project was to improve CRC screening completion rates and follow up referrals from 27.5% to 35% for adult patients, 50-75 years of age, within a family medicine clinic …

Patient-Centered Implementation Of Statin Therapy In Patients With Type 2 Diabetes, Giovanna P. Favarato

Doctor of Nursing Practice

Heart disease is the leading cause of morbidity and mortality in Americans with type 2 diabetes mellitus. The American Diabetes Association recommends statins and lifestyle modifications for all patients with type 2 diabetes mellitus for the prevention of atherosclerotic cardiovascular events. A patient-centered approach to primary prevention is encouraged, yet there are no specific instructions regarding implementation. The Statin Choice Decision Aid is a tool designed to facilitate shared decision-making between the patient and the provider in the clinical setting. The 2018 American College of Cardiology/American Heart Association guidelines for the primary prevention of atherosclerotic cardiovascular disease for patients with …

Disparities In Oral Health: Socioeconomic Status And Policies To Increase Access To Primary Dental Care, Mckenzie Nutter

Theses/Capstones/Creative Projects

Primary dental care is a patient-centered service consisting of routine dental checkups. The oral cavity is the first point of entrance to the body for many harmful pathogens. Therefore, primary dental care is essential to not only prevent and treat conditions in the mouth, but to also reduce the number of systemic diseases in the rest of the body. However, people with higher incomes or wealth have increased access to primary dental care. People with low socioeconomic status have decreased access to primary dental care, at least in part due to difficulties in paying for separate dental insurance. Disparities in …

Bystanders’ Perspectives On The Provision Of Informal, Hospital-Based Care To Bedridden Patients With Cancer In Sri Lanka, B. Sunil S. De Silva

Nursing ETDs

Due to the nursing shortage in Sri Lanka, patients need informal caregivers, known as bystanders, to help provide patient care. This study described bystanders’ perspectives on informal, hospital-based care to bedridden patients with cancer in Sri Lanka. In this qualitative descriptive study, 17 bystanders at Apeksa/Cancer Hospital, Sri Lanka, were recruited using snowballing sampling. Data were collected through telephone interviews and analyzed using content and thematic analyses. Findings showed that paid and unpaid bystanders cover all caregiving tasks with minimum interaction with nurses. Unpaid bystanders described the need for same-sex bystanders and additional help with patients’ mobilization and specialized care. …

Quantifying Hypertension Indicators Through Informatics, Diana Sanchez

Doctor of Nursing Practice

The purpose of this quality improvement project was to create optimal quality indicators for hypertension measures using evidence-based practice to improve metric percentages, improving hypertension management for the practice. Implementing associated interventions for the quality measures and providing the interprofessional team with fundamental knowledge of inclusion and exclusion criteria and will empower the team with knowledge, improving patient care.

An expert panel was chosen to conduct a series of three PDSA cycles for systematic measurement until desired quality indicators were achieved, within a three-month duration. The expert panel consisted of the head physician, a physician assistant, the facility administrator and …

Understanding The Significance Of Virtual Support During Global Pandemic In Young Adults Diagnosed With Hepatitis C, Veronika Arkhipova

Master's Projects and Capstones

Hepatitis C is a viral infection that attacks the liver and leads to inflammation. In recent years, the prevalence of hepatitis C infections among 20 and 30 years of age has increased by 300 percent, and between 30 and 39 years by 400 percent. Due to the global coronavirus pandemic, people diagnosed with Hepatitis C have lost access to mental health services and resources, including in-person meetings with support groups. Since most states enforced stay-at-home order, many community centers, non-profit organizations that work with Hepatitis C patients and the affected population provide limited to no access to support group meetings …

Inferior St-Elevation Myocardial Infarction Presenting When Urgent Primary Percutaneous Coronary Intervention Is Unavailable: Should We Adhere To Current Guidelines?, Yochai Birnbaum, Glenn N Levine, John French, Juan Carlos Kaski, Dan Atar, Mahboob Alam, David Hasdai, Hani Jneid, Barry F Uretsky

Faculty, Staff and Students Publications

The pivotal studies that led to the recommendations for emergent reperfusion therapy for ST-elevation myocardial infarction (STEMI) were conducted for the most part over 25 years ago. At that time, contemporary standard treatments including aspirin, statin, and even anticoagulation were not commonly used. The 2013 American College of Cardiology Foundation (ACCF)/American Heart Association (AHA) guidelines and the 2017 European Society of Cardiology guidelines give a class I recommendation (with the level of evidence A) for primary percutaneous coronary intervention (pPCI) in patients with STEMI and ischemic symptoms of less than 12 h. However, if the patient presents to a hospital …

Innovative Conservation Of Inhaled Medication Devices During The Covid-19 Pandemic Through A Canister Reassignment Process, Mandelin K. Cooper, L. Hayley Burgess, Karla Miller, Theresa Baltz, Julia Moody, Elizabeth Wiggins, Jeffrey Guy

HCA Healthcare Journal of Medicine

Background: The ideal practice for patients requiring metered-dose inhalers (MDI) with coronavirus disease 2019 (COVID-19) is to use patient specific MDIs. However, this practice may not be possible during a time of increased usage throughout the country and limited availability of the medication. Nebulized medications are a concern due to the potential for aerosolized virus and increased exposure for health care workers. An alternative program of canister reassignment is proposed to address concerns for infection prevention, cross-contamination of MDI canisters and the shortage of MDI’s due to the COVID-19 pandemic.

Methods: A comprehensive MDI canister reassignment process was developed for …

Reducing Patient Falls Through Purposeful Hourly Rounding, Amanda Savage

Student Scholarly Projects

Practice Problem: Falls significantly affect patients, resulting in temporary or permanent harm, even death. In a large acute care facility, patient falls increased from 444 in 2016 to 556 falls in 2019.

PICOT: In an adult inpatient hospital setting, does purposeful hourly rounding (PHR), compared to no rounding, reduce patient falls over a period of 30 days during the same time period from the previous year?

Evidence: Of the 360 articles reviewed, 12 articles, varying from evidence levels two (1), level three (4), and level five (7), supported PHR as effective in reducing harm from falls in adult …

Looking Beyond The Numbers: Quality Assurance Procedures In The Global Network For Women's And Children's Health Research Maternal Newborn Health Registry, Ana Garces, Emily Macguire, Holly L. Franklin, Norma Alfaro, Gustavo Arroyo, Lester Figueroa, Shivaprasad S. Goudar, Sarah Saleem, Fabian Esama, Archana Patel

Community Health Sciences

Background: Quality assurance (QA) is a process that should be an integral part of research to protect the rights and safety of study participants and to reduce the likelihood that the results are affected by bias in data collection. Most QA plans include processes related to study preparation and regulatory compliance, data collection, data analysis and publication of study results. However, little detailed information is available on the specific procedures associated with QA processes to ensure high-quality data in multi-site studies.
Methods: The Global Network for Women's and Children's Health Maternal Newborn Health Registy (MNHR) is a prospective population-based registry …

Evaluating The Effect Of Care Around Labor And Delivery Practices On Early Neonatal Mortality In The Global Network's Maternal And Newborn Health Registry, Archana B. Patel, Elizabeth M. Simmon, Sowmya R. Rao, Janet Moore, Tracy L. Nolen, Robert L. Goldenberg, Shivaprasad S. Goudar, Manjunath S. Somannavar, Sarah Saleem, Farnaz Naqvi

Community Health Sciences

Background: Neonatal deaths in first 28-days of life represent 47% of all deaths under the age of five years globally and are a focus of the United Nation's (UN's) Sustainable Development Goals. Pregnant women are delivering in facilities but that does not indicate quality of care during delivery and the postpartum period. The World Health Organization's Essential Newborn Care (ENC) package reduces neonatal mortality, but lacks a simple and valid composite index that measures its effectiveness.
Methods: Data on 5 intra-partum and 3 post-partum practices (indicators) recommended as part of ENC, routinely collected in NICHD's Global Network's (GN) Maternal Newborn …

Comorbidity And Quality Of Life Of Hiv-Positive Adults Living In Supportive Housing, Rose Sharp

Dissertations

Problem: Life expectancy for people living with HIV significantly increased with widespread use of antiretroviral therapy, resulting in population increases in comorbidity prevalence. The increased burden of living with both HIV and comorbidities lowers health-related quality of life (HRQoL).

Methods: Using a descriptive, correlational, cross-sectional design, a convenience sample of HIV-positive adults was selected from seven supportive housing communities. Comorbidities were assessed using a modified Self-Administered Comorbidity Questionnaire, and HRQoL using the Patient-Reported Outcome Measurement Information System Scale v1.2 – Global Health.

Results: A sample of 17 (N = 17) adults reported a mean of 4.2 (SD = …

Effect Of Standardized Nurse Teaching On Patient Experience Using Cahps®, Julie Hake

Dissertations

Abstract

Purpose: This quality improvement (QI) project aimed to determine if a standardized nurse teaching approach improved patient understanding of diagnosis and treatment as it relates to women diagnosed with a pelvic floor disorder (PFD) after receiving a standardized nurse education (SNE) session in an urban tertiary care Urogynecology practice.

Methods: Females aged 18 and older with a newly diagnosed PFD and prescribed PFPT for the first time who agreed to receive the SNE and complete the CAHPS® survey were included in the project. Patient perception of PFPT was assessed via phone interview utilizing the Consumer Assessment of Healthcare …

Couplet Care, Melanie Husk

Scholars Week

Abstract

In many recent studies, maternity units in hospitals have been making the transition from traditional separate care for the mother and baby to couplet care for the mother and baby. (Brenneman, 2014; Abney-Roberts, 2012; Backus, 2017) Couplet care is family-centered care in which the mother and the baby stay together from childbirth until discharge. (Emory-Decatur, 2019) Studies have shown that this form of care has many benefits for both the mother and the baby. Parents become more educated on how to care for their newborn and infants gain the foundation for how they will develop socially, emotionally, and behaviorally. …

Decreasing Readmissions In Medically Complex Children, Colleen Bartlett

Student Scholarly Projects

Practice Problem: There was a report of an existing practice problem of increased 30-day readmission rates in medically complex children at an outpatient clinic within an extensive hospital system. Hospital readmissions can cause clinical, social, and financial burdens to the patients and their families and thus reflected a need for interventions to reduce readmissions.

PICOT: The PICOT question that guided this change project: In medically complex pediatric patients ages 0-17, what is the effect of a discharge intervention bundle in reducing all-cause 30-day hospital readmissions compared to current practice within an 8-week timeframe?

Evidence: The literature revealed 18 …

Predictors Of Birth Center Sustainability In The United States, Melanie Cabezas Phipps

Nursing ETDs

Pregnant women from all racial and socioeconomic communities deserve safe, personalized, and affordable ways to give birth. To meet all three needs, focus is increasing on birth centers, a midwifery model that provides family-centered care before, during, and after normal pregnancy, labor, and birth. However, many U.S. birth centers face significant obstacles to financial sustainability, particularly in rural areas. A better understanding of the factors that contribute to a birth center’s operational success is needed for practitioners and groups interested in establishing or maintaining a birth center, as well as to inform policymakers seeking to improve health care equity, outcomes, …

Implementing Bedside Regional Anesthesia: Improving Clinical Effectiveness, Geoffrey Ho, Everett Chu, Adam Greenwood, Jason Podolnick, Rachel Lubran, Natalie Pudalov, Philip Th Dela Cruz, Paul Dangerfield

Anesthesiology and Critical Care Medicine Faculty Posters and Presentations

No abstract provided.

What Are The Nurse’S Perception Of The Effectiveness Of The Electronic Go-Jo Monitoring System On Hand Hygiene Compliance And Hospital Acquired Infection’S?, Patricia James

Seton Hall University DNP Final Projects

Background: The importance of hand hygiene compliance in preventing hospital acquired infections is well known. Yet national averages for compliance rates with hand hygiene among healthcare workers remains unsatisfactory. Noncompliance with hand hygiene practices can contribute to increased patient mortality, prolonged length of hospitalization, increase healthcare costs and decreased reimbursement for hospitals from the Centers for Medicare and Medicaid. Project Aim: The purpose of this quality improvement project was to explore the nurses’ perceptions of the effectiveness of the electronic Go-Jo monitoring system on hand hygiene compliance and hospital acquired infections. Methods: This was a performance …

Understanding The Relational Implications Of Treating Complex Patients In Integrated Primary Care Settings, Lauren Dennelly Msw, Lcsw, Sarah Bressi

Population Health

No abstract provided.