Health Services Research Commons^™

Measuring The Impact Of Patient-Engaged Research: How A Methods Workshop Identified Critical Outcomes Of Research Engagement, Ellis C. Dillon, Leah Tuzzio, Sarah Madrid, Heather Olden, Robert T. Greenlee

Journal of Patient-Centered Research and Reviews

Purpose: While strategies to evaluate the influence of engaging patient partners in research, such as the Patient-Centered Outcomes Research Institute (PCORI) WE-ENACT surveys, are beginning to emerge, a systematic set of measures for assessing the impact of patient engagement in research (PER) on study approaches and outcomes is lacking. This article describes a workshop and process used to identify and develop Critical Outcomes of Research Engagement (COREs). It proposes preliminary measures for assessing the impact of PER on the research process and outcomes of research studies.

Methods: A group of 24 researchers and 5 patient partners participated in a PCORI-funded …

Patient-Centered Outcomes Measurement: Does It Require Information From Patients?, Leif I. Solberg, Stephen E. Asche, John Butler, David Carrell, Christine K. Norton, Jeffrey G. Jarvik, Rebecca Smith-Bindman, Juliana O. Tillema, Robin R. Whitebird, Ann M. Werner, Jeanette Y. Ziegenfuss

Journal of Patient-Centered Research and Reviews

Purpose: Since collecting outcome measure data from patients can be expensive, time-consuming, and subject to memory and nonresponse bias, we sought to learn whether outcomes important to patients can be obtained from data in the electronic health record (EHR) or health insurance claims.

Methods: We previously identified 21 outcomes rated important by patients who had advanced imaging tests for back or abdominal pain. Telephone surveys about experiencing those outcomes 1 year after their test from 321 people consenting to use of their medical record and claims data were compared with audits of the participants’ EHR progress notes over the time …

Health Care Disparities Knowledge, Attitudes, And Behaviors In Resident Physicians, Rebecca Hammarlund, Diana Hamer, Kathleen Crapanzano, Rachel Bernard, Carine Nzodom, Courtney James, Angie Johnson, Diane Kirby, Laura Hetzler, Chris Woodward, Jesse Sulzer, Lauren Rabalais, Laurinda Calongne

Journal of Patient-Centered Research and Reviews

Purpose: Health care disparities are an important but sometimes underrepresented topic in graduate medical education. In this study we measured the impact of educational and behavioral interventions on resident knowledge about and attitudes toward health care disparities.

Methods: Faculty from 6 residency programs designed and presented an hour-long educational intervention to emphasize the importance of and increase resident knowledge about health care disparities. Selected residents then helped design a month-long behavioral intervention to engage their peers in conversations about disparities with patients. Surveys were administered pre- and post-educational intervention as well as post-behavioral intervention in order to measure the impact …

Improved Service Efficiency Improves Racial Disparity In Diabetic Care, Abel Irena, Kushal Patel, David Thompson, Gregory Schleis, Abiy Gesese, Richard Battiola

Journal of Patient-Centered Research and Reviews

Background: Racial disparities in diabetes care have been documented. Disparities also have been shown to affect service quality and outcome of diabetic care. Analysis of our internal medicine residency clinic diabetic care management performance across REAL-G (race, ethnicity, age, preferred language and/or gender) showed race-based disparity on two outcome measures: 1) measurement of glycohemoglobin (A1C) at least twice a year; and 2) target blood pressure of < 140/90.

Purpose: Develop interventions to decrease racial disparities in diabetes care among patients managed by an internal medicine residency clinic, as part of the Alliance of Independent Academic Medical Center’s National Initiative V project.

Methods: …

Decreasing Time To Broad Spectrum Antibiotics For Septic Patients In The Emergency Department, Joseph J. Zieminski, Emily E. Bryant

Journal of Patient-Centered Research and Reviews

Background: Timely administration of broad spectrum antibiotics has been shown to be directly correlated with decreased mortality for patients with severe sepsis and septic shock. As such, both the Surviving Sepsis Campaign and the SEP-1 CMS measure recognize timely antibiotic administration as a cornerstone of therapy for patients with severe sepsis or septic shock.

Purpose: Decrease time to broad spectrum antibiotic administration for septic patients in the emergency department (ED) of Aurora St. Luke’s Medical Center.

Methods: An alert within the electronic medical record was created to more rapidly identify potentially septic patients in the ED. After receiving the alert, …

Variations In Practice Of Apnea Test For Brain Death: Review From A Multihospital Health Care System, Jeffrey Stein, Marvi V. Rijhwani, Ernesto Brauer

Journal of Patient-Centered Research and Reviews

Background: Ventilation encompasses both active and passive processes. Air is initially drawn into the lungs due to a negative intrathoracic pressure created using the respiratory muscles, most importantly the diaphragm. In contrast, expiration is the passive relaxation of the respiratory muscles. Oxygenation occurs when oxygen diffuses across the alveolar-capillary membrane. The ability to oxygenate without ventilation has been termed apneic diffusion oxygenation or apneic oxygenation. We believe it is crucial to keep alveoli open in order for adequate oxygenation to occur. This can be achieved with the aid of positive end-expiratory pressure (PEEP). We investigated this concept in patients who …

Identifying And Targeting Age-Related Colorectal Cancer Screening Rate Disparities In Family Medicine Residency Clinics, Jonathan J. Blaza, Jasmine R. Wiley, Matthew Gill, Alonzo Jalan, Will Lehmann, Deborah Simpson, Jeffrey A. Stearns

Journal of Patient-Centered Research and Reviews

Background: Health care systems continuously seek to improve patient care through population-level analysis of clinical quality metrics and patient characteristics to identify disparities in care. Nationally, disparities in colorectal cancer (CRC) screening rates have been identified with lower screening rates reported for patients who are uninsured and/or lower socioeconomic status, African American/black, Asian, and non-English-speaking Hispanic patients. No age-related CRC screening rate disparities with associated interventions have been reported.

Purpose: Determine and address CRC screening disparities in care provided to eligible patients > 50 years old in two primary care residency clinics.

Methods: Retrospective analysis using REAL-G (race, ethnicity, age, preferred …

Hospice Utilization Of Medicare Beneficiaries In Hawai‘I Compared To Other States, Deborah Taira, Merle Kataoka-Yahiro, Angela Sy

Asian/Pacific Island Nursing Journal

The objective is to examine hospice utilization among Medicare beneficiaries in Hawai‘i compared to other states. Data were from the 2014 Medicare Hospice Utilization and Payment Public Use File, which included information on 4,025 hospice providers, more than 1.3 million hospice beneficiaries, and over $15 billion in Medicare payments. Multivariable linear regression models were estimated to compare hospice utilization in Hawai‘i to that of other states. Control variables included age, gender, and type of Medicare coverage. Medicare beneficiaries using hospice in Hawai‘i differed significantly from beneficiaries in other states in several ways. Hawai‘i beneficiaries were more likely to be Asian …

Hospitalization Rates And Predictors Of Rehospitalization Among Individuals With Advanced Cancer In The Year After Diagnosis, Robin Whitney, Janice Bell, Daniel Tancredi, Patrick Romano, Richard Bold, Jill Joseph

Faculty Publications

PurposeAmong individuals with advanced cancer, frequent hospitalization increasingly is viewed as a hallmark of poor-quality care. We examined hospitalization rates and individual- and hospital-level predictors of rehospitalization among individuals with advanced cancer in the year after diagnosis.MethodsIndividuals diagnosed with advanced breast, colorectal, non–small-cell lung, or pancreatic cancer from 2009 to 2012 (N = 25,032) were identified with data from the California Cancer Registry (CCR). After linkage with inpatient discharge data, multistate and log-linear Poisson regression models were used to calculate hospitalization rates and to model rehospitalization in the year after diagnosis, accounting for survival.ResultsIn the year after diagnosis, 71% of …

Demystifying Research: Accessing & Understanding Evidence For Clinical Practice, Kimberly A. Murphy, Meredith Poore Harold, Mary Huston

Communication Disorders & Special Education Faculty Publications

The demands on clinicians for evidence-based practice (EBP) are great. However, many speech-language pathologists have received little to no training in how to ‘do’ EBP. In this presentation, we aim to describe and provide practical suggestions for two of the steps in EBP—accessing, then reading and interpreting research to inform clinical decision-making. Our goal is to give clinicians the tools and confidence they need to grow into expert clinicians.

Learner Outcome 1: Describe the components of evidence-based practice (EBP)

Learner Outcome 2: Identify ways to access research

Learner Outcome 3: Identify steps in reading and evaluating the …

St. Luke's Virtual Concussion Clinic: A Unique Structure To Provide Comprehensive Care For Patients, Kurt J. Nilsson, Hilary Flint, Janet Reis, Krisi Pardue

University Author Recognition Bibliography: 2017

Purpose: Failure to provide timely assessment and management of patients with concussions creates prolonged challenges for patients and primary care providers by disrupting work and school, interpersonal and family relationships, and placing patients at risk of injury. Thus, it is essential to provide timely and appropriate care to minimize post-concussion symptoms. The development of a virtual concussion clinic with a central referral and care coordination system is described. Additionally, key identifiers of virtual clinic patients are presented.

Methods: Intake and referral processes were implemented within 18 specialty clinics and 3 emergency departments. All patients (n= 623) completed a modified version …

Leadership For Public Health 3.0: A Preliminary Assessment Of Competencies For Local Health Department Leaders, Emmanuel D. Jadhav, James W. Holsinger Jr., Billie W. Anderson, Nicholas Homant

Health Management and Policy Faculty Publications

Background: The foundational public health services model V1.0, developed in response to the Institute of Medicine report For the Public’s Health: Investing in a Healthier Future identified important capabilities for leading local health departments (LHDs). The recommended capabilities include the organizational competencies of leadership and governance, which are described as consensus building among internal and external stakeholders. Leadership through consensus building is the main characteristic of Democratic Leadership. This style of leadership works best within the context of a competent team. Not much is known about the competency structure of LHD leadership teams. The objectives of this study characterize …

Managing The Cost Of Diabetes, Laressa Bethishou

Pharmacy Faculty Articles and Research

"This is of concern to health care providers because inadequate management of diabetes results in short- and long-term complications. Patients with diabetes and no health insurance have fewer physician visits and are prescribed fewer medications for management of their diabetes. Patients with diabetes make up 11.9% of all emergency department visits in the United States.Hispanic and non-Hispanic blacks are at greater risk for developing diabetes and serious associated health complications, including chronic kidney disease. This may be attributed to a combination of genetics, diet, and exercise. However, access to health care resources may also play an important role."

Ambulance Services For Medicare Beneficiaries: State Differences In Usage, 2012-2014, Suzanne Troske, Alison Davis

Rural & Underserved Health Research Center Publications

Ambulance services are at risk of scaling back or dissolving in some places. We analyzed Medicare beneficiaries’ use of ambulance services across the U.S. Improved understanding of how beneficiaries, most of whom are elderly, use these services provides vital information for policymakers who set rules and regulations about access to the services.

I Want An Omnipotent Doctor: North Korean Defectors’ Unmet Expectations Of South Korean Medical Providers, Soo Jung Hong

The Qualitative Report

This study examines North Korean defectors’ unmet expectations of South Korean medical providers from the perspectives of both North Korean defectors and their medical providers. Seventeen defectors and 12 medical providers were recruited for focus groups and in-depth interviews. Grounded theory was used for data analysis. Data indicates the North Korean defectors were not satisfied with their providers because they (1) preferred human techniques over computerized technology, (2) expected the doctors to be omnipotent, and (3) expected to receive emergency medical service but did not expect to pay for it. Their medical providers felt that it was impossible to satisfy …

Gender Differences In Virologic Response After Antiretroviral Therapy In Treatment-Naïve Hiv-Infected Individuals: Results From The 550 Clinic Hiv Cohort Study., Andrea Reyes-Vega, Alejandra Loban, Kavitha Srinivasan, Stephen P. Furmanek, Conner English, Mary Bishop, Cathy Spencer, Daniel Truelove, Julio A. Ramirez, Anupama Raghuram, Paula Peyrani

Faculty and Staff Scholarship

Background

Controversy still exists regarding gender differences in virologic response between treatment-na•ve HIV-infected individuals. The objective of this study was to evaluate gender difference in virologic and immunologic response to antiretroviral therapy in treatment-na•ve HIV-infected individuals. Methods

This was a retrospective, observational study of treatment-na•ve HIV-infected individuals managed at the 550 clinic who started antiretroviral therapy (ART) between January 1st, 2010 and December 31, 2015. Patients with available viral load and CD4 counts before and one year after initiating ART were included in this study. Virologic suppression was defined as < 48 HIV-1 RNA copies/mL, and mmunologic recovery was defined as a CD4 count increase of at least 150 cells/mm3. Dichotomous variables were reported in number and percentages and analyzed using Chi-squared tests and Fisher’s exact (whichever was appropriate). Continuous variables were reported as median and interquartile range (IQR) and analyzed using Wilcox rank-sum tests. Multivariate analyses performed were logistic regressions with adjustment for other covariates. P value <0.05 was considered statistically significant. R version 3.3.2 was used for the statistical analysis. Results

A total of 70 women and 90 men were included …

Sex Work And Compromised Health: Health Conditions And The Barriers To Accessing Treatment Services In Pelourinho, Salvador, Amelia Fox

Independent Study Project (ISP) Collection

Sex workers remain one of the most marginalized populations in Brazilian society, both coming from and living within realities defined by poverty and poor health. Through partnership with Força Feminina – an organization located in Salvador, dedicated to aiding local sex workers– I explored the day-to-day health complications sex workers encounter and the impact these problems have on quality of life. I then questioned how discrimination and stigma impact a woman’s willingness to prioritize her health and seek out healthcare services. To pursue these questions, I utilized participant observation, interviews with 4 staff members – a pastoral educator, financial coordinator, …

Heroin Use Onset Among Nonmedical Prescription Opioid Users In The Club Scene, Hilary L. Surratt, Steven P. Kurtz, Mance Buttram, Maria A. Levi-Minzi, Maria E. Pagano, Theodore J. Cicero

Center for Health Services Research Faculty Publications

Background—Nonmedical prescription opioid use (NMPOU) is well documented among participants in the club scene, yet prior studies have not examined transition to heroin use. We prospectively examined heroin initiation among a sample of young adults with drug involvement associated with participation in the club scene, to understand factors that influence transition from NMPOU to heroin and to identify opportunities for intervention.

Methods—Data were drawn from a randomized trial that enrolled 750 Miami-based club and prescription drug users through respondent driven sampling, and tested the efficacy of assessment interventions in reducing risk. Participants reported current substance use at baseline, …

Palliative Players: Project Development And Initial Implementation, Eliza Eager

Muskie School Capstones and Dissertations

The Palliative Players are screened and trained hospice volunteers who provide a low-cost, sustainable, role-playing resource for use teaching communication skills to healthcare workers who discuss serious illness with patients and their families. The Palliative Players project was conceived and developed in early 2017 by Dr. Lauren Michalakes, Medical Director of Palliative Care at Coastal Healthcare Alliance (CHA); Sarah Dwelley, RN; Flic Shooter, Director of Hospice Volunteers of Waldo County (HVOWC); and Eliza Eager, Project Coordinator; to provide believable, emotive simulated patients (SPs) for role-play in workshops teaching healthcare workers communication tools and skills for use in conversations with patients …

A Web-Based Interprofessional Education Program For School Nurses And Athletic Trainers: A Pilot Study, Lauren Ashley Welsch

Health Services Research Dissertations

Background: Interprofessional education (IPE) programs have been shown effective in improving interprofessional collaborative practice (ICP) through increased communication and teamwork amongst healthcare professionals with the ultimate goal of improving patient safety and outcomes. However, their use and subsequent outcomes have not been reported amongst athletic trainers (ATs) and school nurses (SNs) in secondary school healthcare. The purpose of this study is to develop, implement and evaluate an IPE program designed to meet the needs of this unique healthcare setting. In addition, qualitative analysis will further describe the communication between ATs and SNs. Methods: A mixed method exploratory design was employed. …