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Attanasio LB, DaCosta M, Kleppel R, Govantes T, Sankey HZ, Goff SL. Community Perspectives on the Creation of a Hospital-Based Doula Program. Health Equity 2021; 5:545-553. [PMID: 34909521 PMCID: PMC8665817 DOI: 10.1089/heq.2020.0096] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2021] [Indexed: 11/15/2022] Open
Abstract
Objective: Racial and ethnic inequities in perinatal health outcomes are pervasive. Doula support is an evidence-based practice for improving maternal outcomes. However, women in lower-income populations often do not have access to doulas. This study explored community perspectives on doula care to inform the development of a hospital-based doula program to serve primarily low-income women of color. Methods: Four focus groups and four individual interviews were conducted with: (1) women who were pregnant or parenting a child under age 2 (n=20); (2) people who had provided support during a birth in the previous 2 years (n=5); and (3) women who had received doula training (n=4). Results: Participants had generally positive perceptions of doula services. Many aspects of doula support desired by participants are core to birth doula services. Participants identified ways that doulas could potentially address critical gaps in health care services known to impact outcomes (e.g., continuity of care and advocacy), and provide much-needed support in the postpartum period. Responses also suggested that doula training and hospital-based doula programs may need to be adapted to address population-specific needs (e.g., women with substance use disorder and younger mothers). Novel program suggestions included “on call” informational doulas. Conclusions: Findings suggested that women in racial/ethnic minority and lower income groups may be likely to utilize a hospital-based doula program and identified adaptations to traditional doula care that may be required to best meet the needs of women in groups with higher risk of poor maternal health and birth outcomes.
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Affiliation(s)
- Laura B Attanasio
- Department of Health Promotion and Policy, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Marisa DaCosta
- Department of Health Promotion and Policy, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Reva Kleppel
- Department of Obstetrics and Gynecology, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts, USA
| | - Tiki Govantes
- Department of Obstetrics and Gynecology, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts, USA
| | - Heather Z Sankey
- Department of Obstetrics and Gynecology, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts, USA
| | - Sarah L Goff
- Department of Health Promotion and Policy, University of Massachusetts Amherst, Amherst, Massachusetts, USA
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Farmer MJS, Kleppel R. Getting to know you: implementing an interprofessional education program for medical and respiratory therapy students in mechanical ventilation - challenges and lessons learned. J Interprof Care 2021; 36:706-715. [PMID: 34855563 DOI: 10.1080/13561820.2021.1982883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The physician and respiratory therapist function as an interprofessional team caring for patients on mechanical ventilation. There is a paucity of research devoted to interprofessional education (IPE) of students from different professions in mechanical ventilation during clinical rotations in the medical intensive care unit (MICU). Student interprofessional education could develop team communication and shared decision-making skills early in training. The uniqueness of this introductory IPE programme is that it occurs during a clinical rotation in a real MICU, as opposed to a pre-clinical simulated campus setting, and it blends students from various educational backgrounds. Medical students and respiratory therapy students from different academic institutions participated in traditional lectures, small interprofessional group case-based problem-solving sessions, MICU bedside teaching sessions, written assessments, and focus groups. Quantitative responses were analyzed using descriptive statistics. Qualitative responses were categorised using the core competencies for Interprofessional Collaborative Practice. The purpose of this introductory IPE programme was to foster opportunities for interprofessional interaction during the student clinical experience while improving knowledge about mechanical ventilation. Qualitative expectations and feedback were predominantly positive. Quantitative responses suggest that students from both disciplines gained knowledge about mechanical ventilation in an IPE setting.
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Affiliation(s)
- Mary Jo S Farmer
- Department of Medicine, University of Massachusetts Medical School - Baystate, Springfield, MA, USA
| | - Reva Kleppel
- Department of Medicine, University of Massachusetts Medical School - Baystate, Springfield, MA, USA
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Blanchard RD, Kleppel R, Bianchi DW. The Impact of an Institutional Grant Program on the Economic, Social, and Cultural Capital of Women Researchers. J Womens Health (Larchmt) 2019; 28:1698-1704. [PMID: 31259641 DOI: 10.1089/jwh.2018.7642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Early funding can have significant impact on a researcher's career. However, funding is not equal for men and women. Not only do female researchers apply for fewer grants than men, but they also experience a lower success rate when they do. The Zucker Grant Program (ZGP) was established in 2000 to promote the early success of women researchers. The purpose of this evaluation is to support other institutions hoping to grow the research careers of women scientists. Methods: This program evaluation reviewed the first 16 years of the program's history. Our mixed-methods, outcomes-based evaluation had four phases: (I) interviews with key stakeholders, (II) development and distribution of a survey to ZGP recipients, (III) focus groups and interviews with ZGP recipients, (IV) document analysis from the ZGP Center and the Tufts University School of Medicine (TUSM) Development Office. This article reports on the qualitative data collection and analysis. Results: Between 2000 and 2016, US$377,050 was awarded for 142 recipients. Qualitative data revealed how grant funding was critical to support pilot data in awardees' research to inform extramural grant applications. However, the program evaluation also identified effects on awardees' confidence as researchers and connection to a community. Conclusion: Outcomes are interpreted through the framework of Bourdieu's three forms of capital, including economic, social, and cultural capital. Viewed through this framework, they provide a critical infrastructure to the development and success of early career female investigators. This work offers other institutions a framework to consider when establishing intramural funding and support programs for their early career investigators.
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Affiliation(s)
- Rebecca D Blanchard
- Department of Medicine, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts
| | - Reva Kleppel
- Department of Medicine, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts
| | - Diana W Bianchi
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Bethesda, Maryland
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4
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Atreya AR, Stefan M, Friderici JL, Kleppel R, Fitzgerald J, Rothberg MB. Characteristics of Successful Internal Medicine Resident Research Projects: Predictors of Journal Publication Versus Abstract Presentation. Acad Med 2018; 93:1182-1188. [PMID: 29419546 DOI: 10.1097/acm.0000000000002164] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
PURPOSE To identify the characteristics of successful research projects at an internal medicine residency program with an established research curriculum. METHOD The authors collected data about all research projects initiated by or involving medicine residents from 2006 to 2013 at Baystate Medical Center, using departmental files and institutional review board applications. Resident and mentor characteristics were determined using personnel files and Medline searches. Using multivariable models, the authors identified predictors of successful completion of projects using adjusted prevalence ratios (PRs). The primary outcome was manuscript publication, and secondary outcome was publication or regional/national presentation. Finally, residents were surveyed to identify barriers and/or factors contributing to project completion. RESULTS Ninety-four research projects were identified: 52 (55.3%) projects achieved the primary outcome and 72 (76.5%) met the secondary outcome, with overlap between categories. Most study designs were cross-sectional (41; 43.6%) or retrospective cohort (30; 31.9%). After adjustment, utilization of the epidemiology/biostatistical core (PR = 2.09; 95% CI: 1.36, 3.21), established publication record of resident (PR = 1.54; 95% CI: 1.14, 2.07), and resident with U.S. medical education (PR = 1.39; 95% CI: 1.02, 1.90) were associated with successful project completion. Mentor publication record (PR = 3.13) did not retain significance because of small sample size. Most respondents (65%) cited "lack of time" as a major project barrier. CONCLUSIONS Programs seeking to increase resident publications should consider an institutional epidemiology/biostatistical core, made available to all residency research projects, and residents should choose experienced mentors with a track record of publications.
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Affiliation(s)
- Auras R Atreya
- A.R. Atreya is a fellow, Division of Cardiovascular Medicine, Department of Internal Medicine, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts. M. Stefan is associate professor, Department of Internal Medicine, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts. J.L. Friderici is informatics/analytics senior specialist, Cigna HealthCare, Bloomfield, Connecticut. R. Kleppel is research coordinator, Department of Internal Medicine, Baystate Medical Center, Springfield, Massachusetts. J. Fitzgerald is a research nurse, Faculty and Resident Development, Department of Internal Medicine, Baystate Medical Center, Springfield, Massachusetts. M.B. Rothberg is professor, Center for Value-Based Care Research, Medicine Institute, Cleveland Clinic, Cleveland, Ohio
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Goff SL, Kleppel R, Makari-Judson G. 'No Pink Ribbons': How Women's Lived Experiences With Breast Atypia Inform Decisions Involving Risk-Reducing Medications. J Patient Cent Res Rev 2018; 5:158-166. [PMID: 31414000 DOI: 10.17294/2330-0698.1594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose Atypical hyperplasia (AH) is associated with a nearly 4-fold elevation of lifetime risk for breast cancer, and lobular carcinoma in situ (LCIS) is associated with a 7- to 8-fold risk. Women with AH/LCIS make numerous decisions in the course of treatment, including whether to take a risk-reducing medication, an option relatively few women pursue. We explored women's decision-making processes through patient narratives in an effort to inform decision supports for AH/LCIS. Methods We conducted in-depth interviews with 20 English-speaking women with AH/LCIS and no subsequent diagnosis of invasive breast cancer who had enrolled in the Rays of Hope Center for Breast Cancer Research patient registry between April 5, 2012, and March 31, 2016. Interviews were audiotaped, professionally transcribed, and qualitatively analyzed using thematic qualitative content analysis. Results We identified three major narrative themes: 1) experiences with medical care; 2) decision-making; and 3) making sense of AH/LCIS. Each major theme had several subthemes, many of which map onto existing decisional theories and heuristics. Subthemes included the impact of life context on diagnosis meaning, emotional responses, changes in self-concept and body image, and understanding of the risk-benefit of risk-reducing medications. Conclusions This narrative analysis offers important insights into how lived experience may influence decision-making for women with AH/LCIS. Decision supports that focus not only on analytic decisional processes, but also patients' subjectivities and decisional heuristics, could prove useful for women and their health care providers.
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Affiliation(s)
- Sarah L Goff
- Division of General Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA.,Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School-Baystate, Springfield, MA
| | - Reva Kleppel
- Division of General Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA
| | - Grace Makari-Judson
- Division of Hematology-Oncology, University of Massachusetts Medical School-Baystate, Springfield, MA
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6
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Bryson C, Boynton G, Stepczynski A, Garb J, Kleppel R, Irani F, Natanasabapathy S, Stefan MS. Geographical assignment of hospitalists in an urban teaching hospital: feasibility and impact on efficiency and provider satisfaction. Hosp Pract (1995) 2017; 45:135-142. [PMID: 28707548 DOI: 10.1080/21548331.2017.1353884] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate whether implementation of a geographic model of assigning hospitalists is feasible and sustainable in a large hospitalist program and assess its impact on provider satisfaction, perceived efficiency and patient outcomes. METHODS Pre (3 months) - post (12 months) intervention study conducted from June 2014 through September 2015 at a tertiary care medical center with a large hospitalist program caring for patients scattered in 4 buildings and 16 floors. Hospitalists were assigned to a particular nursing unit (geographic assignment) with a goal of having over 80% of their assigned patients located on their assigned unit. Satisfaction and perceived efficiency were assessed through a survey administered before and after the intervention. RESULTS Geographic assignment percentage increased from an average of 60% in the pre-intervention period to 93% post-intervention. The number of hospitalists covering a 32 bed unit decreased from 8-10 pre to 2-3 post-intervention. A majority of physicians (87%) thought that geography had a positive impact on the overall quality of care. Respondents reported that they felt that geography increased time spent with patient/caregivers to discuss plan of care (p < 0.001); improved communication with nurses (p = 0.0009); and increased sense of teamwork with nurses/case managers (p < 0.001). Mean length of stay (4.54 vs 4.62 days), 30-day readmission rates (16.0% vs 16.6%) and patient satisfaction (79.9 vs 77.3) did not change significantly between the pre- and post-implementation period. The discharge before noon rate improved slightly (47.5% - 54.1%). CONCLUSIONS Implementation of a unit-based model in a large hospitalist program is feasible and sustainable with appropriate planning and support. The geographical model of care increased provider satisfaction and perceived efficiency; it also facilitated the implementation of other key interventions such as interdisciplinary rounds.
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Affiliation(s)
- Christine Bryson
- a Department of Medicine, Division of Hospital Medicine , Baystate Medical Center , Springfield , MA , USA.,b Department of Medicine , Tufts University School of Medicine , Boston , MA , USA
| | | | - Anna Stepczynski
- d Department of Medicine, Division of Geriatrics, General Medicine and Palliative Care , University of Arizona , Tucson , AZ , USA
| | - Jane Garb
- a Department of Medicine, Division of Hospital Medicine , Baystate Medical Center , Springfield , MA , USA
| | - Reva Kleppel
- a Department of Medicine, Division of Hospital Medicine , Baystate Medical Center , Springfield , MA , USA
| | - Farzan Irani
- a Department of Medicine, Division of Hospital Medicine , Baystate Medical Center , Springfield , MA , USA.,b Department of Medicine , Tufts University School of Medicine , Boston , MA , USA
| | - Siva Natanasabapathy
- a Department of Medicine, Division of Hospital Medicine , Baystate Medical Center , Springfield , MA , USA.,b Department of Medicine , Tufts University School of Medicine , Boston , MA , USA
| | - Mihaela S Stefan
- a Department of Medicine, Division of Hospital Medicine , Baystate Medical Center , Springfield , MA , USA.,b Department of Medicine , Tufts University School of Medicine , Boston , MA , USA
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7
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Luciano GL, Visintainer PF, Kleppel R, Rothberg MB. Ambulatory Morning Report: A Case-Based Method of Teaching EBM Through Experiential Learning. South Med J 2016; 109:108-11. [PMID: 26840967 DOI: 10.14423/smj.0000000000000408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Evidence-based medicine (EBM) skills are important to daily practice, but residents generally feel unskilled incorporating EBM into practice. The Kolb experiential learning theory, as applied to curricular planning, offers a unique methodology to help learners build an EBM skill set based on clinical experiences. We sought to blend the learner-centered, case-based merits of the morning report with an experientially based EBM curriculum. We describe and evaluate a patient-centered ambulatory morning report combining the User's Guides to the Medical Literature approach to EBM and experiential learning theory in the internal medicine department at Baystate Medical Center. METHODS The Kolb experiential learning theory postulates that experience transforms knowledge; within that premise we designed a curriculum to build EBM skills incorporating residents' patient encounters. By developing structured clinical questions based on recent clinical problems, residents activate prior knowledge. Residents acquire new knowledge through selection and evaluation of an article that addresses the structured clinical questions. Residents then apply and use new knowledge in future patient encounters. RESULTS To assess the curriculum, we designed an 18-question EBM test, which addressed applied knowledge and EBM skills based on the User's Guides approach. Of the 66 residents who could participate in the curriculum, 61 (92%) completed the test. There was a modest improvement in EBM knowledge, primarily during the first year of training. CONCLUSIONS Our experiential curriculum teaches EBM skills essential to clinical practice. The curriculum differs from traditional EBM curricula in that ours blends experiential learning with an EBM skill set; learners use new knowledge in real time.
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Affiliation(s)
- Gina L Luciano
- From the Baystate Medical Center, Springfield, Massachusetts, and the Cleveland Clinic, Cleveland, Ohio
| | - Paul F Visintainer
- From the Baystate Medical Center, Springfield, Massachusetts, and the Cleveland Clinic, Cleveland, Ohio
| | - Reva Kleppel
- From the Baystate Medical Center, Springfield, Massachusetts, and the Cleveland Clinic, Cleveland, Ohio
| | - Michael B Rothberg
- From the Baystate Medical Center, Springfield, Massachusetts, and the Cleveland Clinic, Cleveland, Ohio
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8
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Abstract
BACKGROUND Attention-deficit hyperactivity disorder (ADHD) is the most common neurobehavioral disorder of childhood, affecting 5-8% of children. It has been observed that these children have poor sedation experiences; however, to date there is minimal research on procedural sedation in this population. AIM To examine whether children with ADHD required larger doses of propofol for magnetic resonance imaging (MRI) sedation. METHODS The hospital's administrative billing database was used to identify all billing codes for MRI brain scans (with and without contrast) in children aged between 5 and 12 years over the preceding 5.5 years. The hospital's electronic medical record database provided baseline demographics. The sedation record was reviewed for propofol dose, psychostimulant use, and prescribed dose. All children received a standard weight-based dose of midazolam prior to receiving the necessary amount of propofol. Primary outcome was the dose of propofol administered (mg·kg(-1) ) to achieve adequate sedation. RESULTS A total of 258 procedures met the inclusion criteria. The sample was 52% male, 74% White, 7.8% Black, 7.8% Hispanic, 4.3% Asian, and 6.2% other. ADHD was documented for 49 procedures with a prevalence of 18.5%. Patients with ADHD were older, more likely to be male, Hispanic, or to report race as 'Refused/Unknown'. Indications for MRI for patients with ADHD varied significantly, with 'Behavioral' and 'Neurocutaneous' being significantly overrepresented in the ADHD group. The average sedative dose for all patients was 2.8 mg·kg(-1) (95% CI 2.62-2.94). Sedative dose was similar among children with and without ADHD diagnosis. CONCLUSIONS Our study illustrates that children with ADHD do not have higher sedative requirements to achieve a successful brain MRI.
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Affiliation(s)
- Eimear Kitt
- Department of Medicine-Pediatrics, Baystate Medical Center, Springfield, MA, USA.,Department of Medicine and Department of Pediatrics, Tufts University School of Medicine, Boston, MA, USA
| | - Jennifer Friderici
- Department of Medicine and Department of Pediatrics, Tufts University School of Medicine, Boston, MA, USA.,Department of Medicine, Baystate Medical Center, Springfield, MA, USA
| | - Reva Kleppel
- Department of Medicine and Department of Pediatrics, Tufts University School of Medicine, Boston, MA, USA.,Department of Medicine, Baystate Medical Center, Springfield, MA, USA
| | - Michael Canarie
- Department of Medicine and Department of Pediatrics, Tufts University School of Medicine, Boston, MA, USA.,Department of Pediatric Critical Care, Baystate Medical Center, Springfield, MA, USA.,Department of Pediatric Critical Care, Yale University School of Medicine, New Haven, CT, USA
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9
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Arora S, Atreya AR, Bernstein AM, Kleppel R, Friderici J, Schramm S, Lagu T, Rothberg MB. Healthcare Providers' Knowledge of Diets and Dietary Advice. South Med J 2015; 108:539-46. [PMID: 26332479 DOI: 10.14423/smj.0000000000000333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Little is known about healthcare providers' knowledge of dietary evidence or about what dietary advice providers offer to patients. The objective of our study was to determine which diets providers recommended to patients and providers' beliefs about the evidence behind those recommendations. METHODS This was a 22-question cross-sectional survey conducted between February 2013 and September 2013, in 45 ambulatory practices within two health systems. Attending physicians, housestaff, and advanced practitioners in internal medicine, medicine-pediatrics, family medicine, cardiology, and endocrinology practices were audited. Providers' attitudes, perceptions, and beliefs about diet modification were collected. Knowledge scores were constructed based on the number of correct responses to specific questions. RESULTS Of 343 provider responses, largely from primary care specialties (n = 3027, 90%), the top dietary recommendations were low-salt diet (71%) for hypertension, low-carbohydrate diet (64%) for uncontrolled diabetes mellitus, low saturated fat diet (73%) for dyslipidemia, low-calorie diet (72%) for obesity, and low saturated fat diet (63%) for coronary heart disease. Providers believed that 51% of diet recommendations were supported by randomized trial evidence when they were not. Respondents' overall knowledge of randomized trial evidence for dietary interventions was low (mean [standard deviation] knowledge score 44.3% [22.4%], range 0.0%-100.0%). The survey study from two health systems, using a nonvalidated survey tool limits external and internal validity. CONCLUSIONS Providers report recommending different diets depending on specific risk factors and generally believe that their recommendations are evidence based. Substantial gaps between their knowledge and the randomized trial evidence regarding diet for disease prevention remain.
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Affiliation(s)
- Sonali Arora
- From the Department of Internal Medicine and the Epidemiology and Biostatistics Research Core, Baystate Medical Center, Springfield, Massachusetts, the Wellness Institute, Cleveland Clinic, Lyndhurst, Ohio, and the Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Auras R Atreya
- From the Department of Internal Medicine and the Epidemiology and Biostatistics Research Core, Baystate Medical Center, Springfield, Massachusetts, the Wellness Institute, Cleveland Clinic, Lyndhurst, Ohio, and the Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Adam M Bernstein
- From the Department of Internal Medicine and the Epidemiology and Biostatistics Research Core, Baystate Medical Center, Springfield, Massachusetts, the Wellness Institute, Cleveland Clinic, Lyndhurst, Ohio, and the Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Reva Kleppel
- From the Department of Internal Medicine and the Epidemiology and Biostatistics Research Core, Baystate Medical Center, Springfield, Massachusetts, the Wellness Institute, Cleveland Clinic, Lyndhurst, Ohio, and the Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jennifer Friderici
- From the Department of Internal Medicine and the Epidemiology and Biostatistics Research Core, Baystate Medical Center, Springfield, Massachusetts, the Wellness Institute, Cleveland Clinic, Lyndhurst, Ohio, and the Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sarah Schramm
- From the Department of Internal Medicine and the Epidemiology and Biostatistics Research Core, Baystate Medical Center, Springfield, Massachusetts, the Wellness Institute, Cleveland Clinic, Lyndhurst, Ohio, and the Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Tara Lagu
- From the Department of Internal Medicine and the Epidemiology and Biostatistics Research Core, Baystate Medical Center, Springfield, Massachusetts, the Wellness Institute, Cleveland Clinic, Lyndhurst, Ohio, and the Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Michael B Rothberg
- From the Department of Internal Medicine and the Epidemiology and Biostatistics Research Core, Baystate Medical Center, Springfield, Massachusetts, the Wellness Institute, Cleveland Clinic, Lyndhurst, Ohio, and the Medicine Institute, Cleveland Clinic, Cleveland, Ohio
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10
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Loh KP, Stefan MS, Friderici J, Tan EK, Ogunneye O, Kleppel R, Stewart JA. Healthcare Professionals' Perceptions and Knowledge of the USPSTF Guidelines on Breast Self-Examination. South Med J 2015; 108:459-62. [PMID: 26280768 DOI: 10.14423/smj.0000000000000318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES In 2009, the US Preventive Services Task Force (USPSTF) published revised guidelines for breast cancer screening, which recommended against teaching breast self-examination (BSE). The objective of this study was to assess providers' perceptions and knowledge regarding these updated guidelines. METHODS A cross-sectional survey study was administered to 205 attending and resident physicians, nurse practitioners, physician's assistants, and registered nurses working in five medical and gynecological practices affiliated with a large academic teaching hospital in western Massachusetts. The survey solicited demographic data and inquired about practitioners' perceptions and knowledge of the revised guidelines. RESULTS Fewer than half (41.1%) of respondents correctly identified the new USPSTF guidelines for BSE. Among those who stated they were aware of guidelines, only 37.1% adhered to them. Overall, 70% report that they teach patients to perform BSE. Teaching BSE was associated with female sex (odds ratio [OR] 2.64, 95% confidence interval [CI] 1.11-6.29), a belief that BSE reduces morbidity and mortality (OR 2.91, 95% CI 1.08-7.81), and internal medicine residency (OR 0.18, 95% CI 0.06-0.59). CONCLUSIONS Knowledge of the 2009 USPSTF guidelines is suboptimal and greater efforts should be made to educate healthcare professionals about them.
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Affiliation(s)
- Kah Poh Loh
- From the Departments of Internal Medicine, Academic Affairs, and Hematology/Oncology, Baystate Medical Center/Tufts University School of Medicine, Springfield, Massachusetts, and the Department of Nephrology, University of Utah, Salt Lake City
| | - Mihaela S Stefan
- From the Departments of Internal Medicine, Academic Affairs, and Hematology/Oncology, Baystate Medical Center/Tufts University School of Medicine, Springfield, Massachusetts, and the Department of Nephrology, University of Utah, Salt Lake City
| | - Jennifer Friderici
- From the Departments of Internal Medicine, Academic Affairs, and Hematology/Oncology, Baystate Medical Center/Tufts University School of Medicine, Springfield, Massachusetts, and the Department of Nephrology, University of Utah, Salt Lake City
| | - Eng Keong Tan
- From the Departments of Internal Medicine, Academic Affairs, and Hematology/Oncology, Baystate Medical Center/Tufts University School of Medicine, Springfield, Massachusetts, and the Department of Nephrology, University of Utah, Salt Lake City
| | - Owolabi Ogunneye
- From the Departments of Internal Medicine, Academic Affairs, and Hematology/Oncology, Baystate Medical Center/Tufts University School of Medicine, Springfield, Massachusetts, and the Department of Nephrology, University of Utah, Salt Lake City
| | - Reva Kleppel
- From the Departments of Internal Medicine, Academic Affairs, and Hematology/Oncology, Baystate Medical Center/Tufts University School of Medicine, Springfield, Massachusetts, and the Department of Nephrology, University of Utah, Salt Lake City
| | - James A Stewart
- From the Departments of Internal Medicine, Academic Affairs, and Hematology/Oncology, Baystate Medical Center/Tufts University School of Medicine, Springfield, Massachusetts, and the Department of Nephrology, University of Utah, Salt Lake City
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11
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Wells RE, Garb J, Fitzgerald J, Kleppel R, Rothberg MB. Factors associated with emergency department visits in asthma exacerbation. South Med J 2015; 108:276-80. [PMID: 25972214 DOI: 10.14423/smj.0000000000000275] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Despite quality improvement initiatives to prevent asthma-related emergency department (ED) visits, rates have not declined. We sought to determine factors associated with ED visits in an underserved population. METHODS We performed a case-control analysis of asthma patients at three ambulatory care centers serving low-income populations. Cases consisted of asthmatic patients aged 18 to 45 years with ≥1 ED visit for an asthma exacerbation between August 1, 2008 and July 31, 2010. Controls were patients with asthma aged 18 to 45 years with ≥1 outpatient visit during the same period but with no asthma-related ED visit. Data were collected by chart review and included demographics, past referral for asthma education or to a pulmonologist, recent tobacco use, influenza vaccination, and asthma medication prescriptions in the year before the index visit. RESULTS Among 244 cases and 475 controls, there were no significant differences in age, sex, or ethnicity. Cases were more likely than controls to have ever been referred for asthma education (odds ratio [OR] 4.09, 95% confidence interval [CI] 2.57-6.50) or to a pulmonologist (OR 2.31, 95% CI 1.15-4.66). In the year before the index visit, cases were more likely than controls to receive other medications in addition to inhaled corticosteroids (ICS; OR 1.74, 95% CI 1.14-2.66) but less likely to receive influenza vaccination (OR 0.49, 95% CI 0.34-0.71), a short-acting β-agonist (OR 0.43, 95% CI 0.24-0.78), or ICS alone (OR 0.53, 95% CI 0.34-0.84). CONCLUSIONS Markers of severe disease were associated with ED visits, as well as a lack of an influenza vaccination and failure to prescribe either ICS or short-acting β-agonists.
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Affiliation(s)
- Richard E Wells
- From the Tulane University Section of Pulmonary Diseases, Tulane University School of Medicine, New Orleans, Louisiana, Baystate Health, Springfield, Massachusetts, and the Cleveland Clinic Medicine Institute, Cleveland, Ohio
| | - Jane Garb
- From the Tulane University Section of Pulmonary Diseases, Tulane University School of Medicine, New Orleans, Louisiana, Baystate Health, Springfield, Massachusetts, and the Cleveland Clinic Medicine Institute, Cleveland, Ohio
| | - Janice Fitzgerald
- From the Tulane University Section of Pulmonary Diseases, Tulane University School of Medicine, New Orleans, Louisiana, Baystate Health, Springfield, Massachusetts, and the Cleveland Clinic Medicine Institute, Cleveland, Ohio
| | - Reva Kleppel
- From the Tulane University Section of Pulmonary Diseases, Tulane University School of Medicine, New Orleans, Louisiana, Baystate Health, Springfield, Massachusetts, and the Cleveland Clinic Medicine Institute, Cleveland, Ohio
| | - Michael B Rothberg
- From the Tulane University Section of Pulmonary Diseases, Tulane University School of Medicine, New Orleans, Louisiana, Baystate Health, Springfield, Massachusetts, and the Cleveland Clinic Medicine Institute, Cleveland, Ohio
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Rothberg MB, Sivalingam SK, Kleppel R, Schweiger M, Hu B, Sepucha KR. Informed Decision Making for Percutaneous Coronary Intervention for Stable Coronary Disease. JAMA Intern Med 2015; 175:1199-206. [PMID: 25984988 DOI: 10.1001/jamainternmed.2015.1657] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Patients with stable coronary disease undergoing percutaneous coronary intervention (PCI) are frequently misinformed about the benefits of PCI. Little is known about the quality of decision making before angiography and possible PCI. OBJECTIVE To assess the quality of informed decision making and its association with patient decisions. DESIGN, SETTING, AND PARTICIPANTS We performed a cross-sectional analysis of recorded conversations between August 1, 2008, and August 31, 2012, among adults with known or suspected stable coronary disease at outpatient cardiology practices. MAIN OUTCOMES AND MEASURES Presence of 7 elements of informed decision making and the decision to undergo angiography and possible PCI. RESULTS Of 59 conversations conducted by 23 cardiologists, 2 (3%) included all 7 elements of informed decision making; 8 (14%) met a more limited definition of procedure, alternatives, and risks. Specific elements significantly associated with not choosing angiography and possible PCI included discussion of uncertainty (odds ratio [OR], 20.5; 95% CI, 2.3-204.9), patient's role (OR, 5.3; 95% CI, 1.3-21.3), exploration of alternatives (OR, 9.5; 95% CI, 2.5-36.5), and exploration of patient preference (OR, 4.8; 95% CI, 1.2-19.4). Neither the presence of angina nor severity of symptoms was associated with choosing angiography and possible PCI. In a multivariable analysis using the total number of elements as a predictor, better informed patients were less likely to choose angiography and possible PCI (OR per additional element, 3.2; 95% CI, 1.4-7.1; P = .005). CONCLUSIONS AND RELEVANCE In conversations between cardiologists and patients with stable angina, informed decision making is often incomplete. More complete discussions are associated with patients choosing not to undergo angiography and possible PCI.
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Affiliation(s)
- Michael B Rothberg
- Center for Value-Based Care Research, Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Senthil K Sivalingam
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester
| | - Reva Kleppel
- Division of General Medicine, Baystate Medical Center, Springfield, Massachusetts
| | - Marc Schweiger
- Division of Cardiology, Baystate Medical Center, Springfield, Massachusetts
| | - Bo Hu
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Karen R Sepucha
- Health Decision Sciences, Massachusetts General Hospital, Harvard Medical School, Boston
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Atreya AR, Kashef MA, Kleppel R, Visintainer P, Fitzgerald J, Lauture C, Schweiger M, Kugelmass A, Rothberg M, Goff SL. PATIENT BELIEFS REGARDING BENEFITS OF PERCUTANEOUS CORONARY INTERVENTION IN CHRONIC STABLE ANGINA: HAVE THEY CHANGED? J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)61653-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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14
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Affiliation(s)
- Michael B Rothberg
- Center for Value-Based Care Research, Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Joshua Class
- Howard University College of Medicine, Washington, DC
| | - Tara F Bishop
- Division of Outcomes and Effectiveness, Department of Public Health, Weill Cornell Medical College, New York, New York4Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Jennifer Friderici
- Division of Academic Affairs, Baystate Medical Center, Springfield, Massachusetts
| | - Reva Kleppel
- Department of Medicine, Baystate Medical Center, Springfield, Massachusetts
| | - Peter K Lindenauer
- Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts
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Goff SL, Mazor KM, Ting HH, Kleppel R, Rothberg MB. How cardiologists present the benefits of percutaneous coronary interventions to patients with stable angina: a qualitative analysis. JAMA Intern Med 2014; 174:1614-21. [PMID: 25156523 PMCID: PMC4553927 DOI: 10.1001/jamainternmed.2014.3328] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
IMPORTANCE Patients with stable coronary artery disease (CAD) attribute greater benefit to percutaneous coronary interventions (PCI) than indicated in clinical trials. Little is known about how cardiologists' presentation of the benefits and risks may influence patients' perceptions. OBJECTIVES To broadly describe the content of discussions between patients and cardiologists regarding angiogram and PCI for stable CAD, and to describe elements that may affect patients' understanding. DESIGN, SETTING, AND PARTICIPANTS Qualitative content analysis of encounters between cardiologists and patients with stable CAD who participated in the Verilogue Point-of-Practice Database between March 1, 2008, and August 31, 2012. Transcripts in which angiogram and PCI were discussed were retrieved from the database. Patients were aged 44 to 88 years (median, 64 years); 25% were women; 50% reported symptoms of angina; and 6% were taking more than 1 medication to treat angina. MAIN OUTCOMES AND MEASURES Results of conventional and directed qualitative content analysis. RESULTS Forty encounters were analyzed. Five major categories and subcategories of factors that may affect patients' understanding of benefit were identified: (1) rationale for recommending angiogram and PCI (eg, stress test results, symptoms, and cardiologist's preferences); (2) discussion of benefits (eg, accurate discussion of benefit [5%], explicitly overstated benefit [13%], and implicitly overstated benefit [35%]); (3) discussion of risks (eg, minimization of risk); (4) cardiologist's communication style (eg, humor, teach-back, message framing, and failure to respond to patient questions); and (5) patient and family member contributions to the discussion. CONCLUSIONS AND RELEVANCE Few cardiologists discussed the evidence-based benefits of angiogram and PCI for stable CAD, and some implicitly or explicitly overstated the benefits. The etiology of patient misunderstanding is likely multifactorial, but if future quantitative studies support the findings of this hypothesis-generating analysis, modifications to cardiologists' approach to describing the risks and benefits of the procedure may improve patient understanding.
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Affiliation(s)
- Sarah L Goff
- Department of Internal Medicine, Tufts University School of Medicine/Baystate Medical Center, Springfield, Massachusetts2The Center for Quality of Care Research, Tufts University School of Medicine/Baystate Medical Center, Springfield, Massachusetts
| | - Kathleen M Mazor
- Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester
| | - Henry H Ting
- Division of Cardiovascular Diseases, Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota
| | - Reva Kleppel
- Department of Internal Medicine, Tufts University School of Medicine/Baystate Medical Center, Springfield, Massachusetts
| | - Michael B Rothberg
- Department of Internal Medicine, Cleveland Clinic Medicine Institute, Cleveland, Ohio
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Loh KP, Tan EK, Ogunneye O, Friderici J, Kleppel R, Stefan M, Stewart JA. Health care professionals’ practices, perceptions, and awareness regarding breast self-examination. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.26_suppl.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
14 Background: In 2009, the United States Preventive Services Task Force (USPSTF) published the revised guidelines for breast cancer screening which recommended against teaching breast self-examination (BSE).The objective of this study was to assess healthcare professionals' practices, perceptions and knowledge in BSE as well as their adherence to the newly revised USPSTF guideline for BSE. Methods: A cross-sectional survey study was carried out in five medical and gynecological practices affiliated with a large academic teaching hospital in western Massachusetts. The survey was sent to all attending- and resident-physicians, nurse practitioners (NPs), physician assistants (PAs), and registered nurses (RNs) working in these medical practices.The survey collected demographic data and inquired about practitioners’ awareness and perceptions of the 2009 USPSTF guidelines. Results: The survey completion rate was 50.7%. Fewer than half of respondents correctly identified the 2009 USPSTF guidelines recommendations for BSE (41.4%). However, among 35 respondents who stated they were aware of USPSTF guidelines, only 37.1% adhered to them. Overall, 70% (95% CI 61.3%, 79.1%) stated that they do teach patients to perform BSE. The most frequent reasons cited for teaching BSE were: “early detection of cancer” (48.0%), and to “empower women”, (37.0%). In univariable analyses, female practitioners were significantly more likely than male practitioners to report teaching BSE (OR 2.64, 95% CI 1.11, 6.29). Other characteristics which showed an association without reaching statistical significance were: ≥ 5 years of practice (OR 1.67, 95% CI 0.70, 3.98); non-physician practitioner (OR 3.5, 95% CI 0.82, 14.93); US Med School (OR 2.20, 95% CI 0.84, 5.75); ever detecting a lump in a patient (OR 2.95, 95% CI 0.80, 10.87), and belief that BSE reduces morbidity and mortality (OR 2.12, 95% CI 0.84, 5.37). Conclusions: Knowledge of, and adherence to, the 2009 USPSTF guidelines related to BSE are relatively low. Despite being aware of the guidelines, some health professionals still taught BSE. Greater efforts should be made to educate healthcare professionals about the 2009 USPSTF guidelines on BSE.
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Affiliation(s)
- Kah Poh Loh
- Baystate Medical Center/Tufts University, Springfield, MA
| | - Eng Keong Tan
- Baystate Medical Center/Tufts University, Springfield, MA
| | | | - Jennifer Friderici
- Baystate Medical Center, Tufts University School of Medicine, Springfield, MA
| | | | - Mihaela Stefan
- Baystate Medical Center/Tufts University, Springfield, MA
| | - James A. Stewart
- Baystate Medical Center, Tufts University School of Medicine, Springfield, MA
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Abstract
Internal medicine residents are required to participate in scholarly activity, but conducting original research during residency is challenging. Following a poor Match at Baystate Medical Center, the authors implemented a resident research program to overcome known barriers to resident research. The multifaceted program addressed the following barriers: lack of interest, lack of time, insufficient technical support, and paucity of mentors. The program consisted of evidence-based medicine training to stimulate residents' interest in research and structural changes to support their conduct of research, including protected time for research during ambulatory blocks, a research assistant to help with tasks such as institutional review board applications and data entry, a research nurse to help with data collection, easily accessible biostatistical support, and a resident research director to provide mentorship. Following implementation in the fall of 2005, there was a steady rise in the number of resident presentations at national meetings, then in the number of resident publications. From 2001 to 2006, the department saw 3 resident publications. From 2006 to 2012, that number increased to 39 (P< .001). The department also saw more original research (29 publications) and resident first authors (12 publications) after program implementation. The percentage of residents accepted into fellowships rose from 33% before program implementation to 49% after (P = .04). This comprehensive resident research program, which focused on evidence-based medicine and was tailored to overcome specific barriers, led to a significant increase in the number of resident Medline publications and improved the reputation of the residency program.
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Affiliation(s)
- Michael B Rothberg
- Dr. Rothberg is vice chair for research, Medicine Institute, Cleveland Clinic, Cleveland, Ohio. Ms. Kleppel is research coordinator, Internal Medicine Residency Program, Baystate Medical Center, Springfield, Massachusetts. Ms. Friderici is biostatistician, Division of Academic Affairs, Baystate Medical Center, Springfield, Massachusetts. Dr. Hinchey is chief academic officer, Division of Academic Affairs, Baystate Medical Center, Springfield, Massachusetts
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Loh KP, Tan EK, Friderici J, Kleppel R, Stefan M, Ogunneye O, Stewart JA. Health care professionals' attitudes, perceptions, and practices regarding breast self-examination. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e12513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Kah Poh Loh
- Baystate Medical Center/Tufts University, Springfield, MA
| | - Eng Keong Tan
- Baystate Medical Center/Tufts University, Springfield, MA
| | | | | | - Mihaela Stefan
- Baystate Medical Center/Tufts University, Springfield, MA
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Abstract
OBJECTIVES To elicit sources of waste as viewed by hospital workers. DESIGN Qualitative study using photo-elicitation, an ethnographic technique for prompting in-depth discussion. SETTING U.S. academic tertiary care hospital. PARTICIPANTS Physicians, nurses, pharmacists, administrative support personnel, administrators and respiratory therapists. METHODS A purposive sample of personnel at an academic tertiary care hospital was invited to take up to 10 photos of waste. Participants discussed their selections using photos as prompts during in-depth interviews. Transcripts were analysed in an iterative process using grounded theory; open and axial coding was performed, followed by selective and thematic coding to develop major themes and subthemes. RESULTS Twenty-one participants (nine women, average number of years in field=19.3) took 159 photos. Major themes included types of waste and recommendations to reduce waste. Types of waste comprised four major categories: Time, Materials, Energy and Talent. Participants emphasised time wastage (50% of photos) over other types of waste such as excess utilisation (2.5%). Energy and Talent were novel categories of waste. Recommendations to reduce waste included interventions at the micro-level (eg, individual/ward), meso-level (eg, institution) and macro-level (eg, payor/public policy). CONCLUSIONS The waste hospital workers identified differed from previously described waste both in the types of waste described and the emphasis placed on wasted time. The findings of this study represent a possible need for education of hospital workers about known types of waste, an opportunity to assess the impact of novel types of waste described and an opportunity to intervene to reduce the waste identified.
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Affiliation(s)
- Sarah L Goff
- Department of Medicine, Baystate Medical Center, , Springfield, Massachusetts, USA
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McComb SA, Henneman EA, Hinchey KT, Richardson CJ, Peto RR, Kleppel R, Rose DN. Improving teamwork on general medical units: when teams do not work face-to-face. Jt Comm J Qual Patient Saf 2012; 38:471-8. [PMID: 23130394 DOI: 10.1016/s1553-7250(12)38063-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Ogunneye O, Rothberg M, Friderici J, Slawsky M, Kleppel R, Calcasola S, Gadiraju TV, Stefan M. Abstract 225B: Nursing Home Care Quality and 30-Day Readmission Rates for patients with Heart Failure. Circ Cardiovasc Qual Outcomes 2012. [DOI: 10.1161/circoutcomes.5.suppl_1.a225b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Acute decompensated heart failure (ADHF) is one of the most frequent cause for hospitalization in the United States but little is known about how the quality of care provided by the skilled nursing facilities (SNFs) influences readmission rates.
Objectives:
1)To determine the association between care quality reported on Medicare's Nursing Home Compare website and 30-day risk-adjusted readmission rate (RAR) for ADHF. 2) To assess the correlation of processes of care and characteristics of SNFs with 30-day RAR.
Methods:
Retrospective cohort study at Baystate Medical Center, a 659-bed tertiary care hospital. Subjects: Patients aged ≥18 years discharged to 17 local SNFs after hospitalization for ADHF from November 2008 to October 2011. SNF quality of care was assessed based on the quality rating (health inspection, quality measures and staff rating) obtained from www.medicare.gov/NHCompare (range 1 to 5 stars). Based on the distribution of quality ratings, SNFs with only 1 star were considered lower quality. A telephone survey about SNF characteristics (e.g. physician hours, number of beds, licensed nurse's minutes) and processes of care (e.g. telemonitoring capability, onsite IV lasix, Heart failure (HF) treatment protocol) was completed by each director of nursing. RAR's were calculated using a mixed-effects logistic regression model adjusting for demographics, comorbidities and clinical characteristics of the patients.
Results:
Of the 605 discharges (491 patients), 121 were readmitted within 30-days, 57 were ADHF related; 64% were female, 86% white and median age was 84 years (interquartile range 13). Nearly all (99%) patients had Medicare or Medicaid. At discharge, 37% had ejection fraction <40% and 60% had at least one high-risk comorbidity (e.g. coronary artery disease, hypertension, atrial fibrillation). Higher quality SNFs (58%) were more likely to be non-profit and had more beds. The 30-day all-cause RAR was 19% (95% CI 14 -23) and 22% (95% CI 17 - 26) and the 30-day ADHF RAR was 9% (95% CI 6 -11.6) and 10% (95% CI 7 - 12.9) for higher and lower quality SNF's respectively. Both all-cause and ADHF RARs declined significantly between 2008- 2011 (P=0.02, χ2 test of trend). Although RAR were slightly lower in higher quality SNFs, these differences were not statistically significant in either adjusted or unadjusted models. Higher SNF staff ratings was marginally correlated with lower readmission rates (Spearmean R = - 0.39, p = 0.05). Self-reported processes of care (e.g. telemonitoring capability, weight graph), as well as SNF care structure (e.g. physician hours) did not correlate with RAR.
Conclusions:
Overall Quality rating reported on www.medicare.gov/NHCompare, as well as processes of care performed by SNFs were not associated with RARs for patients with Heart failure. Higher staff ratings correlated with lower RAR.
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Affiliation(s)
| | | | | | - Mara Slawsky
- Baystate Med Cntr/Tufts Univ Sch of Medicine, Springfield, MA
| | - Reva Kleppel
- Baystate Med Cntr/Tufts Univ Sch of Medicine, Springfield, MA
| | | | | | - Mihaela Stefan
- Baystate Med Cntr/Tufts Univ Sch of Medicine, Springfield, MA
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Wartak SA, Friderici J, Lotfi A, Verma A, Kleppel R, Naglieri-Prescod D, Rothberg MB. Patients' knowledge of risk and protective factors for cardiovascular disease. Am J Cardiol 2011; 107:1480-8. [PMID: 21414599 DOI: 10.1016/j.amjcard.2011.01.023] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Revised: 01/07/2011] [Accepted: 01/11/2011] [Indexed: 10/18/2022]
Abstract
Coronary heart disease is the leading cause of death in the United States. The American Heart Association has proposed improving overall cardiovascular health by promoting 7 components of ideal cardiovascular health, including health behaviors (not smoking, regular exercise, and healthy diet) and health factors (ideal body mass index, cholesterol, blood pressure, and blood glucose). The patients' knowledge of these 7 components is unknown. We performed a cross-sectional survey of patients at 4 primary care and 1 cardiology clinic. The survey measured demographic data, personal behaviors/health factors, cardiovascular disease history, and knowledge about these 7 components. A multivariate model was developed to assess patient characteristics associated with high knowledge scores. Of the 2,200 surveys distributed, 1,702 (77%) were returned with sufficient responses for analysis. Of these, 49% correctly identified heart disease as the leading cause of death, and 37% (95% confidence interval [CI] 35% to 39%) correctly identified all 7 components. The average respondent identified 4.9 components (95% CI 4.7 to 5.0). The lowest recognition rates were for exercise (57%), fruit/vegetable consumption (58%), and diabetes (63%). In a multivariate model, knowledge of all 7 components was positively associated with high school education or greater (odds ratio 2.43, 95% CI 1.68 to 3.52) and white ethnicity (odds ratio 1.78, 95% CI 1.27 to 2.50), and negatively associated with attending an urban neighborhood clinic (odds ratio 0.60, 95% CI 0.44 to 0.82). In conclusion, just >1/3 of patients could identify all 7 components of ideal cardiovascular health. Educational efforts should target patients in low socioeconomic strata and focus on improving knowledge about healthy diet and regular exercise. Although patients with diabetes were more likely than those without diabetes to recognize their risk, 1 in 5 were not aware that diabetes is a risk factor for cardiovascular disease.
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Abstract
OBJECTIVE To describe the prevalence of and risk factors for experiencing "phantom vibrations," the sensory hallucination sometimes experienced by people carrying pagers or cell phones when the device is not vibrating. DESIGN Cross sectional survey. SETTING Academic medical centre. PARTICIPANTS 176 medical staff who responded to questionnaire (76% of the 232 people invited). Measurements Electronic survey consisting of 17 questions about demographics, device use, phantom vibrations experienced, and attempts to stop them. RESULTS Of the 169 participants who answered the question, 115 (68%, 95% confidence interval 61% to 75%) reported having experienced phantom vibrations. Most (68/112) who experienced phantom vibrations did so after carrying the device between 1 month and 1 year, and 13% experienced them daily. Four factors were independently associated with phantom vibrations: occupation (resident v attending physician, prevalence ratio 1.47, 95% confidence interval 1.10 to 1.97), device location (breast pocket v belt, prevalence ratio 1.66, 1.29 to 2.14), hours carried (per 6 hour increment, prevalence ratio 1.30, 1.07 to 1.58), and more frequent use in vibrate mode (per frequency category, prevalence ratio 1.18, 1.03 to 1.34). Of those who experienced phantom vibrations, 43 (39%, 30% to 48%) were able to stop them. Strategies for stopping phantom vibrations included taking the device off vibrate mode, changing the location of the device, and using a different device (success rates 75% v 63% v 50%, respectively, P=0.217). However, 39% (30% to 49%) of respondents did not attempt any strategies. CONCLUSIONS Phantom vibration syndrome is common among those who use electronic devices.
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Affiliation(s)
- Michael B Rothberg
- Division of General Medicine, Baystate Medical Center, Springfield, MA 01199, USA.
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Rothberg MB, Sivalingam SK, Ashraf J, Visintainer P, Joelson J, Kleppel R, Vallurupalli N, Schweiger MJ. Patients' and cardiologists' perceptions of the benefits of percutaneous coronary intervention for stable coronary disease. Ann Intern Med 2010; 153:307-13. [PMID: 20820040 DOI: 10.7326/0003-4819-153-5-201009070-00005] [Citation(s) in RCA: 123] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND It is unclear whether patients understand that percutaneous coronary intervention (PCI) reduces only chronic stable angina and not myocardial infarction (MI) or associated mortality. OBJECTIVE To compare cardiologists' and patients' beliefs about PCI. DESIGN Survey. SETTING Academic center. PARTICIPANTS 153 patients who consented to elective coronary catheterization and possible PCI, 10 interventional cardiologists, and 17 referring cardiologists. MEASUREMENTS Patients' and cardiologists' beliefs about benefits of PCI. All cardiologists reported beliefs about PCI for patients in hypothetical scenarios. Interventional cardiologists also reported beliefs for study patients who underwent PCI. RESULTS Of 153 patients, 68% had any angina, 42% had activity-limiting angina, 77% had a positive stress test result, and 29% had had previous MI. The 53 patients who underwent PCI were more likely than those who did not to have a positive stress test result, but angina was similar in both groups. Almost three quarters of patients thought that without PCI, they would probably have MI within 5 years, and 88% believed that PCI would reduce risk for MI. Patients were more likely than physicians to believe that PCI would prevent MI (prevalence ratio, 4.25 [95% CI, 2.31 to 7.79]) or fatal MI (prevalence ratio, 4.83 [CI, 2.23 to 10.46]). Patients were less likely than their physicians to report pre-PCI angina (prevalence ratio, 0.79 [CI, 0.67 to 0.92]). For the scenarios, 63% of cardiologists believed that the benefits of PCI were limited to symptom relief. Of cardiologists who identified no benefit of PCI in 2 scenarios, 43% indicated that they would still proceed with PCI in these cases. LIMITATION The study was small and conducted at 1 center, and information about precatheterization counseling was limited. CONCLUSION Cardiologists' beliefs about PCI reflect trial results, but patients' beliefs do not. Discussions with patients before PCI should better explain anticipated benefits. PRIMARY FUNDING SOURCE None.
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Sivalingam S, Rothberg M, Asharf J, Visintainer P, Joelson J, Kleppel R, Vallurupalli N, Schweiger M. PATIENT AND CARDIOLOGISTS’ PERCEPTIONS OF THE BENEFITS OF PCI FOR STABLE CORONARY DISEASE. J Am Coll Cardiol 2010. [DOI: 10.1016/s0735-1097(10)61336-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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