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Andrew M, Briscombe B, Vardavas R, Wolters N, Qureshi N, Nham W, Abir M. Identifying Strategies for Strengthening the Health Care Workforce in the Commonwealth of Virginia. Rand Health Q 2024; 11:1. [PMID: 38601716 PMCID: PMC10911755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
Like the United States as a whole, Virginia faces a significant shortage of health care workers in nursing, primary care, and behavioral health. If current trends persist, these shortages will increase across Virginia. The authors of this study identify interventions that can help the Virginia Health Workforce Development Authority (VHWDA) address these health care workforce shortages. To accomplish this goal, they applied an analytic framework to existing or potential interventions for retaining, recruiting, and improving the structural efficiency of the nursing, primary care, and behavioral health workforces in Virginia. In this study, they highlight which interventions VHWDA should prioritize based on its desired outcomes and policy goals.
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Ehlers AP, Nham W, Vitous CA, Hosea F, Palazzolo KP, Howard R, Delaney L, Shao JM, Rubyan M, Telem DA. Life after "no": barriers to behavior change for persons declined hernia repair due to high-risk features. Surg Endosc 2023; 37:8663-8669. [PMID: 37500919 DOI: 10.1007/s00464-023-10283-8] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 07/05/2023] [Indexed: 07/29/2023]
Abstract
INTRODUCTION Delaying an elective operation to mitigate risk factors improves patient outcomes. Elective ventral hernia repair is one such example. To address this issue, we developed a pre-operative optimization clinic to support high-risk patients seeking elective ventral hernia repair. Unfortunately, few patients progressed to surgery. Within this context, we sought to understand the barriers to behavior change among these patients with the goal of improving care for patients undergoing elective surgery. METHODS We performed semi-structured, qualitative interviews with 20 patients who were declined ventral hernia repair due to either active tobacco use or obesity. Patients were recruited from a pre-operative optimization clinic at an academic hospital. Interviews sought to characterize patients' perceived barriers to behavior change. Interviews were concluded once thematic saturation was reached. We used an inductive thematic analysis to analyze the data. All data analysis was performed using MAXQDA software. RESULTS Among 20 patients (mean age 50, 65% female, 65% White), none had yet undergone ventral hernia repair. While most patients had a positive experience in the clinic, among those who did not, we found three dominant themes around behavior change: (1) Patient's role in behavior change: how the patient perceived their role in making behavior changes optimize their health for surgery; (2) Obtainability of offered resources: the need for more support for patients to access the recommended healthcare; and (3) Patient-provider concordance: the extent to which patients and providers agree on the relative importance of different attributes of their care. CONCLUSION Behavior change prior to elective surgery is complex and multifaceted. While improving access to tobacco cessation resources and obesity management may improve outcomes for some, patients may benefit from increased on-site facilitation to promote access to resources as well as the use of patient-facing decision support tools to promote patient-provider concordance.
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Affiliation(s)
- Anne P Ehlers
- Department of Surgery, University of Michigan, 1500 E Medical Center Drive, SPC 5343, 2210 Taubman Center, Ann Arbor, MI, 48109, USA.
- Michigan Surgical Quality Collaborative-Core Optimization Health Registry (MSQC-COHR), Ann Arbor, MI, USA.
- Henry Ford Health, Detroit, MI, USA.
| | - Wilson Nham
- Michigan Medicine Emergency Medicine Research, Ann Arbor, MI, USA
- Henry Ford Health, Detroit, MI, USA
| | - C Ann Vitous
- Center for Healthcare Outcomes and Policy, Ann Arbor, MI, USA
- Henry Ford Health, Detroit, MI, USA
| | - Forrest Hosea
- Michigan Surgical Quality Collaborative-Core Optimization Health Registry (MSQC-COHR), Ann Arbor, MI, USA
- Henry Ford Health, Detroit, MI, USA
| | - Krisinda P Palazzolo
- Center for Healthcare Outcomes and Policy, Ann Arbor, MI, USA
- Henry Ford Health, Detroit, MI, USA
| | - Ryan Howard
- Department of Surgery, University of Michigan, 1500 E Medical Center Drive, SPC 5343, 2210 Taubman Center, Ann Arbor, MI, 48109, USA
- Michigan Surgical Quality Collaborative-Core Optimization Health Registry (MSQC-COHR), Ann Arbor, MI, USA
- Henry Ford Health, Detroit, MI, USA
| | - Lia Delaney
- Henry Ford Health, Detroit, MI, USA
- Department of Surgery, Stanford University, Palo Alto, CA, USA
| | - Jenny M Shao
- Department of Surgery, University of Michigan, 1500 E Medical Center Drive, SPC 5343, 2210 Taubman Center, Ann Arbor, MI, 48109, USA
- Michigan Surgical Quality Collaborative-Core Optimization Health Registry (MSQC-COHR), Ann Arbor, MI, USA
- Henry Ford Health, Detroit, MI, USA
| | - Michael Rubyan
- Henry Ford Health, Detroit, MI, USA
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Dana A Telem
- Department of Surgery, University of Michigan, 1500 E Medical Center Drive, SPC 5343, 2210 Taubman Center, Ann Arbor, MI, 48109, USA
- Michigan Surgical Quality Collaborative-Core Optimization Health Registry (MSQC-COHR), Ann Arbor, MI, USA
- Henry Ford Health, Detroit, MI, USA
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Lambrecht J, Abir M, Seiler K, Kamdar N, Peterson T, Lin P, Nham W, Greenwood-Ericksen M. Conceptualizing lifer versus destination patients for optimized care delivery. BMC Health Serv Res 2023; 23:1190. [PMID: 37915060 PMCID: PMC10619315 DOI: 10.1186/s12913-023-10214-2] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 10/26/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Patients presenting to academic medical centers (AMC) typically receive primary care, specialty care, or both. Resources needed for each type of care vary, requiring different levels of care coordination. We propose a novel method to determine whether a patient primarily receives primary or specialty care to allow for optimization of care coordination. OBJECTIVES We aimed to define the concepts of a Lifer Patient and Destination Patient and analyze the current state of care utilization in those groups to inform opportunities for improving care coordination. METHODS Using AMC data for a 36-month study period (FY17-19), we evaluated the number of unique patients by residence zip code. Patients with at least one primary care visit and patients without a primary care visit were classified as Lifer and Destination patients, respectively. Cohen's effect sizes were used to evaluate differences in mean utilization of different care delivery settings. RESULTS The AMC saw 35,909 Lifer patients and 744,037 Destination patients during the study period. Most patients were white, non-Hispanic females; however, the average age of a Lifer was seventy-two years whereas that of a Destination patient was thirty-eight. On average, a Lifer had three times more ambulatory care visits than a Destination patient. The proportion of Inpatient encounters is similar between the groups. Mean Inpatient length of stay (LOS) is similar between the groups, but Destination patients have more variance in LOS. The rate of admission from the emergency department (ED) for Destination patients is nearly double Lifers'. CONCLUSION There were differences in ED, ambulatory care, and inpatient utilization between the Lifer and Destination patients. Furthermore, there were incongruities between rate of hospital admissions and LOS between two groups. The Lifer and Destination patient definitions allow for identification of opportunities to tailor care coordination to these unique groups and to allocate resources more efficiently.
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Affiliation(s)
- Jacob Lambrecht
- Department of Emergency Medicine, University of Michigan, TC B1-220 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA
- Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Mahshid Abir
- Department of Emergency Medicine, University of Michigan, TC B1-220 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA.
- RAND Corporation, Santa Monica, CA, USA.
| | - Kristian Seiler
- Data and Methods Hub, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Neil Kamdar
- Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Data and Methods Hub, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Tim Peterson
- Department of Emergency Medicine, University of Michigan, TC B1-220 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA
- Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Paul Lin
- Data and Methods Hub, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Wilson Nham
- Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Department of Emergency Medicine Research, University of Michigan, Ann Arbor, MI, USA
| | - Margaret Greenwood-Ericksen
- Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Department of Emergency Medicine, University of New Mexico, Albuquerque, NM, USA
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Thariath J, Salhi RA, Kamdar N, Seiler K, Greenwood-Ericksen M, Nham W, Simpson K, Peterson T, Abir M. Evaluating the pediatric mental health care continuum at an American health system. SAGE Open Med 2023; 11:20503121231181939. [PMID: 37362613 PMCID: PMC10288394 DOI: 10.1177/20503121231181939] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 05/29/2023] [Indexed: 06/28/2023] Open
Abstract
Objective To describe trends in the pediatric mental health care continuum and identify potential gaps in care coordination. Methods We used electronic medical record data from October 2016 to September 2019 to characterize the prevalence of mental health issues in the pediatric population at a large American health system. This was a single institution case study. From the electronic medical record data, primary mental health discharge and readmission diagnoses were identified using International Classification of Diseases (ICD-9-CM, ICD-10-CM) codes. The electronic medical record was queried for mental health-specific diagnoses as defined by International Classification of Diseases classification, analysis of which was facilitated by the fact that only 176 mental health codes were billed for. Additionally, prevalence of care navigation encounters was assessed through electronic medical record query, as care navigation encounters are specifically coded. These encounter data was then segmented by care delivery setting. Results Major depressive disorder and other mood disorders comprised 49.6% and 89.4% of diagnoses in the emergency department and inpatient settings respectively compared to 9.0% of ambulatory care diagnoses and were among top reasons for readmission. Additionally, only 1% of all ambulatory care encounters had a care navigation component, whereas 86% of care navigation encounters were for mental health-associated reasons. Conclusions Major depressive disorder and other mood disorders were more common diagnoses in the emergency department and inpatient settings, which could signal gaps in care coordination. Bridging potential gaps in care coordination could reduce emergency department and inpatient utilization through increasing ambulatory care navigation resources, improving training, and restructuring financial incentives to facilitate ambulatory care diagnosis and management of major depressive disorder and mood disorders. Furthermore, health systems can use our descriptive analytic approach to serve as a reasonable measure of the current state of pediatric mental health care in their own patient population.
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Affiliation(s)
- Joshua Thariath
- University of Michigan Medical School, Ann Arbor, USA
- Acute Care Research Unit, University of Michigan, Ann Arbor, USA
| | - Rama A. Salhi
- Acute Care Research Unit, University of Michigan, Ann Arbor, USA
- Institute for Healthcare Policy and Innovation, Ann Arbor, USA
- Department of Emergency Medicine, University of Michigan, Ann Arbor, USA
| | - Neil Kamdar
- Institute for Healthcare Policy and Innovation, Ann Arbor, USA
| | - Kristian Seiler
- Institute for Healthcare Policy and Innovation, Ann Arbor, USA
| | - Margaret Greenwood-Ericksen
- Acute Care Research Unit, University of Michigan, Ann Arbor, USA
- Department of Emergency Medicine, University of New Mexico, Albuquerque, USA
| | - Wilson Nham
- Acute Care Research Unit, University of Michigan, Ann Arbor, USA
- Department of Emergency Medicine, University of Michigan, Ann Arbor, USA
| | - Kaitlyn Simpson
- University of Michigan Medical School, Ann Arbor, USA
- Acute Care Research Unit, University of Michigan, Ann Arbor, USA
| | - Timothy Peterson
- Acute Care Research Unit, University of Michigan, Ann Arbor, USA
- Department of Emergency Medicine, University of Michigan, Ann Arbor, USA
- Physician Organization of Michigan Accountable Care Organization, Ann Arbor, USA
- Center for Health and Research Transformation, Ann Arbor, USA
- Henry Ford Health, Detroit, USA
| | - Mahshid Abir
- Acute Care Research Unit, University of Michigan, Ann Arbor, USA
- Institute for Healthcare Policy and Innovation, Ann Arbor, USA
- Department of Emergency Medicine, University of Michigan, Ann Arbor, USA
- RAND Corporation, Santa Monica, CA, USA
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Jackson J, Berri N, Nham W, Wolters N, Adzemovic T, Tsuchida RE, Newton M, Burkhardt J, Perry M, Schulson LB. Key Factors in Designing the Health System-Community Pathways Program for African American/Black Children and Young Adults. Rand Health Q 2023; 10:1. [PMID: 37200824 PMCID: PMC10187557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Many of the ethnic and racial workforce inequities in the United States are present in health care systems. Low representation of African American/Black individuals in the health care system workforce can be traced to a history of exclusionary practices that leave such individuals less likely to pursue health careers. Past research found that low representation is driven by inequities in health, education, and employment that are a result of structural racism. Pathways programs have been identified as one of the methods to increase recruitment, retention, and promotion in health-related career fields for African American/Black individuals. As prior research has shown, these programs recruit and support the graduation of students from underrepresented communities at all educational stages to increase their representation in specific fields. This article describes the development of key factors in framework design for the Health System-Community Pathways Program (HCPP), which aims to increase representation of African American/Black communities in the health care system workforce and improve the quality of their experience in pursuing careers in these fields. The HCPP framework of key factors is informed by an environmental scan, interviews and focus groups, and an expert discussion panel session. The article's authors come from diverse backgrounds; the team included African American/Black physicians and members of other historically marginalized communities. The qualitative research drew insights from diverse African American/Black community stakeholders; the study was reviewed by many stakeholders to ensure that the design of the research and the end product maximally benefits the community on which it focuses.
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Abir M, Dowker SR, Nham W, Berri N, Fouche S, Nelson C, Forman J, Fetters MD, Mendel P, Guetterman T, Forbush B, Neumar R, Nallamothu B. Strategies for Enhancing Prehospital Outcomes for Cardiac Arrest (EPOC). Rand Health Q 2023; 10:2. [PMID: 37200820 PMCID: PMC10187547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Out-of-hospital cardiac arrest (OHCA) is a common, life-threatening event that is a leading cause of death in the United States. However, it is unclear how to design strategies that can be successfully implemented in emergency medical services (EMS) agencies and broader emergency response systems (such as fire, police, dispatch, and bystanders to OHCA events) in different communities to help improve daily care processes and outcomes in OHCA. The National Heart, Lung, and Blood Institute-funded Enhancing Prehospital Outcomes for Cardiac Arrest (EPOC) study lays the foundation for future quality improvement efforts in OHCA by identifying, understanding, and validating the best practices adopted within emergency response systems to address these life-threatening events and by addressing potential barriers to implementation of these practices. RAND researchers developed recommendations covering all levels of the prehospital OHCA incident response and the principles of change management necessary to implement those recommendations.
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Simpson K, Nham W, Thariath J, Schafer H, Greenwood-Eriksen M, Fetters MD, Serlin D, Peterson T, Abir M. How health systems facilitate patient-centered care and care coordination: a case series analysis to identify best practices. BMC Health Serv Res 2022; 22:1448. [PMID: 36447273 PMCID: PMC9710067 DOI: 10.1186/s12913-022-08623-w] [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] [Received: 04/30/2022] [Accepted: 09/29/2022] [Indexed: 12/05/2022] Open
Abstract
Large- and small-scale transformation of healthcare delivery toward improved patient experience through promotion of patient-centered and coordinated care continues to be at the forefront of health system efforts in the United States. As part of a Quality Improvement (QI) project at a large, midwestern health system, a case series of high-performing organizations was explored with the goal of identifying best practices in patient-centered care and/or care coordination (PCC/CC). Identification of best practices was done through rapid realist review of peer-reviewed literature supporting three PCC/CC interventions per case. Mechanisms responsible for successful intervention outcomes and associated institutional-level facilitators were evaluated, and cross-case analysis produced high-level focus items for health system leadership, including (1) institutional values surrounding PCC/CC, (2) optimization of IT infrastructure to enhance performance and communication, (3) pay structures and employment models that enhance accountability, and (4) organizing bodies to support implementation efforts. Health systems may use this review to gain insight into how institutional-level factors may facilitate small-scale PCC/CC behaviors, or to conduct similar assessments in their own QI projects. Based on our analysis, we recommend health systems seeking to improve PCC/CC at any level or scale to evaluate how IT infrastructure affects provider-provider and provider-patient communication, and the extent to which institutional prioritization of PCC/CC is manifest and held accountable in performance feedback, incentivization, and values shared among departments and settings. Ideally, this evaluation work should be performed and/or supported by cross-department organizing bodies specifically devoted to PCC/CC implementation work.
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Affiliation(s)
- Kaitlyn Simpson
- grid.214458.e0000000086837370Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI USA ,grid.214458.e0000000086837370University of Michigan Medical School, University of Michigan, Ann Arbor, MI USA
| | - Wilson Nham
- grid.214458.e0000000086837370Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI USA
| | - Josh Thariath
- grid.214458.e0000000086837370Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI USA ,grid.214458.e0000000086837370University of Michigan Medical School, University of Michigan, Ann Arbor, MI USA
| | - Hannah Schafer
- grid.214458.e0000000086837370Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI USA ,grid.214458.e0000000086837370University of Michigan School of Public Health, University of Michigan, Ann Arbor, MI USA
| | - Margaret Greenwood-Eriksen
- grid.214458.e0000000086837370Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI USA ,grid.266832.b0000 0001 2188 8502Department of Emergency Medicine, University of New Mexico, Albuquerque, New Mexico USA
| | - Michael D. Fetters
- grid.214458.e0000000086837370Michigan Mixed Methods Program, University of Michigan, Ann Arbor, MI USA ,grid.214458.e0000000086837370Department of Family Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI USA
| | - David Serlin
- grid.214458.e0000000086837370Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI USA ,grid.214458.e0000000086837370Department of Family Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI USA
| | - Timothy Peterson
- grid.214458.e0000000086837370Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI USA ,grid.214458.e0000000086837370Department of Emergency Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI USA
| | - Mahshid Abir
- grid.214458.e0000000086837370Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI USA ,grid.34474.300000 0004 0370 7685RAND Corporation, Santa Monica, CA USA
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Schmitzberger FF, Scott KW, Nham W, Mathews K, Schulson L, Fouche S, Berri N, Shehab A, Gupta A, Salhi RA, Kamdar N, Bouey J, Abir M. Identifying Strategies to Boost COVID-19 Vaccine Acceptance in the United States. Rand Health Q 2022; 9:12. [PMID: 35837516 PMCID: PMC9242559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This study presents the results of an evaluation of the root causes of COVID-19 vaccine hesitancy to inform strategies to boost vaccine acceptance among vaccine-hesitant populations in the United States. The authors conducted a literature review of the causes of vaccine hesitancy and vaccine acceptance; focus groups with patients, pre-hospital first responders, and hospital-based health care providers; a social media platform sentiment analysis to review attitudes regarding the COVID-19 vaccine; and a roundtable discussion with experts on vaccine hesitancy. Drawing on this mixed-methods analysis, the authors recommend strategies to help boost COVID-19 vaccine acceptance in the United States, grouping them according to three overall goals: boosting confidence in the safety and effectiveness of the COVID-19 vaccines, combating complacency about the pandemic, and increasing the convenience of getting vaccinated. The authors emphasize that combating misinformation about the COVID-19 vaccine is key to achieving these goals. These recommendations can inform the development of a toolkit of strategies to reach herd immunity and end the pandemic.
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Salhi RA, Fouche S, Mendel P, Nelson C, Fetters MD, Guetterman T, Forman J, Nham W, Goldstick JE, Lehrich J, Forbush B, Iovan S, Hsu A, Shields TA, Domeier R, Setodji CM, Neumar RW, Nallamothu BK, Abir M. Enhancing Prehospital Outcomes for Cardiac Arrest (EPOC) study: sequential mixed-methods study protocol in Michigan, USA. BMJ Open 2020; 10:e041277. [PMID: 33247025 PMCID: PMC7703417 DOI: 10.1136/bmjopen-2020-041277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 10/30/2020] [Accepted: 11/02/2020] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Out-of-hospital cardiac arrest (OHCA) is a common, life-threatening event encountered routinely by first responders, including police, fire and emergency medical services (EMS). Current literature suggests that there is significant regional variation in outcomes, some of which may be related to modifiable factors. Yet, there is a persistent knowledge gap regarding strategies to guide quality improvement efforts in OHCA care and, by extension, survival. The Enhancing Prehospital Outcomes for Cardiac Arrest (EPOC) study aims to fill these gaps and to improve outcomes. METHODS AND ANALYSIS This mixed-methods study includes three aims. In aim I, we will define variation in OHCA survival to the emergency department (ED) among EMS agencies that participate in the Michigan Cardiac Arrest Registry to Enhance Survival (CARES) in order to sample EMS agencies with high-survival and low-survival outcomes. In aim II, we will conduct site visits to emergency medical systems-including 911/dispatch, police, non-transport fire, and EMS agencies-in approximately eight high-survival and low-survival communities identified in aim I. At each site, key informant interviews and a multidisciplinary focus group will identify themes associated with high OHCA survival. Transcripts will be coded using a structured codebook and analysed through thematic analysis. Results from aims I and II will inform the development of a survey instrument in aim III that will be administered to all EMS agencies in Michigan. This survey will test the generalisability of factors associated with increased OHCA survival in the qualitative work to ultimately build an EPOC Toolkit which will be distributed to a broad range of stakeholders as a practical 'how-to' guide to improve outcomes. ETHICS AND DISSEMINATION The EPOC study was deemed exempt by the University of Michigan Institutional Review Board. Findings will be compiled in an 'EPOC Toolkit' and disseminated in the USA through partnerships including, but not limited to, policymakers, EMS leadership and health departments.
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Affiliation(s)
- Rama A Salhi
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Sydney Fouche
- Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | | | | | - Michael D Fetters
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Timothy Guetterman
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Jane Forman
- Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
- Center for Clinical Management Research, Veterans Affairs Health System, Ann Arbor, Michigan, USA
| | - Wilson Nham
- Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Jason E Goldstick
- Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Jessica Lehrich
- Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Bill Forbush
- City of Alpena Fire Department, Alpena County EMS, City of Alpena, Alpena, Michigan, USA
| | - Samantha Iovan
- Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Antony Hsu
- Department of Emergency Medicine, Saint Joseph Mercy Health System, Ann Arbor, Michigan, USA
| | - Theresa A Shields
- Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Robert Domeier
- Department of Emergency Medicine, Saint Joseph Mercy Health System, Ann Arbor, Michigan, USA
| | | | - Robert W Neumar
- Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Brahmajee K Nallamothu
- Division of Cardiovascular Diseases and the Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Mahshid Abir
- Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
- Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA
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