The Impact of Tobacco Smoking on One Year Patient Outcomes at a Family Medicine Residency Clinic

Objective This course was designed to characterize the impact of a curriculum for training family medicine physicians in advanced airway techniques with respect to intubation performance and learner confidence. Methods A training course was introduced into the curriculum in a single-group pretest-posttest model at a community family medicine residency program. Training consisted of a didactic teaching session on airway management and hands-on skill session with direct laryngoscopy (DL) and video-assisted laryngoscopy (VAL) on normal and difficult airway simulators. Participants were scored with the Intubation Difficulty Scale and completed surveys before and after the training. Results Twenty-eight residents of all levels participated. The mean time to successful intubation was significantly decreased after training from 51.96 to 23.71 seconds for DL and from 27.89 to 17.07 seconds for VAL. Participant scores with the Intubation Difficulty Scale were also significantly improved for DL and VAL. All participants rated their comfort levels with both techniques as high following training. Discussion Advanced airway management is a critical skill for any physician involved in caring for critically ill patients, though few trainees receive formal training. Addition of an airway training course with simulation and hands-on experience can improve trainee proficiency and comfort with advanced airway techniques. Implications for Practice Training on airway management should be included in the curriculum for trainees who require the requisite skills and knowledge necessary for advanced airway interventions. This introductory project demonstrates the efficacy and feasibility of a relatively brief training as part of a family medicine residency curriculum.

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Evaluation of Patient Outcome Benefits and Resource Utilization Associated with a Hematopathologist-Directed Workflow for Diagnosis of Hematological Malignancies

Blood ◽

10.1182/blood.v118.21.3127.3127 ◽

2011 ◽

Vol 118 (21) ◽

pp. 3127-3127

Author(s):

John F Leite ◽

Sudipto Sur ◽

Bashar Dabbas ◽

James Gilmore ◽

Sally Haislip ◽

...

Keyword(s):

Overall Survival ◽

Patient Outcomes ◽

Resource Utilization ◽

Analytical Framework ◽

National Study ◽

Regional Study ◽

Cancer Specialists ◽

One Year ◽

The Impact ◽

Selection Of

Abstract Abstract 3127 Background: Traditionally, the appropriate selection of diagnostic tests is determined solely by the ordering clinician. This can be quite challenging in the case of hematological malignancies, where guidelines require detailed correlation between molecular, morphologic and immunologic results for accurate classification. We have undertaken a study to determine the impact of including a hematopathologist in the initial test selection and case management. Our working hypothesis is that this should improve the timeliness and accuracy of diagnoses. Therefore, an analytical framework based on measuring patient outcomes and resource utilization is feasible to compare diagnostic workflows. We compared outcomes and resource utilization between cohorts of patients in which diagnosis was obtained using the traditional or hematopathologist supplemented workflows. Two studies were performed: the first utilized a smaller regional electronic health record (EHR) database from a Southeast US practice, affording a higher degree of practice and demographics uniformity, the second utilized a more heterogeneous national US claims database. Patients were matched by ultimate diagnosis and demographics and all studies were retrospective. Methods: In the first regional cohort, we studied 791 patients collected between 2007 and 2009 and required a minimum of one year of data post bone marrow biopsy to be available. The patients had a diagnostic evaluation by a hematopathologist-managed workflow (Test, n=640) or by laboratories that follow a traditional diagnostic workflow (Control, n=151). Patients were matched by gender, age, ethnicity, ECOG status and diagnosis. Outcomes were assessed as overall survival and transfusion dependence. Resource utilization (lab tests and supportive therapeutics) was also evaluated. As a sensitivity analysis, outcomes of 19, 416 patients from the national cohort were evaluated using patients collected between 2006 and 2008. These patients had a diagnostic evaluation by a hematopathologist-managed workflow (Test, n=3, 236) or by laboratories that follow a traditional diagnostic workflow (Control, n=16, 180). Patients were matched by gender, age, ethnicity, geography, payer type, Charlson co-morbidities and diagnosis. Results: Overall survival benefit for the regional EHR-based study was not observed beyond statistical significance (p=0.564, HR=0.530; 95%CI=0.233–1.205) although a strong trend favoring the Test cohort could be observed. In the national study, where claims data over one year was available for a greater proportion of patients, improved overall survival (p=0.050, HR=0.634; 95%CI=0.402–1.001) for Test cohort patients could be discerned. Test cohort patients exhibited improved transfusion dependence (p=0.009; HR=0.455, 95% CI=0.252–0.824) in the regional study, but this effect was not observed in the national study set (p=0.644; HR=0.959, 95% CI=0.803–1.145). Resource utilization was assessed in the regional study and Test cohort patients appear associated with significantly reduced resource utilization: lab tests (p<0.0001), ancillary procedures (p<0.0001), therapeutics (p<0.0001) and erythropoietin stimulating agents (p<0.0001). Conclusions: We present an analytical framework by which the impact on patient outcomes can be evaluated as a function of adding a hematopathologist in the selection of diagnostic tests and case management. Our initial results using EHR records from a multi-site single practice, and claims data from a national database, suggest that differences in outcomes and resource utilization can be discerned as a function of diagnostic workflow. Though we have done our best to reduce the possibility of distortion by confounding variables and unidentified bias, we hope that this study will provide the impetus for further replication across multiple cohorts, labs and prospective trials in the future. Disclosures: Leite: Genoptix-Novartis: Employment. Sur:Genoptix-Novartis: Consultancy. Dabbas:Genoptix-Novartis: Employment. Gilmore:Georgia Cancer Specialists: Employment. Haislip:Georgia Cancer Specialists: Employment. Nerenberg:Genoptix-Novartis: Employment.

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Patient loneliness in an urban, underserved family medicine residency clinic: prevalence and relationship to health care utilization

Family Practice ◽

10.1093/fampra/cmaa065 ◽

2020 ◽

Vol 37 (6) ◽

pp. 751-758

Author(s):

Stephanie A Hooker ◽

Paul Stadem ◽

Michelle D Sherman ◽

Jason Ricco

Keyword(s):

Primary Care ◽

Health Care ◽

African American ◽

Family Medicine ◽

Health Care Utilization ◽

Care Utilization ◽

Care Clinic ◽

Family Medicine Residency ◽

Ed Visits ◽

The Impact

Abstract Background Mounting evidence suggests that loneliness increases the risk of poor health outcomes, including cardiovascular disease and premature mortality.Objective: This study examined the prevalence of loneliness in an urban, underserved family medicine residency clinic and the association of loneliness with health care utilization. Methods Adult patients (N = 330; M age = 42.1 years, SD = 14.9; 63% female; 58% African American) completed the 3-item UCLA Loneliness screener at their primary care visits between November 2018 and January 2019. A retrospective case–control study design was used to compare health care utilization [hospitalizations, emergency department (ED) visits, primary care visits, no-shows and referrals] in the prior 2 years between patients who identified as lonely versus those who did not. Covariates included demographics and clinical characteristics. Results Nearly half (44%) of patients exceeded the cut-off for loneliness. Patients who were lonely were more likely to identify as African American, have depression and have a substance use disorder. Patients in the lonely group had significantly longer hospital stays and more primary care visits, no-shows and referrals than patients in the non-lonely group; there were no differences in number of hospitalizations or ED visits. Conclusions The prevalence of loneliness in an urban, underserved primary care clinic was much higher than prior prevalence estimates in primary care. Patients who are lonely may use more health care resources than patients who are not lonely. Primary care may be an ideal setting in which to identify patients who are lonely to further understand the impact of loneliness on health care outcomes.

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Education in Quality Improvement for Practice in Primary Care During Residency Training and Subsequent Activities in Practice

Journal of Graduate Medical Education ◽

10.4300/jgme-06-01-39.1 ◽

2014 ◽

Vol 6 (1) ◽

pp. 50-54 ◽

Cited By ~ 8

Author(s):

Peter J. Carek ◽

Lori M. Dickerson ◽

Michele Stanek ◽

Charles Carter ◽

Mark T. Godenick ◽

...

Keyword(s):

South Carolina ◽

Quality Improvement ◽

Family Medicine ◽

Patient Care ◽

Patient Centered ◽

Residency Programs ◽

Family Medicine Residency ◽

The Family ◽

The Impact ◽

Standardized Curriculum

Abstract Background Quality improvement (QI) is an integral aspect of graduate medical education and an important competence for physicians. Objective We examined the QI activities of recent family medicine residency graduates and whether a standardized curriculum in QI during residency resulted in greater self-reported participation in QI activities in practice after graduation. Methods The family medicine residency programs affiliated with the South Carolina Area Health Education Consortium (N = 7) were invited to participate in this study. Following completion of introductory educational activities, each site implemented regularly occurring (at least monthly) educational and patient care activities using QI principles and tools. Semiannually, representatives from each participating site met to review project aims and to provide updates regarding the QI activities in their program. To examine the impact of this project on QI activities, we surveyed graduates from participating programs from the year prior to and 2 years after the implementation of the curriculum. Results Graduates in the preimplementation and postimplementation cohorts reported participating in periodic patient care data review, patient care registries, QI projects, and disease-specific activities (57%–71% and 54%–63%, respectively). There were no significant differences in QI activities between the 2 groups except in activities associated with status of their practice as a patient-centered medical home. Conclusions Most but not all family medicine graduates reported they were actively involved in QI activities within their practices, independent of their exposure to a QI curriculum during training.

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Associations Between Program-Level Abortion Training and Graduate Preparation for and Provision of Reproductive Care

Family Medicine ◽

10.22454/fammed.2019.219951 ◽

2019 ◽

Vol 51 (9) ◽

pp. 750-755 ◽

Cited By ~ 1

Author(s):

Amanda Weidner ◽

Nancy Stevens ◽

Grace Shih

Keyword(s):

Family Medicine ◽

Reproductive Health ◽

Secondary Analysis ◽

Family Physicians ◽

Bivariate Analysis ◽

Full Spectrum ◽

Individual Level ◽

Family Medicine Residency ◽

Abortion Care ◽

The Impact

Background and Objectives: The role of training in the declining rate of family physicians’ provision of women’s reproductive health care is unclear. No requirements for abortion training exist, and curricula vary widely. This study assessed the impact of program-level abortion training availability on graduates’ feelings of training adequacy and their postgraduate practice in reproductive health. Methods: We conducted secondary analysis of graduate survey data from 18 family medicine residency programs in the Northwest categorized by whether or not their program routinely offered abortion training (opt out or elective rotation). We used bivariate analyses and logistic regression to compare groups on preparation for training and current clinical practice of women’s health procedures. Results: Six of 18 programs included in the study had routinely available abortion training for graduates (N=408). In bivariate analysis, these programs with routine abortion training had significantly more graduates who report feeling prepared to perform abortions (19% vs 10%; P=.01), but no difference in likelihood to provide abortion care postresidency compared to programs without routine abortion training. In adjusted analyses, graduates of programs with routine abortion training were significantly less likely to feel prepared for performing colposcopies (OR=0.45, 95% CI, 0.26-0.78; P<.01) and to actually perform them in practice (OR=0.32, 95% CI, 0.18-0.57; P<.001); all other differences are attenuated. Conclusions: Program-level abortion training alone is not enough to overcome the systems- and individual-level barriers to increasing the numbers of trained family medicine residency graduates who provide abortion care and other reproductive care in practice. More must be done to create opportunities for family physicians interested in providing full-spectrum care in their postgraduate practices to be able to do so.

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What Is the Impact of the Underserved Pathway Program on Graduates Entering an Underserved Family Medicine Residency? Five-Year Findings From the University of Washington School of Medicine

Academic Medicine ◽

10.1097/acm.0000000000002073 ◽

2018 ◽

Vol 93 (7) ◽

pp. 1042-1047 ◽

Cited By ~ 1

Author(s):

Amanda Kost ◽

David Evans ◽

Sharon Dobie ◽

Elizabeth Sanders

Keyword(s):

Family Medicine ◽

University Of Washington ◽

Family Medicine Residency ◽

School Of Medicine ◽

The University ◽

The Impact

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Promoting Documentation of Suicidality in a Family Medicine Residency Clinic

Family Medicine ◽

10.22454/fammed.2018.158642 ◽

2018 ◽

Vol 50 (2) ◽

pp. 138-141

Author(s):

Michelle D. Sherman ◽

Kathryn Justesen ◽

Eneniziaogochukwu A. Okocha

Keyword(s):

Family Medicine ◽

Treatment Plan ◽

Educational Interventions ◽

Baseline Period ◽

Clinic Visit ◽

Family Medicine Residency ◽

Patient Reported ◽

Patient Health ◽

The Impact

Background and Objectives: Careful assessment of depression and suicidality are important given their prevalence and consequences for quality of life. Our study evaluated the impact of an educational intervention in a family medicine residency clinic on rates of provider documentation regarding suicidality. Methods: We offered two brief workshops to our clinic staff and created two standardized charting templates to empower and educate providers. One template used with the patient during the clinic visit elicited key factors (eg, plan, intent, barriers) and offered treatment plan options. The second template included supportive text and resources to include in the after-visit summary. A chart review was completed, examining 350 patient records in which the patient reported thoughts of death or suicide in the preceding 2 weeks on the Patient Health Questionnaire-9 ([PHQ-9], 150 over a 5-month baseline period, 150 in months 1 through 4 immediately following the workshops and template development, and 50 at follow-up months 7 through 8 following the intervention). We examined use of the templates and changes in rates of documentation of suicidality. Results: Rates of provider documentation of suicidality for patients who had expressed suicidal ideation on the PHQ-9 increased significantly from 57% at baseline to 78% in the postintervention phase; the rise persisted at follow-up. Rates of use of the assessment template were 58% (postintervention) and 49% (follow-up). Anecdotal provider feedback reflected appreciation of the templates for assessing and documenting challenging issues. Conclusions: Brief educational interventions were associated with improved rates of provider documentation of suicidality. The longer-term impact of the workshops and templates warrant further investigation.

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Drug Therapy Problem Identification and Resolution by Clinical Pharmacists in a Family Medicine Residency Clinic

INNOVATIONS in pharmacy ◽

10.24926/iip.v9i2.971 ◽

2018 ◽

Vol 9 (2) ◽

pp. 4

Author(s):

Danielle MacDonald ◽

Hannah Chang ◽

Yi Wei ◽

Keri D. Hager

Keyword(s):

Drug Therapy ◽

Family Medicine ◽

Clinical Pharmacist ◽

Conflicts Of Interest ◽

Original Research ◽

Clinical Pharmacists ◽

Family Medicine Residency ◽

Medication Therapy ◽

Drug Therapy Problem ◽

The Impact

Purpose: There are limited data to evaluate the impact of ambulatory clinical pharmacist recommendations on family medicine resident prescribing and monitoring of medications. The purpose of this study is to begin to gain insight in this area by answering the research question, “How many ambulatory clinical pharmacist recommendations for drug therapy problem (DTP) resolution are implemented on the day of a medication therapy management (MTM) visit in an outpatient family medicine residency clinic?” Methods: This is a retrospective chart review of face-to-face MTM encounters conducted by ambulatory clinical pharmacists (including pharmacist residents) from August 1, 2012 to June 30, 2015 at a family medicine residency clinic. Descriptive statistics were conducted to both quantify the number of DTPs identified and resolved on the day of the MTM visit as well as categorize the DTPs. Results: Based on the 728 MTM encounters analyzed, patients were an average of 53.6 years old and took 11.9 medications to treat 5.7 medical conditions. A total of 3057 DTPs were identified in the 728 encounters, of which 1303 were resolved the same day as the MTM visit. This resulted in an average of 4.2 DTPs identified and 2.0 resolved per visit per patient. The most common DTP category identified in this study was the need for additional drug therapy (41.6%). Conclusions: Approximately half of the ambulatory clinical pharmacist’s DTP resolution recommendations were implemented the same day they were identified, which highlights the strength of team-based patient care and interprofessional collaboration in a residency teaching clinic. Conflict of Interest We declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received), employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents and royalties. Treatment of Human Subjects: IRB determined project was non-HSR Type: Original Research

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