scholarly journals A Chart Review of Substance Use Screening and Related Documentation among Adolescents in Outpatient Pediatric Clinics: Implications for Practice

2020 ◽  
Author(s):  
Lisa M. Kuhns ◽  
Brookley Rogers ◽  
Katie Greeley ◽  
Abigail L. Muldoon ◽  
Niranjan Karnik ◽  
...  
Keyword(s):  
Primary Care ◽  
Substance Use ◽  
Logistic Regression ◽  
Medical Center ◽  
Academic Medical Center ◽  
The United States ◽  
Screening Tools ◽  
Related Factors ◽  
Multivariable Logistic Regression ◽  
Standardized Screening

Abstract Background: Despite recent reductions, youth substance use continues to be a concern in the United States. Structured primary care screening is recommended, but not widely implemented. The purpose of this study was to describe substance use screening in a large academic medical center, assess related factors, and evaluate screening documentation to inform practice. Methods: We abstracted a random sample of 127 records of patients aged 12-17 and coded clinical notes to identify screening cases and related characteristics. We then analyzed descriptive patterns within the data to calculate screening rates, characteristics of screening, and used multivariable logistic regression to identify related factors. Results: Rates of screening by providers were 72% for common substances (alcohol, marijuana, tobacco). The primary method of screening was use of clinical pneumonic cues rather than standardized screening tools. A total of 6% of patients reported substance use during screening. Older age and racial/ethnic minority status were associated with provider screening in multivariable logistic regression models. Conclusions: Despite recommendations, low rates of screening in primary care persist. Failure to use a standardized screening tool may contribute to low screening rates and biased screening. These findings may be used to inform implementation of standardized and structured screening in the clinical environment.

scholarly journals A Chart Review of Substance Use Screening and Related Documentation among Adolescents in Outpatient Pediatric Clinics: Implications for Practice

2020 ◽  
Author(s):  
Lisa M. Kuhns ◽  
Brookley Rogers ◽  
Katie Greeley ◽  
Abigail L. Muldoon ◽  
Niranjan Karnik ◽  
...  
Keyword(s):  
Primary Care ◽  
Substance Use ◽  
Logistic Regression ◽  
Medical Center ◽  
Academic Medical Center ◽  
The United States ◽  
Screening Tools ◽  
Multiple Logistic Regression ◽  
Related Factors ◽  
Standardized Screening

Abstract Background: Despite recent reductions, youth substance use continues to be a concern in the United States. Structured primary care substance use screening among adolescents is recommended, but not widely implemented. The purpose of this study was to describe the distribution and characteristics of adolescent substance use screening in outpatient clinics in a large academic medical center and assess related factors (i.e., patient age, race/ethnicity, gender, and insurance type) to inform and improve the quality of substance use screening in practice. Methods: We abstracted a random sample of 127 records of patients aged 12-17 and coded clinical notes (e.g., converted open-ended notes to discrete values) to describe screening cases and related characteristics (e.g., which substances screened, how screened). We then analyzed descriptive patterns within the data to calculate screening rates, characteristics of screening, and used multiple logistic regression to identify related factors. Results: Among 127 records, rates of screening by providers were 72% (each) for common substances (alcohol, marijuana, tobacco). The primary method of screening was use of clinical mnemonic cues rather than standardized screening tools. A total of 6% of patients reported substance use during screening. Older age and racial/ethnic minority status were associated with provider screening in multiple logistic regression models. Conclusions: Despite recommendations, low rates of structured screening in primary care persist. Failure to use a standardized screening tool may contribute to low screening rates and biased screening. These findings may be used to inform implementation of standardized and structured screening in the clinical environment.

scholarly journals Depression Screening and Measurement-Based Care in Primary Care

2020 ◽  
Vol 11 ◽  
pp. 215013272093126
Author(s):  
Kimberly A. Siniscalchi ◽  
Marion E. Broome ◽  
Jason Fish ◽  
Joseph Ventimiglia ◽  
Julie Thompson ◽  
...  
Keyword(s):  
Primary Care ◽  
Task Force ◽  
Medical Center ◽  
Academic Medical Center ◽  
Unmet Need ◽  
The United States ◽  
Depression Screening ◽  
Improvement Project ◽  
Measurement Based Care

The health issue addressed is the unmet need to universally screen and treat depression, which is one of the most common mental health disorders among adults in the United States. The US Preventive Services Task Force recommends screening adults for depression in primary care and using evidence-based protocols. This quality improvement project implemented VitalSign6, a measurement-based care program, to improve depression screening and treatment of adults in primary care at an academic medical center. A pre-post design was used to determine effectiveness of changes in screening, outcomes, and satisfaction. Of 1200 unique adult patients, 95.4% received initial screening. Providers diagnosed and administered measurement-based care to 236 patients. After 14 weeks, 27.5% returned for at least 1 follow-up. Results showed a statistically significant decrease in self-reported depression scores from baseline to follow-up. VitalSign6 was effective in improving identification and management of depression in primary care.

Pursuit of performance: An exploration of predictors associated with achieving performance based payments for breast cancer episodes under the Oncology Care Model.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18035-e18035
Author(s):  
Andrew Jehyun Song ◽  
Arianna Kee ◽  
Jared Minetola ◽  
Karen Walsh ◽  
Valerie P Csik ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Logistic Regression ◽  
Systemic Therapy ◽  
Medical Center ◽  
Academic Medical Center ◽  
Novel Therapies ◽  
Care Model ◽  
Logistic Regression Models ◽  
Multivariable Logistic Regression ◽  
Oncology Care

e18035 Background: The Oncology Care Model (OCM) captures patient costs in a 6-month episode triggered by administration of systemic therapy. Most breast cancer (BC) patients will receive systemic therapy, with variations depending on stage and hormonal status, which makes BC an ideal indication to study costs in the OCM. Practices earn performance based payments (PBP) if aggregate episodic expenditures are managed below set target prices. We investigated predictors for episodic expenditures exceeding target prices, thus reducing potential for PBP. Methods: We identified BC episodes with non-decedent beneficiaries attributable to our academic medical center from OCM Reconciliation Reports during 7/1/16-6/30/17. Cohorts were defined as episodes whose costs were above target (Cohort 1) and those below (Cohort 2). The Wilcoxon Rank-Sum test was used to compare actual and target episode expenditure between cohorts. Multivariable logistic regression models were used to assess association of maintaining costs below target due to various predictors. Results: A total of 369 episodes were included in the study, with 124 episodes in Cohort 1 and 245 in Cohort 2. Median actual and target episode expenditures were higher in Cohort 1 (actual: $23,466 vs. $2,691, p < 0.0001; target: $8,425 vs. $5,870, p < 0.0001). In multivariable logistic regression, episodes were more likely to be below target if novel therapies, Part B drugs, or inpatient admissions were not utilized, controlling for other predictors (see Table). Conclusions: Large disparities exist for both actual expenditures and target prices for BC episodes in the OCM. Novel therapies, Part B drugs, and inpatient admissions are negatively associated with maintaining episode expenditures below target. Risk-adjustments for these expenditures need to be overhauled in OCM to accurately capture costs associated with management of cancer patients, and provide practical target prices for institutions to continue delivery of value based care. [Table: see text]

scholarly journals Utilizing Consumer Health Informatics to Support Management of Hypertension by Clinical Pharmacists in Primary Care: Study Protocol (Preprint)

2017 ◽  
Author(s):  
Lorraine R Buis ◽  
Dana N Roberson ◽  
Reema Kadri ◽  
Nicole G Rockey ◽  
Melissa A Plegue ◽  
...  
Keyword(s):  
Primary Care ◽  
Pilot Study ◽  
Clinical Pharmacist ◽  
Medical Center ◽  
Academic Medical Center ◽  
The United States ◽  
Home Blood Pressure ◽  
Health Concern ◽  
Clinical Pharmacists ◽  
Mhealth Intervention

BACKGROUND Hypertension (HTN) is a major public health concern in the United States given its wide prevalence, high cost, and poor rates of control. Multiple strategies to counter this growing epidemic have been studied, and home blood pressure (BP) monitoring, mobile health (mHealth) interventions, and referrals to clinical pharmacists for BP management have all shown potential to be effective intervention strategies. OBJECTIVE The purpose of this study is to establish feasibility and acceptability of BPTrack, a clinical pharmacist-led mHealth intervention that aims to improve BP control by supporting home BP monitoring and medication adherence among patients with uncontrolled HTN. BPTrack is an intervention that makes home-monitored BP data available to clinical pharmacists for use in HTN management. Secondarily, this study seeks to understand barriers to adoption of this intervention, as well as points of improvement among key stakeholders, so that larger scale dissemination of the intervention may be achieved and more rigorous research can be conducted. METHODS This study is recruiting up to 25 individuals who have poorly controlled HTN from a Family Medicine clinic affiliated with a large Midwestern academic medical center. Patient participants complete a baseline visit, including installation and instructions on how to use BPTrack. Patient participants are then asked to follow the BP monitoring protocol for a period of 12 weeks, and subsequently complete a follow-up visit at the conclusion of the study period. RESULTS The recruitment period for the pilot study began in November 2016, and data collection is expected to conclude in late-2017. CONCLUSIONS This pilot study seeks to document the feasibility and acceptability of a clinical pharmacist-led mHealth approach to managing HTN within a primary care setting. Through our 12-week pilot study, we expect to lend support for this approach, and lay the foundation for translating this approach into wider-scale implementation. This mHealth intervention seeks to leverage the multidisciplinary care team already in place within primary care, and to improve health outcomes for patients with uncontrolled HTN. CLINICALTRIAL Clinicaltrials.gov NCT02898584; https://clinicaltrials.gov/ct2/show/NCT02898584 (Archived by WebCite® at http://www.webcitation.org/6u3wTGbe6)

scholarly journals Patient Satisfaction and Trust in Telemedicine during the COVID-19 Pandemic (Preprint)

2021 ◽  
Author(s):  
Sharon Orrange ◽  
Arpna Patel ◽  
Wendy Jean Mack ◽  
Julia Cassetta
Keyword(s):  
Patient Satisfaction ◽  
Los Angeles ◽  
Rank Order ◽  
Medical Center ◽  
Academic Medical Center ◽  
The United States ◽  
Related Factors ◽  
Significant Positive Association ◽  
Patients Satisfaction ◽  
Technical Issues

BACKGROUND Los Angeles County is a hub for COVID-19 cases in the United States. Academic health centers rapidly deployed and leveraged telemedicine to permit uninterrupted care of patients. Telemedicine enjoys high patient satisfaction, yet little is known about the level of satisfaction during a crisis and to what extent patient or visit-related factors and trust play when in-person visits are eliminated. OBJECTIVE To examine correlates of patients’ satisfaction with a telemedicine visit. METHODS In this retrospective observational study conducted in our single-institution, urban, academic medical center in Los Angeles, internal medicine patients aged 18 years and above who completed a telemedicine visit between March 10th and April 17th, 2020 were invited for a survey (n=1624). Measures included patient-demographics, degree of interpersonal trust in patient-physician relationships using the” Trust in Physician Scale,” and visit-related concerns. Statistical analysis used descriptive statistics, Spearman rank-order correlation, and linear and ordinal logistic regression. RESULTS Of 1,624 telemedicine visits conducted during this period, 368 (22.7%) patients participated in the survey. Across the study, respondents were very satisfied (47.4%) or satisfied (35.3%) with their telemedicine visit. Higher physician trust was associated with higher patient satisfaction (Spearman correlation r=0.51, P<.001). Visit-related factors with significant correlation with trust in physician score were technical issues with the telemedicine visit (r=-0.16), concerns about privacy (r=-0.19), concerns about cost (r=-0.23), satisfaction with telemedicine convenience (r=0.41), and amount of time spent (r=0.47) (all P<0.01). Visit-related factors associated with patients’ satisfaction included fewer technical issues (P<.001), less concern about privacy (P<.001) or cost (P=0.02), and successful face to face video (P<.001). The only patient variable with a significant positive association was income and level of trust in physician (r=0.18, P<.001). Younger age was associated with higher satisfaction with the telemedicine visit (P=.005). CONCLUSIONS There have been calls for redesigning primary care after the COVID-19 pandemic and for the widespread adoption of telemedicine. Patients’ satisfaction with telemedicine during the COVID-19 pandemic is high. Their satisfaction is shaped by the degree of trust in physician and visit-related factors more so than patient factors. This has widespread implications for outpatient practices and further research into visit-related factors and the patient-provider connection over telemedicine is needed. CLINICALTRIAL IRB Approval University of Southern California July 2020 HS-20-00479

scholarly journals 1026. Trends in Infective Endocarditis During the Substance Use Disorder Epidemic at an Academic Medical Center

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S306-S306 ◽  
Author(s):  
Craig A Martin ◽  
Donna R Burgess ◽  
Katie L Wallace ◽  
Jeremy Vanhoose ◽  
Sarah Cotner ◽  
...  
Keyword(s):  
Substance Use ◽  
Infective Endocarditis ◽  
Substance Use Disorders ◽  
Medical Center ◽  
Academic Medical Center ◽  
The United States ◽  
Opioid Overdose ◽  
Academic Medical ◽  
The Mean ◽  
Overdose Deaths

Abstract Background In many areas of the United States, substance use disorders (SUD) have increased dramatically over the past decade. Overdose deaths have increased as well, and Kentucky ranks among the nation’s leaders in deaths per 100,000 population. Infective endocarditis (IE) is a well-known complication of intravenous drug use, contributing to significant morbidity and mortality, but few studies have evaluated the effect of the current SUD epidemic on rates and demographics of IE. We sought to examine the trends in IE and IE with SUD at our institution. Methods We collected data from patients admitted to a large academic medical center in Kentucky between January 1, 2013 and December 31, 2016. Patients were classified according to the International Classification of Diseases, Tenth Revision. Patients were considered to have IE if they received codes I33 or I38. Patients were considered to have an SUD if they received codes F11.10, F15.10, F14.10, F19.10, or Z86.59. Data were collected through the TriNetX database (TriNetX, Cambridge, MA). Results There were 2,100 cases of IE during the study period. The mean (SD) age was 53 years (21). Of those, 440 also had an SUD. The mean (SD) age of these patients was 41 years (11). Patients in both the IE and IE/SUD categories were primarily male (54% and 55%) and white (94% and 94%). The number of cases of IE increased from 190 in 2013 to 430 in 2016 (R2 = 0.9877). The number of IE cases diagnosed as having an SUD increased from 30 (16% of all IE cases) in 2013 to 130 (30% of all IE cases) in 2016 (R2 = 0.7352 for the trend). This increase in cases corresponds to a 333% increase in the number of cases of IE with SUD. Conclusion Between 2014 and 2016, opioid overdose deaths in Kentucky rose from 24.7 to 33.5 per 100,000 population, a 35.6% increase. During a similar timeframe, the number of IE cases associated with SUD at our institution rose 333%. While it is possible that increased coding of substance use disorders factored into this dramatic increase, it appears that the number of IE cases associated with SUD is rising at a disproportionately rapid rate. Disclosures All authors: No reported disclosures.

scholarly journals Patient Satisfaction and Trust in Telemedicine during the COVID-19 Pandemic   (Preprint)

2020 ◽  
Author(s):  
Sharon Elizabeth Orrange ◽  
Wendy Jean Mack ◽  
Julia Ann Cassetta ◽  
Arpna S Patel
Keyword(s):  
Patient Satisfaction ◽  
Los Angeles ◽  
Rank Order ◽  
Medical Center ◽  
Academic Medical Center ◽  
The United States ◽  
Urgent Care ◽  
Related Factors ◽  
Patients Satisfaction ◽  
Technical Issues

BACKGROUND Background: Los Angeles County is a hub for COVID-19 cases in the United States. Academic health centers rapidly deployed and leveraged telemedicine to permit uninterrupted care of patients. Telemedicine enjoys high patient satisfaction yet little is known about the level of satisfaction during a crisis and to what extent patient or visit-related factors and trust play when in-person visits are eliminated. OBJECTIVE Objective: To examine correlates of patients’ satisfaction with a telemedicine visit.  METHODS Methods: In this retrospective observational study conducted in our single-institution, urban, academic medical center in Los Angeles, we surveyed internal medicine patients who had completed a telemedicine visit between March 10th and April 17th, 2020 (n=1624). Measures included degree of interpersonal trust in patient-physician relationships using the ”Trust in Physician Scale”, visit-related concerns, and post-visit recovery. Statistical analysis used descriptive statistics, Spearman rank-order correlation, and linear and ordinal logistic regression.  RESULTS Results: Of 1,624 telemedicine visits conducted during this period, 368 (22.7%) patients participated in the survey. Across the study, respondents were very satisfied (47.4%) or satisfied (35.3%) with their telemedicine visit. Higher physician trust was associated with higher patient satisfaction (Spearman correlation r=0.51, P<.01). Visit-related factors with significant correlation with trust in physician score were report of telemedicine technical issues (r=-0.16), concerns about privacy (r=-0.19), concerns about cost (r=-0.23), satisfaction with telemedicine convenience (r=0.41), and amount of time spent (r=0.47) (all P<0.01).  Visit-related factors associated with patients’ satisfaction included fewer technical issues (P<0.01), less concern about privacy (P<0.01) or cost (P=0.02), and successful face to face video (P<0.01). The only patient variable with a significant positive association was income and level of trust in physician (r=0.18, P<.01). Younger age was associated with higher telemedicine satisfaction (P<0.01). Despite high satisfaction and degree of trust, most respondents required in-person evaluation after the telemedicine visit, and only 12 respondents (3.9%) recovered at home without additional telemedicine visits or in-person evaluation at urgent care or emergency room.  CONCLUSIONS Conclusions: Patients’ satisfaction with telemedicine during the COVID-19 pandemic is high. Their satisfaction is shaped by the degree of trust in physician and visit-related factors more so than patient factors. This has implications for outpatient practices and the widespread adoption of telemedicine and further research into visit-related factors and the patient-provider connection over telemedicine is needed.  CLINICALTRIAL IRB Approval 7/6/2020 Proposal #HS-20-00479

Multimodal Education Program to Improve Nurses' Knowledge and Confidence on Delirium Recognition in a Surgical-Trauma Intermediate-Care Setting

2020 ◽  
Vol 13 (1) ◽  
pp. 31-41
Author(s):  
Min Choi ◽  
Regina DeGennaro ◽  
Cheri Blevins
Keyword(s):  
Education Program ◽  
Medical Center ◽  
Academic Medical Center ◽  
The United States ◽  
Screening Tools ◽  
Surgical Trauma ◽  
Intermediate Care ◽  
Bachelor Of Science ◽  
Post Test ◽  
Quasi Experimental

BackgroundHigh incidence of delirium in hospitalized patients has been reported in the United States and is significantly associated with increased morbidity and mortality. The lack of knowledge and confidence in performing delirium assessment (KCDA) has led to significant underrecognition of delirium by nurses regardless of evidence-based education intervention.ObjectiveThe purpose of this study was to determine the effectiveness of a multimodal educational program (MEP) to enhance nurses' KCDA.MethodsA MEP including an online didactic with a video-simulation and 1:1 bedside coaching with delirium screening (DS) was conducted in the surgical intermediate-care unit of an academic medical center. A quasi-experimental pre- and post-test design was used.ResultsOf 23 nurses, the majority were <41 years old (73.9%) and had at least a bachelor of science in nursing degree (78.3%) with <6 years of experience (60.9%). The overall KCDA scores and the performance of DS improved significantly after the MEP (p < .001). A positive correlation was noted between the changes of the KCDA scores (p = .009).ConclusionsThe MEP demonstrated improvement in nurses' KCDA. The MEP should focus on an individualized learning approach with a targeted patient population, using current delirium screening tools.Implications for NursingEducational programs are recommended in either an orientation or continuing education program on nursing units. This is also recommended for use in other academic centers that encompass similar clinical settings and could possibly be considered for use in other disease processes.

scholarly journals COVID-19-Related Changes in Perceived Household Food Waste in the United States: A Cross-Sectional Descriptive Study

2021 ◽  
Vol 18 (3) ◽  
pp. 1104
Author(s):  
Kelly Cosgrove ◽  
Maricarmen Vizcaino ◽  
Christopher Wharton
Keyword(s):  
Logistic Regression ◽  
Food Waste ◽  
The United States ◽  
Food Groups ◽  
Related Factors ◽  
Cross Sectional ◽  
Household Level ◽  
Binomial Logistic Regression ◽  
Household Food ◽  
Fresh Vegetables

Food waste contributes to adverse environmental and economic outcomes, and substantial food waste occurs at the household level in the US. This study explored perceived household food waste changes during the COVID-19 pandemic and related factors. A total of 946 survey responses from primary household food purchasers were analyzed. Demographic, COVID-19-related household change, and household food waste data were collected in October 2020. Wilcoxon signed-rank was used to assess differences in perceived food waste. A hierarchical binomial logistic regression analysis was conducted to examine whether COVID-19-related lifestyle disruptions and food-related behavior changes increased the likelihood of household food waste. A binomial logistic regression was conducted to explore the contribution of different food groups to the likelihood of increased food waste. Perceived food waste, assessed as the estimated percent of food wasted, decreased significantly during the pandemic (z = −7.47, p < 0.001). Food stockpiling was identified as a predictor of increased overall food waste during the pandemic, and wasting fresh vegetables and frozen foods increased the odds of increased food waste. The results indicate the need to provide education and resources related to food stockpiling and the management of specific food groups during periods of disruption to reduce food waste.

scholarly journals Perinatal Mood and Anxiety Disorder Management in Multicenter Community Practices: Clinicians’ Training, Current Practices and Perceived Strategies to Improve Future Implementation

2021 ◽  
Vol 12 ◽  
pp. 215013272199688
Author(s):  
Ajeng J. Puspitasari ◽  
Dagoberto Heredia ◽  
Elise Weber ◽  
Hannah K Betcher ◽  
Brandon J. Coombes ◽  
...  
Keyword(s):  
Anxiety Disorder ◽  
Health Services ◽  
Behavioral Health ◽  
Psychiatric Symptoms ◽  
Medical Center ◽  
Academic Medical Center ◽  
Management Training ◽  
The United States ◽  
Behavioral Health Services ◽  
Perinatal Women

Background: This study aimed to explore clinicians’ perspectives on the current practice of perinatal mood and anxiety disorder (PMAD) management and strategies to improve future implementation. Methods: This study had a cross-sectional, descriptive design. A 35-item electronic survey was sent to clinicians (N = 118) who treated perinatal women and practiced at several community clinics at an academic medical center in the United States. Results: Among clinicians who provided care for perinatal women, 34.7% reported never receiving PMAD management training and 66.3% had less than 10 years of experience. Out of 10 patients who reported psychiatric symptoms, 47.8% of clinicians on average reported providing PMAD management to 1 to 3 patients and 40.7% noted that they conducted screening only when patient expresses PMAD symptoms. Suggested future improvements were providing training, developing a referral list, and establishing integrated behavioral health services. Conclusions: Results from this study indicated that while PMAD screening and management was implemented, improvements are warranted to meet established guidelines. Additionally, clinicians endorsed providing PMAD management to a small percentage of perinatal patients. Suggested strategies to increase adoption and implementation of PMAD management should be explored to improve access to behavioral health services for perinatal women.

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