provider education
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2088 ◽  
Vol 11 (1) ◽  
pp. 84-90 ◽  
Author(s):  
Tina Saryeddine ◽  
Charissa Levy ◽  
Aileen Davis ◽  
John Flannery ◽  
Susan Jaglal ◽  
...  

2022 ◽  
Vol 13 (01) ◽  
pp. 030-036
Author(s):  
Carrie T. Chan ◽  
Megen Vo ◽  
Jennifer Carlson ◽  
Tzielan Lee ◽  
Marcello Chang ◽  
...  

Abstract Objectives An electronic clinical decision support (CDS) alert can provide real-time provider support to offer pre-exposure prophylaxis (PrEP) to youth at risk for human immunodeficiency virus (HIV). The purpose of this study was to evaluate provider utilization of a PrEP CDS alert in a large academic-community pediatric network and assess the association of the alert with PrEP prescribing rates. Methods HIV test orders were altered for patients 13 years and older to include a hard-stop prompt asking if the patient would benefit from PrEP. If providers answered “Yes” or “Not Sure,” the CDS alert launched with options to open a standardized order set, refer to an internal PrEP specialist, and/or receive an education module. We analyzed provider utilization using a frequency analysis. The rate of new PrEP prescriptions for 1 year after CDS alert implementation was compared with the year prior using Fisher's exact test. Results Of the 56 providers exposed to the CDS alert, 70% (n = 39) responded “Not sure” to the alert prompt asking if their patient would benefit from PrEP, and 54% (n = 30) chose at least one clinical support tool. The PrEP prescribing rate increased from 2.3 prescriptions per 10,000 patients to 6.6 prescriptions per 10,000 patients in the year post-intervention (p = 0.02). Conclusion Our findings suggest a knowledge gap among pediatric providers in identifying patients who would benefit from PrEP. A hard-stop prompt within an HIV test order that offers CDS and provider education might be an effective tool to increase PrEP prescribing among pediatric providers.


Author(s):  
Vanessa McFadden ◽  
Sarah Corey Bauer ◽  
Kelsey Porada ◽  
Sonia Mehta ◽  
Michelle L. Pickett

OBJECTIVES: Hospitals are an important nontraditional setting in which to address adolescent reproductive health. However, opportunities for intervention are frequently missed, especially for boys and patients hospitalized for noningestion complaints. Our global aim was to increase delivery of reproductive health care to adolescents hospitalized through our children’s hospital Pediatric Hospital Medicine service. METHODS: We performed 2 quality improvement intervention cycles: (1) provider education and monthly reminder e-mails and (2) an automated electronic health record (EHR) adolescent history and physical note template with social history prompts while discontinuing reminder e-mails. The primary outcome measure was sexual history documentation (SHD). Secondary measures were sexually transmitted infection (STI) testing and contraception provision. Statistical process control charts were used to analyze effectiveness of interventions. RESULTS: From July 2018 through June 2019, 528 Primary Hospital Medicine encounters were included in this study and compared with published baseline data on 150 encounters. Control charts revealed a special cause increase in SHD from 60% to 82% overall, along with 37% to 73% for boys and 57% to 80% for noningestion hospitalizations. Increased SHD correlated with cycle 1 and was maintained through cycle 2. Percent STI testing significantly increased but did not shift or trend toward special cause variation. Contraception provision, length of stay, and patient relations consultations were not affected. CONCLUSIONS: The interventions were successful in increasing SHD, including among boys and noningestion hospitalizations. The EHR enhancement maintained these increases after reminder emails were discontinued. Future interventions should specifically address STI testing and provision of contraception.


2021 ◽  
Author(s):  
Westyn Branch-Elliman ◽  
Rebecca Lamkin ◽  
Marlena Shin ◽  
Hillary J Mull ◽  
Isabella Epshtein ◽  
...  

Abstract Background: Despite a strong evidence base and clinical guidelines specifically recommending against prolonged post-procedural antimicrobial use, studies indicate that the practice is common following cardiac device procedures. Formative evaluations conducted by the study team suggest that inappropriate antimicrobial use may be driven by information silos that drive provider belief that antimicrobials are not harmful, in part due to lack of complete feedback about all types of clinical outcomes. De-implementation is recognized as an important area of research that can lead to reductions in unnecessary, wasteful, or harmful practices, such as excess antimicrobial use following cardiac device procedures; however, investigations into strategies that lead to successful de-implementation are limited. The overarching hypothesis to be tested in this trial is that a bundle of implementation strategies that includes audit and feedback about direct patient harms caused by inappropriate prescribing can lead to successful de-implementation of guideline-discordant care.Methods: We propose a Hybrid Type III effectiveness-implementation stepped-wedge intervention trial at three high-volume, high-complexity VA medical centers. The main study intervention (an informatics-based, real-time audit-and-feedback tool) was developed based on learning/unlearning theory and formative evaluations and guided by the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) Framework. Elements of the bundled and multifaceted implementation strategy to promote appropriate prescribing will include audit-and-feedback reports that include information about antibiotic harms, stakeholder engagement, patient and provider education, identification of local champions, and blended facilitation. The primary study outcome is adoption of evidence-based practice (de-implementation of inappropriate antimicrobial use). Clinical outcomes (cardiac device infections, acute kidney injuries and Clostridioides difficile infections) are secondary. Qualitative interviews will assess relevant implementation outcomes (acceptability, adoption, fidelity, feasibility).Discussion: De-implementation theory suggests that factors that may have a particularly strong influence on de-implementation include strength of the underlying evidence, the complexity of the intervention, and patient and provider anxiety and fear about changing an established practice. This study will assess whether a multifaceted intervention mapped to identified de-implementation barriers leads to measurable improvements in provision of guideline-concordant antimicrobial use. Findings will improve understanding about factors that impact successful or unsuccessful de-implementation of harmful or wasteful healthcare practices.Trial Registration: Clinicaltrials.gov (NCT05020418)


2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 433-433
Author(s):  
Phillip Clark ◽  
Kelly Munly

Abstract Individuals with lifelong intellectual and developmental disabilities (IDD) have unique needs associated with aging that pose challenges for them and their families. In particular, an increased likelihood for early onset Alzheimer’s disease is a major concern that can place individuals at risk for a host of biomedical, psychological, and social challenges. Faced with providers not trained in how to properly screen for, diagnose, and treat conditions, individuals and families are often left with inadequate care, services, and support. To address these concerns, education for professionals is essential in providing accurate information based on clinical best practices. This symposium presents an innovative and interprofessional model developed by a partnership of geriatrics and IDD educational and service organizations based on Project ECHO (Extension for Community Healthcare Outcomes) methodology. A virtual community is created in which participants both teach and learn from each other through a combination of didactic and case presentations. The first paper describes the ECHO model, including the development of the hub and spoke structure, recruitment of providers, and collaborative and multidisciplinary process of curriculum development. The second paper explores educational experiences of participating spoke agencies in the program, including professionals’ and clients’ outcomes. The third paper presents the implications of creating a foundation based on interprofessional education and networking principles to bridge the gap between health and social care disciplines and parallel service systems. The final paper provides recommendations and implications for developing and refining methods to address the need for provider education in this rapidly expanding field.


2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 434-434
Author(s):  
Phillip Clark

Abstract The needs of individuals aging with intellectual and developmental disabilities (IDD) and their families do not fall neatly within defined policies, programs, and professions. They comprise complex challenges based on medical, psychological, social, environmental, economic and familial dimensions. These needs pose a challenge for providers in developing solutions at three levels: (1) different policies and programs create barriers based on different funding sources, eligibility requirements, and administrative restrictions; (2) clinical and community-based programs embody the gap between healthcare and human service providers; and (3) different professions are trained in their own methods of assessment and care plan development that impede the design of integrated approaches to defining and solving problems. This paper proposes an intersectoral, interorganizational, and interprofessional framework for addressing these problems based on networking and collaborative practice principles embodying bridge-building, boundary-spanning, and team-working as a basis for provider education. Implications for expanded education in this field are explored.


2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 596-596
Author(s):  
Karen Valcheff ◽  
Hoffart Nancy

Abstract Patient-centered care strives to improve older adult outcomes from the emergency department (ED). Appropriate disposition decisions from the ED for older adults are becoming increasingly complex and challenging. The purpose of this study was to explore the perceptions of older adults as to their disposition from the emergency department, the decision making process, and their engagement in that process. The Three-Talk Shared Decision Making (SDM) model guided the study. A qualitative approach was used to interview seven older adults two days after being treated in the ED. Transcribed data were thematically analyzed using MAXQDA to identify codes, patterns, and themes. Analysis revealed that the Three-Talk SDM model was not being used. Participants identified only one option regarding their disposition from the ED and perceived they had little voice in decision making. They reported a variety of emotional reactions, feelings of helplessness and empathy regarding the decision making process. Three factors that participants perceived as vital to them before making a disposition decision were safety, pain relief, and a definitive diagnosis. The findings of this small sample are clinically meaningful. These older adults wanted to be heard regarding their treatment and disposition decisions. Findings indicate the need for provider education about the use of a model such as the Three -Talk SDM. Further research is needed to look at both the older adult and provider’s perception of the ED disposition decision. Additional strategies and skills are warranted to enhance shared decision making in the ED with the growing aging population.


2021 ◽  
Vol 16 (1) ◽  
Author(s):  
John L. Jefferies ◽  
Alison K. Spencer ◽  
Heather A. Lau ◽  
Matthew W. Nelson ◽  
Joseph D. Giuliano ◽  
...  

Abstract Background Fabry disease (FD) is a rare genetic disorder characterized by glycosphingolipid accumulation and progressive damage across multiple organ systems. Due to its heterogeneous presentation, the condition is likely significantly underdiagnosed. Several approaches, including provider education efforts and newborn screening, have attempted to address underdiagnosis of FD across the age spectrum, with limited success. Artificial intelligence (AI) methods present another option for improving diagnosis. These methods isolate common health history patterns among patients using longitudinal real-world data, and can be particularly useful when patients experience nonspecific, heterogeneous symptoms over time. In this study, the performance of an AI tool in identifying patients with FD was analyzed. The tool was calibrated using de-identified health record data from a large cohort of nearly 5000 FD patients, and extracted phenotypic patterns from these records. The tool then used this FD pattern information to make individual-level estimates of FD in a testing dataset. Patterns were reviewed and confirmed with medical experts. Results The AI tool demonstrated strong analytic performance in identifying FD patients. In out-of-sample testing, it achieved an area under the receiver operating characteristic curve (AUROC) of 0.82. Strong performance was maintained when testing on male-only and female-only cohorts, with AUROCs of 0.83 and 0.82 respectively. The tool identified small segments of the population with greatly increased prevalence of FD: in the 1% of the population identified by the tool as at highest risk, FD was 23.9 times more prevalent than in the population overall. The AI algorithm used hundreds of phenotypic signals to make predictions and included both familiar symptoms associated with FD (e.g. renal manifestations) as well as less well-studied characteristics. Conclusions The AI tool analyzed in this study performed very well in identifying Fabry disease patients using structured medical history data. Performance was maintained in all-male and all-female cohorts, and the phenotypic manifestations of FD highlighted by the tool were reviewed and confirmed by clinical experts in the condition. The platform’s analytic performance, transparency, and ability to generate predictions based on existing real-world health data may allow it to contribute to reducing persistent underdiagnosis of Fabry disease.


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