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Reuben DB, Rosenstein HL, Chen K, Pillai A, Lee DR, Meshkat SD, Chen GI. A population-based, electronic health record-guided approach to improve the quality of dementia care. J Am Geriatr Soc 2023; 71:927-934. [PMID: 36550629 DOI: 10.1111/jgs.18193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/22/2022] [Accepted: 11/27/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The quality of care of the 6.5 million Americans living with dementia has been suboptimal, leading to worse outcomes and higher costs. Few health systems have formal systems in place to guide the care of these patients. To help improve the care of persons living with dementia, we developed and preliminarily evaluated the effectiveness of electronic health record (EHR)-generated recommendations for patients with dementia. METHODS This quality improvement study was conducted from October 2020 through June 2022 at a single academic healthcare system and included patients identified as having dementia on their problem list and their physicians. Ten (seven outpatient and three inpatient) algorithms based on clinical logic and evidence were embedded in an EHR system to generate specific recommendations based on combinations of utilization, diagnosis, and medications. The number of each type of recommendation generated, and orders for each type of recommendation were recorded, as well as physician's perceptions of this approach. RESULTS Three thousand six hundred and nine recommendations on 763 patients were triggered by the algorithms in the outpatient setting, and 185 referrals were placed. The most common recommendations were for ongoing care through the UCLA Alzheimer's and Dementia Care program, Palliative Care, the Extensivist Clinic, Urogynecology, and Clinical Pharmacy. The most commonly acted upon by providers were recommendations for referral to Pharmacists and the UCLA Alzheimer's and Dementia Care program. The most common reason for not responding to specific recommendations was that these were not perceived as relevant to the patient. Compared to general medicine physicians, geriatricians felt more comfortable managing dementia care without a referral to a service (23% (95% CI 15%-34%) versus 3% (95% CI 0%-17%), p = 0.012) and less commonly felt the recommendation was appropriate (1% (95% CI 0%-7%) versus 13% (95% CI 4%-30%), p = 0.02). CONCLUSIONS EHR-generated algorithms can help guide patients with dementia to appropriate clinical services.
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Affiliation(s)
- David B Reuben
- Division of Geriatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Hanina L Rosenstein
- Office of Population Health & Accountable Care, UCLA Health Faculty Practice Group, Los Angeles, California, USA
| | - Kimberly Chen
- Information Services & Solutions, UCLA Health Information Technology, Los Angeles, California, USA
| | - Ajaya Pillai
- Information Services & Solutions, UCLA Health Information Technology, Los Angeles, California, USA
| | - David R Lee
- Division of Geriatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Sarah D Meshkat
- Office of Population Health & Accountable Care, UCLA Health Faculty Practice Group, Los Angeles, California, USA
| | - Grace I Chen
- Division of Geriatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Shelton RC, Dolor RJ, Tobin J, Baumann A, Rohweder C, Patel S, Baldwin LM. Dissemination and implementation science resources, training, and scientific activities provided through CTSA programs nationally: Opportunities to advance D&I research and training capacity. J Clin Transl Sci 2022; 6:e41. [PMID: 35574154 PMCID: PMC9066314 DOI: 10.1017/cts.2022.377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 03/18/2022] [Accepted: 03/19/2022] [Indexed: 12/14/2022] Open
Abstract
Introduction Clinical and Translational Science Award (CTSA) Program hubs are well-positioned to advance dissemination and implementation (D&I) research and training capacity nationally, though little is known about what D&I research support and services CTSAs provide. To address this gap, the CTSA Dissemination, Implementation, and Knowledge Transfer Working Group conducted an environmental scan of CTSAs (2017-2018). Methods Of 67 CTSA institutions, we contacted 43 that previously reported delivering D&I research services. D&I experts from these institutions were emailed a survey assessing D&I resources, services, training, and scientific projects. Responses were categorized and double-coded by study authors using a content analysis approach. Results Thirty-five of the 43 D&I experts (81.4%) responded. Challenges to CTSAs in developing and supporting D&I science activities were related to inadequate D&I science workforce (45.7%) and lack of understanding of D&I science (25.7%). Services provided included consultation/mentoring programs (68%), pilot funding/grants (50%), and workshops/seminars/conferences (46%). Training and workforce development in D&I were frequently identified as future priorities. Recommendations included increase training to meet demand (68.6%), accessible D&I tools/resources (34.3%), greater visibility/awareness of D&I methods (34.3%), consultation services (22.9%), and expand D&I science workforce (22.9%). Conclusions CTSAs have tremendous potential to support the advancement and impact of D&I science across the translational continuum. Despite the growing presence of D&I science in CTSAs, continued commitment and prioritization are needed from CTSA and institutional leadership to raise awareness of D&I science and its value, meet training demands, and develop necessary infrastructure for conducting D&I science.
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Affiliation(s)
- Rachel C. Shelton
- Columbia University Mailman School of Public Health and Columbia’s Irving Institute for Clinical and Translational Research, New York, NY, USA
| | - Rowena J. Dolor
- Division of General Internal Medicine, Department of Medicine, Duke Clinical and Translational Science Institute, Duke University, Durham, NC
| | - Jonathan Tobin
- Clinical Directors Network (CDN) and The Rockefeller University Center for Clinical and Translational Science, New York, NY, USA
| | - Ana Baumann
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Catherine Rohweder
- UNC Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sapana Patel
- New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Laura-Mae Baldwin
- Department of Family Medicine and the Institute of Translational Health Sciences, University of Washington, Seattle, WA, USA
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Wakschlag LS, Finlay-Jones AL, MacNeill LA, Kaat AJ, Brown CH, Davis MM, Franklin P, Berkel C, Krogh-Jespersen S, Smith JD. Don't Get Lost in Translation: Integrating Developmental and Implementation Sciences to Accelerate Real-World Impact on Children's Development, Health, and Wellbeing. Front Public Health 2022; 10:827412. [PMID: 35493380 PMCID: PMC9046665 DOI: 10.3389/fpubh.2022.827412] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/24/2022] [Indexed: 01/14/2023] Open
Abstract
Translation of developmental science discoveries is impeded by numerous barriers at different stages of the research-to-practice pipeline. Actualization of the vast potential of the developmental sciences to improve children's health and development in the real world is imperative but has not yet been fully realized. In this commentary, we argue that an integrated developmental-implementation sciences framework will result in a translational mindset essential for accelerating real world impact. We delineate key principles and methods of implementation science of salience to the developmental science audience, lay out a potential synthesis between implementation and developmental sciences, provide an illustration of the Mental Health, Earlier Partnership (MHE-P), and set actionable steps for realization. Blending these approaches along with wide-spread adoption of the translational mindset has transformative potential for population-level impact of developmental science discovery.
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Affiliation(s)
- Lauren S. Wakschlag
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States,Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, United States,*Correspondence: Lauren S. Wakschlag
| | - Amy L. Finlay-Jones
- Early Neurodevelopment and Mental Health Team, Telethon Kids Institute, Nedlands, WA, Australia,School of Population Health, Curtin University, Bentley, WA, Australia
| | - Leigha A. MacNeill
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States,Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, United States
| | - Aaron J. Kaat
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States,Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, United States
| | - C. Hendricks Brown
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States,Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States,Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Matthew M. Davis
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States,Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, United States,Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States,Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Patricia Franklin
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Cady Berkel
- College of Health Solutions, Arizona State University, Tempe, AZ, United States
| | - Sheila Krogh-Jespersen
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States,Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, United States
| | - Justin D. Smith
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, United States,Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, United States
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