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Herasevich S, Minteer SA, Boswell CL, Hanson AC, Dong Y, Gajic O, Barwise AK. Individualized prediction of critical illness in older adults: Validation of an elders risk assessment model. J Am Geriatr Soc 2024. [PMID: 38450712 DOI: 10.1111/jgs.18861] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/17/2024] [Accepted: 02/07/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND The electronic health record (EHR) presents new opportunities for the timely identification of patients at high risk of critical illness and the implementation of preventive strategies. This study aims to externally validate an EHR-based Elders Risk Assessment (ERA) score to identify older patients at high risk of future critical illness during a primary care visit. METHODS This historical cohort study included patients aged ≥65 years who had primary care visits at Mayo Clinic Rochester, MN, between July 2019 and December 2021. The ERA score at the time of the primary care visit was used to predict critical illness, defined as death or ICU admission within 1 year of the visit. RESULTS A total of 12,885 patients were included in the analysis. The median age at the time of the primary care visit was 75 years, with 44.6% being male. 93.7% of participants were White, and 64.2% were married. The median (25th, 75th percentile) ERA score was 4 (0, 9). 11.3% of study participants were admitted to the ICU or died within 1 year of the visit. The ERA score predicted critical illness within 1 year of a primary care visit with an area under the receiver operating characteristic curve of 0.84 (95% CI 0.83-0.85), which indicates good discrimination. An ERA score of 9 was identified as optimal for implementing and testing potential preventive strategies, with the odds ratio of having the primary outcome in patients with ERA score ≥9 being 11.33 (95%CI 9.98-12.87). CONCLUSIONS This simple EHR-based risk assessment model can predict critical illness within 1 year of primary care visits in older patients. The findings of this study can serve as a basis for testing and implementation of preventive strategies to promote the well-being of older adults at risk of critical illness and its consequences.
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Affiliation(s)
- Svetlana Herasevich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Sarah A Minteer
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Andrew C Hanson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Yue Dong
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ognjen Gajic
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Amelia K Barwise
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, USA
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Barwise AK, Curtis S, Diedrich DA, Pickering BW. Using artificial intelligence to promote equitable care for inpatients with language barriers and complex medical needs: clinical stakeholder perspectives. J Am Med Inform Assoc 2024; 31:611-621. [PMID: 38099504 PMCID: PMC10873784 DOI: 10.1093/jamia/ocad224] [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: 06/23/2023] [Accepted: 11/14/2023] [Indexed: 02/18/2024] Open
Abstract
OBJECTIVES Inpatients with language barriers and complex medical needs suffer disparities in quality of care, safety, and health outcomes. Although in-person interpreters are particularly beneficial for these patients, they are underused. We plan to use machine learning predictive analytics to reliably identify patients with language barriers and complex medical needs to prioritize them for in-person interpreters. MATERIALS AND METHODS This qualitative study used stakeholder engagement through semi-structured interviews to understand the perceived risks and benefits of artificial intelligence (AI) in this domain. Stakeholders included clinicians, interpreters, and personnel involved in caring for these patients or for organizing interpreters. Data were coded and analyzed using NVIVO software. RESULTS We completed 49 interviews. Key perceived risks included concerns about transparency, accuracy, redundancy, privacy, perceived stigmatization among patients, alert fatigue, and supply-demand issues. Key perceived benefits included increased awareness of in-person interpreters, improved standard of care and prioritization for interpreter utilization; a streamlined process for accessing interpreters, empowered clinicians, and potential to overcome clinician bias. DISCUSSION This is the first study that elicits stakeholder perspectives on the use of AI with the goal of improved clinical care for patients with language barriers. Perceived benefits and risks related to the use of AI in this domain, overlapped with known hazards and values of AI but some benefits were unique for addressing challenges with providing interpreter services to patients with language barriers. CONCLUSION Artificial intelligence to identify and prioritize patients for interpreter services has the potential to improve standard of care and address healthcare disparities among patients with language barriers.
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Affiliation(s)
- Amelia K Barwise
- Biomedical Ethics Research Program, Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN 55902, United States
| | - Susan Curtis
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN 55902, United States
| | - Daniel A Diedrich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN 55902, United States
| | - Brian W Pickering
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN 55902, United States
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Huang L, Huschka TR, Barwise AK, Allen JSP, Wolfersteig W, Hamm K, Cardenas LD, Phelan SM, Allyse MA. Psychological reactance, misinformation, and distrust: A mixed methods analysis of COVID-19 vaccine uptake. J Clin Transl Sci 2024; 8:e48. [PMID: 38510694 PMCID: PMC10951926 DOI: 10.1017/cts.2024.15] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 01/03/2024] [Accepted: 01/17/2024] [Indexed: 03/22/2024] Open
Abstract
Background Assessing perceptions of the COVID-19 vaccines is essential for understanding vaccine hesitancy and for improving uptake during public health emergencies. In the complicated landscape of COVID-19 vaccine mandates and rampant misinformation, many individuals faced challenges during vaccination decision-making. The purpose of our mixed methods study is to elucidate factors affecting vaccine decision-making and to highlight the discourse surrounding the COVID-19 vaccines in diverse and underserved communities. Methods This mixed methods study was conducted in Arizona, Florida, Minnesota, and Wisconsin between March and November 2021, combining a cross-sectional survey (n = 3593) and focus groups (n = 47). Results The groups least likely to report receiving a vaccination were non-Hispanic Whites, Indigenous people, males, and those with moderate socioeconomic status (SES). Those indicating high and low SES reported similar vaccination uptake. Focus group data highlighted resistance to mandates, distrust, misinformation, and concerns about the rapid development surrounding the COVID-19 vaccines. Psychological reactance theory posits that strongly persuasive messaging and social pressure can be perceived as a threat to freedom, encouraging an individual to take action to restore that freedom. Conclusion Our findings indicate that a subsection of participants felt pressured to get the vaccine, which led to weaker intentions to vaccinate. These results suggest that vaccine rollout strategies should be reevaluated to improve and facilitate informed decision-making.
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Affiliation(s)
- Lily Huang
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, USA
| | - Todd R. Huschka
- Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Amelia K. Barwise
- Program in Biomedical Ethics Research, Mayo Clinic, Rochester, MN, USA
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jay-Sheree P. Allen
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, MN, USA
| | - Wendy Wolfersteig
- Southwest Interdisciplinary Research Center, Arizona State University, Tempe, AZ, USA
| | - Kathryn Hamm
- Southwest Interdisciplinary Research Center, Arizona State University, Tempe, AZ, USA
| | | | - Sean M. Phelan
- Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Megan A. Allyse
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, USA
- Program in Biomedical Ethics Research, Mayo Clinic, Rochester, MN, USA
- Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN, USA
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Boswell CL, Minteer SA, Herasevich S, Garcia-Mendez JP, Dong Y, Gajic O, Barwise AK. Early Prevention of Critical Illness in Older Adults: Adaptation and Pilot Testing of an Electronic Risk Score and Checklist. J Prim Care Community Health 2024; 15:21501319241231238. [PMID: 38344983 PMCID: PMC10863481 DOI: 10.1177/21501319241231238] [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: 12/08/2023] [Revised: 01/10/2024] [Accepted: 01/22/2024] [Indexed: 02/15/2024] Open
Abstract
OBJECTIVE Given limited critical care resources and an aging population, early interventions to prevent critical illness are vital. In this work, we measured post-implementation outcomes after introducing a novel electronic scoring system (Elders Risk Assessment-ERA) and a risk-factor checklist, Checklist for Early Recognition and Treatment of Acute Illness (CERTAIN), to detect older patients at high risk of critical illness in a primary care setting. METHODS The study was conducted at a family medicine clinic in Kasson, MN. The ADAPT-ITT framework was used to modify the CERTAIN checklist for primary care during 2 co-design workshops involving interdisciplinary clinicians, held in April 2023. The ERA score and modified CERTAIN checklist were implemented between May and July 2023 and identify and assess all patients age ≥60 years at risk of critical illness during their primary care visits. Implementation outcomes were evaluated at the end of the study via an anonymous survey and EHR data extraction. RESULTS Fourteen clinicians participated in 2 co-design workshops. A total of 19 clinicians participated in a post-pilot survey. All survey items were rated on a 5-point Likert type scale. Mean acceptability of the ERA score and checklist was rated 3.35 (SD = 0.75) and 3.09 (SD = 0.64), respectively. Appropriateness had a mean rating of 3.38 (SD = 0.82) for the ERA score and 3.19 (SD = 0.59) for the checklist. Mean feasibility was rated 3.38(SD = 0.85) and 2.92 (SD = 0.76) for the ERA score and checklist, respectively. The adoption rate was 50% (19/38) among clinicians, but the reach was low at 17% (49/289) of eligible patients. CONCLUSIONS This pilot study evaluated the implementation of an intervention that introduced the ERA score and CERTAIN checklist into a primary care practice. Results indicate moderate acceptability, appropriateness, and feasibility of the ERA score, and similar ratings for the checklist, with slightly lower feasibility. While checklist adoption was moderate, reach was limited, indicating inconsistent use. RECOMMENDATIONS We plan to use the open-ended resurvey responses to further modify the CERTAIN-FM checklist and implementation process. The ADAPT-ITT framework is a useful model for adapting the checklist to meet the primary care clinician needs.
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Herasevich S, Soleimani J, Huang C, Pinevich Y, Dong Y, Pickering BW, Murad MH, Barwise AK. Diagnostic error among vulnerable populations presenting to the emergency department with cardiovascular and cerebrovascular or neurological symptoms: a systematic review. BMJ Qual Saf 2023; 32:676-688. [PMID: 36972982 DOI: 10.1136/bmjqs-2022-015038] [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: 04/11/2022] [Accepted: 03/10/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Diagnostic error (DE) is a common problem in clinical practice, particularly in the emergency department (ED) setting. Among ED patients presenting with cardiovascular or cerebrovascular/neurological symptoms, a delay in diagnosis or failure to hospitalise may be most impactful in terms of adverse outcomes. Minorities and other vulnerable populations may be at higher risk of DE. We aimed to systematically review studies reporting the frequency and causes of DE in under-resourced patients presenting to the ED with cardiovascular or cerebrovascular/neurological symptoms. METHODS We searched EBM Reviews, Embase, Medline, Scopus and Web of Science from 2000 through 14 August 2022. Data were abstracted by two independent reviewers using a standardised form. The risk of bias (ROB) was assessed using the Newcastle-Ottawa Scale, and the certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation approach. RESULTS Of the 7342 studies screened, we included 20 studies evaluating 7436,737 patients. Most studies were conducted in the USA, and one study was multicountry. 11 studies evaluated DE in patients with cerebrovascular/neurological symptoms, 8 studies with cardiovascular symptoms and 1 study examined both types of symptoms. 13 studies investigated missed diagnoses and 7 studies explored delayed diagnoses. There was significant clinical and methodological variability, including heterogeneity of DE definitions and predictor variable definitions as well as methods of DE assessment, study design and reporting.Among the studies evaluating cardiovascular symptoms, black race was significantly associated with higher odds of DE in 4/6 studies evaluating missed acute myocardial infarction (AMI)/acute coronary syndrome (ACS) diagnosis compared with white race (OR from 1.18 (1.12-1.24) to 4.5 (1.8-11.8)). The association between other analysed factors (ethnicity, insurance and limited English proficiency) and DE in this domain varied from study to study and was inconclusive.Among the studies evaluating DE in patients with cerebrovascular/neurological symptoms, no consistent association was found indicating higher or lower odds of DE. Although some studies showed significant differences, these were not consistently in the same direction.The overall ROB was low for most included studies; however, the certainty of evidence was very low, mostly due to serious inconsistency in definitions and measurement approaches across studies. CONCLUSIONS This systematic review demonstrated consistent increased odds of missed AMI/ACS diagnosis among black patients presenting to the ED compared with white patients in most studies. No consistent associations between demographic groups and DE related to cerebrovascular/neurological diagnoses were identified. More standardised approaches to study design, measurement of DE and outcomes assessment are needed to understand this problem among vulnerable populations. TRIAL REGISTRATION NUMBER The study protocol was registered in the International Prospective Register of Systematic Reviews PROSPERO 2020 CRD42020178885 and is available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020178885.
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Affiliation(s)
- Svetlana Herasevich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jalal Soleimani
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Chanyan Huang
- Department of Anaesthesiology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Yuliya Pinevich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Yue Dong
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Brian W Pickering
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohammad H Murad
- Center for Science of Healthcare Delivery, Division of Preventive Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Amelia K Barwise
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Bioethics Research Program, Mayo Clinic, Rochester, MN, USA
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Brumbaugh JE, Tschida‐Reuter DJ, Barwise AK. Meeting the needs of the patient with non-English language preference in the hospital setting. Health Serv Res 2023; 58:965-969. [PMID: 37580055 PMCID: PMC10480083 DOI: 10.1111/1475-6773.14217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023] Open
Affiliation(s)
- Jane E. Brumbaugh
- Department of Pediatric and Adolescent MedicineMayo ClinicRochesterMinnesotaUSA
| | | | - Amelia K. Barwise
- Program in Biomedical Ethics Research and Division of Pulmonary and Critical Care MedicineMayo ClinicRochesterMinnesotaUSA
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Ahmad SR, Rhudy L, Fogelson LA, LeMahieu AM, Barwise AK, Gajic O, Karnatovskaia LV. Humanizing the Intensive Care Unit: Perspectives of Patients and Families on the Get to Know Me Board. J Patient Exp 2023; 10:23743735231201228. [PMID: 37736130 PMCID: PMC10510354 DOI: 10.1177/23743735231201228] [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] [Indexed: 09/23/2023] Open
Abstract
In this qualitative study, we explored perspectives of patients in the intensive care unit (ICU) and their families on the Get to Know Me board (GTKMB). Of the 46 patients approached, 38 consented to participate. Of the 66 family members approached, 60 consented to participate. Most patients (26, 89%) and family members (52, 99%) expressed that GTKMB was important in recognizing patient's humanity. Most patients (20, 68%) and families (39, 74%) said that it helped to build a better relationship with the provider team. 60% of patients and families commented that the GTKMB was used as a platform by providers to interact with them. Up to 45 (85%) of the family members supported specific contents of the GTKMB. In structured interviews (11 patients, 7 family members), participants additionally commented on ways providers used the GTKMB to communicate, support patient's personhood, and on caveats in interacting with GTKMB. Critically ill patients and families found the GTKMB helpful in preserving personhood of patient, fostering communication, and building relationships with clinicians.
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Affiliation(s)
- Sumera R. Ahmad
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Lori Rhudy
- Department of Graduate Nursing, Winona State University, Rochester, MN, USA
| | | | | | - Amelia K. Barwise
- Department of Bioethics Research Program, Mayo Clinic, Rochester, MN, USA
| | - Ognjen Gajic
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
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Herasevich S, Pinevich Y, Lindroth HL, Herasevich V, Pickering BW, Barwise AK. Who needs clinician attention first? A qualitative study of critical care clinicians' needs that enable the prioritization of care for populations of acutely ill patients. Int J Med Inform 2023; 177:105118. [PMID: 37295137 PMCID: PMC10527757 DOI: 10.1016/j.ijmedinf.2023.105118] [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: 03/10/2023] [Revised: 05/15/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND To adequately care for groups of acutely ill patients, clinicians maintain situational awareness to identify the most acute needs within the entire intensive care unit (ICU) population through constant reappraisal of patient data from electronic medical record and other information sources. Our objective was to understand the information and process requirements of clinicians caring for multiple ICU patients and how this information is used to support their prioritization of care among populations of acutely ill patients. Additionally, we wanted to gather insights on the organization of an Acute care multi-patient viewer (AMP) dashboard. METHODS We conducted and audio-recorded semi-structured interviews of ICU clinicians who had worked with the AMP in three quaternary care hospitals. The transcripts were analyzed with open, axial, and selective coding. Data was managed using NVivo 12 software. RESULTS We interviewed 20 clinicians and identified 5 main themes following data analysis: (1) strategies used to enable patient prioritization, (2) strategies used for optimizing task organization, (3) information and factors helpful for situational awareness within the ICU, (4) unrecognized or missed critical events and information, and (5) suggestions for AMP organization and content. Prioritization of critical care was largely determined by severity of illness and trajectory of patient clinical status. Important sources of information were communication with colleagues from the previous shift, bedside nurses, and patients, data from the electronic medical record and AMP, and physical presence and availability in the ICU. CONCLUSIONS This qualitative study explored ICU clinicians' information and process requirements to enable the prioritization of care among populations of acutely ill patients. Timely recognition of patients who need priority attention and intervention provides opportunities for improvement of critical care and for preventing catastrophic events in the ICU.
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Affiliation(s)
- Svetlana Herasevich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
| | - Yuliya Pinevich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN; Department of Anesthesiology, Republican Clinical Medical Center, Minsk, Belarus
| | - Heidi L Lindroth
- Department of Nursing, Mayo Clinic, Rochester, MN; Center for Health Innovation and Implementation Science, Center for Aging Research, School of Medicine, Indiana University, Indianapolis, IN
| | - Vitaly Herasevich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Brian W Pickering
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Amelia K Barwise
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN; Bioethics Research Program, Mayo Clinic, Rochester, MN
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Chipman SA, Meagher K, Barwise AK. A Public Health Ethics Framework for Populations with Limited English Proficiency. Am J Bioeth 2023:1-16. [PMID: 37379053 DOI: 10.1080/15265161.2023.2224263] [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] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
25.6 Million people in the United States have Limited English Proficiency (LEP), defined as insufficient ability to read, write, or understand English. We will (1) Delineate the merits of approaching language as a social determinant of health, (2) highlight pertinent public health values and guidelines which are most relevant to the plight of populations with LEP and (3) Use the COVID-19 pandemic as an example of how a breakdown in public health ethics values created harm for populations and patients with LEP. We define a framework to tease out public health responsibilities given some populations' limited proficiency in a society's predominant language. The American Public Health Association (APHA) public health ethics core values serve as a framework to interrogate current practices. We use the COVID-19 case to illustrate gaps between health policy and healthcare disparities experienced by populations with LEP.
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Barwise AK, Allyse MA, Hirsch JR, McGowan ML, Meaghar KM, Riggan KA. Wither Vulnerability? The Over/Under Protection Dilemma and Research Equity. Am J Bioeth 2023; 23:113-116. [PMID: 37220354 PMCID: PMC10753848 DOI: 10.1080/15265161.2023.2201201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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Herasevich S, Pinevich Y, Lipatov K, Barwise AK, Lindroth HL, LeMahieu AM, Dong Y, Herasevich V, Pickering BW. Evaluation of Digital Health Strategy to Support Clinician-Led Critically Ill Patient Population Management: A Randomized Crossover Study. Crit Care Explor 2023; 5:e0909. [PMID: 37151891 PMCID: PMC10158897 DOI: 10.1097/cce.0000000000000909] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023] Open
Abstract
To investigate whether a novel acute care multipatient viewer (AMP), created with an understanding of clinician information and process requirements, could reduce time to clinical decision-making among clinicians caring for populations of acutely ill patients compared with a widely used commercial electronic medical record (EMR). DESIGN Single center randomized crossover study. SETTING Quaternary care academic hospital. SUBJECTS Attending and in-training critical care physicians, and advanced practice providers. INTERVENTIONS AMP. MEASUREMENTS AND MAIN RESULTS We compared ICU clinician performance in structured clinical task completion using two electronic environments-the standard commercial EMR (Epic) versus the novel AMP in addition to Epic. Twenty subjects (10 pairs of clinicians) participated in the study. During the study session, each participant completed the tasks on two ICUs (7-10 beds each) and eight individual patients. The adjusted time for assessment of the entire ICU and the adjusted total time to task completion were significantly lower using AMP versus standard commercial EMR (-6.11; 95% CI, -7.91 to -4.30 min and -5.38; 95% CI, -7.56 to -3.20 min, respectively; p < 0.001). The adjusted time for assessment of individual patients was similar using both the EMR and AMP (0.73; 95% CI, -0.09 to 1.54 min; p = 0.078). AMP was associated with a significantly lower adjusted task load (National Aeronautics and Space Administration-Task Load Index) among clinicians performing the task versus the standard EMR (22.6; 95% CI, -32.7 to -12.4 points; p < 0.001). There was no statistically significant difference in adjusted total errors when comparing the two environments (0.68; 95% CI, 0.36-1.30; p = 0.078). CONCLUSIONS When compared with the standard EMR, AMP significantly reduced time to assessment of an entire ICU, total time to clinical task completion, and clinician task load. Additional research is needed to assess the clinicians' performance while using AMP in the live ICU setting.
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Affiliation(s)
- Svetlana Herasevich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Yuliya Pinevich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
- Department of Anesthesiology, Republican Clinical Medical Center, Minsk, Belarus
| | - Kirill Lipatov
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic Health Systems, Eau Claire, WI
| | - Amelia K Barwise
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
- Bioethics Research Program, Mayo Clinic, Rochester, MN
| | - Heidi L Lindroth
- Department of Nursing, Mayo Clinic, Rochester, MN
- Center for Health Innovation and Implementation Science, Center for Aging Research, School of Medicine, Indiana University, Indianapolis, IN
| | | | - Yue Dong
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Vitaly Herasevich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Brian W Pickering
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
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Pinevich Y, Barwise AK, Austin JM, Soleimani J, Herasevich S, Redmond S, Dong Y, Herasevich V, Gajic O, Pickering BW. Time to diagnostic certainty for saddle pulmonary embolism in hospitalized patients. Biomol Biomed 2023. [PMID: 36724023 PMCID: PMC10351091 DOI: 10.17305/bb.2022.8393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/10/2023] [Indexed: 01/16/2023]
Abstract
There is a lack of diagnostic performance measures associated with pulmonary embolism (PE). We aimed to explore the concept of the time to diagnostic certainty, which we defined as the time interval that elapses between first presentation of a patient to a confirmed PE diagnosis with computed tomography pulmonary angiogram (CT PA). This approach could be used to highlight variability in health system diagnostic performance, and to select patient outliers for structured chart review in order to identify underlying contributors to diagnostic error or delay. We performed a retrospective observational study at academic medical centers and associated community-based hospitals in one health system, examining randomly selected adult patients admitted to study sites with a diagnosis of acute saddle PE. One hundred patients were randomly selected from 340 patients discharged with saddle PE. Twenty-four patients were excluded. Among the 76 included patients, time to diagnostic certainty ranged from 1.5 to 310 hours. We found that 73/76 patients were considered to have PE present on admission (CT PA ≤ 48 hours). The proportion of patients with PE present on admission with time to diagnostic certainty of > 6 hours was 26% (19/73). The median (IQR) time to treatment (thrombolytics/anticoagulants) was 3.5 (2.5-5.1) hours among the 73 patients. The proportion of patients with PE present on admission with treatment delays of > 6 hours was 16% (12/73). Three patients acquired PE during hospitalization (CT PA > 48 hours). In this study, we developed and successfully tested the concept of time to diagnostic certainty for saddle PE.
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Affiliation(s)
- Yuliya Pinevich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Amelia K Barwise
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Jalal Soleimani
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Svetlana Herasevich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sarah Redmond
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Yue Dong
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Vitaly Herasevich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ognjen Gajic
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Brian W Pickering
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
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Pinevich Y, Barwise AK, Austin JM, Soleimani J, Herasevich S, Redmond S, Dong Y, Herasevich V, Gajic O, Pickering BW. Time to diagnostic certainty for saddle pulmonary embolism in hospitalized patients. Biomol Biomed 2023. [PMID: 36724023 DOI: 10.17305/bjbms.2022.8393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/10/2023] [Indexed: 02/02/2023]
Abstract
There is a lack of diagnostic performance measures associated with pulmonary embolism (PE). We aimed to explore the concept of the time to diagnostic certainty, which we defined as the time interval that elapses between first presentation of a patient to a confirmed PE diagnosis with computed tomography pulmonary angiogram (CT PA). This approach could be used to highlight variability in health system diagnostic performance, and to select patient outliers for structured chart review in order to identify underlying contributors to diagnostic error or delay. We performed a retrospective observational study at academic medical centers and associated community-based hospitals in one health system, examining randomly selected adult patients admitted to study sites with a diagnosis of acute saddle PE. One hundred patients were randomly selected from 340 patients discharged with saddle PE. Twenty-four patients were excluded. Among the 76 included patients, time to diagnostic certainty ranged from 1.5 to 310 hours. We found that 73/76 patients were considered to have PE present on admission (CT PA ≤ 48 hours). The proportion of patients with PE present on admission with time to diagnostic certainty of > 6 hours was 26% (19/73). The median (IQR) time to treatment (thrombolytics/anticoagulants) was 3.5 (2.5-5.1) hours among the 73 patients. The proportion of patients with PE present on admission with treatment delays of > 6 hours was 16% (12/73). Three patients acquired PE during hospitalization (CT PA > 48 hours). In this study, we developed and successfully tested the concept of time to diagnostic certainty for saddle PE.
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Affiliation(s)
- Yuliya Pinevich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Amelia K Barwise
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Jalal Soleimani
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Svetlana Herasevich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sarah Redmond
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Yue Dong
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Vitaly Herasevich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ognjen Gajic
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Brian W Pickering
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
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14
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Barwise AK, Moriarty JP, Rosedahl JK, Soleimani J, Marquez A, Weister TJ, Gajic O, Borah BJ. Comparative costs for critically ill patients with limited English proficiency versus English proficiency. PLoS One 2023; 18:e0279126. [PMID: 37186248 PMCID: PMC10132690 DOI: 10.1371/journal.pone.0279126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 11/30/2022] [Indexed: 05/17/2023] Open
Abstract
OBJECTIVES To conduct comparative cost analysis of hospital care for critically ill patients with Limited English Proficiency (LEP) versus patients with English proficiency (controls). PATIENTS AND METHODS We conducted a historical cohort study using propensity matching at Mayo Clinic Rochester, a quaternary care academic center. We included hospitalized patients who had at least one admission to ICU during a 10-year period between 1/1/2008-12/31/2017. RESULTS Due to substantial differences in baseline characteristics of the groups, propensity matching for the covariates age, sex, race, ethnicity, APACHE 3 score, and Charlson Comorbidity score was used, and we achieved the intended balance. The final cohort included 80,404 patients, 4,246 with LEP and 76,158 controls. Patients with LEP had higher costs during hospital admission to discharge, with a mean cost difference of $3861 (95% CI $822 to $6900, p = 0.013) and also higher costs during index ICU admission to hospital discharge, with a mean cost difference of $3166 (95% CI $231 to $6101, p = 0.035). A propensity matched cohort including only those that survived showed those with LEP had significantly greater mean costs for all outcomes. Sensitivity analysis revealed that international patients with LEP had significantly greater overall hospital costs of $9,240 than patients with LEP who resided in the US (95% CI $3341 to $15,140, p = 0.002). CONCLUSION This is the first study to demonstrate significantly higher costs for patients with LEP experiencing a critical illness. The causes for this may be increased healthcare utilization secondary to communication deficiencies that impede timely decision making about care.
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Affiliation(s)
- Amelia K Barwise
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
- Bioethics Research Program, Mayo Clinic, Rochester, Minnesota, United States of America
| | - James P Moriarty
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Jordan K Rosedahl
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Jalal Soleimani
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Alberto Marquez
- Anesthesia Clinical Research Unit (ACRU), Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Timothy J Weister
- Anesthesia Clinical Research Unit (ACRU), Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Ognjen Gajic
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Bijan J Borah
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, United States of America
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15
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Lindroth HL, Pinevich Y, Barwise AK, Fathma S, Diedrich D, Pickering BW, Herasevich V. Information and Data Visualization Needs among Direct Care Nurses in the Intensive Care Unit. Appl Clin Inform 2022; 13:1207-1213. [PMID: 36577501 PMCID: PMC9797346 DOI: 10.1055/s-0042-1758735] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES Intensive care unit (ICU) direct care nurses spend 22% of their shift completing tasks within the electronic health record (EHR). Miscommunications and inefficiencies occur, particularly during patient hand-off, placing patient safety at risk. Redesigning how direct care nurses visualize and interact with patient information during hand-off is one opportunity to improve EHR use. A web-based survey was deployed to better understand the information and visualization needs at patient hand-off to inform redesign. METHODS A multicenter anonymous web-based survey of direct care ICU nurses was conducted (9-12/2021). Semi-structured interviews with stakeholders informed survey development. The primary outcome was identifying primary EHR data needs at patient hand-off for inclusion in future EHR visualization and interface development. Secondary outcomes included current use of the EHR at patient hand-off, EHR satisfaction, and visualization preferences. Frequencies, means, and medians were calculated for each data item then ranked in descending order to generate proportional quarters using SAS v9.4. RESULTS In total, 107 direct care ICU nurses completed the survey. The majority (46%, n = 49/107) use the EHR at patient hand-off to verify exchanged verbal information. Sixty-four percent (n = 68/107) indicated that current EHR visualization was insufficient. At the start of an ICU shift, primary EHR data needs included hemodynamics (mean 4.89 ± 0.37, 98%, n = 105), continuous IV medications (4.55 ± 0.73, 93%, n = 99), laboratory results (4.60 ± 0.56, 96%, n = 103), mechanical circulatory support devices (4.62 ± 0.72, 90%, n = 97), code status (4.40 ± 0.85, 59%, n = 108), and ventilation status (4.35 + 0.79, 51%, n = 108). Secondary outcomes included mean EHR satisfaction of 65 (0-100 scale, standard deviation = ± 21) and preferred future EHR user-interfaces to be organized by organ system (53%, n = 57/107) and visualized by tasks/schedule (61%, n = 65/107). CONCLUSION We identified information and visualization needs of direct care ICU nurses. The study findings could serve as a baseline toward redesigning an EHR interface.
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Affiliation(s)
- Heidi L. Lindroth
- Department of Nursing, Mayo Clinic, Rochester, Minnesota, United States,Center for Aging Research, Regenstrief Institute, School of Medicine, Indiana University, Indianapolis, Indiana, United States,Address for correspondence Heidi L. Lindroth, PhD RN Department of Nursing, Mayo Clinic200 First Street SW, Rochester, MN 55905United States
| | - Yuliya Pinevich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States,Department of Anesthesiology and Intensive Care for Cardiac Surgery, Republican Clinical Medical Center, Belarus
| | - Amelia K. Barwise
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Sawsan Fathma
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Daniel Diedrich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Brian W. Pickering
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Vitaly Herasevich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States
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16
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Herasevich S, Lindroth HL, Pinevich Y, Lipatov K, Tekin A, Herasevich V, Pickering BW, Barwise AK. The authors reply. Crit Care Med 2022; 50:e804-e805. [PMID: 36227053 DOI: 10.1097/ccm.0000000000005664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Svetlana Herasevich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Heidi L Lindroth
- Department of Nursing, Mayo Clinic, Rochester, MN
- Center for Health Innovation and Implementation Science, Center for Aging Research, School of Medicine, Indiana University, Indianapolis, IN
| | - Yuliya Pinevich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Kirill Lipatov
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Aysun Tekin
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Vitaly Herasevich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Brian W Pickering
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Amelia K Barwise
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
- Bioethics Research Program, Mayo Clinic, Rochester, MN
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17
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Malnoske ML, Quill CM, Barwise AK, Pietropaoli AP. Disparities in Lung-Protective Ventilation in the United States. Cureus 2022; 14:e29834. [PMID: 36337793 PMCID: PMC9625078 DOI: 10.7759/cureus.29834] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2022] [Indexed: 06/16/2023] Open
Abstract
Background The objective of our study was to determine whether disparities exist in the use of lung-protective ventilation for critically ill mechanically ventilated patients in the United States based on gender, race/ethnicity, or insurance status. Methods This was a secondary data analysis of a prospective multicenter cohort study conducted from 2010 to 2012. The outcome of interest was the proportion of patients receiving tidal volume > 8 mL/kg predicted body weight (PBW). Results There were 1,595 patients in our primary analysis (710 women, 885 men). Women were more likely to receive tidal volumes > 8 mL/kg PBW than men (odds ratio [OR] = 3.42, 95% confidence interval [CI] = 2.67-4.40), a finding largely but not completely explained by gender differences in height. The underinsured were significantly more likely to receive tidal volume > 8 mL/kg PBW than the insured in multivariable analysis (OR = 1.54, 95% CI = 1.16-2.04). The prescription of > 8 mL/kg PBW tidal volume did not differ by racial or ethnic categories. Conclusions In this prospective nationwide cohort of critically ill mechanically ventilated patients, women and the underinsured were less likely than their comparators to receive lung-protective ventilation, with no apparent differences based on race/ethnicity alone.
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Affiliation(s)
- Michelle L Malnoske
- Division of Pulmonary and Critical Care Medicine, University of Rochester Medical Center, Rochester, USA
| | - Caroline M Quill
- Division of Pulmonary and Critical Care Medicine, University of Rochester Medical Center, Rochester, USA
| | - Amelia K Barwise
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, USA
| | - Anthony P Pietropaoli
- Division of Pulmonary and Critical Care Medicine, University of Rochester Medical Center, Rochester, USA
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18
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Huang C, Gao S, Barwise AK, Lai X, Huang W, Xiao Y, Wang Z. The impact of COVID-19 pandemic on the initiation of interventional clinical trials conducted in intensive care units. J Crit Care 2022; 69:154019. [PMID: 35290933 PMCID: PMC8917824 DOI: 10.1016/j.jcrc.2022.154019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 02/15/2022] [Accepted: 03/04/2022] [Indexed: 10/29/2022]
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19
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Soleimani J, Marquez A, Fathma S, Weister TJ, Barwise AK. Detecting professional interpreter use among patients with limited English proficiency: Derivation and validation study. SAGE Open Med 2022; 10:20503121221098146. [PMID: 35600712 PMCID: PMC9118401 DOI: 10.1177/20503121221098146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 04/13/2022] [Indexed: 11/23/2022] Open
Abstract
Objectives: The objective of this derivation and validation study was to develop and validate a search strategy algorithm to detect patients who used professional interpreter services. Methods: We identified all adults who had at least one intensive care unit admission during their hospital stay across the Mayo Clinic Enterprise between 1 January 2015 and 30 June 2020. Three random subsets of 100 patients were extracted from 60,268 patients to develop the search strategy algorithm. Two physician reviewers conducted gold standard manual chart review and any discrepancies were resolved by a third reviewer. These results were compared with the search strategy algorithm each time it was refined. Sensitivity and specificity were calculated during each phase by comparing the search strategy results to the reference gold standard for both derivation cohorts and the final validation cohort. Results: The first search strategy resulted in a sensitivity of 100% and a specificity of 89%. The second revised search strategy achieved a sensitivity of 100% and a specificity of 87%. The final version of the search strategy was applied to the validation subset and sensitivity and specificity were 100% and 89%, respectively. Conclusion: We derived and validated a search strategy algorithm to assess interpreter use among hospitalized patients. Using a search strategy algorithm with high sensitivity and specificity can reduce the time required to abstract data from the electronic medical records compared with manual data abstraction.
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Affiliation(s)
- Jalal Soleimani
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
- Amelia Barwise, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Alberto Marquez
- Anesthesia Clinical Research Unit (ACRU), Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sawsan Fathma
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Timothy J Weister
- Anesthesia Clinical Research Unit (ACRU), Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Amelia K Barwise
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
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20
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Huang L, Cleveland T, Clift K, Egginton JS, Pacheco-Spann L, Johnson MG, Albertie M, Cardenas LD, Phelan SM, Allyse MA, Barwise AK. Key Stakeholder Perspectives of Community Engagement Efforts and the Impact of the Covid-19 Pandemic. J Prim Care Community Health 2022; 13:21501319221133076. [PMID: 36331120 PMCID: PMC9638525 DOI: 10.1177/21501319221133076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introduction: The COVID-19 pandemic has disproportionally affected historically
marginalized populations and their access to resources and healthcare. In
times of crisis, authentic community engagement is more important than ever.
This study was Phase 1 of a larger 3-phase study to conduct timely
community-engaged research with community members to understand the
disproportionate impact of COVID-19 on historically underserved communities.
The objective of this work was to conduct key informant (KI) interviews (1)
to understand community organizations perspectives about the role that large
academic health centers play as they interface with community organizations
to support their work, (2) to leverage KI’s expertise to identify needs and
assets within the community, and (3) to inform both Phase 2 (focus group
qualitative research) and Phase 3 (survey) of the broader study. Methods: A total of 24 key informants were identified through purposeful sampling and
one-on-one semi-structured interviews were conducted across 4 states using
video conferencing. Results: Barriers to access and lack of transparency were highlighted as major issues
requiring reform—in particular, aggressive billing practices and insurance
barriers exacerbated local distrust of medical institutions. KIs recognized
the health institution’s support for testing and vaccination during the
COVID-19 pandemic, but noted other significant gaps in care, especially
regarding mental health support. Although communication with the health
institution was consistent for some KIs, others experienced unsustained
communication efforts that hindered cooperation and relationship
building. Conclusions: Leaders in the community as key stakeholders can provide unique insights into
the challenges and potential solutions required to promote health equity,
and foster understanding between local communities and healthcare
institutions.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Megan A. Allyse
- Mayo Clinic, Jacksonville, FL, USA
- Mayo Clinic, Rochester, MN, USA
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21
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Suarez NRE, Urtecho M, Jubran S, Yeow ME, Wilson ME, Boehmer KR, Barwise AK. The Roles of medical interpreters in intensive care unit communication: A qualitative study. Patient Educ Couns 2021; 104:1100-1108. [PMID: 33168459 PMCID: PMC8068732 DOI: 10.1016/j.pec.2020.10.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 10/08/2020] [Accepted: 10/10/2020] [Indexed: 05/22/2023]
Abstract
OBJECTIVES To understand healthcare team perceptions of the role of professional interpreters and interpretation modalities during end of life and critical illness discussions with patients and families who have limited English proficiency in the intensive care unit (ICU). METHODS We did a secondary analysis of data from a qualitative study with semi-structured interviews of 16 physicians, 12 nurses, and 12 professional interpreters from 3 ICUs at Mayo Clinic, Rochester. RESULTS We identified 3 main role descriptions for professional interpreters: 1) Verbatim interpretation; interpreters use literal interpretation; 2) Health Literacy Guardian; interpreters integrate advocacy into their role; 3) Cultural Brokers; interpreters transmit information incorporating cultural nuances. Clinicians expressed advantages and disadvantages of different interpretation modalities on the professional interpreter's role in the ICU. CONCLUSION Our study illuminates different professional interpreters' roles. Furthermore, we describe the perceived relationship between interpretation modalities and the interpreter's roles and influence on communication dynamics in the ICU for patients with LEP. PRACTICE IMPLICATIONS Patients benefit from having an interpreter, who can function as a cultural broker or literacy guardian during communication in the ICU setting where care is especially complex, good communication is vital, and decision making is challenging.
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Affiliation(s)
| | - Meritxell Urtecho
- Knowledge and Evaluation Research Unit (KER), Mayo Clinic, Rochester, Minnesota, USA.
| | - Samira Jubran
- Language Services, Mayo Clinic, Rochester, Minnesota, USA.
| | - Mei-Ean Yeow
- Center For Palliative Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
| | - Michael E Wilson
- Knowledge and Evaluation Research Unit (KER), Mayo Clinic, Rochester, Minnesota, USA; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA.
| | - Kasey R Boehmer
- Knowledge and Evaluation Research Unit (KER), Mayo Clinic, Rochester, Minnesota, USA.
| | - Amelia K Barwise
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA; Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, USA.
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23
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Espinoza Suarez NR, Urtecho M, Nyquist CA, Jaramillo C, Yeow ME, Thorsteinsdottir B, Wilson ME, Barwise AK. Consequences of suboptimal communication for patients with limited English proficiency in the intensive care unit and suggestions for a way forward: A qualitative study of healthcare team perceptions. J Crit Care 2021; 61:247-251. [PMID: 33221592 PMCID: PMC8423101 DOI: 10.1016/j.jcrc.2020.10.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 12/03/2019] [Revised: 03/14/2020] [Accepted: 10/13/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To understand the healthcare team's perceptions of the negative consequences of suboptimal communication and their recommendations to improve communication with patients and families who have Limited English Proficiency (LEP) in the Intensive Care Unit (ICU). MATERIALS AND METHODS We performed a qualitative study using semi-structured interviews of physicians, nurses, and interpreters from 3 ICUs at Mayo Clinic Rochester, between November 2017 and April 2018. RESULTS We identified 5 consequences of suboptimal communication: 1) Suboptimal assessment and treatment of patient symptoms, 2) Unmet patient and family expectations, 3) Decreased patient autonomy, 4) Unmet end of life wishes and 5) Clinician Distress. Recommendations to improve communication include: 1) Education and training for patients,families, clinicians and interpreters, 4) Greater integration of interpreters into the ICU team 5) Standardized timeline for goals of care conversations with patients and families with LEP. CONCLUSIONS Patients with LEP are at risk of experiencing suboptimal communication with the healthcare team in the ICU. There are several educational and quality improvement strategies that ICUs and institutions can take to mitigate these issues.
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Affiliation(s)
- Nataly R Espinoza Suarez
- Knowledge and Evaluation Research Unit (KER), Mayo Clinic, Rochester, MN, United States of America.
| | - Meritxell Urtecho
- Knowledge and Evaluation Research Unit (KER), Mayo Clinic, Rochester, MN, United States of America.
| | - Christina A Nyquist
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, United States of America; University of Minnesota Medical School, Duluth Campus, MN, United States of America.
| | - Carolina Jaramillo
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Mei-Ean Yeow
- Division of Palliative Medicine, Mayo Clinic, Rochester, MN, United States of America.
| | - Bjorg Thorsteinsdottir
- Knowledge and Evaluation Research Unit (KER), Mayo Clinic, Rochester, MN, United States of America; Department of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, United States of America; Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, United States of America.
| | - Michael E Wilson
- Knowledge and Evaluation Research Unit (KER), Mayo Clinic, Rochester, MN, United States of America; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States of America.
| | - Amelia K Barwise
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States of America; Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, United States of America.
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24
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Huang C, Soleimani J, Herasevich S, Pinevich Y, Pennington KM, Dong Y, Pickering BW, Barwise AK. Clinical Characteristics, Treatment, and Outcomes of Critically Ill Patients With COVID-19: A Scoping Review. Mayo Clin Proc 2021; 96:183-202. [PMID: 33413817 PMCID: PMC7586927 DOI: 10.1016/j.mayocp.2020.10.022] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [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: 07/17/2020] [Revised: 10/14/2020] [Accepted: 10/21/2020] [Indexed: 01/08/2023]
Abstract
A growing number of studies on coronavirus disease 2019 (COVID-19) are becoming available, but a synthesis of available data focusing on the critically ill population has not been conducted. We performed a scoping review to synthesize clinical characteristics, treatment, and clinical outcomes among critically ill patients with COVID-19. Between January 1, 2020, and May 15, 2020, we identified high-quality clinical studies describing critically ill patients with a sample size of greater than 20 patients by performing daily searches of the World Health Organization and LitCovid databases on COVID-19. Two reviewers independently reviewed all abstracts (2785 unique articles), full text (218 articles), and abstracted data (92 studies). The 92 studies included 61 from Asia, 16 from Europe, 10 from North and South America, and 5 multinational studies. Notable similarities among critically ill populations across all regions included a higher proportion of older males infected and with severe illness, high frequency of comorbidities (hypertension, diabetes, and cardiovascular disease), abnormal chest imaging findings, and death secondary to respiratory failure. Differences in regions included newly identified complications (eg, pulmonary embolism) and epidemiological risk factors (eg, obesity), less chest computed tomography performed, and increased use of invasive mechanical ventilation (70% to 100% vs 15% to 47% of intensive care unit patients) in Europe and the United States compared with Asia. Future research directions should include proof-of-mechanism studies to better understand organ injuries and large-scale collaborative clinical studies to evaluate the efficacy and safety of antivirals, antibiotics, interleukin 6 receptor blockers, and interferon. The current established predictive models require further verification in other regions outside China.
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Key Words
- acei, angiotensin-converting enzyme inhibitor
- apache, acute physiology and chronic health evaluation
- arb, angiotensin receptor blocker
- ards, acute respiratory distress syndrome
- covid-19, coronavirus disease 2019
- crp, c-reactive protein
- ct, computed tomography
- eua, emergency use authorization
- hfnc, high-flow nasal cannula oxygen therapy
- icu, intensive care unit
- if, impact factor
- il, interleukin
- imv, invasive mechanical ventilation
- los, length of stay
- nimv, noninvasive mechanical ventilation
- pe, pulmonary embolism
- rct, randomized clinical trial
- sars-cov-2, severe acute respiratory syndrome coronavirus 2
- sofa, sequential organ failure assessment
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Affiliation(s)
- Chanyan Huang
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN; Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
| | - Jalal Soleimani
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Svetlana Herasevich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Yuliya Pinevich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Kelly M Pennington
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Yue Dong
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Brian W Pickering
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Amelia K Barwise
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
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Soleimani J, Pinevich Y, Barwise AK, Huang C, Dong Y, Herasevich V, Gajic O, Pickering BW. Feasibility and Reliability Testing of Manual Electronic Health Record Reviews as a Tool for Timely Identification of Diagnostic Error in Patients at Risk. Appl Clin Inform 2020; 11:474-482. [PMID: 32668480 DOI: 10.1055/s-0040-1713750] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Although diagnostic error (DE) is a significant problem, it remains challenging for clinicians to identify it reliably and to recognize its contribution to the clinical trajectory of their patients. The purpose of this work was to evaluate the reliability of real-time electronic health record (EHR) reviews using a search strategy for the identification of DE as a contributor to the rapid response team (RRT) activation. OBJECTIVES Early and accurate recognition of critical illness is of paramount importance. The objective of this study was to test the feasibility and reliability of prospective, real-time EHR reviews as a means of identification of DE. METHODS We conducted this prospective observational study in June 2019 and included consecutive adult patients experiencing their first RRT activation. An EHR search strategy and a standard operating procedure were refined based on the literature and expert clinician inputs. Two physician-investigators independently reviewed eligible patient EHRs for the evidence of DE within 24 hours after RRT activation. In cases of disagreement, a secondary review of the EHR using a taxonomy approach was applied. The reviewers categorized patient experience of DE as Yes/No/Uncertain. RESULTS We reviewed 112 patient records. DE was identified in 15% of cases by both reviewers. Kappa agreement with the initial review was 0.23 and with the secondary review 0.65. No evidence of DE was detected in 60% of patients. In 25% of cases, the reviewers could not determine whether DE was present or absent. CONCLUSION EHR review is of limited value in the real-time identification of DE in hospitalized patients. Alternative approaches are needed for research and quality improvement efforts in this field.
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Affiliation(s)
- Jalal Soleimani
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Yuliya Pinevich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Amelia K Barwise
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Chanyan Huang
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States.,Department of Anesthesiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Yue Dong
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Vitaly Herasevich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Ognjen Gajic
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Brian W Pickering
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States
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26
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Barwise AK, Wilson ME, Sharp RR, DeMartino ES. Ethical Considerations About Clinician Reimbursement for Advance Care Planning. Mayo Clin Proc 2020; 95:653-657. [PMID: 32247339 PMCID: PMC7709876 DOI: 10.1016/j.mayocp.2019.12.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 11/19/2019] [Accepted: 12/16/2019] [Indexed: 10/24/2022]
Affiliation(s)
- Amelia K Barwise
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
| | - Michael E Wilson
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
| | - Richard R Sharp
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN
| | - Erin S DeMartino
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
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27
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Barwise AK, Patten CA, Bock MJ, Hughes CA, Brockman TA, Valdez Soto MA, Wi CI, Juhn YJ, Witt DR, Sinicrope S, Kreps SR, Saling HD, Levine JA, Balls-Berry JE. Acceptability of Robotic-Assisted Exercise Coaching Among Diverse Youth: Pilot Study. JMIR Pediatr Parent 2019; 2:e12549. [PMID: 31518333 PMCID: PMC6715060 DOI: 10.2196/12549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 04/11/2019] [Accepted: 04/30/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Almost 80% of adolescents do not achieve 60 minutes or more of physical activity each day as recommended by current US national guidelines. There is a need to develop and promote interventions that increase physical activity among adolescents. With increased interest in digital technologies among adolescents, robotic-assisted platforms are a novel and engaging strategy to deliver physical activity interventions. OBJECTIVE This study sought to assess the potential acceptability of robotic-assisted exercise coaching among diverse youth and to explore demographic factors associated with acceptance. METHODS This pilot study used a cross-sectional survey design. We recruited adolescents aged 12-17 years at three community-based sites in Rochester, MN. Written informed consent was obtained from participants' parents or guardians and participants gave consent. Participants watched a brief demonstration of the robotic system-human interface (ie, robotic human trainer). The exercise coaching was delivered in real time via an iPad tablet placed atop a mobile robotic wheel base and controlled remotely by the coach using an iOS device or computer. Following the demonstration, participants completed a 28-item survey that assessed sociodemographic information, smoking and depression history, weight, and exercise habits; the survey also included the eight-item Technology Acceptance Scale (TAS), a validated instrument used to assess perceived usefulness and ease of use of new technologies. RESULTS A total of 190 adolescents participated in this study. Of the participants, 54.5% were (103/189) male, 42.6% (81/190) were racial minorities, 5.8% (11/190) were Hispanic, and 28.4% (54/190) lived in a lower-income community. Their mean age was 15.0 years (SD 2.0). A total of 24.7% (47/190) of participants met national recommendations for physical activity. Their mean body mass index (BMI) was 21.8 kg/m2 (SD 4.0). Of note, 18.4% (35/190) experienced depression now or in the past. The mean TAS total score was 32.8 (SD 7.8) out of a possible score of 40, indicating high potential receptivity to the technology. No significant associations were detected between TAS score and gender, age, racial minority status, participant neighborhood, BMI, meeting national recommendations for physical activity levels, or depression history (P>.05 for all). Of interest, 67.8% (129/190) of participants agreed that they and their friends were likely to use the robot to help them exercise. CONCLUSIONS This preliminary study found that among a racially and socioeconomically diverse group of adolescents, robotic-assisted exercise coaching is likely acceptable. The finding that all demographic groups represented had similarly high receptivity to the robotic human exercise trainer is encouraging for ultimate considerations of intervention scalability and reach among diverse adolescent populations. Next steps will be to evaluate consumer preferences for robotic-assisted exercise coaching (eg, location, duration, supervised or structured, choice of exercise, and/or lifestyle activity focus), develop the treatment protocol, and evaluate feasibility and consumer uptake of the intervention among diverse youth.
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Affiliation(s)
- Amelia K Barwise
- Clinical and Translational Science PhD Program, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN, United States.,Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States
| | - Christi A Patten
- Department of Psychiatry and Psychology, Behavioral Health Research Program, Minnesota BioBusiness Center, Mayo Clinic, Rochester, MN, United States
| | - Martha J Bock
- Department of Psychiatry and Psychology, Behavioral Health Research Program, Minnesota BioBusiness Center, Mayo Clinic, Rochester, MN, United States
| | - Christine A Hughes
- Department of Psychiatry and Psychology, Behavioral Health Research Program, Minnesota BioBusiness Center, Mayo Clinic, Rochester, MN, United States
| | - Tabetha A Brockman
- Center for Clinical and Translational Science,Community Engagement Program, Department of Psychiatry and Psychology, Minnesota BioBusiness Center, Mayo Clinic, Rochester, MN, United States
| | - Miguel A Valdez Soto
- Center for Clinical and Translational Science, Community Engagement Program, Mayo Clinic, Rochester, MN, United States
| | - Chung-Il Wi
- Asthma Epidemiology Research Unit and Community Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, United States
| | - Young J Juhn
- Asthma Epidemiology Research Unit and Community Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, United States
| | - Daniel R Witt
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, MN, United States
| | - Stephen Sinicrope
- Department of Psychiatry and Psychology, Behavioral Health Research Program, Minnesota BioBusiness Center, Mayo Clinic, Rochester, MN, United States
| | - Samantha R Kreps
- Health Sciences, University of Minnesota, Rochester, MN, United States.,Center for Clinical and Translational Science, Community Engagement Program, Minnesota BioBusiness Center, Mayo Clinic, Rochester, MN, United States
| | - Henry D Saling
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - James A Levine
- Fondation Ipsen, Paris, France.,Division of Endocrinology, Department of Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - Joyce E Balls-Berry
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN, United States
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28
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O'Horo JC, Marcelin JR, Abu Saleh OM, Barwise AK, Odean PM, Rivera CG, Tande AJ, Wilson JW, Osmon DR, Tosh PK. Standardizing Febrile Neutropenia Management: Antimicrobial Stewardship in the Hematologic Malignancy Population. J Oncol Pract 2019; 15:e843-e848. [PMID: 31322989 DOI: 10.1200/jop.18.00775] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Patients with febrile neutropenia (FN) often are subject to antibiotic and diagnostic test overuse. We sought to improve appropriate use of antimicrobials and diagnostic tests for patients with FN. We used a blended quality approach with Lean Six Sigma tools and iterative improvement of a clinical decision aid to guide providers through empirical antimicrobial selection and diagnostic evaluation of patients with FN during a yearlong period. We evaluated the incidence of nonadherence to best practice before, during, and after rollout of a clinical decision aid in conjunction with an educational initiative. At baseline, 71% of patients with FN had at least one critical deviation from best practice. During the project, the percentage decreased to 27.3%; 4 months after the project was completed, the percentage was 33.3% (P = .04). A clinical decision aid can improve adherence to best practices for the empirical management of FN.
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Affiliation(s)
- John C O'Horo
- Mayo Clinic, Rochester, MN.,Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC) Group, Mayo Clinic, Rochester, MN
| | | | | | - Amelia K Barwise
- Mayo Clinic, Rochester, MN.,Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC) Group, Mayo Clinic, Rochester, MN
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