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Bouchelle Z, G. Menko S, Yazdani M, Vasan A, Scribano P, Shea JA, Kenyon CC. Parent Perspectives on Documentation and Sharing of Health-Related Social Needs Data. Hosp Pediatr 2024; 14:308-316. [PMID: 38477053 PMCID: PMC10965757 DOI: 10.1542/hpeds.2023-007478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2023] [Indexed: 03/14/2024]
Abstract
OBJECTIVE Parents of pediatric patients are key stakeholders in the design and implementation of health-related social needs (HRSN) screening programs. Yet, there is little research exploring their perspectives on the documentation and sharing of HRSN data. We aimed to examine parents' preferences regarding how HRSN data are documented and shared. METHODS We conducted semi-structured interviews with parents of hospitalized children participating in an HRSN screening program at a quaternary care children's hospital. Interviews were coded using an inductive and deductive approach to identify emergent themes. RESULTS The 20 interviewed parents were uniformly female with 55% identifying as Black or African American and 20% identifying as Hispanic or Latino. Parents expressed comfort with electronic health record documentation of HRSN data and the use of International Classification of Diseases, 10th Revision Z codes as long as this information was used to provide families with meaningful support. Most parents viewed social workers and medical teams as the most appropriate recipients of HRSN data. Few parents felt comfortable with HRSN data being shared with payors. Parents desired transparency around HRSN data sharing. Many expressed concerns that documentation and sharing of HRSN data could lead to unwanted or unsafe disclosures or result in child welfare referrals. CONCLUSIONS Parents expressed comfort with HRSN documentation and sharing with health care providers, but requested that providers be transparent and respect parental preferences regarding data sharing to mitigate potential harms. When implementing HRSN support programs, health systems and payors should prioritize transparency around documentation and data sharing with families.
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Affiliation(s)
- Zoe Bouchelle
- National Clinician Scholars Program
- Department of Pediatrics
- Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- PolicyLab
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Mishaal Yazdani
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Aditi Vasan
- Department of Pediatrics
- Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- PolicyLab
- Clinical Futures
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Philip Scribano
- Department of Pediatrics
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Judy A. Shea
- University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Chén C. Kenyon
- Department of Pediatrics
- Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- PolicyLab
- Clinical Futures
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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Bouchelle Z, Yazdani M, Dalembert G, Negro D, Jenssen BP, Virudachalam S, Shea JA, Gwynn K, Morrow K, Kenyon CC. Low-Income Caregiver Perspectives on a State Education Savings Program and Receptivity to Clinic-Based Financial Counseling. Acad Pediatr 2024; 24:494-502. [PMID: 37611694 DOI: 10.1016/j.acap.2023.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/09/2023] [Accepted: 08/14/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND AND OBJECTIVE In 2019, Pennsylvania launched a Children's Development Account (CDA) program that invests $100 in an education savings account for every child born in the state. However, as of 2021, only 10.6% of families claimed the investment. Low-income communities may stand to benefit most from educational investments, but few studies have assessed barriers and facilitators of uptake in these communities. We sought to examine low-income caregivers' perceptions of and barriers and facilitators to participation in a statewide CDA program and their receptivity to clinic-based financial counseling through a medical financial partnership. METHODS We surveyed 100 caregivers of Medicaid-insured children from 2 primary care practices serving a predominantly low-income community. From these 100, we purposively sampled 30 caregivers for follow-up interviews. RESULTS The 100 survey participants were predominantly female (83%), Black or African American (92%), and non-Hispanic or Latino (93%). Twenty-nine percent of survey participants were aware of the CDA program, 4% had enrolled, and 64% were interested in clinic-based financial counseling. In interviews, caregivers identified several barriers to and facilitators of engagement in the CDA program. They also identified several strategies to boost engagement, including simplifying registration, providing additional and personalized program information, expanding the investment amount, and providing clinic- and community-based outreach. CONCLUSIONS Low-income caregivers identified several barriers to enrollment in a statewide CDA program and strategies to boost enrollment, including clinic-based financial counseling. Future research should examine the effectiveness, cost-effectiveness, and long-term financial and health consequences of clinic-based financial services for low-income families.
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Affiliation(s)
- Zoe Bouchelle
- National Clinician Scholars Program (Z Bouchelle), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Pediatrics (Z Bouchelle, G Dalembert, BP Jenssen, S Virudachalam, and CC Kenyon), Perelman School of Medicine, University of Pennsylvania, Philadelphia; PolicyLab (Z Bouchelle, M Yazdani, G Dalembert, BP Jenssen, S Virudachalam, K Gwynn, K Morrow, and CC Kenyon), Children's Hospital of Philadelphia, Pa; Leonard Davis Institute of Health Economics (Z Bouchelle, G Dalembert, BP Jenssen, S Virudachalam, and CC Kenyon), Perelman School of Medicine, University of Pennsylvania, Philadelphia.
| | - Mishaal Yazdani
- PolicyLab (Z Bouchelle, M Yazdani, G Dalembert, BP Jenssen, S Virudachalam, K Gwynn, K Morrow, and CC Kenyon), Children's Hospital of Philadelphia, Pa.
| | - George Dalembert
- Department of Pediatrics (Z Bouchelle, G Dalembert, BP Jenssen, S Virudachalam, and CC Kenyon), Perelman School of Medicine, University of Pennsylvania, Philadelphia; PolicyLab (Z Bouchelle, M Yazdani, G Dalembert, BP Jenssen, S Virudachalam, K Gwynn, K Morrow, and CC Kenyon), Children's Hospital of Philadelphia, Pa; Leonard Davis Institute of Health Economics (Z Bouchelle, G Dalembert, BP Jenssen, S Virudachalam, and CC Kenyon), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Clinical Futures (G Dalembert, BP Jenssen, S Virudachalam, and CC Kenyon), Children's Hospital of Philadelphia, Pa.
| | - DanaRose Negro
- Perelman School of Medicine (D Negro), University of Pennsylvania, Philadelphia, Pa.
| | - Brian P Jenssen
- Department of Pediatrics (Z Bouchelle, G Dalembert, BP Jenssen, S Virudachalam, and CC Kenyon), Perelman School of Medicine, University of Pennsylvania, Philadelphia; PolicyLab (Z Bouchelle, M Yazdani, G Dalembert, BP Jenssen, S Virudachalam, K Gwynn, K Morrow, and CC Kenyon), Children's Hospital of Philadelphia, Pa; Leonard Davis Institute of Health Economics (Z Bouchelle, G Dalembert, BP Jenssen, S Virudachalam, and CC Kenyon), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Clinical Futures (G Dalembert, BP Jenssen, S Virudachalam, and CC Kenyon), Children's Hospital of Philadelphia, Pa.
| | - Senbagam Virudachalam
- Department of Pediatrics (Z Bouchelle, G Dalembert, BP Jenssen, S Virudachalam, and CC Kenyon), Perelman School of Medicine, University of Pennsylvania, Philadelphia; PolicyLab (Z Bouchelle, M Yazdani, G Dalembert, BP Jenssen, S Virudachalam, K Gwynn, K Morrow, and CC Kenyon), Children's Hospital of Philadelphia, Pa; Leonard Davis Institute of Health Economics (Z Bouchelle, G Dalembert, BP Jenssen, S Virudachalam, and CC Kenyon), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Clinical Futures (G Dalembert, BP Jenssen, S Virudachalam, and CC Kenyon), Children's Hospital of Philadelphia, Pa.
| | - Judy A Shea
- Department of Medicine (JA Shea), University of Pennsylvania School of Medicine, Philadelphia, Pa.
| | - Katie Gwynn
- PolicyLab (Z Bouchelle, M Yazdani, G Dalembert, BP Jenssen, S Virudachalam, K Gwynn, K Morrow, and CC Kenyon), Children's Hospital of Philadelphia, Pa.
| | - Kate Morrow
- PolicyLab (Z Bouchelle, M Yazdani, G Dalembert, BP Jenssen, S Virudachalam, K Gwynn, K Morrow, and CC Kenyon), Children's Hospital of Philadelphia, Pa.
| | - Chén C Kenyon
- Department of Pediatrics (Z Bouchelle, G Dalembert, BP Jenssen, S Virudachalam, and CC Kenyon), Perelman School of Medicine, University of Pennsylvania, Philadelphia; PolicyLab (Z Bouchelle, M Yazdani, G Dalembert, BP Jenssen, S Virudachalam, K Gwynn, K Morrow, and CC Kenyon), Children's Hospital of Philadelphia, Pa; Leonard Davis Institute of Health Economics (Z Bouchelle, G Dalembert, BP Jenssen, S Virudachalam, and CC Kenyon), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Clinical Futures (G Dalembert, BP Jenssen, S Virudachalam, and CC Kenyon), Children's Hospital of Philadelphia, Pa.
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Edmondson EK, Garcia SM, Gregory EF, Vajravelu ME, Szalda D, Shea JA, Virudachalam S. Emerging Adults With Type 2 Diabetes: Understanding Illness Experience and Transition to Adult Care. J Adolesc Health 2024:S1054-139X(24)00111-3. [PMID: 38520432 DOI: 10.1016/j.jadohealth.2024.02.021] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 02/09/2024] [Accepted: 02/14/2024] [Indexed: 03/25/2024]
Abstract
PURPOSE Youth-onset type 2 diabetes (T2D) is increasingly common and is often diagnosed shortly before transition from pediatric to adult care. Little is known about the experience of emerging adults (EAs) with T2D and the readiness, barriers, and facilitators to transition. This study sought to describe the illness experience of EAs with T2D and perceptions about transition, and explore themes by "transition readiness," measured by the Transition Readiness Assessment Questionnaire (TRAQ). METHODS In this mixed-methods study, we conducted semi-structured interviews with EAs with T2D using a guide grounded in the health belief model, administered the TRAQ, and collected disease metrics from the electronic medical record. We developed a coding scheme using a directed content-analysis approach and triangulated qualitative and quantitative data to compare themes stratified by mean TRAQ score. RESULTS Participants described modifying factors like adjusting to life with a chronic illness and coping with mental health issues as critical elements of the illness experience that influence transition. Individual beliefs emerged including the perceived risk of disease complications being informed by experience of family members, self-efficacy in diabetes care hinging on the ability to be highly organized, and transition as a daunting obstacle with numerous emotional and logistical barriers. Participants emphasized the need for support from caregivers and providers throughout transition. Themes did not vary significantly by TRAQ score. DISCUSSION Experiences of EAs with T2D suggest more assistance is needed in the transition period to address factors such as mental health, organizational skills, and identifying support people to facilitate care.
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Affiliation(s)
- Emma K Edmondson
- Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Policy Lab and Clinical Futures, Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
| | - Stephanie M Garcia
- Policy Lab and Clinical Futures, Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, Philadelphia, Pennsylvania
| | - Emily F Gregory
- Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Policy Lab and Clinical Futures, Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, Philadelphia, Pennsylvania
| | - Mary Ellen Vajravelu
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Dava Szalda
- Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Judy A Shea
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Senbagam Virudachalam
- Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Policy Lab and Clinical Futures, Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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Morgan JW, Salmon MK, Ambady M, Piazza KM, Rhodes CM, Eneanya ND, Shea JA, Grande D. Factors Informing High-Risk Primary Care Patient Choice around Telehealth Use: a Framework. J Gen Intern Med 2024; 39:540-548. [PMID: 37940757 DOI: 10.1007/s11606-023-08491-y] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/13/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND While telehealth's presence in post-pandemic primary care appears assured, its exact role remains unknown. Value-based care's expansion has heightened interest in telehealth's potential to improve uptake of preventive and chronic disease care, especially among high-risk primary care populations. Despite this, the pandemic underscored patients' diverse preferences around using telehealth. Understanding the factors underlying this population's preferences can inform future telehealth strategies. OBJECTIVE To describe the factors informing high-risk primary care patient choice of whether to pursue primary care via telehealth, in-office or to defer care altogether. DESIGN Qualitative, cross-sectional study utilizing semi-structured telephone interviews of a convenience sample of 29 primary care patients between July 13 and September 30, 2020. PARTICIPANTS Primary care patients at high risk of poor health outcomes and/or acute care utilization who were offered a follow-up primary care visit via audiovisual, audio-only or in-office modalities. APPROACH Responses were analyzed via grounded theory, using a constant comparison method to refine emerging categories, distinguish codes, and synthesize evolving themes. KEY RESULTS Of the 29 participants, 16 (55.2%) were female and 19 (65.5%) were Black; the mean age (SD) was 64.6 (11.1). Participants identified four themes influencing their choice of visit type: perceived utility (encapsulating clinical and non-clinical utility), underlying costs (in terms of time, money, effort, and safety), modifiers (e.g., participants' clinical situation, choice availability, decision phenotype), and drivers (inclusive of their background experiences and digital environment). The relationship of these themes is depicted in a novel framework of patient choice around telehealth use. CONCLUSIONS While visit utility and cost considerations are foundational to participants' decisions around whether to pursue care via telehealth, underappreciated modifiers and drivers often magnify or mitigate these considerations. Policymakers, payers, and health systems can leverage these factors to anticipate and enhance equitable high-value telehealth use in primary care settings among high-risk individuals.
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Affiliation(s)
- John W Morgan
- Leonard Davis Institute at the University of Pennsylvania, Philadelphia, PA, USA.
- Department of Medical Assistance Services, Commonwealth of Virginia, Richmond, VA, USA.
| | - Mandy K Salmon
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Maya Ambady
- Albright Stonebridge Group, Washington, DC, USA
- Center for Healthcare Innovation, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Kirstin M Piazza
- Center for Health Equity Research and Promotion, Michael J Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Corinne M Rhodes
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Nwamaka D Eneanya
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Judy A Shea
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - David Grande
- Leonard Davis Institute at the University of Pennsylvania, Philadelphia, PA, USA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Finn CB, Syvyk S, Bakillah E, Brown DE, Mesiti AM, Highet A, Bergmark RW, Yeo HL, Waljee JF, Wick EC, Shea JA, Kelz RR. Barriers and Facilitators to Clinical Practice Development in Men and Women Surgeons. JAMA Surg 2024; 159:43-50. [PMID: 37851422 PMCID: PMC10585584 DOI: 10.1001/jamasurg.2023.5125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 07/17/2023] [Indexed: 10/19/2023]
Abstract
Importance Many early-career surgeons struggle to develop their clinical practices, leading to high rates of burnout and attrition. Furthermore, women in surgery receive fewer, less complex, and less remunerative referrals compared with men. An enhanced understanding of the social and structural barriers to optimal growth and equity in clinical practice development is fundamental to guiding interventions to support academic surgeons. Objective To identify the barriers and facilitators to clinical practice development with attention to differences related to surgeon gender. Design, Setting, and Participants A multi-institutional qualitative descriptive study was performed using semistructured interviews analyzed with a grounded theory approach. Interviews were conducted at 5 academic medical centers in the US between July 12, 2022, and January 31, 2023. Surgeons with at least 1 year of independent practice experience were selected using purposeful sampling to obtain a representative sample by gender, specialty, academic rank, and years of experience. Main Outcomes and Measures Surgeon perspectives on external barriers and facilitators of clinical practice development and strategies to support practice development for new academic surgeons. Results A total of 45 surgeons were interviewed (23 women [51%], 18 with ≤5 years of experience [40%], and 20 with ≥10 years of experience [44%]). Surgeons reported barriers and facilitators related to their colleagues, department, institution, and environment. Dominant themes for both genders were related to competition, case distribution among partners, resource allocation, and geographic market saturation. Women surgeons reported additional challenges related to gender-based discrimination (exclusion, questioning of expertise, role misidentification, salary disparities, and unequal resource allocation) and additional demands (related to appearance, self-advocacy, and nonoperative patient care). Gender concordance with patients and referring physicians was a facilitator of practice development for women. Surgeons suggested several strategies for their colleagues, department, and institution to improve practice development by amplifying facilitators and promoting objectivity and transparency in resource allocation and referrals. Conclusions and Relevance The findings of this qualitative study suggest that a surgeon's external context has a substantial influence on their practice development. Academic institutions and departments of surgery may consider the influence of their structures and policies on early career surgeons to accelerate practice development and workplace equity.
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Affiliation(s)
- Caitlin B. Finn
- Department of Surgery, Weill Cornell Medicine, New York, New York
- Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania, Philadelphia
- Leonard David Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Solomiya Syvyk
- Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania, Philadelphia
| | - Emna Bakillah
- Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania, Philadelphia
- Leonard David Institute of Health Economics, University of Pennsylvania, Philadelphia
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Danielle E. Brown
- Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania, Philadelphia
| | - Andrea M. Mesiti
- Department of Surgery, Weill Cornell Medicine, New York, New York
| | | | - Regan W. Bergmark
- Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School and Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Heather L. Yeo
- Department of Surgery, Weill Cornell Medicine, New York, New York
| | | | | | - Judy A. Shea
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Rachel R. Kelz
- Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania, Philadelphia
- Leonard David Institute of Health Economics, University of Pennsylvania, Philadelphia
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Reddy AR, Doshi AK, Mak A, Shea JA, Fardad JT, Moon J, Hu P, Garcia-Marcinkiewicz AG. Assessing the health literacy of caregivers in the pediatric intensive care unit: a mixed-methods study. Front Pediatr 2023; 11:1308673. [PMID: 38188919 PMCID: PMC10771288 DOI: 10.3389/fped.2023.1308673] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/01/2023] [Indexed: 01/09/2024] Open
Abstract
Background Limited health literacy is associated with increased hospitalizations, emergency visits, health care costs, and mortality. The health literacy levels of caregivers of critically ill children are unknown. This mixed-methods study aims to quantitatively assess the health literacy of caregivers of children admitted to the pediatric intensive care unit (PICU) and qualitatively describe facilitators and barriers to implementing health literacy screening from the provider perspective. Methods Caregivers of patients admitted to our large, academic PICU (between August 12, 2022 and March 31, 2023) were approached to complete a survey with the Newest Vital Sign (NVS), which is a validated health literacy screener offered in English and Spanish. We additionally conducted focus groups of interdisciplinary PICU providers to identify factors which may influence implementation of health literacy screening using the Consolidated Framework for Implementation Research (CFIR) framework. Results Among 48 surveyed caregivers, 79% demonstrated adequate health literacy using the Newest Vital Sign screener. The majority of caregivers spoke English (96%), were mothers (85%), and identified as White (75%). 83% of caregivers were able to attend rounds at least once and 98% believed attending rounds was helpful. Within the PICU provider focus groups, there were 11 participants (3 attendings, 3 fellows, 2 nurse practitioners, 1 hospitalist, 2 research assistants). Focus group participants described facilitators and barriers to implementation, which were mapped to CFIR domains. Timing of screening and person administering screening were identified as modifiable factors to improve future implementation. Conclusion We found the health literacy levels of PICU caregivers in our setting is similar to prior assessments of parental health literacy. Participation in morning rounds was helpful for developing understanding of their child's illness, regardless of health literacy status. Qualitative feedback from providers identified barriers across all CFIR domains, with timing of screening and person administering screening as modifiable factors to improve future implementation.
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Affiliation(s)
- Anireddy R. Reddy
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- Department of Anesthesiology and Critical Care, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States
| | - Anushree K. Doshi
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- Department of Anesthesiology and Critical Care, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Allison Mak
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States
- Department of General Surgery, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Judy A. Shea
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States
- Department of Medicine, Perelman School of Medicine and University of Pennsylvania, Philadelphia, PA, United States
| | - Joana T. Fardad
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Jiwon Moon
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Paula Hu
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Annery G. Garcia-Marcinkiewicz
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- Department of Anesthesiology and Critical Care, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
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Perez MA, Williams C, Henderson K, McGregor R, Vapiwala N, Shea JA, Dine CJ. Association of applicant demographic factors with medical school acceptance. BMC Med Educ 2023; 23:960. [PMID: 38098006 PMCID: PMC10720109 DOI: 10.1186/s12909-023-04897-8] [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] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Medical school acceptance rates in the United States (US) have been lower for applicants who identify as Underrepresented-in-Medicine (UiM) compared to non-UiM applicants. The gap between UiM and no-UiM groups is narrowing in recent years. Less well-studied are associations of acceptance decisions with family income and parental education. This study's purpose is to evaluate the relationships between medical school acceptance and family income, parental education status, racial/ethnic background, Grade Point Average (GPA), Medical College Admission Test (MCAT) score, and participation in extracurricular activities. METHODS This is a cross-sectional study of first-time US medical school applicants between 2017 and 2020. Acceptance rates for first-time applicants were calculated for first-generation (FG), low-income (LI), and UiM applicants. Associations of these attributes with MCAT scores, science GPAs, and seven categories of extracurricular activities were evaluated. Regression analyses estimated associations between acceptance to medical school with all variables with and without interaction terms (FG*URM, LI*URM, FG*LI). RESULTS The overall acceptance rate for first-time applicants from 2017-2020 was 45.3%. The acceptance rates among FG, LI and UiM applicants were 37.9%, 39.6% and 44.2%, respectively. In univariable logistic regression analyses, acceptance was negatively associated with being FG (OR: 0.68, CI: 0.67-0.70), LI (OR: 0.70, CI: 0.69-0.72), and UiM (OR: 0.95, CI: 0.93-0.97). In multivariable regression, acceptance was most strongly associated with science GPA (OR: 7.15, CI: 6.78-7.54 for the highest quintile) and UiM (OR: 5.56, CI: 5.48-5.93) status and MCAT score (OR: 1.19, CI: 1.18-1.19), FG (OR: 1.14, CI: 1.10-1.18), and most extracurricular activities. Including interaction terms revealed a negative association between acceptance and LI (OR:0.90, CI: 0.87-0.94) and FG was no longer significant (OR:1.10, CI:0.96-1.08). CONCLUSIONS Collectively these results suggest medical school admissions committees may be relying on holistic admission practices. While MCAT and GPA scores continue to predict acceptance, individuals from racially and ethnically UiM backgrounds have favorable odds of acceptance when controlling for MCAT and GPA. However, these positive associations were not seen for low-income and first-generation applicants. Additional preparation for college and the MCAT for these latter groups may help further diversify the medical profession.
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Affiliation(s)
- Michael A Perez
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA, US
| | - Cheyenne Williams
- Department of Urology, Hospital of the University of Pennsylvania, Philadelphia, PA, US
| | - Korey Henderson
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, US
| | - Ryan McGregor
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, US
| | - Neha Vapiwala
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, US
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, US
| | - Judy A Shea
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, US
- Leonard Davis Institute of Economics, University of Pennsylvania, Philadelphia, PA, US
| | - C Jessica Dine
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, US.
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA, US.
- Leonard Davis Institute of Economics, University of Pennsylvania, Philadelphia, PA, US.
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Van Pelt AE, Bonafide CP, Rendle KA, Wolk C, Shea JA, Bettencourt A, Beidas RS, Lane-Fall MB. Evaluation of a brief virtual implementation science training program: the Penn Implementation Science Institute. Implement Sci Commun 2023; 4:131. [PMID: 37932840 PMCID: PMC10626776 DOI: 10.1186/s43058-023-00512-5] [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: 06/06/2023] [Accepted: 10/20/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND To meet the growing demand for implementation science expertise, building capacity is a priority. Various training opportunities have emerged to meet this need. To ensure rigor and achievement of specific implementation science competencies, it is critical to systematically evaluate training programs. METHODS The Penn Implementation Science Institute (PennISI) offers 4 days (20 h) of virtual synchronous training on foundational and advanced topics in implementation science. Through a pre-post design, this study evaluated the sixth PennISI, delivered in 2022. Surveys measures included 43 implementation science training evaluation competencies grouped into four thematic domains (e.g., items related to implementation science study design grouped into the "design, background, and rationale" competency category), course-specific evaluation criteria, and open-ended questions to evaluate change in knowledge and suggestions for improving future institutes. Mean composite scores were created for each of the competency themes. Descriptive statistics and thematic analysis were completed. RESULTS One hundred four (95.41% response rate) and 55 (50.46% response rate) participants completed the pre-survey and post-survey, respectively. Participants included a diverse cohort of individuals primarily affiliated with US-based academic institutions and self-reported as having novice or beginner-level knowledge of implementation science at baseline (81.73%). In the pre-survey, all mean composite scores for implementation science competencies were below one (i.e., beginner-level). Participants reported high value from the PennISI across standard course evaluation criteria (e.g., mean score of 3.77/4.00 for overall quality of course). Scores for all competency domains increased to a score between beginner-level and intermediate-level following training. In both the pre-survey and post-survey, competencies related to "definition, background, and rationale" had the highest mean composite score, whereas competencies related to "design and analysis" received the lowest score. Qualitative themes offered impressions of the PennISI, didactic content, PennISI structure, and suggestions for improvement. Prior experience with or knowledge of implementation science influenced many themes. CONCLUSIONS This evaluation highlights the strengths of an established implementation science institute, which can serve as a model for brief, virtual training programs. Findings provide insight for improving future program efforts to meet the needs of the heterogenous implementation science community (e.g., different disciplines and levels of implementation science knowledge). This study contributes to ensuring rigorous implementation science capacity building through the evaluation of programs.
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Affiliation(s)
- Amelia E Van Pelt
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N Michigan Ave Suite 2100, Chicago, IL, 60611, USA.
- Penn Implementation Science Center at the Leonard Davis Institute for Health Economics, University of Pennsylvania, 3641 Locust Walk, Philadelphia, PA, 19104, USA.
| | - Christopher P Bonafide
- Penn Implementation Science Center at the Leonard Davis Institute for Health Economics, University of Pennsylvania, 3641 Locust Walk, Philadelphia, PA, 19104, USA
- Section of Hospital Medicine, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Katharine A Rendle
- Penn Implementation Science Center at the Leonard Davis Institute for Health Economics, University of Pennsylvania, 3641 Locust Walk, Philadelphia, PA, 19104, USA
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, 51 N 39th Street floor 7, Philadelphia, PA, 19104, USA
| | - Courtney Wolk
- Penn Implementation Science Center at the Leonard Davis Institute for Health Economics, University of Pennsylvania, 3641 Locust Walk, Philadelphia, PA, 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3553 Market Street, 3Rd Floor, Philadelphia, PA, 19104, USA
| | - Judy A Shea
- Department of Medicine, Division of General Internal Medicine, University of Pennsylvania Perelman School of Medicine, 423 Guardian Drive, Philadelphia, PA, 19104, USA
| | - Amanda Bettencourt
- Penn Implementation Science Center at the Leonard Davis Institute for Health Economics, University of Pennsylvania, 3641 Locust Walk, Philadelphia, PA, 19104, USA
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, 19104, USA
| | - Rinad S Beidas
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N Michigan Ave Suite 2100, Chicago, IL, 60611, USA
- Penn Implementation Science Center at the Leonard Davis Institute for Health Economics, University of Pennsylvania, 3641 Locust Walk, Philadelphia, PA, 19104, USA
| | - Meghan B Lane-Fall
- Penn Implementation Science Center at the Leonard Davis Institute for Health Economics, University of Pennsylvania, 3641 Locust Walk, Philadelphia, PA, 19104, USA
- Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, 3400 Spruce Street Suite 680, Philadelphia, PA, 19104, USA
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Teal CR, Cianciolo AT, Berry A, Boscardin C, Riddle J, Rougas S, Shaull L, Shea JA, Szauter K, Bierer SB. Impact of a Regional Grant Program Through the Lens of Social Cognitive Career Theory: A Mixed-Method Evaluation. Acad Med 2023; 98:S149-S156. [PMID: 37983407 DOI: 10.1097/acm.0000000000005369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
PURPOSE Evaluations of educational grant programs have focused on research productivity, with few examining impacts on grantees or effective program characteristics. This evaluation examined the regional grant program sponsored by Group on Educational Affairs to examine if and how grantees' careers were affected by funding, and if these experiences aligned with program goals. METHOD In this concurrent, mixed-methods theory-driven evaluation, quantitative and qualitative data were analyzed independently and then integrated to examine complementarity. Quantitative data examined differences among 4 geographic regions and included proposal and grantee characteristics abstracted from administrative records of 52 funded proposals from 2010-2015 grant cycles. Qualitative data from 23 interviews conducted from 2018 to 2019 explored the impact on grantees, with Social Cognitive Career Theory (SCCT) serving as a framework for deductive thematic analysis. To facilitate integration of findings, quantitative data were layered onto each interview to permit exploration of associations between the 2 data types. RESULTS Although significant regional differences existed in project length and amount of funding, there were few regional differences in grantee experiences. Despite small funding amounts, grants were perceived as career launching pads. The SCCT framework accounted for grantee experiences, including researcher identity formation and subsequent research, but did not capture collaboration phenomena. Integration of the 2 data types identified experience patterns unique to different groups of grantees (e.g., more or less research experience). The diversity among grantees suggests that clarification of program goals and stronger alignment with criteria for funding may be warranted. CONCLUSIONS This evaluation illuminates why small educational grant programs may or may not impact interest and productivity in research. Implications exist for funders, including clarifying program goals and providing support for less experienced grantees. Future research should explore grantee subsets (e.g., underrepresented in medicine) to further identify what fosters or inhibits careers of medical education scholars.
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Affiliation(s)
- Cayla R Teal
- C.R. Teal is associate dean for assessment and evaluation and education associate professor, Department of Population Health, University of Kansas School of Medicine, Kansas City, Kansas
| | - Anna T Cianciolo
- A.T. Cianciolo is professor, Department of Medical Education, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Andrea Berry
- A. Berry is executive director of faculty life, University of Central Florida College of Medicine, Orlando, Florida
| | - Christy Boscardin
- C. Boscardin is professor, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California
| | - Janet Riddle
- J. Riddle was director of faculty development, University of Illinois-Chicago College of Medicine, Chicago, Illinois
| | - Steven Rougas
- S. Rougas is associate professor of emergency medicine and medical science and director, Doctoring Program, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Lynn Shaull
- L. Shaull is a senior research analyst, Association of American Medical Colleges, Washington, DC
| | - Judy A Shea
- J.A. Shea is professor, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Karen Szauter
- K. Szauter is assistant dean, educational affairs, and professor, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
| | - S Beth Bierer
- S.B. Bierer is professor of medicine and director of assessment and evaluation, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
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10
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Eberly LA, Shultz K, Merino M, Brueckner MY, Benally E, Tennison A, Biggs S, Hardie L, Tian Y, Nathan AS, Khatana SAM, Shea JA, Lewis E, Bukhman G, Shin S, Groeneveld PW. Cardiovascular Disease Burden and Outcomes Among American Indian and Alaska Native Medicare Beneficiaries. JAMA Netw Open 2023; 6:e2334923. [PMID: 37738051 PMCID: PMC10517375 DOI: 10.1001/jamanetworkopen.2023.34923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 07/17/2023] [Indexed: 09/23/2023] Open
Abstract
Importance American Indian and Alaska Native persons face significant health disparities; however, data regarding the burden of cardiovascular disease in the current era is limited. Objective To determine the incidence and prevalence of cardiovascular disease, the burden of comorbid conditions, including cardiovascular disease risk factors, and associated mortality among American Indian and Alaska Native patients with Medicare insurance. Design, Setting, and Participants This was a population-based cohort study conducted from January 2015 to December 2019 using Medicare administrative data. Participants included American Indian and Alaska Native Medicare beneficiaries 65 years and older enrolled in both Medicare part A and B fee-for-service Medicare. Statistical analyses were performed from November 2022 to April 2023. Main Outcomes and Measures The annual incidence, prevalence, and mortality associated with coronary artery disease (CAD), heart failure (HF), atrial fibrillation/flutter (AF), and cerebrovascular disease (stroke or transient ischemic attack [TIA]). Results Among 220 598 American Indian and Alaska Native Medicare beneficiaries, the median (IQR) age was 72.5 (68.5-79.0) years, 127 402 were female (57.8%), 78 438 (38.8%) came from communities in the most economically distressed quintile in the Distressed Communities Index. In the cohort, 44.8% of patients (98 833) were diagnosed with diabetes, 61.3% (135 124) were diagnosed with hyperlipidemia, and 72.2% (159 365) were diagnosed with hypertension during the study period. The prevalence of CAD was 38.6% (61 125 patients) in 2015 and 36.7% (68 130 patients) in 2019 (P < .001). The incidence of acute myocardial infarction increased from 6.9 per 1000 person-years in 2015 to 7.7 per 1000 patient-years in 2019 (percentage change, 4.79%; P < .001). The prevalence of HF was 22.9% (36 288 patients) in 2015 and 21.4% (39 857 patients) in 2019 (P < .001). The incidence of HF increased from 26.1 per 1000 person-years in 2015 to 27.0 per 1000 person-years in 2019 (percentage change, 4.08%; P < .001). AF had a stable prevalence of 9% during the study period (2015: 9.4% [14 899 patients] vs 2019: 9.3% [25 175 patients]). The incidence of stroke or TIA decreased slightly throughout the study period (12.7 per 1000 person-years in 2015 and 12.1 per 1000 person-years in 2019; percentage change, 5.08; P = .004). Fifty percent of patients (110 244) had at least 1 severe cardiovascular condition (CAD, HF, AF, or cerebrovascular disease), and the overall mortality rate for the cohort was 19.8% (43 589 patients). Conclusions and Relevance In this large cohort study of American Indian and Alaska Native patients with Medicare insurance in the US, results suggest a significant burden of cardiovascular disease and cardiometabolic risk factors. These results highlight the critical need for future efforts to prioritize the cardiovascular health of this population.
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Affiliation(s)
- Lauren A. Eberly
- Gallup Indian Medical Center, Indian Health Service, Gallup, New Mexico
- Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Cardiovascular Institute, University of Pennsylvania, Philadelphia
- Penn Cardiovascular Center for Health Equity and Social Justice, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Kaitlyn Shultz
- Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia
| | - Maricruz Merino
- Gallup Indian Medical Center, Indian Health Service, Gallup, New Mexico
| | | | - Ernest Benally
- Gallup Indian Medical Center, Indian Health Service, Gallup, New Mexico
| | - Ada Tennison
- Gallup Indian Medical Center, Indian Health Service, Gallup, New Mexico
| | - Sabor Biggs
- Gallup Indian Medical Center, Indian Health Service, Gallup, New Mexico
| | - Lakotah Hardie
- Division of General Internal Medicine, Massachusetts General Hospital, Boston
| | - Ye Tian
- Division of Pulmonary and Critical Care, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania
| | - Ashwin S. Nathan
- Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Cardiovascular Institute, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Sameed Ahmed M. Khatana
- Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Cardiovascular Institute, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Judy A. Shea
- Division of General Internal Medicine, University of Pennsylvania, Philadelphia
| | - Eldrin Lewis
- Division of Cardiovascular Medicine, Stanford University Medical Center, Palo Alto, California
| | - Gene Bukhman
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Global Health and Social Medicine, Program in Global Noncommunicable Diseases and Social Change, Harvard Medical School, Boston, Massachusetts
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Sonya Shin
- Gallup Indian Medical Center, Indian Health Service, Gallup, New Mexico
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Peter W. Groeneveld
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Cardiovascular Institute, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
- Division of General Internal Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
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11
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Ramadurai D, Shea JA. Leveraging the health equity implementation framework to foster an equity focus in medical education. Adv Health Sci Educ Theory Pract 2023:10.1007/s10459-023-10277-0. [PMID: 37668934 PMCID: PMC10912357 DOI: 10.1007/s10459-023-10277-0] [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] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 08/13/2023] [Indexed: 09/06/2023]
Abstract
Teaching equitable clinical practice is of critical importance, yet how best to do so remains unknown. Educators utilize implementation science frameworks to disseminate clinical evidence-based practices (EBP). The Health Equity Implementation Framework (HEIF) is one of these frameworks, and it delineates how health equity may be concomitantly assessed and addressed in planning the implementation of an EBP. The HEIF therefore lays a strong foundation to understand and explain barriers and facilitators to implementation through an equity lens, making it well-suited for use by medical educators. Three equity-focused frames of reference within the model include (1) the clinical encounter, (2) societal context, and (3) culturally relevant factors, herein referred to as domains. The HEIF provides a structure for prospective and retrospective assessment of how EBP are taught and ultimately incorporated into clinical practice by trainees, with specific attention to delivering equitable care. We present three examples of common topics in internal medicine, contextualized by the three equity domains of the HEIF. We additionally acknowledge the limitations of this framework as a research tool with complex features that may not be suitable for brief teaching in the clinical environment. We propose a 360-degree learner assessment to ensure implementation of this framework is successful. By encouraging trainees to explore the narrative experiences of their patients and examine their own implicit biases, the HEIF provides a structure to address gaps in knowledge about delivering equitable care.
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Affiliation(s)
- Deepa Ramadurai
- Division of Pulmonary, Allergy and Critical Care Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
| | - Judy A Shea
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
- Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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12
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Heath JK, Clancy CB, Pluta W, Weissman GE, Anderson U, Kogan JR, Dine CJ, Shea JA. Natural Language Processing of Learners' Evaluations of Attendings to Identify Professionalism Lapses. Eval Health Prof 2023; 46:225-232. [PMID: 36826805 PMCID: PMC10443919 DOI: 10.1177/01632787231158128] [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] [Indexed: 02/25/2023]
Abstract
Unprofessional faculty behaviors negatively impact the well-being of trainees yet are infrequently reported through established reporting systems. Manual review of narrative faculty evaluations provides an additional avenue for identifying unprofessional behavior but is time- and resource-intensive, and therefore of limited value for identifying and remediating faculty with professionalism concerns. Natural language processing (NLP) techniques may provide a mechanism for streamlining manual review processes to identify faculty professionalism lapses. In this retrospective cohort study of 15,432 narrative evaluations of medical faculty by medical trainees, we identified professionalism lapses using automated analysis of the text of faculty evaluations. We used multiple NLP approaches to develop and validate several classification models, which were evaluated primarily based on the positive predictive value (PPV) and secondarily by their calibration. A NLP-model using sentiment analysis (quantifying subjectivity of the text) in combination with key words (using the ensemble technique) had the best performance overall with a PPV of 49% (CI 38%-59%). These findings highlight how NLP can be used to screen narrative evaluations of faculty to identify unprofessional faculty behaviors. Incorporation of NLP into faculty review workflows enables a more focused manual review of comments, providing a supplemental mechanism to identify faculty professionalism lapses.
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Affiliation(s)
- Janae K. Heath
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Caitlin B. Clancy
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - William Pluta
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Gary E. Weissman
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Palliative and Advanced Illness Research (PAIR) Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Ursula Anderson
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Jennifer R. Kogan
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - C. Jessica Dine
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Judy A. Shea
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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13
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Dalton EM, Worsley D, Krass P, Kovacs B, Raymond K, Feudtner C, Shea JA, Doupnik SK. Factors influencing agitation, de-escalation, and physical restraint at a children's hospital. J Hosp Med 2023; 18:693-702. [PMID: 37401165 PMCID: PMC10529788 DOI: 10.1002/jhm.13159] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/30/2023] [Accepted: 06/14/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Children hospitalized in medical hospitals are at risk of agitation. Physical restraint may be used to maintain patient and staff safety during de-escalation, but physical restraint use is associated with physical and psychological adverse events. OBJECTIVE We sought to better understand which work system factors help clinicians prevent patient agitation, improve de-escalation, and avoid physical restraint. DESIGN, SETTING, AND PARTICIPANTS We used directed content analysis to extend the Systems Engineering Initiative for Patient Safety model to clinicians working with children at risk for agitation at a freestanding children's hospital. INTERVENTION, MAIN OUTCOME, AND MEASURES We conducted semistructured interviews to examine how five clinician work system factors affected patient agitation, de-escalation, and restraint: person, environment, tasks, technology and tools, and organization. Interviews were recorded, transcribed, and analyzed until saturation. RESULTS Forty clinicians participated in this study, including 21 nurses, 15 psychiatric technicians, 2 pediatric physicians, 1 psychologist, and 1 behavior analyst. Work system factors that contributed to patient agitation were medical tasks like vital signs and the hospital environment including bright lights and neighboring patients' noises. Supports that helped clinicians de-escalate patients included adequate staffing and accessible toys and activities. Participants indicated that organizational factors were integral to team de-escalation, drawing connections between units' teamwork and communication cultures and their likelihood of successful de-escalation without the use of physical restraint. CONCLUSION Clinicians perceived that medical tasks, hospital environmental factors, clinician attributes, and team communication influenced patients' agitation, de-escalation, and physical restraint. These work system factors provide opportunities for future multi-disciplinary interventions to reduce physical restraint use.
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Affiliation(s)
- Evan M. Dalton
- Division of General Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Clinical Futures and PolicyLab, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania, USA
| | - Diana Worsley
- Clinical Futures and PolicyLab, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Polina Krass
- Clinical Futures and PolicyLab, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania, USA
- Division of Emergency Medicine, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Brian Kovacs
- Department of Nursing and Clinical Care Services, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kathleen Raymond
- Department of Nursing and Clinical Care Services, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Chris Feudtner
- Division of General Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Clinical Futures and PolicyLab, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Judy A. Shea
- Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania, USA
- Department of Medicine, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Medical Ethics and Health Policy, Philadelphia, Pennsylvania, USA
| | - Stephanie K. Doupnik
- Division of General Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Clinical Futures and PolicyLab, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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14
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Chaiyachati KH, Shea JA, Ward M, Nelson MN, Ghosh M, Reilly J, Kelly S, Chisholm DL, Barbati Z, Hemmons JE, Abdel-Rahman D, Ebert JP, Xiong RA, Snider CK, Lee KC, Friedman AB, Meisel ZF, Kilaru AS, Asch DA, Delgado MK, Morgan AU. Patient and clinician perspectives of a remote monitoring program for COVID-19 and lessons for future programs. BMC Health Serv Res 2023; 23:698. [PMID: 37370059 PMCID: PMC10304230 DOI: 10.1186/s12913-023-09684-1] [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: 11/03/2022] [Accepted: 06/11/2023] [Indexed: 06/29/2023] Open
Abstract
COVID Watch is a remote patient monitoring program implemented during the pandemic to support home dwelling patients with COVID-19. The program conferred a large survival advantage. We conducted semi-structured interviews of 85 patients and clinicians using COVID Watch to understand how to design such programs even better. Patients and clinicians found COVID Watch to be comforting and beneficial, but both groups desired more clarity about the purpose and timing of enrollment and alternatives to text-messages to adapt to patients' preferences as these may have limited engagement and enrollment among marginalized patient populations. Because inclusiveness and equity are important elements of programmatic success, future programs will need flexible and multi-channel human-to-human communication pathways for complex clinical interactions or for patients who do not desire tech-first approaches.
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Affiliation(s)
- Krisda H Chaiyachati
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
- Center for Health Care Innovation, University of Pennsylvania Health System, Philadelphia, PA, USA.
| | - Judy A Shea
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Michaela Ward
- Mixed Methods Research Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Maria N Nelson
- Mixed Methods Research Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Medha Ghosh
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Julianne Reilly
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sheila Kelly
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Deena L Chisholm
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Zoe Barbati
- Mixed Methods Research Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jessica E Hemmons
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Dina Abdel-Rahman
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jeffrey P Ebert
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ruiying A Xiong
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- The Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Christopher K Snider
- Center for Health Care Innovation, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Kathleen C Lee
- Comcast NBCUniversal in Philadelphia, PA, Philadelphia, USA
| | - Ari B Friedman
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
- The Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Zachary F Meisel
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Injury Science Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Austin S Kilaru
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - David A Asch
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for Health Care Innovation, University of Pennsylvania Health System, Philadelphia, PA, USA
- The Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - M Kit Delgado
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
- Center for Health Care Innovation, University of Pennsylvania Health System, Philadelphia, PA, USA
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- The Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Anna U Morgan
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for Health Care Innovation, University of Pennsylvania Health System, Philadelphia, PA, USA
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Wietlisbach LE, Asch DA, Eriksen W, Barg FK, Bellini LM, Desai SV, Yakubu AR, Shea JA. Using poetry to elicit internal medicine residents' perspectives on wellness. Postgrad Med J 2023; 99:428-432. [PMID: 37294722 PMCID: PMC9530064 DOI: 10.1136/postgradmedj-2021-141493] [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: 12/28/2021] [Accepted: 03/19/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE To elicit internal medicine residents' perspectives on wellness through poetry writing, examining (1) response rates, (2) the tone/sentiment of their submissions and (3) the primary thematic content. STUDY DESIGN In academic year 2019-2020, a random sample of 88 residents from four internal medicine residency programmes was invited to participate in a year-long study of wellness. In December 2019, an open-ended prompt asked residents to write a poem reflecting on their well-being. Responses were inductively coded using content analysis techniques. RESULTS The response rate for the poetry prompt was 94%. The tone of the entries was most often neutral or contradictory (42%), followed by negative (33%) and positive (25%). There were three main themes: (1) Mindsets: most residents simply wanted to make it through their programme; (2) wellness influencers: the main wellness supporters were external to the programme such as vacationing and exercise; within hospitals, friendships with colleagues and boosted wellness and (3) scheduling/repetition: difficult schedules drained energy as did the monotony of administrative tasks. CONCLUSIONS Poetry appears to be an innovative and effective vehicle to elicit residents' perspectives without compromising response rate. Poetry survey techniques allow medical trainees to provide powerful messaging to leadership. Most of what is known about trainee wellness is derived from quantitative surveys. This study showed medicine trainees' willingness to engage in poetry and add richness and personal detail to highlight key drivers of wellness. Such information provides context and brings attention in a compelling manner to an important topic.
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Affiliation(s)
- Larissa E Wietlisbach
- Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David A Asch
- Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Whitney Eriksen
- Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Frances K Barg
- Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lisa M Bellini
- Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sanjay V Desai
- Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Abdul-Rakeem Yakubu
- Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Judy A Shea
- Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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16
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Serper M, Agha A, Garren PA, Taddei TH, Kaplan DE, Groeneveld PW, Werner RM, Shea JA. Multidisciplinary teams, efficient communication, procedure services, and telehealth improve cirrhosis care: A qualitative study. Hepatol Commun 2023; 7:e0157. [PMID: 37219845 PMCID: PMC10208700 DOI: 10.1097/hc9.0000000000000157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/29/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Cirrhosis care and outcomes are improved with access to subspecialty gastroenterology and hepatology care. In qualitative interviews, we investigated clinicians' perceptions of factors that optimize or impede cirrhosis care. METHODS We conducted 24 telephone interviews with subspecialty clinicians at 7 Veterans Affairs medical centers with high- and low-complexity services. Purposive sampling stratified Veterans Affairs medical centers on timely post-hospitalization follow-up, a quality measure. We asked open-ended questions about facilitators and barriers of care coordination, access to appointments, procedures, transplantation, management of complications, keeping up to date with medical knowledge, and telehealth use. RESULTS Key themes that facilitated care were structural: multidisciplinary teams, clinical dashboards, mechanisms for appointment tracking and reminders, and local or virtual access to transplant and liver cancer specialists through the "specialty care access network extension for community health care outcomes" program. Coordination and efficient communication between transplant and non-transplant specialists and between transplant and primary care facilitated timely care. Same-day access to laboratory, procedural, and clinical services is an indicator of high-quality care. Barriers included lack of on-site procedural services, clinician turnover, patient social needs related to transportation, costs, and patient forgetfulness due to HE. Telehealth enabled lower complexity sites to obtain recommendations for complex patient cases. Barriers to telehealth included lack of credit (eg, VA billing equivalent), inadequate staff, lack of audiovisual technology support, and patient and staff discomfort with technology. Telehealth was optimal for return visits, cases where physical examination was nonessential, and where distance and transportation precluded in-person care. Rapid telehealth uptake during the COVID-19 pandemic was a positive disruptor and facilitated use. CONCLUSIONS We identify multi-level factors related to structure, staffing, technology, and care organization to optimize cirrhosis care delivery.
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Affiliation(s)
- Marina Serper
- Division of Gastroenterology and Hepatology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Medicine, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
- Leonard David Institute of Health Economics, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Aneeza Agha
- Corporal Michael J. Crescenz VA Medical Center, VA Center for Health Equity Research and Promotion (CHERP), Philadelphia, Pennsylvania, USA
| | - Patrik A. Garren
- School of Nursing, NewCourtland Center for Transitions in Health, Department of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tamar H. Taddei
- Division of Digestive Diseases, Yale University School of Medicine, Department of Medicine, New Haven, Connecticut, USA
- VA Connecticut Healthcare System, Department of Medicine, West Haven, Connecticut, USA
| | - David E. Kaplan
- Division of Gastroenterology and Hepatology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Medicine, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Peter W. Groeneveld
- Leonard David Institute of Health Economics, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Corporal Michael J. Crescenz VA Medical Center, VA Center for Health Equity Research and Promotion (CHERP), Philadelphia, Pennsylvania, USA
- Department of Medicine, Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Cardiovascular Outcomes, Quality, and Evaluation Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rachel M. Werner
- Department of Medicine, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
- Leonard David Institute of Health Economics, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Medicine, Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Judy A. Shea
- Department of Medicine, Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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17
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Jenssen BP, Kelleher S, Karavite DJ, Nekrasova E, Thayer JG, Ratwani R, Shea JA, Nabi-Burza E, Drehmer JE, Winickoff JP, Grundmeier RW, Schnoll RA, Fiks AG. A Clinical Decision Support System for Motivational Messaging and Tobacco Cessation Treatment for Parents: Pilot Evaluation of Use and Acceptance. Appl Clin Inform 2023; 14:439-447. [PMID: 36972687 PMCID: PMC10247306 DOI: 10.1055/a-2062-9627] [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: 12/19/2022] [Accepted: 03/23/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Research is needed to identify how clinical decision support (CDS) systems can support communication about and engagement with tobacco use treatment in pediatric settings for parents who smoke. We developed a CDS system that identifies parents who smoke, delivers motivational messages to start treatment, connects parents to treatment, and supports pediatrician-parent discussion. OBJECTIVE The objective of this study is to assess the performance of this system in clinical practice, including receipt of motivational messages and tobacco use treatment acceptance rates. METHODS The system was evaluated at one large pediatric practice through a single-arm pilot study from June to November 2021. We collected data on the performance of the CDS system for all parents. Additionally, we surveyed a sample of parents immediately after the clinical encounter who used the system and reported smoking. Measures were: (1) the parent remembered the motivational message, (2) the pediatrician reinforced the message, and (3) treatment acceptance rates. Treatments included nicotine replacement therapy, quitline referral (phone counseling), and/or SmokefreeTXT referral (text message counseling). We described survey response rates overall and with 95% confidence intervals (CIs). RESULTS During the entire study period, 8,488 parents completed use of the CDS: 9.3% (n = 786) reported smoking and 48.2% (n = 379) accepted at least one treatment. A total of 102 parents who smoke who used the system were approached to survey 100 parents (98% response rate). Most parents self-identified as female (84%), aged 25 to 34 years (56%), and Black/African American (94%), and had children with Medicaid insurance (95%). Of parents surveyed, 54% accepted at least one treatment option. Most parents recalled the motivational message (79%; 95% CI: 71-87%), and 31% (95% CI: 19-44%) reported that the pediatrician reinforced the motivational message. CONCLUSION A CDS system to support parental tobacco use treatment in pediatric primary care enhanced motivational messaging about smoking cessation and evidence-based treatment initiation.
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Affiliation(s)
- Brian P. Jenssen
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Clinical Futures, PolicyLab, and The Possibilities Project, Children's Hospital of Philadelphia, Pennsilvania, United States
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Shannon Kelleher
- Clinical Futures, PolicyLab, and The Possibilities Project, Children's Hospital of Philadelphia, Pennsilvania, United States
| | - Dean J. Karavite
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Ekaterina Nekrasova
- Clinical Futures, PolicyLab, and The Possibilities Project, Children's Hospital of Philadelphia, Pennsilvania, United States
| | - Jeritt G. Thayer
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Raj Ratwani
- MedStar Health National Center for Human Factors in Healthcare, Washington, District of Columbia, United States
| | - Judy A. Shea
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Emara Nabi-Burza
- Division of General Academic Pediatrics, Tobacco Research and Treatment Center, Massachusetts General Hospital for Children, Boston, Massachusetts, United States
| | - Jeremy E. Drehmer
- Division of General Academic Pediatrics, Tobacco Research and Treatment Center, Massachusetts General Hospital for Children, Boston, Massachusetts, United States
| | - Jonathan P. Winickoff
- Division of General Academic Pediatrics, Tobacco Research and Treatment Center, Massachusetts General Hospital for Children, Boston, Massachusetts, United States
| | - Robert W. Grundmeier
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Robert A. Schnoll
- Department of Psychiatry, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Alexander G. Fiks
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Clinical Futures, PolicyLab, and The Possibilities Project, Children's Hospital of Philadelphia, Pennsilvania, United States
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
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18
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Henretig FM, Wood JN, Shea JA, Schapira MM, Ruddy RM. Pediatric Emergency Medicine Physicians' Perceptions of Colleagues' Clinical Performance Over Career Span. Pediatr Emerg Care 2023; 39:304-310. [PMID: 35766881 DOI: 10.1097/pec.0000000000002785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The US physician workforce is aging, prompting concerns regarding clinical performance of senior physicians. Pediatric emergency medicine (PEM) is a high-acuity, multitasking, diagnostically complex and procedurally demanding specialty. Aging's impact on clinical performance in PEM has not been examined. We aimed to assess PEM physician's' perceptions of peers' clinical performance over career span. METHODS We surveyed 478 PEM physician members of the American Academy of Pediatrics' Section on Emergency Medicine survey study list-serve in 2020. The survey was designed by the investigators with iterative input from colleagues. Respondents rated, using a 5-point Likert scale, the average performance of 4 age categories of PEM physicians in 9 clinical competencies. Additional items included concerns about colleague's performance and preferences for age of physician managing a critically ill child family member. RESULTS We received 232 surveys with responses to core initial items (adjusted response rate, 49%). Most respondents were 36 to 49 (34.9%) or 50 to 64 (47.0%) years old. Fifty-three percent reported ever having concern about a colleague's performance. For critical care-related competencies, fewer respondents rated the ≥65-year age group as very good or excellent compared with midcareer physicians (36-49 or 50-64 years old). The ratings for difficult communications with families were better for those 65 years or older than those 35 years or younger. Among 129 of 224 respondents (58%) indicating a preferred age category for a colleague managing a critically ill child relative, most (69%) preferred a 36 to 49-year-old colleague. CONCLUSIONS Pediatric emergency medicine physicians' perceptions of peers' clinical performance demonstrated differences by peer age group. Physicians 65 years or older were perceived to perform less well than those 36 to 64 years old in procedural and multitasking skills. However, senior physicians were perceived as performing as well if not better than younger peers in communication skills. Further study of age-related PEM clinical performance with objective measures is warranted.
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Affiliation(s)
| | - Joanne N Wood
- General Pediatrics, Children's Hospital of Philadelphia, Departments of Pediatrics
| | | | - Marilyn M Schapira
- Division of General Internal Medicine, Veteran's Administration Medical Center, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Richard M Ruddy
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
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19
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Zhao CS, Owei L, Card E, Scire E, Wen CZ, Shea JA, Morales CZ, Goldshore M, Morris JB, Martin N. Introducing Surgical Equity into Contemporary Medical Education: Results From Operation Equity, a Pilot Curriculum. J Surg Educ 2023; 80:528-536. [PMID: 36572606 DOI: 10.1016/j.jsurg.2022.12.004] [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] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/10/2022] [Accepted: 12/11/2022] [Indexed: 06/18/2023]
Abstract
OBJECTIVE To date, education about health equity for early-stage healthcare trainees is largely situated outside of surgical disciplines. This study aims to evaluate the effectiveness of a surgical equity curriculum offered to a voluntary group of medical and graduate students. DESIGN Mixed-methods cohort study from January to June 2021. Pre- and post-course surveys measured domains of attitudes, self-reported confidence, and knowledge via 5-point Likert scale and multiple-choice questions. Paired t tests were used to analyze quantitative responses. Qualitative responses were studied via iterative thematic analysis. SETTING At the University of Pennsylvania in Philadelphia, PA which provides tertiary level, institutional care, 10, interdisciplinary 1.5-hour sessions were held over 1 semester, teaching surgical equity topics that spanned the peri-operative continuum. PARTICIPANTS Twenty-four medical and graduate students from across the University of Pennsylvania enrolled. Twenty completed both surveys. RESULTS From pre- to post-course, students improved across all domains. Students improved in their self-rated ability to identify strategies to talk about sensitive health topics with patients (pre: 20%, post: 90%) and identify strategies to address healthcare disparities in surgery (pre: 10%, post: 90%). Qualitatively, from pre- to post-course, more students could articulate the role of bias and identify opportunities for surgeons to engage in surgical equity. The course strengthened any pre-existing interest in surgical equity, and for 1 student, created interest in a surgical career where it had not previously existed. Many also expressed greater resolve to provide patient-centric care. CONCLUSIONS Formal curricula can improve students' ability to advocate for surgical equity. A similar framework may fill a need for medical students interested in health equity and surgical careers at other institutions.
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Affiliation(s)
- Cindy S Zhao
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lily Owei
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Elizabeth Card
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Emily Scire
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christopher Z Wen
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Judy A Shea
- Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Carrie Z Morales
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew Goldshore
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jon B Morris
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Niels Martin
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
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20
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Woods-Hill CZ, Nelson MN, Eriksen W, Rendle KA, Beidas RS, Bonafide CP, Brajcich MR, Milstone AM, Shea JA. Determinants of Blood Culture Use in Critically Ill Children: A Multicenter Qualitative Study. Pediatr Qual Saf 2023; 8:e647. [PMID: 37051407 PMCID: PMC10085482 DOI: 10.1097/pq9.0000000000000647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 03/11/2023] [Indexed: 04/14/2023] Open
Abstract
Blood cultures are fundamental in diagnosing and treating sepsis in the pediatric intensive care unit (PICU), but practices vary widely. Overuse can lead to false positive results and unnecessary antibiotics. Specific factors underlying decisions about blood culture use and overuse are unknown. Therefore, we aimed to identify perceived determinants of blood culture use in the PICU. Methods We conducted semistructured interviews of clinicians (M.D., D.O., R.N., N.P., P.A.) from 6 PICUs who had participated in a quality improvement collaborative about blood culture practices. We developed interview questions by combining elements of the Consolidated Framework for Implementation Research and behavioral economics. We conducted telephone interviews, open-coded the transcripts, and used modified content analysis to determine key themes and mapped themes to elements of Consolidated Framework for Implementation Research and behavioral economics. Results We reached thematic saturation in 24 interviews. Seven core themes emerged across 3 Consolidated Framework for Implementation Research domains: individual characteristics [personal belief in the importance of blood cultures, the perception that blood cultures are a low-risk test]; inner setting [adherence to site-specific usual practices, site-specific overall approach to PICU care (collaborative versus hierarchical), influence of non-PICU clinicians on blood culture decisions]; and outer setting [patient-specific risk factors, sepsis guidelines]. In addition, outcome bias, default bias, and loss aversion emerged as salient behavioral economics concepts. Conclusions Determinants of blood culture use include individual clinician characteristics, inner setting, and outer setting, as well as default bias, outcome bias, and loss aversion. These determinants will now inform the development of candidate strategies to optimize culture practices.
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Affiliation(s)
- Charlotte Z. Woods-Hill
- From the Division of Critical Care Medicine, The Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia Pa
| | - Maria N. Nelson
- University of Pennsylvania Mixed Methods Research Laboratory
| | | | | | | | - Christopher P. Bonafide
- Section of Pediatric Hospital Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Michelle R. Brajcich
- From the Division of Critical Care Medicine, The Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa
| | - Aaron M. Milstone
- Division of Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Judy A. Shea
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
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21
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Fatemi Y, Costello A, Lieberman L, Hart J, Shaw KN, Shea JA, Coffin S. Clinical pathways and diagnostic reasoning: A qualitative study of pediatric residents' and hospitalists' perceptions. J Hosp Med 2023; 18:139-146. [PMID: 36424711 DOI: 10.1002/jhm.13010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 10/11/2022] [Accepted: 10/25/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Clinical pathways are evidence-based guidelines adapted to local settings. They have been shown to improve patient outcomes and reduce resource utilization. However, it is unknown how physicians integrate clinical pathways into their clinical reasoning. METHODS We conducted a single-center qualitative study involving one-on-one semi-structured interviews of pediatric residents and pediatric hospitalist attendings between August 2021 and March 2022. Interviews were audio-recorded and professionally transcribed. We utilized a qualitative descriptive framework to code data and identify themes. RESULTS We interviewed 15 pediatric residents and 12 pediatric hospitalists. Thematic analysis of interview transcripts revealed four themes related to physician utilization of and experience with clinical pathways: (1) utility as a tool, (2) means of standardizing care, (3) reflection of institutional culture, and (4) element of the dynamic relationship with the clinician diagnostic process. These themes were generally common to both residents and attending physicians; however, some differences existed and are noted when they occurred. CONCLUSIONS Clinical pathways are part of many clinicians' diagnostic processes. Pathways can standardize care, influence the diagnostic process, and express local institutional culture. Further research is required to ascertain the optimal clinical pathway design to augment and not inhibit the clinician's diagnostic process.
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Affiliation(s)
- Yasaman Fatemi
- Division of Infectious Diseases, The Children's Hospital of Philadelphia, Pennsylvania, Philadelphia, USA
- Division of Infectious Diseases, Seattle Children's Hospital, Seattle, Washington, USA
| | - Anna Costello
- Division of General Pediatrics, The Children's Hospital of Philadelphia, Pennsylvania, Philadelphia, USA
| | - Leora Lieberman
- Department of Pediatrics, The Children's Hospital of Philadelphia, Pennsylvania, Philadelphia, USA
| | - Jessica Hart
- Division of General Pediatrics, The Children's Hospital of Philadelphia, Pennsylvania, Philadelphia, USA
| | - Kathy N Shaw
- Division of Emergency Medicine, The Children's Hospital of Philadelphia, Pennsylvania, Philadelphia, USA
| | - Judy A Shea
- Department of Internal Medicine, University of Pennsylvania, Pennsylvania, Philadelphia, USA
| | - Susan Coffin
- Division of Infectious Diseases, The Children's Hospital of Philadelphia, Pennsylvania, Philadelphia, USA
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22
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Meltzer KK, Rhodes CM, Morgan AU, Lautenbach GL, Shea JA, Balasta MA. Insights Into Patients' Perceptions of Health-Related Social Needs and the Role of the Adult Primary Care Clinic. J Prim Care Community Health 2023; 14:21501319231184380. [PMID: 37381821 PMCID: PMC10333991 DOI: 10.1177/21501319231184380] [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: 05/07/2023] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 06/30/2023] Open
Abstract
INTRODUCTION/OBJECTIVES While it is well established that unmet healthrelated social needs (HRSN) adversely affect health outcomes, there has been limited evaluation in adult primary care of patients' perceptions of how these needs impact their health and the role of the primary care provider (PCP). The objective of this study is to identify patients' perceptions of HRSN and how PCPs could help address them. Secondary objectives include exploring the impact of goal setting and a 1-time cash transfer (CT). METHODS This qualitative study used semi-structured baseline and follow-up interviews with patients in internal medicine clinics. Adult primary care patients were included if they screened positive as having 1 of 3 HRSN: financial resource strain, transportation needs, or food insecurity. All participants completed an initial interview about their HRSN and health, and were asked to set a 6-month health goal. At enrollment, participants were randomized to receive a $500 CT or a $50 participation reward. At 6-months, patients were interviewed again to investigate progress toward meeting their health goals, [when applicable] how the CT helped, and their beliefs about the role of PCPs in addressing HRSN. RESULTS We completed 30 initial and 25 follow-up interviews. Participants identified their HRSN, however most did not readily connect identified needs to health. Although participants were receptive to HRSN screening, they did not feel it was their PCP's responsibility to address these needs. Verbal goal-setting appeared to be a useful tool, and while the CTs were appreciated, patients often found them inadequate to address HRSN. CONCLUSIONS Given the importance of identifying the social conditions that shape patients' health, providers, and health systems have an opportunity to re-evaluate their role in helping patients address these barriers. Future studies could examine the effect of more frequent disbursement of CTs over time.
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Affiliation(s)
- Kerry K. Meltzer
- National Clinician Scholars Program,
University of Pennsylvania, Philadelphia, PA, USA
- Crescenz Veterans Affairs Medical
Center, Philadelphia, PA, USA
- Leonard Davis Institute of Health
Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Corinne M. Rhodes
- Division of General Internal Medicine,
Department of Medicine, Perelman School of Medicine, University of Pennsylvania,
Philadelphia, PA, USA
| | - Anna U. Morgan
- Leonard Davis Institute of Health
Economics, University of Pennsylvania, Philadelphia, PA, USA
- Division of General Internal Medicine,
Department of Medicine, Perelman School of Medicine, University of Pennsylvania,
Philadelphia, PA, USA
| | - Gillian L. Lautenbach
- Division of General Internal Medicine,
Department of Medicine, Perelman School of Medicine, University of Pennsylvania,
Philadelphia, PA, USA
| | - Judy A. Shea
- Division of General Internal Medicine,
Department of Medicine, Perelman School of Medicine, University of Pennsylvania,
Philadelphia, PA, USA
| | - Marguerite A. Balasta
- Division of General Internal Medicine,
Department of Medicine, Perelman School of Medicine, University of Pennsylvania,
Philadelphia, PA, USA
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23
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Quinn SM, Goldfarb Terry R, Boock S, Shea JA. Integrating long-acting reversible contraceptives into primary care internal medicine practices: A clinical innovation to reduce wait time. Womens Health (Lond) 2023; 19:17455057231219569. [PMID: 38130094 DOI: 10.1177/17455057231219569] [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] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
BACKGROUND Long-acting reversible contraception (LARC) has long been regarded as highly effective and safe. However, access is limited and lengthy when specialty referrals are required. OBJECTIVES To integrate LARC services into an urban internal medicine primary care practice to decrease wait time for LARC procedures. DESIGN/METHODS This pre-post with control group study took place at two large urban academic primary care practices (Practices A and B) and included patients ages 18 to 45 years assigned female sex at birth. Pre-implementation baseline data were collected retrospectively from 2019 to 2020 by identifying subjects who requested LARC insertion or removal via their primary care practice and were referred to Obstetrics and Gynecology (Ob/Gyn) for the procedure. Wait time was noted from time of initial request in the medical record to time of procedure. Practice A developed an integrated primary care LARC program in which one of their LARC-trained providers began offering these procedures within their own practice. All other providers within the practice were educated on how to counsel patients about the devices and procedures. Practice B did not have an in-house LARC provider and continued referring patients to Ob/Gyn. Post-implementation data were collected prospectively 2021-2022. RESULTS Ninety-one patients in Practice A experienced a significant decrease in wait time (87 vs 21 days, p < 0.001) over the observation period, with a majority undergoing procedures on their first visit with the in-house LARC provider. Wait time for the 54 patients in Practice B remained unchanged (57 vs 47 days, p = .59), often requiring multiple specialty visits. CONCLUSION Integrating LARC services into a primary care internal medicine practice can significantly reduce wait times for these procedures with the potential to contribute to increased reproductive and menstrual autonomy.
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Affiliation(s)
- Sheila M Quinn
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Shelby Boock
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Judy A Shea
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Parikh RB, Manz CR, Nelson MN, Ferrell W, Belardo Z, Temel JS, Patel MS, Shea JA. Oncologist Perceptions of Algorithm-Based Nudges to Prompt Early Serious Illness Communication: A Qualitative Study. J Palliat Med 2022; 25:1702-1707. [PMID: 35984992 PMCID: PMC9836678 DOI: 10.1089/jpm.2022.0095] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Accepted: 07/15/2022] [Indexed: 01/22/2023] Open
Abstract
Background: Early serious illness conversations (SICs) about goals of care and prognosis improve mood, quality of life, and end-of-life care quality. Algorithm-based behavioral nudges to oncologists increase the frequency and timeliness of such conversations. However, clinicians' perspectives on such nudges are unknown. Design: Qualitative study consisting of semistructured interviews among medical oncology clinicians who participated in a stepped-wedge cluster randomized trial of Conversation Connect, an algorithm-based intervention consisting of behavioral nudges to promote early SICs in the outpatient oncology setting. Results: Of 79 eligible oncology clinicians, 56 (71%) were approached to participate in interviews and 25 (45%) accepted. Key facilitators to algorithm-based nudges included prompting documentation of conversations, peer comparisons, performance reports, and validating norms around early conversations. Barriers included cancer-specific heterogeneity in algorithm performance and the frequency and tone of text messages. Areas of improvement included utilizing different information channels, identifying patients earlier in the disease trajectory, and incorporating patient-targeted messaging that emphasizes the value of early conversations. Conclusions: Oncology clinicians identified key facilitators and barriers to Conversation Connect. These insights inform future algorithm-based supportive care interventions in oncology. Controlled trial (NCT03984773).
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Affiliation(s)
- Ravi B. Parikh
- Perelman School of Medicine and University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Christopher R. Manz
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Maria N. Nelson
- Perelman School of Medicine and University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - William Ferrell
- Perelman School of Medicine and University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Zoe Belardo
- Perelman School of Medicine and University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jennifer S. Temel
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Hematology and Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Mitesh S. Patel
- Perelman School of Medicine and University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Penn Medicine Nudge Unit, Philadelphia, Pennsylvania, USA
- Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Judy A. Shea
- Perelman School of Medicine and University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Whitsett MP, Ufere NN, Patel A, Shea JA, Jones CA, Fix OK, Serper M. Palliative care experience and perceived gaps in training among transplant hepatology fellows: A national survey. Hepatol Commun 2022; 6:1680-1688. [PMID: 35411683 PMCID: PMC9234628 DOI: 10.1002/hep4.1939] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 01/25/2022] [Accepted: 02/17/2022] [Indexed: 11/20/2022] Open
Abstract
Despite the likely benefits of palliative care (PC) for patients with cirrhosis, physician experiences and perspectives about best practices are variable. We aimed to assess PC experience and gaps in training among transplant hepatology fellows. We conducted a national survey of all transplant hepatology fellows enrolled in accredited fellowship programs during the 2020-2021 academic year. We assessed the frequency of PC provision and comfort with physical and psychological symptom management, psychosocial care, communication skills, advance care planning, and end-of-life care. A total of 45 of 56 (79%) of transplant hepatology fellows responded to the survey; 50% (n = 22) were female. Most trained at centers performing over 100 transplants per year (67%, n = 29) distributed evenly across geographic regions. Most fellows (69%, n = 31) had a PC or hospice care rotation during residency, and 42% (n = 19) of fellows received education in PC during transplant hepatology fellowship. Fellows reported feeling moderately to very comfortable with communication skills such as breaking bad news (93%, n = 41) and leading family meetings (75%, n = 33), but nearly one-third (30%, n = 13) reported feeling not very or not at all comfortable assessing and managing anxiety and depression (30%, n = 13) and spiritual distress (34%, n = 15). Nearly one-quarter (22%, n = 10) had never discussed or documented advance care plans during fellowship. Fellows wished to receive future instruction on the assessment and management of physical symptoms (68%, n = 30) and anxiety and depression (64%, n = 28). Conclusion: Our survey highlights gaps in PC experience and education during transplant hepatology fellowship, lack of comfort in managing psychological distress and advance care planning, and desire to improve skills, particularly in symptom management. Future studies should investigate how to enhance transplant hepatology competencies in these PC domains and whether this impacts clinical care, advance care planning, or patient experience.
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Affiliation(s)
- Maureen P Whitsett
- Division of Gastroenterology and HepatologyCleveland ClinicClevelandOhioUSA
| | - Nneka N Ufere
- Liver CenterGastrointestinal UnitMassachusetts General HospitalBostonMassachusettsUSA
| | - Arpan Patel
- Vatche and Tamar Manoukian Division of Digestive Diseases, Department of MedicineDavid Geffen School of Medicine at UCLALos AngelesCaliforniaUSA.,Veterans Affairs Greater Los Angeles Healthcare SystemLos AngelesCaliforniaUSA
| | - Judy A Shea
- Division of General Internal MedicineDepartment of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Christopher A Jones
- Department of Internal MedicineDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Oren K Fix
- Division of Gastroenterology and HepatologyUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Marina Serper
- Division of Gastroenterology and HepatologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA.,Corporal Michael J. Crescenz VA Medical CenterPhiladelphiaPennsylvaniaUSA.,Leonard Davis InstituteUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
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Jones JM, Berman AB, Tan EX, Mohanty S, Rose MA, Shea JA, Kogan JR. Amplifying the Student Voice: Medical Student Perceptions of AΩA. J Gen Intern Med 2022:10.1007/s11606-022-07544-y. [PMID: 35764758 DOI: 10.1007/s11606-022-07544-y] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 03/30/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Recent literature has suggested racial disparities in Alpha Omega Alpha Honor Medical Society (AΩA) selection and raised concerns about its effects on the learning environment. Internal reviews at multiple institutions have led to changes in selection practices or suspension of student chapters; in October 2020, the national AΩA organization provided guidance to address these concerns. OBJECTIVE This study aimed to better understand student opinions of AΩA. DESIGN An anonymous survey using both multiple response option and free response questions. PARTICIPANTS Medical students at the Perelman School of Medicine at the University of Pennsylvania. MAIN MEASURES Descriptive statistics and logistic regressions were used to examine predictors of student opinion towards AΩA. Free responses were analyzed by two independent coders to identify key themes. KEY RESULTS In total, 70% of the student body (n = 547) completed the survey. Sixty-three percent had a negative opinion of AΩA, and 57% felt AΩA should not exist at the student level. Thirteen percent believed AΩA membership appropriately reflects the student body; 8% thought selection processes were fair. On multivariate analysis, negative predictors of a student's preference to continue AΩA at the student level included belief that AΩA membership does not currently mirror class composition (OR: 0.45, [95% CI: 0.23-0.89]) and that AΩA selection processes were unfair (OR: 0.20 [0.08-0.47]). Self-perception as not competitive for AΩA selection was also a negative predictor (OR: 0.44 [0.22-0.88]). Major qualitative themes included equity, impact on the learning environment, transparency, and positive aspects of AΩA. CONCLUSIONS This single-institution survey demonstrated significant student concerns regarding AΩA selection fairness and effects on the learning environment. Many critiques extended beyond AΩA itself, instead focusing on the perceived magnification of existing disparities in the learning environment. As the national conversation about AΩA continues, engaging student voices in the discussion is critical.
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Affiliation(s)
- Jeremy M Jones
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Alexandra B Berman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Anesthesiology, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
| | - Erik X Tan
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Division of General Internal Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sarthak Mohanty
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michelle A Rose
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Judy A Shea
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Division of General Internal Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jennifer R Kogan
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Division of General Internal Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Lee KC, Morgan AU, Chaiyachati KH, Asch DA, Xiong RA, Do D, Kilaru AS, Lam D, Parambath A, Friedman AB, Meisel ZF, Snider CK, Chisholm DL, Kelly S, Hemmons JE, Abdel-Rahman D, Ebert J, Ghosh M, Reilly J, O'Malley CJ, Hahn L, Mannion NM, Huffenberger AM, McGinley S, Balachandran M, Khan N, Shea JA, Mitra N, Delgado MK. Pulse Oximetry for Monitoring Patients with Covid-19 at Home - A Pragmatic, Randomized Trial. N Engl J Med 2022; 386:1857-1859. [PMID: 35385625 PMCID: PMC9006781 DOI: 10.1056/nejmc2201541] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Kathleen C Lee
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Anna U Morgan
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - David A Asch
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Ruiying A Xiong
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - David Do
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Austin S Kilaru
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Doreen Lam
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Andrew Parambath
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Ari B Friedman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Zachary F Meisel
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Deena L Chisholm
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Sheila Kelly
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jessica E Hemmons
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Dina Abdel-Rahman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jeffrey Ebert
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Medha Ghosh
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Julianne Reilly
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Lauren Hahn
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Nancy M Mannion
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Ann M Huffenberger
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Susan McGinley
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Mohan Balachandran
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Neda Khan
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Judy A Shea
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Nandita Mitra
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - M Kit Delgado
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Wietlisbach LE, Asch DA, Eriksen W, Barg FK, Bellini LM, Desai SV, Yakubu AR, Shea JA. Using poetry to elicit internal medicine residents' perspectives on wellness. Postgrad Med J 2022:7130726. [PMID: 37084142 DOI: 10.1136/postmj/postgradmedj-2021-141493] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/19/2022] [Indexed: 04/22/2023]
Abstract
PURPOSE To elicit internal medicine residents' perspectives on wellness through poetry writing, examining (1) response rates, (2) the tone/sentiment of their submissions and (3) the primary thematic content. STUDY DESIGN In academic year 2019-2020, a random sample of 88 residents from four internal medicine residency programmes was invited to participate in a year-long study of wellness. In December 2019, an open-ended prompt asked residents to write a poem reflecting on their well-being. Responses were inductively coded using content analysis techniques. RESULTS The response rate for the poetry prompt was 94%. The tone of the entries was most often neutral or contradictory (42%), followed by negative (33%) and positive (25%). There were three main themes: (1) Mindsets: most residents simply wanted to make it through their programme; (2) wellness influencers: the main wellness supporters were external to the programme such as vacationing and exercise; within hospitals, friendships with colleagues and boosted wellness and (3) scheduling/repetition: difficult schedules drained energy as did the monotony of administrative tasks. CONCLUSIONS Poetry appears to be an innovative and effective vehicle to elicit residents' perspectives without compromising response rate. Poetry survey techniques allow medical trainees to provide powerful messaging to leadership. Most of what is known about trainee wellness is derived from quantitative surveys. This study showed medicine trainees' willingness to engage in poetry and add richness and personal detail to highlight key drivers of wellness. Such information provides context and brings attention in a compelling manner to an important topic.
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Affiliation(s)
- Larissa E Wietlisbach
- Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David A Asch
- Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Whitney Eriksen
- Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Frances K Barg
- Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lisa M Bellini
- Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sanjay V Desai
- Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Abdul-Rakeem Yakubu
- Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Judy A Shea
- Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Shea JA, Bellini LM, Desai SV, Barg FK, Eriksen W, Wietlisbach LE, Yakubu AR, Asch DA. Exploring Residents' Well-Being and Burnout via Qualitative Ecological Momentary Assessment. Acad Med 2022; 97:414-419. [PMID: 34753860 PMCID: PMC8881344 DOI: 10.1097/acm.0000000000004508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE Most of what is known about resident burnout and wellness comes from cross-sectional snapshot surveys. The purpose of this study was to elicit qualitative perspectives on wellness from a cohort of internal residents over time using ecological momentary assessment. METHOD Drawing on principles of ecological momentary assessment, 13 different open-ended survey prompts were delivered between October and March during the 2019-2020 academic year. Participants were 88 randomly selected internal medicine residents from 4 internal medicine training programs in the Northeast. RESULTS The response rate was 95%. Three main themes regarding wellness were self, program/education environment, and medical/structural system. A fourth theme, the desire to provide quality patient care, cut across all other themes. The patient care theme repeatedly stressed residents' desire to spend more time with patients. The self theme primarily reflected messages about personal emotions and the need for work-life balance and wellness. The program/education environment theme reflected the value of learning, teamwork and community, and program culture. The medical/structural system theme showed that residents' experiences were shaped by the efficiency of their days and largely a product of their schedules and administrative support. Closing advice to future trainees was optimistic and reassuring. CONCLUSIONS While findings support much of what has been learned via single-occasion survey snapshots, an ecological momentary assessment design allowed a deeper dive into contextual associations. The results affirm the primacy of patient care and also highlight the value of teamwork and culture. Peers and program leaders are heavily influential in setting the tone for the learning experience, whether for the day or with a more enduring message of respect and support. There is opportunity to maximize high- or higher-value learning experiences for residents and find solutions to reduce and reframe the perceived "low-value administrative work" that is part of care coordination.
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Affiliation(s)
- Judy A Shea
- J.A. Shea is the Leon Hess Professor of Internal Medicine, Department of Medicine, and associate dean of medical education research, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; ORCID: https://orcid.org/0000-0002-7334-4192
| | - Lisa M Bellini
- L.M. Bellini is professor, Department of Medicine, and senior vice dean for academic affairs, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; ORCID: https://orcid.org/0000-0003-0985-2384
| | - Sanjay V Desai
- S.V. Desai is director, Osler Medical Residency, and vice-chair for education, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; ORCID: https://orcid.org/0000-0002-9759-7696
| | - Frances K Barg
- F.K. Barg is director, University of Pennsylvania Mixed Methods Research Lab, and professor, Department of Family Medicine and Community Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; ORCID: https://orcid.org/0000-0003-3328-1980
| | - Whitney Eriksen
- W. Eriksen is a senior researcher, University of Pennsylvania Mixed Methods Research Lab, Philadelphia, Pennsylvania; ORCID: https://orcid.org/0000-0003-2196-1815
| | - Larissa E Wietlisbach
- L.E. Wietlisbach is a medical student and research assistant, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; ORCID: https://orcid.org/0000-0002-8375-3264
| | - Abdul-Rakeem Yakubu
- A.-R. Yakubu is a research assistant, University of Pennsylvania Mixed Methods Research Lab, Philadelphia, Pennsylvania
| | - David A Asch
- D.A. Asch is a professor, Perelman School of Medicine and Wharton School at the University of Pennsylvania, and physician, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; ORCID: https://orcid.org/0000-0002-7970-286X
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Mergler BD, Goldshore MA, Shea JA, Lane-Fall MB, Hadler RA. The Patient Dignity Inventory and Dignity-Related Distress among the Critically Ill. J Pain Symptom Manage 2022; 63:359-365. [PMID: 34890727 DOI: 10.1016/j.jpainsymman.2021.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/24/2021] [Accepted: 12/01/2021] [Indexed: 11/27/2022]
Abstract
CONTEXT Critical illness confers a significant risk of psychological distress, both during and after intensive care unit (ICU) admission. The Patient Dignity Inventory is a 25-item instrument initially designed to measure psychosocial, existential and symptom-related distress in terminally ill patients. OBJECTIVES This study was conducted to validate the inventory as a means of identifying distress in inpatient critical care settings. METHODS Single-center prospective cohort study of adult patients admitted to one of five ICUs within the University of Pennsylvania Health System for greater than 48 hours from January 2019 to February 2020. Patients completed the inventory in addition to the Patient Health Questionnaire-9 and the Generalized Anxiety Disorder-seven questionnaires. RESULTS The tool's internal structure was assessed via principal components analysis. 155 participants consented, completed the surveys and were included for analysis. Scores on the inventory showed evidence of internal consistency when used in critical care settings (Cronbach's α=0.95). Moreover, principal components analysis elucidated four themes prevalent in critically-ill patients: Illness-related Concerns, Interactions with Others, Peace of Mind and Dependency. Construct validity was assessed through correlational analysis with depression and anxiety questionnaires. Scores on the inventory appear to be valid for assessing dignity-related psychological concerns in the critical care setting although there is overlap among components and with anxiety and depression scores. CONCLUSIONS This study demonstrates that the inventory can be used to assess patient distress in critical care settings. Further research may elucidate the role of dignity-based interventions in treating and preventing post-intensive care psychological symptoms.
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Affiliation(s)
- Blake D Mergler
- Department of Anesthesiology and Critical Care (B.D.M., M.B.L.F.), University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Matthew A Goldshore
- Department of Surgery (M.A.G.), University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Judy A Shea
- Department of Medicine (J.A.S.), University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Meghan B Lane-Fall
- Department of Anesthesiology and Critical Care (B.D.M., M.B.L.F.), University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rachel A Hadler
- Department of Anesthesia (R.A.H.), University of Iowa, Iowa City, Iowa, USA
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Cotner CE, Mercadante SF, Shea JA. Assessing the Impact of the COVID-19 Pandemic on Geographic Residency Placement Relative to Medical School Location. J Grad Med Educ 2022; 14:108-111. [PMID: 35222828 PMCID: PMC8848873 DOI: 10.4300/jgme-d-21-00614.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 09/14/2021] [Accepted: 10/27/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The 2020-2021 residency application cycle was altered to reduce COVID-19 transmission, with moves to all virtual interviews and no away rotations for medical students. These changes may have affected how students ranked residency programs, such as choosing programs near their medical schools. OBJECTIVE To determine if a larger percentage of medical students matched to residency programs in the same state as their medical schools in 2021 vs 2018-2020. METHODS We searched the webpages or emailed student affairs deans of the 155 Liaison Committee on Medical Education accredited MD programs to attain medical school match lists. Differences in the percentage of students matching to residency programs in the same US state as their medical schools in 2021 vs 2018-2020 were compared using chi-square tests. RESULTS We recorded 36 021 of 79 406 (45%) National Resident Matching Program, 759 of 1720 (44%) ophthalmology, and 586 urology MD residency matches between 2018 and 2021. The percentage of students matching to residency programs in the same state as their medical schools was 35.9% in 2021 versus 34.3% in 2018-2020 (P=.005). Students were more likely to match to programs in the same state as their medical schools in 2021 if they attended a public medical school (40.3% vs 38.5%, P=.009) or applied into specialties where ≥50% of students traditionally perform away rotations (32.2% vs 30.2%, P=.031). CONCLUSIONS There was a small difference in the percentage of medical students matching to residency programs in the same state as their medical schools in 2021 vs 2018-2020.
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Affiliation(s)
- Cody E. Cotner
- Cody E. Cotner, MD, is an Internal Medicine Resident, Brigham and Women's Hospital, Harvard Medical School
| | - Sophia F. Mercadante
- Sophia F. Mercadante, BS, is a Fourth-Year Medical Student, Lewis Katz School of Medicine, Temple University
| | - Judy A. Shea
- Judy A. Shea, PhD, is The Leon Hess Professor of Internal Medicine, Perelman School of Medicine, University of Pennsylvania
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32
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Asch DA, Bellini LM, Desai SV, Darragh D, Asch EL, Shea JA. An innovation tournament to improve medical residency. Healthc (Amst) 2022; 10:100614. [PMID: 35114599 PMCID: PMC8881444 DOI: 10.1016/j.hjdsi.2022.100614] [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] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 01/12/2022] [Accepted: 01/14/2022] [Indexed: 11/15/2022]
Abstract
Two large national studies of resident duty hours incidentally revealed surgical and medical resident dissatisfaction with residency training. Aiming for an inclusive and democratic approach to improve graduate medical education, we conducted a national innovation tournament–reaching out to the program directors of all 474 US internal medicine residency programs to invite them and their residents and associate program directors to participate. Participants could submit multiple ideas as individuals or teams in four domains: [1] resident well-being and personal and professional development; [2] resident education and clinical preparedness; [3] resident sleep and alertness; and [4] patient safety. Residents and program directors were reinvited to rate ideas, whether they had submitted ideas themselves or not. We used a schedule of lottery-based prizes to stimulate the submission and rating of ideas and encourage engagement. 164 residents and program directors from 51 different programs submitted 328 ideas. 153 residents and program directors from 48 different programs submitted 15,345 ratings of ideas. Winning ideas aimed to reduce residents’ work burden or improve their mental health, sleep, eating, or relaxation or reflected technical fixes to the operations of residency, such as changing vacation schedules and the timing of pay. The results of this tournament provided actionable suggestions to improve residency training now being tested in our own residency programs. Innovation tournaments drive engagement and generate value by their opportunities for inclusion and by shifting problem solving to the end user.
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Affiliation(s)
- David A Asch
- From the University of Pennsylvania (DAA, LMB, DD, ELA, JAS), in Philadelphia, PA, and the Johns Hopkins University (SVD), in Baltimore, MD, USA.
| | - Lisa M Bellini
- From the University of Pennsylvania (DAA, LMB, DD, ELA, JAS), in Philadelphia, PA, and the Johns Hopkins University (SVD), in Baltimore, MD, USA
| | - Sanjay V Desai
- From the University of Pennsylvania (DAA, LMB, DD, ELA, JAS), in Philadelphia, PA, and the Johns Hopkins University (SVD), in Baltimore, MD, USA
| | - Deirdre Darragh
- From the University of Pennsylvania (DAA, LMB, DD, ELA, JAS), in Philadelphia, PA, and the Johns Hopkins University (SVD), in Baltimore, MD, USA
| | - Elizabeth L Asch
- From the University of Pennsylvania (DAA, LMB, DD, ELA, JAS), in Philadelphia, PA, and the Johns Hopkins University (SVD), in Baltimore, MD, USA
| | - Judy A Shea
- From the University of Pennsylvania (DAA, LMB, DD, ELA, JAS), in Philadelphia, PA, and the Johns Hopkins University (SVD), in Baltimore, MD, USA
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Abstract
BACKGROUND Pre-transplant evaluation is mandated by Centers for Medicare and Medicaid Services, but there is wide institutional variation in implementation, and the family experience of the process is incompletely understood. Current literature largely focuses on adult transplant recipients. METHODS This qualitative study begins to fill the knowledge gap about family experience of the pre-transplant evaluation for children through interviews with caregivers at a large pediatric transplant center. RESULTS Prominent themes heard from caregivers include (1) the pre-transplant evaluation is overwhelming and emotional, (2) prior experiences and background knowledge frame the evaluation experience, and (3) frustration with communication among teams is common. CONCLUSIONS These findings are relevant to efforts by transplant centers to optimize information delivery, minimize concrete barriers, and address healthcare systems issues. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Eloise C Salmon
- University of Michigan, 1540 Hospital Drive, Ann Arbor, MI, 48109-4297, USA.
| | - Laura G Barr
- University of Pennsylvania, Philadelphia, PA, USA
| | - Douglas L Hill
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Judy A Shea
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sandra Amaral
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Ganetsky VS, Shea JA, Szapary C, Ikechi R, Keddem S, Kaufman ST, Long JA. Exploring Barriers and Facilitators to Glycemic Control and Shared Medical Appointment Engagement in Underserved Patients with Diabetes. J Health Care Poor Underserved 2022; 33:88-103. [DOI: 10.1353/hpu.2022.0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Goldmuntz E, Zheng Z, Shea JA. Reported practice patterns in the ambulatory care setting for patients with CHD. Cardiol Young 2021; 32:1-6. [PMID: 34776030 DOI: 10.1017/s1047951121004303] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION In the absence of evidence-based guidelines, paediatric cardiologists monitor patients in the ambulatory care setting largely according to personal, patient, institutional, and/or financial dictates, all of which likely contribute to practice variability. Minimising practice variability may optimise quality of care while incurring lower costs. We sought to describe self-reported practice patterns and physician attitudes about factors influencing their testing strategies using vignettes describing common scenarios in the care of asymptomatic patients with tetralogy of Fallot and d-transposition of the great arteries. METHODS We conducted a cross-sectional survey of paediatric cardiologists attending a Continuing Medical Educational conference and at our centre. The survey elicited physician characteristics, self-reported testing strategies, and reactions to factors that might influence their decision to order an echocardiogram. RESULTS Of 267 eligible paediatric cardiologists, 110 completed the survey. The majority reported performing an annual physical examination (66-82%), electrocardiogram (74-79%), and echocardiogram (56-76%) regardless of patient age or severity of disease. Other tests (i.e. Holter monitors, exercise stress tests or cardiac MRIs) were ordered less frequently and less consistently. We observed within physician consistency in frequency of test ordering. In vignettes of younger children with mild disease, higher frequency testers were younger than lower frequency testers. CONCLUSIONS These results suggest potential practice pattern variability, which needs to be further explored in real-life settings. If clinical outcomes for patients followed by low frequency testers match that of high frequency testers, then room to modify practice patterns and lower costs without compromising quality of care may exist.
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Affiliation(s)
- Elizabeth Goldmuntz
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Zihe Zheng
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Judy A Shea
- Department of Medicine, Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Williams C, Perez MA, Vapiwala N, Shea JA. The Impact of Socioeconomic Factors on Medical School Acceptance Rates. Acad Med 2021; 96:S219-S220. [PMID: 34705722 DOI: 10.1097/acm.0000000000004281] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Cheyenne Williams
- Author affiliations: C. Williams, M.A. Perez, N. Vapiwala, J.A. Shea, Perelman School of Medicine, University of Pennsylvania
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Cordoza M, Basner M, Asch DA, Shea JA, Bellini LM, Carlin M, Ecker AJ, Malone SK, Desai SV, Katz JT, Bates DW, Small DS, Volpp KG, Mott CG, Coats S, Mollicone DJ, Dinges DF. Sleep and Alertness Among Interns in Intensive Care Compared to General Medicine Rotations: A Secondary Analysis of the iCOMPARE Trial. J Grad Med Educ 2021; 13:717-721. [PMID: 34721802 PMCID: PMC8527933 DOI: 10.4300/jgme-d-21-00045.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 07/08/2021] [Accepted: 07/22/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Medical interns are at risk for sleep deprivation from long and often rotating work schedules. However, the effects of specific rotations on sleep are less clear. OBJECTIVE To examine differences in sleep duration and alertness among internal medicine interns during inpatient intensive care unit (ICU) compared to general medicine (GM) rotations. METHODS This secondary analysis compared interns during a GM or ICU rotation from a randomized trial (2015-2016) of 12 internal medicine residency programs assigned to different work hour limit policies (standard 16-hour shifts or no shift-length limits). The primary outcome was sleep duration/24-hour using continuous wrist actigraphy over a 13-day period. Secondary outcomes assessed each morning during the concomitant actigraphy period were sleepiness (Karolinska Sleepiness Scale [KSS]), alertness (number of Brief Psychomotor Vigilance Test [PVT-B] lapses), and self-report of excessive sleepiness over past 24 hours. Linear mixed-effect models with random program intercept determined associations between each outcome by rotation, controlling for age, sex, and work hour policy followed. RESULTS Of 398 interns, 386 were included (n = 261 GM, n = 125 ICU). Average sleep duration was 7.00±0.08h and 6.84±0.10h, and number of PVT lapses were 5.5±0.5 and 5.7±0.7 for GM and ICU, respectively (all P > .05). KSS was 4.8±0.1 for both rotations. Compared to GM, ICU interns reported more days of excessive sleepiness from 12am-6am (2.6 vs 1.7, P < .001) and 6am-12pm (2.6 vs 1.9, P = .013) and had higher percent of days with sleep duration < 6 hours (27.6% vs 23.4%, P < .001). GM interns reported more days with no excessive sleepiness (5.3 vs 3.7, P < .001). CONCLUSIONS Despite ICU interns reporting more excessive sleepiness in morning hours and more days of insufficient sleep (<6 hours), overall sleep duration and alertness did not significantly differ between rotations.
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Affiliation(s)
- Makayla Cordoza
- Makayla Cordoza, PhD, RN, CCRN-K*, is a Lecturer, University of Pennsylvania
| | - Mathias Basner
- Mathias Basner, MD, PhD, MSc*, is a Professor, University of Pennsylvania
| | - David A. Asch
- David A. Asch, MD, MBA, is a Professor, University of Pennsylvania, and Practicing Physician, Corporal Michael J. Crescenz Veterans Affairs Medical Center
| | - Judy A. Shea
- Judy A. Shea, PhD, is a Professor, University of Pennsylvania
| | - Lisa M. Bellini
- Lisa M. Bellini, MD, is a Professor, University of Pennsylvania
| | - Michele Carlin
- Michele Carlin is a Project Manager, University of Pennsylvania
| | - Adrian J. Ecker
- Adrian J. Ecker is a Senior IT Project Leader, University of Pennsylvania
| | - Susan K. Malone
- Susan K. Malone, PhD, RN, is an Assistant Professor, New York University
| | - Sanjay V. Desai
- Sanjay V. Desai, MD, is a Professor, Johns Hopkins University
| | - Joel T. Katz
- Joel T. Katz, MD, is Vice Chair for Education, Brigham and Women's Hospital
| | - David W. Bates
- David W. Bates, MD, MSc, is Division of General Internal Medicine Chief, Brigham and Women's Hospital
| | - Dylan S. Small
- Dylan S. Small, PhD, is a Professor, University of Pennsylvania
| | - Kevin G. Volpp
- Kevin G. Volpp, MD, PhD, is a Professor, University of Pennsylvania, and Practicing Physician, Corporal Michael J. Crescenz Veterans Affairs Medical Center
| | | | - Sara Coats
- Sara Coats, BS, is Lead Project Coordinator, Pulsar Informatics
| | | | - David F. Dinges
- David F. Dinges, PhD, is a Professor, University of Pennsylvania; and iCOMPARE Research Group
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Wietlisbach LE, Asch DA, Eriksen W, Barg FK, Bellini LM, Desai SV, Yakubu AR, Shea JA. Dark Clouds With Silver Linings: Resident Anxieties About COVID-19 Coupled With Program Innovations and Increased Resident Well-Being. J Grad Med Educ 2021; 13:515-525. [PMID: 34434512 PMCID: PMC8370362 DOI: 10.4300/jgme-d-20-01497.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/05/2021] [Accepted: 05/04/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic forced numerous unprecedented systemic changes within residency programs and hospital systems. OBJECTIVE We explored how the COVID-19 pandemic, and associated changes in clinical and educational experiences, were related to internal medicine residents' well-being in the early months of the pandemic. METHODS Across 4 internal medicine residency programs in the Northeast United States that have previously participated in the iCOMPARE study, all 394 residents were invited to participate in a study with open-ended survey prompts about well-being approximately every 2 weeks in academic year 2019-2020. In March and April 2020, survey prompts were refocused to COVID-19. Content analysis revealed themes in residents' open-ended responses to 4 prompts. RESULTS One hundred and eighty-six residents expressed interest, and 88 were randomly selected (47%). There were 4 main themes: (1) in early days of the pandemic, internal medicine residents reported fear and anxiety about uncertainty and lack of personal protective equipment; (2) residents adapted and soon were able to reflect, rest, and pursue personal wellness; (3) communication from programs and health systems was inconsistent early in the pandemic but improved in clarity and frequency; (4) residents appreciated the changes programs had made, including shorter shifts, removal of pre-rounding, and telemedicine. CONCLUSIONS COVID-19 introduced many challenges to internal medicine residency programs and to resident well-being. Programs made structural changes to clinical schedules, educational/conference options, and communication that boosted resident well-being. Many residents hoped these changes would continue regardless of the pandemic's course.
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Affiliation(s)
- Larissa E. Wietlisbach
- Larissa E. Wietlisbach, BSA, is a Medical Student and Research Assistant, Perelman School of Medicine, University of Pennsylvania
| | - David A. Asch
- David A. Asch, MD, MBA, is Professor, Perelman School of Medicine and The Wharton School, and an Internal Medicine Physician, Department of Medicine, University of Pennsylvania
| | - Whitney Eriksen
- Whitney Eriksen, PhD, RN, is a Senior Researcher, University of Pennsylvania Mixed Methods Research Lab
| | - Frances K. Barg
- Frances K. Barg, PhD, MEd, is Director, University of Pennsylvania Mixed Methods Research Lab, and Professor, Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania
| | - Lisa M. Bellini
- Lisa M. Bellini, MD, is Senior Vice Dean for Academic Affairs, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, and University of Pennsylvania
| | - Sanjay V. Desai
- Sanjay V. Desai, MD, is Director, Osler Medical Residency, and Vice-Chair for Education, Department of Medicine, Johns Hopkins University
| | - Abdul-Rakeem Yakubu
- Abdul-Rakeem Yakubu is a Research Assistant, University of Pennsylvania Mixed Methods Research Lab
| | - Judy A. Shea
- Judy A. Shea, PhD, is Associate Dean of Medical Education Research, Perelman School of Medicine, and Professor, Department of Medicine, University of Pennsylvania
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Abstract
There is widespread agreement that medical education should include multi-source, multi-method, and multi-purpose forms of assessment and thus should move towards cohesive systems of assessment. One possibility that fits comfortably with a system of assessment framework is to organize assessments around a competency based medical education model. However conceptually appealing a competency based medical education model is, discussions are sparse regarding the details of determining competence (or the pass/fail point) within each competency. In an effort to make discussions more concrete, we put forth three key issues relevant to implementation of competency-based assessment: (1) each competency is measured with multiple assessments, (2) not all assessments produce a score for a competency as a good portion of assessment in medical school is narrative, and (3) competence decisions re-occur as assessments cumulate. We agree there are a host of other issues to consider, but think the practical action-oriented issues we set forth will be helpful in putting form into what is now largely abstract discussions.
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Affiliation(s)
- Jorie M Colbert-Getz
- Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Judy A Shea
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Haynes NA, Saint-Joy V, Swain J, Ezekwesili A, Vernet FV, Dawson C, Laneau D, Tierney A, Shea JA, Ambrose MS. Implementation of a virtual international cardiology curriculum to address the deficit of cardiovascular education in Haiti: a pilot study. BMJ Open 2021; 11:e048690. [PMID: 34155081 PMCID: PMC8217944 DOI: 10.1136/bmjopen-2021-048690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) remains a leading cause of morbidity and mortality worldwide, conferring a disparate burden on low-income and middle-income countries (LMICs). Haiti represents a resource-constrained setting, limited by a paucity of resources and trained cardiovascular professionals equipped to address the increasing burden of CVD. OBJECTIVE Here, we describe the creation of a comprehensive cardiology curriculum delivered through a virtual classroom. The curriculum was created to augment cardiovascular education in LMICs such as Haiti. METHODS Over one academic year (May 2019-2020), International Cardiology Curriculum Accessible by Remote Distance Learning-Haiti consisted of biweekly, live-streamed, synchronous didactic lectures, seminars and case presentations broadcasted to 16 internal medicine (IM) residents at Hôpital Universitaire de Mirebalais, one of only four IM training programmes in Haiti. The virtual classroom was created using commercially available videoconferencing and data-sharing platforms. Prelecture and postlecture surveys and an end of the year survey were administered to assess the impact of the curriculum. RESULTS Participant performance analysis revealed that 80% of the curriculum demonstrated a positive trend in knowledge acquisition postintervention. Based on the end of the year evaluation, 94% of participants reported that the curriculum was educational and relevant to medical practice in Haiti and 100% reported that the curriculum was good to excellent. Additionally, the curriculum was cited as an effective means of maintaining trainee education during the COVID-19 pandemic. CONCLUSION This international medical education pilot study demonstrates the feasibility of augmenting cardiology education in LMICs by creating a virtual curriculum made possible by local partnerships, internet access and technology.
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Affiliation(s)
| | - Veauthyelau Saint-Joy
- Cardiology, Centre Hospitalier d Antibes Juan les Pins, Antibes, Provence-Alpes-Côte d'Azu, France
| | - JaBaris Swain
- Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Agnes Ezekwesili
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Fritz Verly Vernet
- Internal Medicine, Hôpital Universitaire de Mirebalais, Mirebalais, Haiti
| | - Calixte Dawson
- Internal Medicine, Hôpital Universitaire de Mirebalais, Mirebalais, Haiti
| | - Davidson Laneau
- Internal Medicine, Hôpital Universitaire de Mirebalais, Mirebalais, Haiti
| | - Ann Tierney
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Judy A Shea
- Division of General Internal Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Olave M, Lavery C, Leonard CE, Lo Re V, Shea JA, Kay J, Baker JF. Knowledge of biosimilars and perceptions of the naming conventions for biosimilar products in clinical practice in the United States. Drugs Ther Perspect 2021; 37:338-346. [PMID: 34712041 PMCID: PMC8547319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Biosimilar therapies and their naming conventions are both relatively new to the drug development market and in clinical practice. We studied the use of the four-letter naming convention in practice and the knowledge, perceptions, and preferences of US health care providers. METHODS A survey was distributed among health care professionals with a history of utilizing biosimilars in clinical practice to measure key knowledge and the presence of discernable naming trends. Differences in responses across pre-hypothesized subgroups were tested for statistical significance. RESULTS Of the 506 surveys emailed, 83 (16%) people responded. Overall, there was poor knowledge about the key concepts surrounding biosimilars. For example, only 52% of respondents correctly identified that biosimilars were not the same as the generic drug; however, frequent use correlated with superior knowledge across all groups. In reference to naming preferences, 67% of all respondents indicated that they commonly use the brand name to distinguish biosimilars in clinical practice and a majority of them (85%) indicated that the brand name was easier to remember than the nonproprietary name with the four-letter suffix. An unexpected number of neutral responses was documented. Notably, more than half of respondents (68%) indicated a neutral response when asked if the four-letter suffix promoted medical errors. CONCLUSIONS There remains a knowledge gap with regard to biosimilars, and lack of consensus on how the naming convention is and should be utilized in clinical practice. The data also suggest that effective biosimilar education could aid in promoting familiarity with the naming convention among health care providers.
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Affiliation(s)
- Marianna Olave
- Rheumatology and Infectious Disease, Medical Research Program, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Criswell Lavery
- Division of Rheumatology, Perelman School of Medicine, University of Pennsylvania, 5th Floor White Building, 3600 Spruce Street, Philadelphia, PA 19104, USA
| | - Charles E. Leonard
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Vincent Lo Re
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Judy A. Shea
- Division of General Internal Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jonathan Kay
- Division of Rheumatology, Department of Medicine, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA, USA
- Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Joshua F. Baker
- Division of Rheumatology, Perelman School of Medicine, University of Pennsylvania, 5th Floor White Building, 3600 Spruce Street, Philadelphia, PA 19104, USA
- Rheumatology and Infectious Disease, Medical Research Program, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Kirschen MP, Smith KA, Snyder M, Zhang B, Flibotte J, Heimall L, Budzynski K, DeLeo R, Cona J, Bocage C, Hur L, Winters M, Hanna R, Mensinger JL, Huh J, Lang SS, Barg FK, Shea JA, Ichord R, Berg RA, Levine JM, Nadkarni V, Topjian A. Serial Neurologic Assessment in Pediatrics (SNAP): A New Tool for Bedside Neurologic Assessment of Critically Ill Children. Pediatr Crit Care Med 2021; 22:483-495. [PMID: 33729729 DOI: 10.1097/pcc.0000000000002675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We developed a tool, Serial Neurologic Assessment in Pediatrics, to screen for neurologic changes in patients, including those who are intubated, are sedated, and/or have developmental disabilities. Our aims were to: 1) determine protocol adherence when performing Serial Neurologic Assessment in Pediatrics, 2) determine the interrater reliability between nurses, and 3) assess the feasibility and acceptability of using Serial Neurologic Assessment in Pediatrics compared with the Glasgow Coma Scale. DESIGN Mixed-methods, observational cohort. SETTING Pediatric and neonatal ICUs. SUBJECTS Critical care nurses and patients. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Serial Neurologic Assessment in Pediatrics assesses Mental Status, Cranial Nerves, Communication, and Motor Function, with scales for children less than 6 months, greater than or equal to 6 months to less than 2 years, and greater than or equal to 2 years old. We assessed protocol adherence with standardized observations. We assessed the interrater reliability of independent Serial Neurologic Assessment in Pediatrics assessments between pairs of trained nurses by percent- and bias- adjusted kappa and percent agreement. Semistructured interviews with nurses evaluated acceptability and feasibility after nurses used Serial Neurologic Assessment in Pediatrics concurrently with Glasgow Coma Scale during routine care. Ninety-eight percent of nurses (43/44) had 100% protocol adherence on the standardized checklist. Forty-three nurses performed 387 paired Serial Neurologic Assessment in Pediatrics assessments (149 < 6 mo; 91 ≥ 6 mo to < 2 yr, and 147 ≥ 2 yr) on 299 patients. Interrater reliability was substantial to near-perfect across all components for each age-based Serial Neurologic Assessment in Pediatrics scale. Percent agreement was independent of developmental disabilities for all Serial Neurologic Assessment in Pediatrics components except Mental Status and lower extremity Motor Function for patients deemed "Able to Participate" with the assessment. Nurses reported that they felt Serial Neurologic Assessment in Pediatrics, compared with Glasgow Coma Scale, was easier to use and clearer in describing the neurologic status of patients who were intubated, were sedated, and/or had developmental disabilities. About 92% of nurses preferred to use Serial Neurologic Assessment in Pediatrics over Glasgow Coma Scale. CONCLUSIONS When used by critical care nurses, Serial Neurologic Assessment in Pediatrics has excellent protocol adherence, substantial to near-perfect interrater reliability, and is feasible to implement. Further work will determine the sensitivity and specificity for detecting clinically meaningful neurologic decline.
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Affiliation(s)
- Matthew P Kirschen
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Department of Nursing, Children's Hospital of Philadelphia, Philadelphia, PA
- Division of Neonatology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Department of Physical Therapy, Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Occupational Therapy, Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Speech-Language Pathology, Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Family Medicine and Community Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA
- Division of Neurosurgery, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Katherine A Smith
- Department of Nursing, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Megan Snyder
- Department of Nursing, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Bingqing Zhang
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - John Flibotte
- Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Division of Neonatology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Lauren Heimall
- Department of Nursing, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Katrina Budzynski
- Department of Physical Therapy, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Ryan DeLeo
- Department of Occupational Therapy, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Jackelyn Cona
- Department of Speech-Language Pathology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Claire Bocage
- Department of Family Medicine and Community Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Lynn Hur
- Department of Family Medicine and Community Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Madeline Winters
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Richard Hanna
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Janell L Mensinger
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA
| | - Jimmy Huh
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Shih-Shan Lang
- Division of Neurosurgery, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Frances K Barg
- Department of Family Medicine and Community Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Judy A Shea
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Rebecca Ichord
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Robert A Berg
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Joshua M Levine
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Vinay Nadkarni
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Alexis Topjian
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Chang YHA, Folmer RL, Shasha B, Shea JA, Sarmiento K, Stepnowsky CJ, Lim D, Pack A, Kuna ST. Barriers and facilitators to the implementation of a novel web-based sleep apnea management platform. Sleep 2021; 44:5995904. [PMID: 33216916 DOI: 10.1093/sleep/zsaa243] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 11/01/2020] [Indexed: 11/12/2022] Open
Abstract
STUDY OBJECTIVE Obstructive sleep apnea (OSA) is a highly prevalent yet underdiagnosed disorder affecting US military Veterans. The Remote Veterans Apnea Management Platform (REVAMP) is a web-based OSA management program created to improve access to care. REVAMP was launched within the Veterans Health Administration (VHA) in July 2017, with variable patient recruitment rates (from 0 to 573 patients per site) at the first 10 Veterans Affairs (VA) medical centers (Wave-1 sites). This study aimed to examine the contextual circumstances surrounding the implementation of REVAMP from the provider perspective to inform strategies to increase its uptake at future rollout sites. METHODS A purposive sample of REVAMP site leaders from the Wave-1 sites was recruited with additional staff members being solicited as well. Semi-structured interviews were conducted. Two independent coders reviewed individual transcripts using content analysis to identify emerging themes. RESULTS Fifteen individuals from Wave-1 sites were interviewed. Implementation of REVAMP was facilitated by the presence of leadership support, staff, and time dedicated to REVAMP, and perceived usefulness of REVAMP by staff as well as positive feedback from the Veterans using REVAMP. The difficulty of supporting Veteran creation of login credentials to the program and integrating REVAMP into the existing workflow were major barriers to its implementation. CONCLUSION Improving leadership engagement, simplifying the enrollment process, and enhancing the medical staff experience through shared best practice alerts were identified as actions needed to improve the penetration of REVAMP at future rollout sites.
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Affiliation(s)
- Yoon Hee A Chang
- EvergreenHealth Sleep Disorders Center, Kirkland, WA.,Department of Medicine, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA
| | - Robert L Folmer
- VA National Center for Rehabilitative Auditory Research, VA Portland Medical Center, Portland, OR.,Department of Otolaryngology, Oregon Health and Science University, Portland, OR
| | - Becky Shasha
- Veterans Integrated Service Network 4, Center for Evaluation of PACT (CEPACT), Philadelphia, PA
| | - Judy A Shea
- Department of Medicine, Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Kathleen Sarmiento
- San Francisco VA Health Care System, San Francisco, CA.,University of California San Francisco, San Francisco, CA
| | - Carl J Stepnowsky
- VA San Diego Healthcare System, San Diego, CA.,University of California San Diego, La Jolla, CA
| | - Diane Lim
- Department of Medicine, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA.,Department of Medicine, Division of Sleep Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Allan Pack
- Department of Medicine, Division of Sleep Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Samuel T Kuna
- Department of Medicine, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA.,Department of Medicine, Division of Sleep Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Buckley R, Spadaro A, Rosin R, Shea JA, Myers JS. Comparing the Effects of Design Thinking and A3 Problem-Solving on Resident Attitudes Toward Systems Change. J Grad Med Educ 2021; 13:231-239. [PMID: 33897957 PMCID: PMC8054598 DOI: 10.4300/jgme-d-20-00793.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 12/08/2020] [Accepted: 01/22/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Quality improvement (QI) is a required component of graduate medical education. Many medical educators struggle to foster an improvement mindset within residents. OBJECTIVE We conducted a mixed-methods study to compare a Design Thinking (DT) approach to QI education with a Lean, A3 problem-solving approach. We hypothesized that a DT approach would better promote a mentality of continuous improvement, measured by residents' resistance to change. METHODS Thirty-eight postgraduate year 2 internal medicine residents were divided into 4 cohorts during the 2017-2018 academic year. One cohort participated in an experimental QI curriculum utilizing DT while 3 control cohorts participated in the existing curriculum based on Lean principles. Participants voluntarily completed a quantitative Resistance to Change (RTC) scale pre- and post-curriculum. To inform our understanding of these results, we also conducted semistructured interviews for qualitative thematic analysis. RESULTS The effect size on the overall RTC score (response rate 92%) was trivial in both groups. Three major themes emerged from the qualitative data: factors influencing the QI learning experience, factors influencing creativity, and general attitudes toward QI. Each contained several subthemes with minimal qualitative differences between groups. CONCLUSIONS This study found similar results in terms of their effect on attitudes toward systems change, ability to promote creative change agency, and educational experience. Despite positive educational experiences, many residents still did not view systems-based problem-solving as part of their professional identity.
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Affiliation(s)
- Ryan Buckley
- At the time of research, Ryan Buckley, MD, was a Faculty Member, Perelman School of Medicine at the University of Pennsylvania, and is now Assistant Professor of Clinical Medicine, Section of Hospital Medicine, Division of General Internal Medicine & Public Health, Department of Medicine, Vanderbilt University Medical Center
| | - Anthony Spadaro
- Anthony Spadaro, MD, MPH, is a Resident Physician, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania
| | - Roy Rosin
- Roy Rosin, MBA, is Chief Innovation Officer, Penn Medicine, University of Pennsylvania
| | - Judy A. Shea
- Judy A. Shea, PhD, is Professor of Medicine, Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania
| | - Jennifer S. Myers
- Jennifer S. Myers, MD, is Professor of Clinical Medicine, Section of Hospital Medicine, Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania
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Mittl GS, Cook TS, Hill PA, Cho J, Shea JA, Kahn CE, Zafar HM. Patient Understanding of Abnormal Imaging Findings Under Pennsylvania Act 112: A Call to Revise Mandated Notification Message Language. J Am Coll Radiol 2021; 18:951-961. [PMID: 33726983 DOI: 10.1016/j.jacr.2021.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/04/2021] [Accepted: 02/08/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The aim of this study was to evaluate the effect of Pennsylvania Act 112 notification reading level and presentation on patient understanding and anxiety. METHODS Four notifications were developed by alternating 12th grade and 6th grade reading level Act 112 language with letters or infographics. Using Amazon Mechanical Turk, 909 US adult volunteers were randomly assigned to one notification followed by a survey. Participants who answered all 12 survey questions on understanding, anxiety, and sociodemographics were paid $0.10. Chi-square analysis and multivariate regression were used to determine the impact of notification type and sociodemographic data on understanding of communicated information and anxiety. RESULTS Sixty percent of participants (489 of 821) correctly understood all three questions directly answered within notifications regarding Act 112 subject, next steps, and process for obtaining reports. Approximately half of respondents understood that notifications indirectly conveyed "definitely" or "possibly" abnormal test results (344 of 821 [42%] and 99 of 821 [12%], respectively). Compared with the 12th grade letter, correct understanding of all directly communicated information was lower with the 12th grade infographic after adjustment (odds ratio, 0.61; 95% confidence interval, 0.39-0.95; P = .028) and equivalent with the 6th grade infographic and letter (P = .744 and P = .316). Correct indirect understanding of abnormal test results was not associated with notification type after adjustment but was associated with higher anxiety (odds ratio, 2.86; 95% confidence interval, 0.57-1.35; P < .001). CONCLUSIONS Layperson understanding of information directly and indirectly communicated in Pennsylvania Act 112 is suboptimal, regardless of reading level or presentation. New Act 112 language is needed to improve patient understanding, which would ideally be coproduced with Pennsylvania patients, policymakers, and other relevant stakeholders.
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Affiliation(s)
- Gregory S Mittl
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Tessa S Cook
- Director, Center for Translational Imaging Informatics, Perelmen School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Paul A Hill
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joshua Cho
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Judy A Shea
- Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Charles E Kahn
- Vice Chairman, Department of Radiology, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Hanna M Zafar
- Associate Professor, Co-director, Automated Radiology Recommendation Tracking Engine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Mehringer JE, Harrison JB, Quain KM, Shea JA, Hawkins LA, Dowshen NL. Experience of Chest Dysphoria and Masculinizing Chest Surgery in Transmasculine Youth. Pediatrics 2021; 147:peds.2020-013300. [PMID: 33536330 DOI: 10.1542/peds.2020-013300] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/17/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Transmasculine individuals, those assigned female sex at birth but who identify as masculine, have high rates of suicidal behavior and often suffer from chest dysphoria (discomfort and distress from unwanted breast development). Growing numbers of transmasculine youth are pursuing definitive treatment with masculinizing chest surgery (MCS), and adult studies reveal marked benefits of MCS, although little is known about the impact of chest dysphoria on transmasculine youth or the optimal timing of MCS. In this study, we aimed to explore youth experiences of chest dysphoria and the impact of MCS. METHODS Transmasculine youth aged 13 to 21 were recruited from a pediatric hospital-based gender clinic. Participants completed a semistructured qualitative interview exploring the experience of chest dysphoria and thoughts about or experiences with MCS. Interview transcripts were coded by 3 investigators employing modified grounded theory, with the median interrater reliability at κ = 0.92. RESULTS Subjects (N = 30) were a mean age of 17.5 years, and 47% had undergone MCS. Youth reported that chest dysphoria triggered strong negative emotions and suicidal ideation, caused a myriad of functional limitations, and was inadequately relieved by testosterone therapy alone. All post-MCS youth reported near or total resolution of chest dysphoria, lack of regret, and improved quality of life and functioning. CONCLUSIONS We observed consensus that chest dysphoria is a major source of distress and can be functionally disabling to transmasculine youth. MCS performed during adolescence, including before age 18, can alleviate suffering and improve functioning. Additional research is needed to develop patient-reported outcome measures to assess the impact of chest dysphoria and MCS.
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Affiliation(s)
- Jamie E Mehringer
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York;
| | | | - Kit M Quain
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | | | - Linda A Hawkins
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | - Nadia L Dowshen
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and.,Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Chhabra M, Stavas N, Vij N, Kumar E, Shea JA. Understanding the Health Needs and Priorities of People Who Access Comprehensive Harm Reduction Programs. J Health Care Poor Underserved 2021; 31:1747-1764. [PMID: 33416750 DOI: 10.1353/hpu.2020.0130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Substance use disorder is a common cause of morbidity and mortality in the United States. Comprehensive harm reduction programs have emerged as a public health strategy to help those with substance use disorder. At this time little is known about the population of people who use comprehensive harm reduction programs. To address this gap in knowledge we examined health needs and priorities among people who utilize a comprehensive harm reduction program. We conducted in depth semi-structured interviews with 29 people who access services at a harm reduction program. Themes from the qualitative interviews revealed priorities included improving housing stability, sobriety, and reunification with children. Lack of trust of the health care system was often reported as a barrier to optimal medical care. Comprehensive harm reduction programs are in a position to offer services that can help improve physical health and social determinants of health for people with substance use disorder.
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Keddem S, Agha AZ, Long JA, Shasha B, Hausmann LRM, Shea JA. The Gears of Knowledge Translation: Process Evaluation of the Dissemination and Implementation of a Patient Engagement Toolkit. J Gen Intern Med 2020; 35:808-814. [PMID: 33107002 PMCID: PMC7652949 DOI: 10.1007/s11606-020-06099-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 07/30/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Patient engagement is a key tenet of patient-centered care and is associated with many positive health outcomes. To improve resources for patient engagement, we created a web-based, interactive patient engagement toolkit to improve patient engagement in primary care across the Veterans Health Administration (VHA). OBJECTIVE To use the knowledge translation (KT) framework to evaluate the dissemination and implementation of a patient engagement toolkit at facilities across one region in the VHA. DESIGN Using a mixed-methods approach, this process evaluation involved phone monitoring via semi-structured interviews and group meetings, during which we explored barriers and facilitators to KT. Outcomes were assessed using a structured rubric and existing patient satisfaction measures. PARTICIPANTS We enlisted implementers at 40 VHA facilities primarily serving Pennsylvania, New Jersey, and Delaware to implement patient engagement practices at their sites. Sites were randomly assigned into a high or low coaching group to assess whether external support influenced implementation. KEY RESULTS Sites with high rubric scores employed and possessed several elements across the KT trajectory from identification of the problem to sustainment of knowledge use. Key factors for successful implementation and dissemination included implementer engagement, organizational support, and strong collaborators. The most frequently cited barriers included short staffing, time availability, lack of buy-in, and issues with leadership. Successful implementers experienced just as many barriers, but leveraged facilitators to overcome obstacles. While sites that received more coaching did not have different outcomes, they were more likely to revisit the toolkit and indicated that they felt more accountable to local personnel. CONCLUSIONS Because leveraging available resources is a key component of successful implementation, future toolkits should highlight the type of facilitators necessary for successful implementation of toolkit content in healthcare settings. The ability to tailor interventions to local context is critical for overcoming barriers faced in most healthcare settings.
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Affiliation(s)
- Shimrit Keddem
- VISN 4 Center for the Evaluation of Patient Aligned Care Teams (CEPACT), Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA. .,Corporal Michael J. Crescenz VA Medical Center, VA Center for Health Equity Research and Promotion (CHERP), Philadelphia, PA, USA. .,Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA, USA.
| | - Aneeza Z Agha
- VISN 4 Center for the Evaluation of Patient Aligned Care Teams (CEPACT), Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA.,Corporal Michael J. Crescenz VA Medical Center, VA Center for Health Equity Research and Promotion (CHERP), Philadelphia, PA, USA.,Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA, USA
| | - Judith A Long
- VISN 4 Center for the Evaluation of Patient Aligned Care Teams (CEPACT), Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA.,Corporal Michael J. Crescenz VA Medical Center, VA Center for Health Equity Research and Promotion (CHERP), Philadelphia, PA, USA.,Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA, USA
| | - Becky Shasha
- Jhpiego Corporation, an affiliate of Johns Hopkins University, Baltimore, MD, USA
| | - Leslie R M Hausmann
- Veterans Affairs Pittsburgh Healthcare System, VA Center for Health Equity Research and Promotion (CHERP), Pittsburgh, PA, USA.,Division of General Internal Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Judy A Shea
- VISN 4 Center for the Evaluation of Patient Aligned Care Teams (CEPACT), Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA.,Corporal Michael J. Crescenz VA Medical Center, VA Center for Health Equity Research and Promotion (CHERP), Philadelphia, PA, USA.,Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA, USA
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Sherman CB, Said A, Kriss M, Potluri VS, Levitsky J, Reese PP, Shea JA, Serper M. In-Person Outreach and Telemedicine in Liver and Intestinal Transplant: A Survey of National Practices, Impact of Coronavirus Disease 2019, and Areas of Opportunity. Liver Transpl 2020; 26:1354-1358. [PMID: 32772459 PMCID: PMC7436220 DOI: 10.1002/lt.25868] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 07/06/2020] [Accepted: 07/24/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Courtney B. Sherman
- Division of GastroenterologyDepartment of MedicineUniversity of California, San FranciscoSan FranciscoCA
| | - Adnan Said
- Division of Gastroenterology and HepatologyUniversity of Wisconsin School of Medicine and Public HealthMadisonWI
- William S. Middleton Memorial Veteran’s HospitalMadisonWI
| | - Michael Kriss
- Division of Gastroenterology and HepatologyUniversity of Colorado School of MedicineAuroraCO
| | - Vishnu S. Potluri
- Divisions of Renal Electrolytes and HypertensionUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPA
| | - Josh Levitsky
- Division of Gastroenterology and HepatologyNorthwestern UniversityChicagoIL
| | - Peter P. Reese
- Divisions of Renal Electrolytes and HypertensionUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPA
- University of Pennsylvania Perelman School of MedicinePhiladelphiaPA
| | - Judy A. Shea
- University of Pennsylvania Perelman School of MedicinePhiladelphiaPA
| | - Marina Serper
- Gastroenterology and HepatologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPA
- Leonard Davis Institute of Health EconomicsPhiladelphiaPA
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50
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Rose S, Kogan JR, Bennett NL, Dlugos DJ, Delaney A, Schorr R, Shea JA. Perelman School of Medicine at the University of Pennsylvania. Acad Med 2020; 95:S439-S443. [PMID: 33626739 DOI: 10.1097/acm.0000000000003317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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