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Okeke N, Hennessey KC, Sitapati AM, Weisshaar D, Shah NP, Alicki R, Haft H. Sustainable Approach to Justice, Equity, Diversity, and Inclusion Through Better Quality Measurement. Circ Cardiovasc Qual Outcomes 2024:e010791. [PMID: 38618717 DOI: 10.1161/circoutcomes.123.010791] [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: 04/16/2024]
Abstract
The US health care industry has broadly adopted performance and quality measures that are extracted from electronic health records and connected to payment incentives that hope to improve declining life expectancy and health status and reduce costs. While the development of a quality measurement infrastructure based on electronic health record data was an important first step in addressing US health outcomes, these metrics, reflecting the average performance across diverse populations, do not adequately adjust for population demographic differences, social determinants of health, or ecosystem vulnerability. Like society as a whole, health care must confront the powerful impact that social determinants of health, race, ethnicity, and other demographic variations have on key health care performance indicators and quality metrics. Tools that are currently available to capture and report the health status of Americans lack the granularity, complexity, and standardization needed to improve health and address disparities at the local level. In this article, we discuss the current and future state of electronic clinical quality measures through a lens of equity.
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Affiliation(s)
- Nkem Okeke
- Medicalincs, Silver Spring, MD (N.O.)
- Harvard Medical School, Center for Primary Care, Boston, MA (N.O.)
| | - Kerrilynn C Hennessey
- Department of Medicine, Section of Cardiovascular Medicine, Dartmouth Hitchcock Health, Lebanon, NH (K.C.H.)
| | - Amy M Sitapati
- Division of Biomedical Informatics, Department of Medicine, University of California San Diego Health (A.M.S.)
| | - Dana Weisshaar
- Institute of Medical Educators, Kaiser Permanente Santa Clara, CA (D.W.)
| | - Nishant P Shah
- Duke University School of Medicine, Duke Clinical Research Institute, Durham, NC (N.P.S)
| | - Rebecca Alicki
- American Heart Association, Department of Quality, Outcomes Research and Analytics, Dallas, TX (R.A.)
| | - Howard Haft
- University of Maryland School of Medicine, Division of Health Sciences and Human Services, Baltimore (H.H.)
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Hennessey KC, Zeitler E, Welch T, Dodge S, Bachour K, Martinez-Camblor P, Douglas PS, Coylewright M, Forcino R. THE CURRENT STATE OF WOMEN IN CARDIOVASCULAR LEADERSHIP AND THEIR IMPACT ON TRAINEE PROGRAM SELECTION. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02828-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Ali T, Paulenka Y, Hennessey KC. SAFE PREGNANCY AND NORMAL SPONTANEOUS VAGINAL DELIVERY FACILITATED BY THE ANGIOVAC SYSTEM FOR TREATMENT OF INFECTIVE ENDOCARDITIS IN PREGNANCY. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)04177-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Altujjar M, Khokher W, Sajdeya O, Hennessey KC, Henkin S, Andrus BW, Taub CC. WEEKEND EFFECT ON PATIENTS PRESENTING WITH CARDIAC ARREST: A NATIONWIDE ANALYSIS. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02031-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Park J, Kim Y, Pereira J, Hennessey KC, Faridi KF, McNamara RL, Velazquez EJ, Hur DJ, Sugeng L, Agarwal V. Understanding the role of left and right ventricular strain assessment in patients hospitalized with COVID-19. ACTA ACUST UNITED AC 2021; 6:100018. [PMID: 34095889 PMCID: PMC8168299 DOI: 10.1016/j.ahjo.2021.100018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 05/16/2021] [Accepted: 05/17/2021] [Indexed: 01/07/2023]
Abstract
Background Coronavirus disease 2019 (COVID-19) can cause cardiac injury resulting in abnormal right or left ventricular function (RV/LV) with worse outcomes. We hypothesized that two-dimensional (2D) speckle-tracking assessment of LV global longitudinal strain (GLS) and RV free wall strain (FWS) by transthoracic echocardiography can assist as markers for subclinical cardiac injury predicting increased mortality. Methods We performed 2D strain analysis via proprietary software in 48 patients hospitalized with COVID-19. Clinical information, demographics, comorbidities, and lab values were collected via retrospective chart review. The primary outcome was in-hospital mortality based on an optimized abnormal LV GLS value via ROC analysis and RV FWS. Results The optimal LV GLS cutoff to predict death was −13.8%, with a sensitivity of 85% (95% CI 55–98%) and specificity of 54% (95% CI 36–71%). Abnormal LV GLS >-13.8% was associated with a higher risk of death [unadjusted hazard ratio 5.15 (95% CI 1.13–23.45), p = 0.034], which persisted after adjustment for clinical variables. Among patients with LV ejection fraction (LVEF) >50%, those with LV GLS > −13.8% had higher mortality compared to those with LV GLS <-13.8% (41% vs. 10%, p = 0.030). RV FWS value was higher in patients with LV GLS >-13.8% (−13.7 ± 5.9 vs. −19.6 ± 6.7, p = 0.003), but not associated with decreased survival. Conclusion Abnormal LV strain with a cutoff of >−13.8% in patients with COVID-19 is associated with significantly higher risk of death. Despite normal LVEF, abnormal LV GLS predicted worse outcomes in patients hospitalized with COVID-19. There was no mortality difference based on RV strain.
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Key Words
- 2D, Two-dimensional
- ARDS, acute respiratory distress syndrome
- COVID-19
- COVID-19, Coronavirus Disease 2019
- EF, ejection fraction
- FAC, fractional area change
- FWS, free wall strain
- GLS, global longitudinal strain
- HFrEF, heart failure reduced ejection fraction
- Hs-TNT, high sensitivity troponin T
- ICC, intra-class correlation coefficient
- LV, left ventricle
- Left ventricular strain
- NT-proBNP, NT-pro-brain natriuretic peptide
- RV, right ventricle
- Speckle-tracking echocardiography
- TTE, transthoracic echocardiography
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Affiliation(s)
- Jakob Park
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Yekaterina Kim
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Jason Pereira
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Kerrilynn C Hennessey
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Kamil F Faridi
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Robert L McNamara
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Eric J Velazquez
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - David J Hur
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Lissa Sugeng
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Vratika Agarwal
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, USA
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Sharma S, Leech M, Palmer JP, Rothstein E, Grove E, Burrage P, Hennessey KC. SEVERE CORONARY VASOSPASM LEADING TO SUDDEN CARDIAC DEATH-CONSIDERATIONS FOR IMPLANTABLE DEVICE THERAPY. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)03441-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Faridi KF, Hennessey KC, Shah N, Soufer A, Wang Y, Sugeng L, Agarwal V, Sharma R, Sewanan LR, Hur DJ, Velazquez EJ, McNamara RL. Left Ventricular Systolic Function and Inpatient Mortality in Patients Hospitalized with Coronavirus Disease 2019 (COVID-19). J Am Soc Echocardiogr 2020; 33:1414-1415. [PMID: 32951969 PMCID: PMC7442910 DOI: 10.1016/j.echo.2020.08.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 08/16/2020] [Accepted: 08/17/2020] [Indexed: 12/26/2022]
Affiliation(s)
- Kamil F Faridi
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Kerrilynn C Hennessey
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Nimish Shah
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Aaron Soufer
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Yanting Wang
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Lissa Sugeng
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Vratika Agarwal
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Richa Sharma
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut
| | | | - David J Hur
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Eric J Velazquez
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Robert L McNamara
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
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Hennessey KC, Shah N, Soufer A, Wang Y, Agarwal V, McNamara RL, Crandall I, Balan S, Pereira J, Kim Y, Hur DJ, Velazquez EJ, Sugeng L, Faridi KF. Inpatient Transthoracic Echocardiography during the COVID-19 Pandemic: Evaluating a New Triage Process. J Am Soc Echocardiogr 2020; 33:1418-1419. [PMID: 32888760 PMCID: PMC7392041 DOI: 10.1016/j.echo.2020.07.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 07/25/2020] [Accepted: 07/26/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Kerrilynn C Hennessey
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Nimish Shah
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Aaron Soufer
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Yanting Wang
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Vratika Agarwal
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Robert L McNamara
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Ian Crandall
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Samantha Balan
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Jason Pereira
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Yekaterina Kim
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - David J Hur
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Eric J Velazquez
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Lissa Sugeng
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Kamil F Faridi
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
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Hennessey KC, Hickman C, Krawczyk B, Opare M, Churchwell L, Tucker K, Do T, Renauer M, Churchwell K, Spatz ES. Abstract 242: Evaluating the Impact and Barriers to a Collaborative Physician-pharmacist Care Model to Control Hypertension in a Low-income Population. Circ Cardiovasc Qual Outcomes 2020. [DOI: 10.1161/hcq.13.suppl_1.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives:
Physician-pharmacist collaborative practice models have emerged as an effective model for managing hypertension (HTN). We implemented this model in a low-income, hospital-based cardiology clinic and sought to identify programmatic features necessary to control HTN in this vulnerable population.
Methods:
Patients with persistently elevated blood pressure (>130/80) were referred by their primary cardiologist. Patients were excluded if they were pregnant, had acute kidney injury, or acute cardiovascular complaints including anginal chest pain, decompensated heart failure, or unstable arrhythmia. The initial pharmacist appointment occurred within 2 weeks of referral, with the goal of bi-weekly visits for 6 weeks or until blood pressure was controlled. Patients were prescribed home blood pressure cuffs and given specific instructions for home-based monitoring. Telehealth visits were made available to interested patients. During each encounter, pharmacists assessed response and side effects to medication, adherence, lifestyle behaviors, stressors, and social barriers to blood pressure control. Clinical management and barriers to HTN control were reviewed at standing weekly staff meetings that included cardiologists and pharmacists.
Early results:
Among 35 people referred, 22 patients attended at least one pharmacist visit. A total of 139 reminder or follow-up calls were made for these 22 patients. Among the first 35 referrals (mean age 58; 57% male; 65% African American or Latinx), 26% have documented substance use disorders, 34% have a mental health comorbidity, 20% were not taking their medications as prescribed on intake, and 17% had side effects from 2 or more prior antihypertensive medications. Medications adjustments were made in 21/43 patient visits (49% of visits). In 8/43 visits more than 1 medication change was made. The most common patient reported barriers to care include transportation (20%) and language barriers (11%).
Discussion and Future Direction:
Managing HTN in a low-income population requires attention to the social and contextual factors impacting blood pressure control. We plan to: 1) support the uptake of telehealth to address issues of transportation and access; 2) pilot blue-tooth connected blood pressure cuffs to facilitate home monitoring and management; and 3) partner with community health workers to assess best practices for capturing and addressing social determinants of health in the clinical setting.
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Affiliation(s)
| | | | | | | | | | | | - Tina Do
- Yale New Haven Hosp, New Haven, CT
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