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Description
Background: Advance Care Planning (ACP) conversations are discussions between patients, providers, and loved ones addressing key care decisions in the event of incapacity. Nearly twothirds of US adults have not completed an Advance Directive (AD), yet ACP conversations rarely occur in practice. The objective of this quality improvement project was

Background: Advance Care Planning (ACP) conversations are discussions between patients, providers, and loved ones addressing key care decisions in the event of incapacity. Nearly twothirds of US adults have not completed an Advance Directive (AD), yet ACP conversations rarely occur in practice. The objective of this quality improvement project was to implement workflow changes with a reminder system to facilitate ACP conversations during Medicare Wellness Visits (MWV). Method: Social Cognitive Theory describes the complex relationship between variables that can influence an individual’s decision to address ACP. Providers in a primary care office in the Southwestern United States participated in an ACP education session and confidence survey. Patients presenting for the MWV were screened for ACP, and visual reminders were attached outside the exam room for provider review. Aggregate data were used to evaluate provider surveys. Descriptive statistics were used to evaluate patient characteristics and the Chi-square Test of Independence, and Fisher’s test was used to compare the pre-and post-intervention advance directive documentation. Results: Qualitative feedback from the survey indicates reminders and easily accessible resources may help facilitate ACP conversations. Of the 251 MWVs, 21 (8%) had an AD documented, significantly less than the nationally reported rate of 37.7% (p < 0.05, z = -2.39). Conclusions: Healthcare providers face multiple barriers preventing or delaying ACP conversations in practice. System-level changes and provider education can improve the rate of ACP conversations and impact patients’ care at the end of life.
Created2022-04-29
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Description
Background: An evidence-based project was performed to train and increase skills among healthcare providers to perform advance care planning. Training decreases barriers and improves attitudes and confidence to perform advance care planning. Advance care planning can include the Physician Order for Life-sustaining Treatment, an out-of-hospital order that directs emergency medical

Background: An evidence-based project was performed to train and increase skills among healthcare providers to perform advance care planning. Training decreases barriers and improves attitudes and confidence to perform advance care planning. Advance care planning can include the Physician Order for Life-sustaining Treatment, an out-of-hospital order that directs emergency medical services of a patient’s wishes. Internal evidence found that many providers are unfamiliar with the Physician Order for Life-Sustaining Treatment form. The Theory of Planned Behavior was used to guide the project. Objectives: To improve advanced care planning processes in a healthcare organization. Design: A quality improvement project was performed at a medical center with outpatient provider groups. Virtual training was provided by the Arizona Hospital and Healthcare Association on the Physician Order for Life-Sustaining Treatment. Participants completed a three-part survey to measure skills for advance care planning after a training event. Setting/Subjects: Five (n=5) American palliative and primary care providers at a medical center. Measurements: The East Midlands Evaluation Toolkit is a validated survey tool that measures confidence and competence in advance care planning after training. Results: Descriptive statistics, Friedman’s test, and the Kruskal-Wallis test were used for data analysis. Results provided evidence to the healthcare facility that there is a significant need to train their healthcare professionals on advance care planning. Conclusions: Recommendations are made to focus research on larger studies looking at the types of advance care planning, and differences in disciplines and specialties.
Created2022-04-29
Description

The electric transportation (ET) and electric vehicle (EV) landscape is currently inequitable and inaccessible for many living in the Phoenix area. This is especially true for people without single-occupancy vehicles (SOVs), who are reliant on public transit, or do not live in the Metropolitan center. Transit is intricately related to

The electric transportation (ET) and electric vehicle (EV) landscape is currently inequitable and inaccessible for many living in the Phoenix area. This is especially true for people without single-occupancy vehicles (SOVs), who are reliant on public transit, or do not live in the Metropolitan center. Transit is intricately related to the environment and, due to societal and political structures, most of these environmental injustices are concentrated in low-income and minority communities. The lack of political representation within these communities has led to increased exposure to a variety of issues. Equitable transportation has also suffered due to a significant gap in addressing the needs of these underserved communities (Bolin, et al., 2005). The concentration of inequities and environmental injustices is a direct result of the lack of representation. Therefore, equitable and inclusive collaboration on solutions is required in order to maintain fairness and access, (Clement, 2020) considering the legacy of institutional harm within historically marginalized communities. The TE Activator was created by Salt River Project (SRP) and Anthesis Group, a sustainability consulting agency. The Activator is a group of Phoenix-area organizations interested in shaping the ET landscape to positively influence the well-being of Arizonans. With this in mind, they have asked our team to focus on making the transition to electric transportation equitable and inclusive. Our report details the current state of electric transportation nationally and locally, analyzes equitable EV/ET programs and utility plans across the country, and reviews the City of Tempe’s electric transportation related efforts. For this, we conducted listening sessions with a national expert, the City of Tempe, Tempe Community Action Agency, and CHISPA, creating a Community Listening Pilot Project based on the preliminary listening sessions. Through our research, listening, and discussions we compiled tiered recommendations for the TE Activator that suggest systemic policy changes based on community priorities. Accompanying the report is an Equity Roadmap, Community Listening Script, and one-page Debrief.

ContributorsBartholomew, Anna (Author) / Fielding, Raven (Author) / Logan, Grace (Author) / Shufeldt, Kaleigh (Author) / Stivers, John (Author)
Created2022-04
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Description

The electric transportation (ET) and electric vehicle (EV) landscape is currently inequitable and inaccessible for many living in the Phoenix area. This is especially true for people without single-occupancy vehicles (SOVs), who are reliant on public transit, or do not live in the Metropolitan center. Transit is intricately related to

The electric transportation (ET) and electric vehicle (EV) landscape is currently inequitable and inaccessible for many living in the Phoenix area. This is especially true for people without single-occupancy vehicles (SOVs), who are reliant on public transit, or do not live in the Metropolitan center. Transit is intricately related to the environment and, due to societal and political structures, most of these environmental injustices are concentrated in low-income and minority communities. The lack of political representation within these communities has led to increased exposure to a variety of issues. Equitable transportation has also suffered due to a significant gap in addressing the needs of these underserved communities (Bolin, et al., 2005). The concentration of inequities and environmental injustices is a direct result of the lack of representation. Therefore, equitable and inclusive collaboration on solutions is required in order to maintain fairness and access, (Clement, 2020) considering the legacy of institutional harm within historically marginalized communities. The TE Activator was created by Salt River Project (SRP) and Anthesis Group, a sustainability consulting agency. The Activator is a group of Phoenix-area organizations interested in shaping the ET landscape to positively influence the well-being of Arizonans. With this in mind, they have asked our team to focus on making the transition to electric transportation equitable and inclusive. Our report details the current state of electric transportation nationally and locally, analyzes equitable EV/ET programs and utility plans across the country, and reviews the City of Tempe’s electric transportation related efforts. For this, we conducted listening sessions with a national expert, the City of Tempe, Tempe Community Action Agency, and CHISPA, creating a Community Listening Pilot Project based on the preliminary listening sessions. Through our research, listening, and discussions we compiled tiered recommendations for the TE Activator that suggest systemic policy changes based on community priorities. Accompanying the report is an Equity Roadmap, Community Listening Script, and one-page Debrief.

ContributorsBartholomew, Anna (Author) / Fielding, Raven (Author) / Logan, Grace (Author) / Shufeldt, Kaleigh (Author) / Stivers, John (Author)
Created2022-04
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Description

The electric transportation (ET) and electric vehicle (EV) landscape is currently inequitable and inaccessible for many living in the Phoenix area. This is especially true for people without single-occupancy vehicles (SOVs), who are reliant on public transit, or do not live in the Metropolitan center. Transit is intricately related to

The electric transportation (ET) and electric vehicle (EV) landscape is currently inequitable and inaccessible for many living in the Phoenix area. This is especially true for people without single-occupancy vehicles (SOVs), who are reliant on public transit, or do not live in the Metropolitan center. Transit is intricately related to the environment and, due to societal and political structures, most of these environmental injustices are concentrated in low-income and minority communities. The lack of political representation within these communities has led to increased exposure to a variety of issues. Equitable transportation has also suffered due to a significant gap in addressing the needs of these underserved communities (Bolin, et al., 2005). The concentration of inequities and environmental injustices is a direct result of the lack of representation. Therefore, equitable and inclusive collaboration on solutions is required in order to maintain fairness and access, (Clement, 2020) considering the legacy of institutional harm within historically marginalized communities. The TE Activator was created by Salt River Project (SRP) and Anthesis Group, a sustainability consulting agency. The Activator is a group of Phoenix-area organizations interested in shaping the ET landscape to positively influence the well-being of Arizonans. With this in mind, they have asked our team to focus on making the transition to electric transportation equitable and inclusive. Our report details the current state of electric transportation nationally and locally, analyzes equitable EV/ET programs and utility plans across the country, and reviews the City of Tempe’s electric transportation related efforts. For this, we conducted listening sessions with a national expert, the City of Tempe, Tempe Community Action Agency, and CHISPA, creating a Community Listening Pilot Project based on the preliminary listening sessions. Through our research, listening, and discussions we compiled tiered recommendations for the TE Activator that suggest systemic policy changes based on community priorities. Accompanying the report is an Equity Roadmap, Community Listening Script, and one-page Debrief.

ContributorsBartholomew, Anna (Author) / Fielding, Raven (Author) / Logan, Grace (Author) / Shufeldt, Kaleigh (Author) / Stivers, John (Author)
Created2022-04
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Description

The electric transportation (ET) and electric vehicle (EV) landscape is currently inequitable and inaccessible for many living in the Phoenix area. This is especially true for people without single-occupancy vehicles (SOVs), who are reliant on public transit, or do not live in the Metropolitan center. Transit is intricately related to

The electric transportation (ET) and electric vehicle (EV) landscape is currently inequitable and inaccessible for many living in the Phoenix area. This is especially true for people without single-occupancy vehicles (SOVs), who are reliant on public transit, or do not live in the Metropolitan center. Transit is intricately related to the environment and, due to societal and political structures, most of these environmental injustices are concentrated in low-income and minority communities. The lack of political representation within these communities has led to increased exposure to a variety of issues. Equitable transportation has also suffered due to a significant gap in addressing the needs of these underserved communities (Bolin, et al., 2005). The concentration of inequities and environmental injustices is a direct result of the lack of representation. Therefore, equitable and inclusive collaboration on solutions is required in order to maintain fairness and access, (Clement, 2020) considering the legacy of institutional harm within historically marginalized communities. The TE Activator was created by Salt River Project (SRP) and Anthesis Group, a sustainability consulting agency. The Activator is a group of Phoenix-area organizations interested in shaping the ET landscape to positively influence the well-being of Arizonans. With this in mind, they have asked our team to focus on making the transition to electric transportation equitable and inclusive. Our report details the current state of electric transportation nationally and locally, analyzes equitable EV/ET programs and utility plans across the country, and reviews the City of Tempe’s electric transportation related efforts. For this, we conducted listening sessions with a national expert, the City of Tempe, Tempe Community Action Agency, and CHISPA, creating a Community Listening Pilot Project based on the preliminary listening sessions. Through our research, listening, and discussions we compiled tiered recommendations for the TE Activator that suggest systemic policy changes based on community priorities. Accompanying the report is an Equity Roadmap, Community Listening Script, and one-page Debrief.

ContributorsBartholomew, Anna (Author) / Fielding, Raven (Author) / Logan, Grace (Author) / Shufeldt, Kaleigh (Author) / Stivers, John (Author)
Created2022-04
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Description

The electric transportation (ET) and electric vehicle (EV) landscape is currently inequitable and inaccessible for many living in the Phoenix area. This is especially true for people without single-occupancy vehicles (SOVs), who are reliant on public transit, or do not live in the Metropolitan center. Transit is intricately related to

The electric transportation (ET) and electric vehicle (EV) landscape is currently inequitable and inaccessible for many living in the Phoenix area. This is especially true for people without single-occupancy vehicles (SOVs), who are reliant on public transit, or do not live in the Metropolitan center. Transit is intricately related to the environment and, due to societal and political structures, most of these environmental injustices are concentrated in low-income and minority communities. The lack of political representation within these communities has led to increased exposure to a variety of issues. Equitable transportation has also suffered due to a significant gap in addressing the needs of these underserved communities (Bolin, et al., 2005). The concentration of inequities and environmental injustices is a direct result of the lack of representation. Therefore, equitable and inclusive collaboration on solutions is required in order to maintain fairness and access, (Clement, 2020) considering the legacy of institutional harm within historically marginalized communities. The TE Activator was created by Salt River Project (SRP) and Anthesis Group, a sustainability consulting agency. The Activator is a group of Phoenix-area organizations interested in shaping the ET landscape to positively influence the well-being of Arizonans. With this in mind, they have asked our team to focus on making the transition to electric transportation equitable and inclusive. Our report details the current state of electric transportation nationally and locally, analyzes equitable EV/ET programs and utility plans across the country, and reviews the City of Tempe’s electric transportation related efforts. For this, we conducted listening sessions with a national expert, the City of Tempe, Tempe Community Action Agency, and CHISPA, creating a Community Listening Pilot Project based on the preliminary listening sessions. Through our research, listening, and discussions we compiled tiered recommendations for the TE Activator that suggest systemic policy changes based on community priorities. Accompanying the report is an Equity Roadmap, Community Listening Script, and one-page Debrief.

ContributorsBartholomew, Anna (Author) / Fielding, Raven (Author) / Logan, Grace (Author) / Shufeldt, Kaleigh (Author) / Stivers, John (Author)
Created2022-04
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Description

As Baby Boomers age, the number of older homeless patients facing end of life is increasing. Homeless individuals die of the same diseases as their domiciled counterparts, but they have distinct barriers to equitable end-of-life care, such as lack of regular medical care, a higher likelihood of comorbid serious mental

As Baby Boomers age, the number of older homeless patients facing end of life is increasing. Homeless individuals die of the same diseases as their domiciled counterparts, but they have distinct barriers to equitable end-of-life care, such as lack of regular medical care, a higher likelihood of comorbid serious mental illness and substance abuse, alienation from potential healthcare proxies, and specific fears related to dying. Completion of an advance directive (AD) would address many of these barriers, as well as national goals of reducing medical costs associated with end of life care. A review of the literature indicates that homeless individuals, once educated on the purpose and significance of ADs, complete them at a higher rate than non-homeless people. Further, racial and ethnic disparities in document completion are minimized with educational interventions about an AD’s purpose.

King’s Theory of Goal Attainment provides the theoretical basis for the application of such an intervention in the setting of a medical respite center and a day resource center that both serve the homeless. Thirty-seven clients of the two sites and 14 staff members were administered a pre-and post-test measuring attitudes and knowledge relating to ADs on a Likert scale, resulting in an increase in knowledge about one of the two documents that traditionally comprise an AD, while not significantly affecting attitudes. Implications for practice include an inexpensive intervention that does not require a medically trained individual to deliver, enabling a broad application to a variety of settings with the goal of empowering a traditionally disenfranchised population to make health decisions related to the most vulnerable of life passages.

ContributorsMorrison, Melissa (Author) / Baker, Laurie (Thesis advisor)
Created2016-05-07
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Description
Many older Americans don’t have an advance directive (AD). ADs are legal documents that allow a person to express what types of medical treatment or cares that they want at the end of their life if they were unable to speak for themselves. Patients without an AD could

Many older Americans don’t have an advance directive (AD). ADs are legal documents that allow a person to express what types of medical treatment or cares that they want at the end of their life if they were unable to speak for themselves. Patients without an AD could receive unwanted treatment. Providers can utilize advance care planning (ACP) to educate patients and support them in forming a medical power of attorney (MPOA) and AD. Evidence suggests that having ACP conversations can engage a patient to form an AD. The purpose of this project was to see if ACP discussions with older patients encouraged them to complete an AD and MPOA.

The project used a mixed method design. Participants were recruited from a primary care practice. Descriptive statistics described the sample and outcome variable. An independent t- test measured if there were significant changes in the participant responses for the ACP survey.

The average age (standard deviation) of the chart review sample was 72.22 (SD=9.47). The ages ranged from 60 to 100 years of age. Most of the sample in the chart audit were female with 105 (53%) participants and 95 (48%) were male. Most of the sample, 183 (92.5%) reported having a chronic health condition and 17 (7.5%) of the sample reported having no chronic condition. Overall, the results were inclined towards a significant difference in participants who did the ACP discussions and those who did not when comparing completed AD forms.
ContributorsKrasowski, Maria (Author) / Rauton, Monica (Thesis advisor)
Created2018-05-01
Description

The New Jersey Childhood Obesity Study, funded by the Robert Wood Johnson Foundation, aims to provide vital information for planning, implementing and evaluating interventions aimed at preventing childhood obesity in five New Jersey municipalities: Camden, Newark, New Brunswick, Trenton, and Vineland.

These five communities are being supported by RWJF's New Jersey

The New Jersey Childhood Obesity Study, funded by the Robert Wood Johnson Foundation, aims to provide vital information for planning, implementing and evaluating interventions aimed at preventing childhood obesity in five New Jersey municipalities: Camden, Newark, New Brunswick, Trenton, and Vineland.

These five communities are being supported by RWJF's New Jersey Partnership for Healthy Kids program to plan and implement policy and environmental change strategies to prevent childhood obesity.

Effective interventions for addressing childhood obesity require community-specific information on who is most at risk and on contributing factors that can be addressed through tailored interventions that meet the needs of the community.

Using a comprehensive research study, the Center for State Health Policy at Rutgers University is working collaboratively with the State Program Office for New Jersey Partnership for Healthy I<ids and the five communities to address these information needs. The main components of the study include:

• A household survey of 1700 families with 3 -18 year old children

• De-identified heights and weights data from public school districts

• Assessment of the food and physical activity environments using objective data

Data books and maps based on the results of the study are being shared with the community coalitions in the five communities to help them plan their interventions.

Created2010