Programs and Communities
The collection collates collections by schools, centers, programs, and research groups.
Filtering by
- All Subjects: technical communication
- All Subjects: Prevention
- All Subjects: Asthma
Methods: A multifaceted intervention was utilized that included educational sessions for providers, adjustments to the electronic health record (EHR), access to toolkits, and workflow changes. Pediatric patients aged 5-18 years and diagnosed with asthma (N = 173) were evaluated using a pre-post design. Provider adherence to key components of clinical practice guidelines were assessed prior to implementation, and a three and six months post-implementation. Data was analyzed using descriptive statists and the Friedman’s ANOVA by rank.
Results: Provider education, EHR adjustments, provider toolkits, and changes to office workflow improved provider adherence to key aspects of asthma clinical practice guidelines. A significant difference was found between the pre and post implementation groups (p < .01).
Conclusion: Increased adherence to clinical practice guidelines leads to fewer complications and an overall improved quality of life. Continuing provider education is critical to sustained adherence.
Background and Significance: Drownings are the leading cause of death in one to four year old children in the United States. Arizona’s drowning rate is nearly double the national average for this age group. Water safety is an important anticipatory guidance topic a primary care provider should be discussing at all well visits. The Health Belief Model is an effective framework to guide family education interventions. It is strongly encouraged that providers incorporate water safety education into the developmental milestone discussions.
Methods: Ten providers recruited from six Arizona pediatric primary care clinics participated in an educational one-hour session. Providers were encouraged to prioritize water safety discussions within the one to four year old age group and deliver education in the context of individual child development. Additionally, providers were updated on water safety recommendations from the Center for Family Health and Safety at Phoenix Children’s Hospital. Supplemental handouts with developmental water safety information were given to each office to aid providers in parent education. A pre-survey was administered to the providers prior to the education session and a post-survey was given at an eight-week follow up. The surveys measured provider perception and current practices of water safety education and utilized a Likert scale to compare data sets. Current and retrospective chart reviews were conducted to evaluate sustainability of the educational intervention.
Outcomes/Results: Sixty percent of provider participants were Medical Doctors (MD) and 40% were Nurse Practitioners (NP) with experience ranging from one year to over 20 years. Following the education session, providers were more likely to discuss keeping a child at arms-reach at all times (p=0.046) during their well visits. There was also an increase in providers incorporating water safety discussions into milestone education (p=0.054).
Conclusion: This educational intervention empowered providers to deliver water safety education in the context of normal developmental milestones at each one to four year old well visit. The anticipatory guidance emphasizes to parents that the behaviors their children exhibit are healthy and normal, but also explains how achieving these milestones put their children at greater risk for drownings. This quality improvement project is part of a larger initiative to decrease the number of drownings in Arizona through education and policy
Methods: An academic detailing session was provided by the Florida Department of Health in Broward County to primary care providers (PCPs) at a private clinic in the Southeastern US. The Conceptual Model of Nursing and Population Health (CMNPH) and the Promoting Action on Research Implementation in Health Services Framework (PARIHS) were used as guides for project design and evidence-based practice implementation. There were five participants in the academic detailing session including: a physician, a physician assistant (PA), and three medical students. PCP PrEP knowledge, attitudes, and behaviors were measured using pre and post intervention surveys. PrEP prescription, HIV/Sexually Transmitted Infection (STI) screening, and HIV testing were measured using aggregate data queries for the time periods of four and eight weeks before and four and eight weeks after the educational intervention. No personal identifying information was obtained.
Results: Pre and post surveys were analyzed using Wilcoxon signed rank testing to examine differences between matched pairs of ordinal data. Significant PrEP screening and HIV/STI testing were analyzed pre and post intervention using paired t tests to compare pre and post intervention practices. Significant differences were found in the results (Z = 2.03, 1.84, and 1.83 respectively, p > 0.1) The academic detailing intervention significantly improved knowledge, attitudes, and behaviors of primary care providers and medical students regarding PrEP. The mean of active qualifying ICD 10 codes prior to the intervention versus post intervention were 5 (sd = 5.64) vs. 4.2 (sd = 4.87) respectively. No significant difference was found between active ICD 10 codes for patient visits before compared to after the intervention (t (9) = 1.12, p>.1).
Conclusions: This project found that academic detailing improved provider self-reported knowledge, attitudes, and behaviors regarding PrEP. However, self-reported survey scores were not correlated with changes in clinical practice based on ICD 10 codes. Additional clinical implications may include fostering clinical outreach and cooperation between the county health department and local primary care clinics. Further research is needed on the effects of PrEP academic detailing on clinical practice.
Randomized controlled trials and systematic reviews of paired education involving both diet and activity recommendations have shown significant reductions in the advancement of adult (age 18 to 80) prediabetes to type 2 diabetes mellitus (T2DM). Paired education on diet and activity has been effective for persons from diverse races, ethnicities, and levels of education. For this project, the paired education focused on the dietary guidance of the Whole 30 plan and the current exercise/activity recommendations of the American Diabetes Association (ADA). The ADA recommends 30 min 5 x week or 60 min 3 x week of exercise, with no more than 48 hours between exercise occurrences.
Ten adults with HbA1C between 5.7%-6.4%, levels specified by the ADA as prediabetes, were invited to participate in the project at an outpatient wellness practice. Participants took a pretest on basic food and activity knowledge, received educational sessions on the Whole 30™ plan and activity recommendations from the ADA, then completed a posttest. Participants were scheduled for one month follow ups. At the 3 month follow up appointment, repeat HbA1C was drawn. Most of the patients (7/10) completed return appointments at the 3-month time frame. Statistically significant results were seen in diet and exercise knowledge using a paired T-test. Clinically significant reductions were seen in HbA1C averages as well as weight, BMI, and glucose levels.
Suicide has become a national concern due to the increasing rates across the country. The 2012 National Strategy for Suicide Prevention aims to improve the area of clinical prevention. Emergency departments (ED) play a key role in addressing this effort as they have multiple opportunities to connect with patients who are at risk. There exists a high-risk period of time immediately following a patient’s discharge from emergency care. To address this period of concern, a review of the literature was conducted on the effectiveness of follow-up contacts as a means to prevent suicide and suicide related attempts in this at-risk population.
Based on this review, a follow-up intervention was proposed to increase patients’ social support and knowledge on suicide prevention through a safety plan and the use of caring postcards. The aim was to evaluate the degree to which implementation of a safety plan and follow-up using postcards reduces suicide risk in the ED. ED suicide prevention practices such as safety planning and caring contacts with postcards have shown to be feasible and cost-effective methods to reduce patients’ risk of suicide as they provide education and address the high-risk period of time after discharge.
Using a quasi-experimental pre and post-test design, English speaking adults 18 years of age and older, admitted to an ED in the Phoenix Metropolitan area with suicidal ideation, were voluntarily recruited for two weeks. The self-rated Suicidal Behaviors Questionnaire-Revised (SBQ-R) was used as a baseline assessment along with the introduction of a safety plan. Participants were then followed with the receipt of postcards with caring messages over a two-week period, and a final SBQ-R. The SBQ-R has shown beneficial reliability and validity measuring suicidality in the adult population. Data from the pre-SBQ-R was analyzed using descriptive statistics as no post-SBQ-Rs were received. Outcomes for this project included a reduction in suicidal ideation and suicide risk.
This project provides insight into the implementation of a safety plan and follow-up intervention in the ED and their attempts to reduce acute suicide risk as well as highlight the value that post-ED support provides.
Keywords: suicide, prevention, safety plan, caring messages, postcards, emergency department, follow-up, contacts, brief intervention
Background:
Asthma is one of the most common pediatric diseases, affecting 6.3 million U.S. children in 2014, that can result in negative health outcomes if not managed correctly due to it's chronic and complex nature requiring frequent and close management (NHLBI, 2007). The National Heart, Lung, and Blood Institute's (NHLBI) Guidelines for the Diagnosis and Management of Asthma will be implemented into practice to determine the health outcomes of patients before and after guideline implementation.
Methods:
Inclusion criteria includes patients 5-18 years with a history of asthma, recurrent albuterol use, or intermittent symptoms of airflow obstruction. Data will be collected through EHR data reports at pre implementation, 3 months, and 6 months post implementation and will be analyzed using SPSS. Descriptive statistics, paired t-tests, and a Friedman's ANOVA will be conducted to analyze data.
Results:
A Friedman ANOVA was conducted comparing the outcome variables six months priot to the practice change, at three months post implementation, and at six months post implementation. A significant difference was found (x2(15) = 216.62, p<.05). The implementation of the practice change significantly affected the outcome variables.
Conclusions:
In general, the implementation of a practice change to use evidence based NHLBI ERP-3 Asthma Guidelines, along with staff and provider education sessions and creation of standardized assessment and documentation tools resulted in positive changes in the outcomes variables. Findings from this study along with the literature of implementing evidence based asthma guidelines supports similar practice change implementations in other pediatric primary care clinics.
Introduction and Background: Drowning is the leading cause of preventable injury death in Arizona for children under five years old. Tailored education has demonstrated efficacy in behavior change and knowledge retention. The purpose of this evidence-based project was to evaluate if tailored education improved knowledge and self-reported behaviors related to pediatric drowning. The Elaboration Likelihood Model provided the framework for this project.
Methods/Experimental Approach: The prospective pilot project was conducted using the Iowa Model of Evidence Based Practice. Parents with children under five years, presenting with low acuity complaints in a pediatric emergency department were approached. A baseline assessment identified high-risk behaviors and a custom education plan was delivered to parents. Outcome variables were measured at baseline and three weeks after initial assessment.
Results: The average parent age was 29 (M = 28.5; SD = 6.35) years. Participant (n=29) responses were analyzed using descriptive statistics. Participants (n = 27, 93%) reported likelihood to change behaviors and 29 (100%) perceived the tailored intervention as relevant. Secondary outcome variables were not measured at three weeks due to a lack of survey response.
Conclusions: Parents reported a high likelihood of behavior change when water safety education was tailored and relevant to their child. The tailored intervention evoked positive interaction and receptivity from parents and suggested a high motivation to make a behavior change. The effect of the intervention could not be tested due to the lack of follow-up and post data collection. The design of this evidence-based project is quantifiable and replicable in a low-acuity setting, which allows for future evaluations of self-reported behavior change and knowledge improvement.
Funding: No sponsorship or financial conflict of interest.
Background: Influenza presents burdens for children with chronic respiratory conditions including increased mortality, morbidity, hospitalizations, and decreased quality of life for children and caregivers. Influenza vaccinations may reduce these complications yet approximately half of children remain unprotected annually. Synthesized evidence supports integration of text messaging into a multi-component strategy to increase the influenza vaccination rate in many populations of interest.
Methods: The intervention was a single text message and electronic mail message sent to all families in a private pediatric pulmonology practice who enabled text and/or electronic mail messages in the patient portal. A follow-up survey assessed various aspects of message receipt. Surveys were completed without collection of demographic information.
Results: Electronic mail messages were sent to 3140 addresses available in the patient portal. The number of text messages sent out via the patient portal was 75 with 66 (88%) delivered successfully. Follow-up surveys were initiated by 107 recipients. Frequency analysis showed that participants preferred text and electronic mail messages over other forms of communication. A statistically significant positive relationship was found utilizing Chi Square between those who received a message and those whose child received an influenza vaccination (p= .027).
Conclusions: Text and electronic mail messaging are cost-effective and well-received forms of communication that can be easily integrated into existing systems. These delivery routes are translatable to many populations and can convey various types of messages.