Matching Items (20)

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Implementation of Adolescent Depression Care Guidelines into the Electronic Health Record at a Rural Pediatric Primary Care Clinic

Description

Background: Healthcare providers are encouraged to prepare their practice to effectively manage the care of mild to moderate adolescent depression. Cost-effective screening, diagnostic, and newly developed pediatric primary care depression

Background: Healthcare providers are encouraged to prepare their practice to effectively manage the care of mild to moderate adolescent depression. Cost-effective screening, diagnostic, and newly developed pediatric primary care depression management guidelines have been established. To integrate guidelines into practice, primary care providers (PCPs) must document effectively to ensure a complete treatment plan is in place in the patient’s electronic health record (EHR).

Intervention: Elements from a flowsheet were implemented into the EHR to promote thorough assessment and documentation of care delivered to adolescents with depression.

Methods: An initial chart review was completed on patients diagnosed with depression. An updated depression template was implemented within the EHR for six weeks. A follow-up chart review was completed post-intervention to determine if documentation of elements from the adolescent depression guidelines improved after the EHR update. Pre-intervention and post- intervention surveys were delivered to PCP’s to understand their perspective on adolescent depression management.

Outcomes: The chart review revealed that baseline PHQ-9 screenings were documented in 91% (n=43) of the charts reviewed in the pre-intervention timeframe. Only 78% (n=7) of the charts reviewed during post-intervention included PHQ-9 screenings. Early intervention treatment options documented in the pre-intervention timeframe included education 100% (n=47), medication prescriptions 53% (n=25), and psychotherapy referrals 18% (n=18). During post- intervention, education 100% (n=9), medication prescriptions 78% (7), and psychotherapy referrals 22% (n=7) were documented by the PCPs.

Recommendation: The quality improvement project focused heavily on documentation completed over a one year pre-intervention timeframe compared to a six-week post-intervention timeframe. Further evaluation and chart review over the next year will provide a more adequate comparison of documentation within primary care practice.

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Created

Date Created
  • 2020-05-01

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Enhanced Primary Care Electronic Medical Record Education to Improve the Use of Patient Portals

Description

Background: Health information technology (HIT) refers to the electronic health care systems organizations used to store, share and analyze healthcare information. A central component of the HIT infrastructure is an

Background: Health information technology (HIT) refers to the electronic health care systems organizations used to store, share and analyze healthcare information. A central component of the HIT infrastructure is an electronic health record (EMR) and although HIT has been shown to increase enthusiasm for patient care, decrease healthcare costs and improve patient outcomes overall utilization in the United States (US) remains low.

Methods: At an urban primary care pediatric office located in the southwestern US, an educational quality improvement project for healthcare practice providers and front office staff was conducted to increase the utilization of the existing EMR-linked patient portal. The healthcare providers were asked to complete a pre- and post- survey evaluation of their knowledge and usage of the patient portal. Provider and patient portal data usage was collected over a five-month period, September 2019 to January 2020.

Results: Data was analyzed using the Intellectus Statistics softwareTM. Significant results were found at the conclusion of the project in the number of active patient portal users, web-enabled, portal logins, labs published/viewed, messages sent, appointment reminders and Santovia utilization. At the end of the project no significance was found with messages received by the healthcare providers or staff through the patient portal. Survey results found significant differences between pre- and post- portal usage. No significance was found on providers’ knowledge on how to web-enable patients. Providers’ also demonstrated no significant change in their perceptions of the benefit in utilizing the portal in patient care after the educational intervention. Survey results allowed for additional analysis of commonly utilized portal functionalities, disease or health topics utilized in Santovia, and suggestions on how to make the use of the patient portal easier for providers.

Implications for Health Care Providers: This quality improvement project found that implementation an EMR-linked patient portal requires a comprehensive practice approach with structured education sessions. Including all employees can improve patient portal utilization. This educational project resulted in significant increases in most portal functionalities within 5 months. Further practice change evaluations are needed to evaluate how to improve patient portal utilization with a larger group of participants in a variety of outpatient settings.

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Created

Date Created
  • 2020-05-01

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Screening for Posttraumatic Stress Disorder in Behavioral Health

Description

Background: Non-Veteran Affair (VA) mental health care facilities are admitting increased numbers of military affiliated members due to recent changes, allowing veterans to outsource healthcare at civilian treatment centers. The

Background: Non-Veteran Affair (VA) mental health care facilities are admitting increased numbers of military affiliated members due to recent changes, allowing veterans to outsource healthcare at civilian treatment centers. The VA reports less than 9 million veterans enrolled in VA services, leaving over 50% seeking treatment from civilian providers. Given the high prevalence of Posttraumatic Stress Disorder (PTSD) in the military population, it is imperative to implement a valid and reliable screening tool at primary care facilities to ensure timely and accurate diagnosis and treatment.

Method: This project aimed to provide an evidence-based education for intake nurses to understand prevalence of PTSD and to use a screening tool Primary Care PTSD for DSM-5 (PC-PTSD-5) in a non-VA behavioral health facility.

Setting: The project site was a civilian behavioral health facility located in West Phoenix Metropolitan area. The behavioral health facility serves mental health and substance abuse needs. Project implementation focused on the intake department.

Measures: Sociodemographic data, PTSD diagnosis criteria, prevalence and PC-PTDSD-5 screening tool knowledge collected from pre and posttest evaluation. Patients’ charts for those admitted 6-week before and 6-week after the education to calculate numbers of screening tools completed by nurses at intake assessment.

Data analysis: Descriptive statistics was used to describe the sample and key measures; the Wilcoxon Signed Rank Test was used to examine differences between pre-test and post-test scores. Cohen’s effect size was used to estimate clinical significance.

Results: A total of 23 intake nurses (87.0% female, 65.2% 20-39 years old, 52.2% Caucasian, 95.6% reported having 0-10 years of experience, 56.5% completed Associate’s degree) received the education. For PTSD-related knowledge, the pre-test score (Mdn = 6.00) was significantly lower than the post-test score (Mdn = 10.00; Z= -4.23, p < .001), suggesting an increase of PTSD knowledge among nurses after the education. Regarding the diagnosis, the percentage of patients who were diagnosed with PTSD increased from (0.02% to 20% after the education).

Discussion: An evidence-based education aimed at enhancing intake nurses’ knowledge, confidence and skills implementing a brief and no-cost PTSD screening tool showed positive results, including an increase of PTSD diagnosis. The implementation of this screening tool in a civilian primary mental health care facility was feasible and helped patients connect to PTSD treatment in a timely fashion. Continued use of paper version of screening tool will be maintained at facility as an intermediary solution until final approval through parent company is received to implement into electronic medical records.

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Created

Date Created
  • 2020-05-06

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Being Proactive in Geriatric Advance Care Planning

Description

Disease burden is higher in the United States than in comparable countries. The Patient Self Determination Act of 1990 requires healthcare facilities to provide Advance Care Planning (ACP) information to

Disease burden is higher in the United States than in comparable countries. The Patient Self Determination Act of 1990 requires healthcare facilities to provide Advance Care Planning (ACP) information to all Medicare patients. The healthcare staffs’ (n=7) commitment to 3-days of ACP training increase ACP rates in the primary care setting. The Medicare Incentive Program is the platform for this initiative. This quantitative project used a valid and reliable pre and posttest design that consisted of 27 items on a Likert-scale. A 3.5-month chart audit (n=91) was conducted to assess the completion rate. Descriptive statistics was used to describe the demographic data.

The results of the two-tailed Wilcoxon signed rank test were significant based on an alpha value of 0.05, V = 0.00, z = -2.37, p = .018. There was a significant increase in the post-readiness to change average scores. A Mann Whitney test was used to analyze the statistically significant difference between the averages in two ACP types and electronic health record documentation (EHR). Staff did not always code (Mdn = 0.00) but they documented in the EHR (Mdn =1.00; 512.00, p = 0.003). ACP discussion was performed 63% of the time during Annual Wellness Visits (AWV), and there was a 49% increase in the EHR documentation. Trained staff are key stakeholders in guiding ACP conversations. They understand the barriers, impact, and consequences related to the lack of advance directives.

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Created

Date Created
  • 2020-04-30

Substituting Hospitals: An Analysis of Urgent Care Centers in the Market for Healthcare

Description

The primary purpose of this paper is to analyze urgent care centers and explain their role within the U.S. healthcare system. The introduction of urgent care into the market for

The primary purpose of this paper is to analyze urgent care centers and explain their role within the U.S. healthcare system. The introduction of urgent care into the market for health care services has brought with it a new way for consumers to receive non-emergent healthcare outside of traditional hours. Urgent care is often cited as a plausible alternative to care received at an emergency department or primary care physician's office. One of the key questions the author attempts to answer is: "To what degree are urgent care centers an economic substitute to emergency departments or physician's offices?" This paper looks at both projected demand from currently operating urgent care centers and consumer preference surveys to estimate the willingness of consumers to use urgent care. The method used to accomplish this task has been compiling scholarly research and data on urgent care centers. After a thorough examination of relevant studies and datasets, urgent care centers have been found to be just as preferred as emergency departments when considering non-emergent cases, specifically among individuals aged 18-44. The clear majority of consumers still prefer visiting a primary care physician over an urgent care center when it comes to episodic care, however. When taking into account wait times, differences in cost, and ease of access, urgent care becomes much more preferred than an emergency department and weakly preferred to a physician's office. There are still some concerns with urgent care, however. Questions of capacity to meet demand, access for underserved communities, and susceptibility to adverse selection have yet to be fully explored.

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Created

Date Created
  • 2018-05

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Behavioral Health Integration in Primary Care: A Systematic Review

Description

The integration of behavioral health services into primary care in a rapidly evolving innovation that has shown potential to improve access to care, health outcomes, and lower health costs. In

The integration of behavioral health services into primary care in a rapidly evolving innovation that has shown potential to improve access to care, health outcomes, and lower health costs. In an effort to reform healthcare system, integrating behavioral health services become a vital part of the patient-centered medical home (PCMH). As research and developments in integration continue to evolve, there is a need to identify consistencies, discrepancies, and gaps in the field to inform the best ways to move forward. This study is a systematic review seeking to identify trends, gaps, and future directions of research in integrated behavioral health in primary care. Using Google Scholar 171 papers were included, 95 being original research and 76 being reviews, commentary, and editorials. From the results, it is clear that the case for integration has been made, and now it is time to move to the specifics. Both empirical and theoretical evidence supports the benefits of integration to patients and health systems. However, there is a lack of literature that tackles problems that hinder or facilitate integration in independent clinics with unique characteristics. Most notably, specific interventions that are effective and appropriate in primary care, payment reforms that are feasible and sustainable, and the effect of integration on health disparities.

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Created

Date Created
  • 2019-12

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A Water Safety Education Program for Primary Care Providers

Description

Purpose/Aims: We aim to increase understanding of water safety measures among primary care providers and improve the quality and efficiency of parent water-safety education.

Background and Significance: Drownings are the

Purpose/Aims: We aim to increase understanding of water safety measures among primary care providers and improve the quality and efficiency of parent water-safety education.

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

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Agent

Created

Date Created
  • 2019-04-29

Asthma Clinical Excellence – A Quality Improvement Project

Description

Purpose: Improper management of asthma leads to poor patient outcomes and increases in both costs and resources. This study aims to increase provider adherence to asthma clinical practice guidelines.

Methods:

Purpose: Improper management of asthma leads to poor patient outcomes and increases in both costs and resources. This study aims to increase provider adherence to asthma clinical practice guidelines.

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.

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Created

Date Created
  • 2018-04-27

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Advance Care Planning: How Do We Get to Completion?

Description

Advance care planning (ACP) is the act of deciding ones wishes at the end-of-life and making those wishes known. Healthcare providers rely on these wishes to provide end-of-life care. Despite

Advance care planning (ACP) is the act of deciding ones wishes at the end-of-life and making those wishes known. Healthcare providers rely on these wishes to provide end-of-life care. Despite the impact ACP has on quality of life at the end-of-life, most conversations remain undocumented. Even when ACP conversations take place, completion rates remain at an all-time low. This report explored the impact of appointment call reminders and patient portal messages on advance directive (AD) completion and documentation in the EHR. Following completion, a primary care practice experienced an increase in ACP conversation and ACP completion in the EHR. This report will discuss the methods utilized to improve ACP completion.

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Created

Date Created
  • 2019-04-28

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Skin and Soft Tissue Infections: Using a Severity Stratification Tool to Improve Knowledge

Description

Skin and soft tissue infections (SSTI’s) are a significant health concern with serious potential implications. Evidence suggests the importance of implementing a severity stratification tool to improve early identification of

Skin and soft tissue infections (SSTI’s) are a significant health concern with serious potential implications. Evidence suggests the importance of implementing a severity stratification tool to improve early identification of SSTI’s. The aim of this evidence based project is to examine if educating healthcare staff on the use of a severity stratification tool would increase staff knowledge of SSTI's. The sample consisted of 18 participants, 12 healthcare providers and 6 healthcare staff at a correctional facility in the Southwestern United States. A pre-and posttest design, including an educational session was implemented.

A 14-item multiple choice self-developed questionnaire was used to evaluate participants’ knowledge of identifying and ranking SSTI’s using the CREST tool. A one tail paired t-test was performed to compare the pre-and post-test case study scores for the healthcare provider group. A significant increase from pre-test to post-test case study scores was found (t(13)= -6.19, p < 0.00). Of the healthcare providers, 57% found the tool “moderately helpful.” Of the non-provider sample, 50% found the tool “extremely helpful” and plan to use the tool “all of the time.” The findings of this study suggest that implementing an educational session on a wound severity stratification tool improves staff knowledge and increases the likelihood of the tool being used in practice. Recommendations for future research include larger sample sizes across a variety of regional correctional facilities to further explore the use and knowledge of the tool in practice.

Contributors

Agent

Created

Date Created
  • 2018-04-30