Matching Items (17)

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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.

Contributors

Agent

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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Agent

Created

Date Created
  • 2020-05-01

Seizure Discharge Education for Pediatric Patients: An Online Platform

Description

There is a shortage of online resources for children who have epilepsy. Most of the current online resources are designed for populations with a higher health literacy. This creative project

There is a shortage of online resources for children who have epilepsy. Most of the current online resources are designed for populations with a higher health literacy. This creative project addresses this shortage by offering education for children with epilepsy that they are able to access and utilize online to understand their disease in greater depth. Comprehending discharge information after hospitalization can be difficult for children and families, which is why providing an accessible resource that also can be utilized at home increases understanding about the disorder and ability to manage the disorder. Basic information on epilepsy, safety tips for daily living, medication explanation, first aid information, and interactive resources are included on the website and are all geared toward children. A website developer, Sylvestri Customization™, assisted with creating the website utilizing template, search engine optimization and strategies for website sustainability. The website was created after completing a thorough review of current research literature and reviewing multiple, similar hospital educational websites while also consulting with healthcare professionals to ensure the information was evidence-based. While the website provides supplemental education via an online platform for children with epilepsy to explore, there is a need for future research to test the acceptability and efficacy of the website.

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Agent

Created

Date Created
  • 2016-12

Nurses' Views on Music Therapy: A Survey Study

Description

The purpose of this study is to learn about registered nurses' thoughts and experiences about the use of music and music therapy in the nursing field and whether or not

The purpose of this study is to learn about registered nurses' thoughts and experiences about the use of music and music therapy in the nursing field and whether or not nurses believe that there is supporting evidence practicing music therapy. Through an online survey administered to a local chapter of Sigma Theta Tau International Nursing Honors Society via SurveyMonkey, the study will 1) Assess the awareness and knowledge that registered nurses have regarding the use of music in the medical field. 2) Understand bedside nurses' willingness to use music as a complementary medicine in their own practices. 3) Ascertain where and how bedside nurses get knowledge about the use of music in the medical field. 4) Determine what constraints or barriers may influence bedside nurses' utilization of music in their practice. 5) The study will also examine the extent to which bedside nurses have had experience with observing music therapy or have utilized music therapists in their own practice.

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Agent

Created

Date Created
  • 2013-12

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Objective Measurement of Physical Activity in Preschool Children: A Review of Validation Studies and Establishment of Cut-Points

Description

Abstract
Objective: The purpose of this literature review is to examine the most psychometrically sound (e.g., valid and reliable) instruments measuring physical activity (PA) so that reflection of preschool children’s

Abstract
Objective: The purpose of this literature review is to examine the most psychometrically sound (e.g., valid and reliable) instruments measuring physical activity (PA) so that reflection of preschool children’s activity and documentation of intervention effects on preschool child PA is accurate.
Methods: Rigorous validation and calibration studies and those studies designed to test the psychometric properties of PA measurement instruments were specifically sought out to include in this review. Articles were excluded if they did not include specific information about the validity and reliability of the PA measures used with preschool children.
Discussion: Of the six articles reviewed, the systematic review used the most rigorous protocols to conduct its review, yielding the highest level of evidence appraising several validation studies. Because Pfeiffer et al. (2006) utilized the most valid and reliable criterion measure (Cosmed® portable metabolic system), the validation study this research team conducted is deemed to have identified the most valid and reliable cut points to utilize when reducing accelerometry data.
Conclusion: Current cut-points vary widely and greatly affect the reported results of a study. Therefore, it is critical that authors reference validation studies used to support the cut-points that were employed in the data-reduction phase. Currently, validation methods have been identified using high quality criterion measures in rigorous validation studies and thus it is strongly recommended that those cut points be used in data reduction processes.

Contributors

Agent

Created

Date Created
  • 2014-05

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Socio-Emotional and Behavior Issues of Children Separated from Military Parent

Description

Introduction: More than 1.2 million children in military families face long separations from a parent due to deployment or extended assignment, which can lead to significant family dysfunction as well

Introduction: More than 1.2 million children in military families face long separations from a parent due to deployment or extended assignment, which can lead to significant family dysfunction as well as behavioral, emotional, and scholastic problems for the child. The purpose of From Caring 2 Coping is to identify and provide healthcare providers of military children tools to recognize and address maladaptive and externalizing behaviors of these children, while also assisting the nondeployed parent or caregiver to provide their children with the necessary support to reduce stress and increase their own coping skills.

Materials and Methods: After approval from Arizona State University IRB, children aged 4-11 years who are currently or forecasted to be separated from a military parent due to a deployment or extended assignment, were recruited from a military pediatric clinic along with their primary caregiver. An intervention was adapted from Bowen and Martin’s (2011) Resiliency Model of Role Performance for Service Members, Veterans, and their Families to identify and improve individual assets and family communication skills, find support through social connections, and prepare for potential stressors by constructing a Roadmap of Life. The Parental Stress Scale (PSS) and Pediatric Symptom Checklist (PSC-17) were completed before and after the 4-week intervention along with a final caregiver survey to evaluate the caregiver’s perceptions of From Caring 2 Coping.

Results: Four mothers and eight children completed the program for which Wilcoxon matched-pairs signed-rank test compared results from pre- and post PSC-17 surveys from the children showing significant improvement post-intervention (p = 0.017). The post PSC-17 results were compared to post PSS results with Spearman Correlation Coefficient, r = 0.949, that is statistically significant (p = 0.05). From Caring 2 Coping is rated as an effective program by parents in a postintervention survey that is easy to incorporate into daily activities. Parents ranked highest satisfaction through use of the Family Communication Plan and Family Timeline.

Conclusions: From Caring 2 Coping intervention tools improved family communication, use of individual assets and Roadmap of Life coping skills, thereby improving child and caregiver coping response as evidenced by improved PSC-17 and PSS scores. Basing the intervention on the Resiliency Model of Role Performance which has proven successful in the military population, improves the chances for success in this target population. However, the small sample size of four families requires further study with more families at all levels of the deployment cycle in order to refine the intervention.

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Agent

Created

Date Created
  • 2018-04-30

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Health Literacy Education: For Parents of Children Preschool Aged and Younger

Description

Purpose: The purpose of health literacy education is to increase an individual’s understanding of health and use of the healthcare system. Low health literacy is associated with misuse of healthcare

Purpose: The purpose of health literacy education is to increase an individual’s understanding of health and use of the healthcare system. Low health literacy is associated with misuse of healthcare resources and misunderstanding of healthcare teaching. Education has demonstrated efficacy in improving health literacy. A personalized educational program was provided to parents of Head Start children, offered in Spanish and English, and at a 3rd to 5th education level.

Design: Using an established program for health literacy education, a Doctor of Nursing Practice project was implemented. The effect the program had on increasing the health literacy of participants over a period of 4 weeks was examined. The predominately, Latina participants received three hours of instruction based upon the health literacy book “What to do When Your Child Gets Sick”.

Setting and Subjects: The educational program took place in a large, urban county in the Southwestern United States with 24 parents of preschool age children in Head Start.

Intervention: The educational program contained three hours of classroom instruction utilizing PowerPoint® presentation, demonstration, and teach-back techniques on how to care for a child’s healthcare needs.

Measures and Analysis: Pre-, post- and telephone surveys were used to assess the impact of the health literacy educational program. Wilcoxon and Freidman tests were used to interpret the results.

Results: Despite no significant increases in health literacy post implementation, participants’ remarked that they felt the class was helpful and wanted to share the information with friends and family. They appreciated the program and wanted more educational opportunities.

Conclusion: Advanced practice nurses must acquire understanding, cultural sensitivity, and assess the needs of the community when implementing health literacy educational projects.

Contributors

Agent

Created

Date Created
  • 2017-05-02

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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

Contributors

Agent

Created

Date Created
  • 2019-04-29

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Cystic Fibrosis Education for School Personnel

Description

Aim: The purpose of this project was to determine if educating elementary school personnel would improve their knowledge and self-efficacy in caring for students with Cystic Fibrosis (CF) and improve the

Aim: The purpose of this project was to determine if educating elementary school personnel would improve their knowledge and self-efficacy in caring for students with Cystic Fibrosis (CF) and improve the health and educational outcomes of students with this disease.

Background: Evidence suggests that teachers play a big role in the management of students with chronic illnesses. However, current literature indicates that teachers lack basic knowledge about childhood chronic illnesses and how to manage students with chronic illnesses. Synthesis of evidence indicated that an online CF educational intervention would improve knowledge and self-efficacy among school personnel, thereby improving the health and educational outcomes of students with CF.

Methods: Elementary school personnel in Southern Arizona were asked to do an online pre-survey to evaluate knowledge and self-efficacy, view a short presentation on cystic fibrosis, and complete a post-survey. Parents of students with CF were asked to track 504 plan use and CF related absences. Frequencies were used to evaluate participant demographic data and survey data. The McNemar and Wilcoxon Signed Test were used to analyze survey data.

Results: Analysis showed a statistically significant improvement in perceived knowledge (p = .024) and self-efficacy scores (p = .034). Although survey scores showed an average score improvement between pre-survey and post-survey total scores (p = .212), it was not statistically significant.

Conclusion: Results showed an overall improvement in CF knowledge and self-efficacy among elementary school personnel. These results may provide an opportunity for CF healthcare providers and schools to promote the health and education of students with CF.

Contributors

Agent

Created

Date Created
  • 2016-05-06

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Adolescent Depression: Integrating Behavioral Healthcare in a Pediatric Primary Care Setting

Description

Introduction: Despite depression affecting one of every ten adolescents, primary care providers struggle to detect depression in affected individuals. Unmanaged early onset adolescent mood disorders have an increased potential to

Introduction: Despite depression affecting one of every ten adolescents, primary care providers struggle to detect depression in affected individuals. Unmanaged early onset adolescent mood disorders have an increased potential to result in suicide, the second leading cause of death in adolescents. Referring all patients with a positive depression screen to a mental health specialist creates treatment delay and burdens already limited community resources.

Objective: The objective of this primary care practice transformation was to improve pediatric primary care provider confidence and behavior to support and deliver evidence-based behavioral healthcare for adolescents with mild to moderate depression.

Methods: An evidence-based adolescent depression education program was delivered to pediatric primary care providers in a small community setting. The program’s components included measures to identify and manage mild to moderate depression. Outcome measures included: 1. Provider knowledge, beliefs, and confidence measured pre- and post-intervention; and 2. Electronic health record documentation of provider adherence to guideline recommendations one, two, and three months post-intervention.

Results: Four providers participated in the intervention. The mean total score for the provider beliefs and knowledge from a 5-point Likert scale demonstrated a positive increase after the intervention (14.75 vs. 23.25, p = .068). The mean total provider confidence score achieved near significance as well (12.25 vs. 21.75, p = .066). Resultant behavior change in the providers did not reach statistical significance when the electronic health records of all adolescent well visits over a three-month period were assessed. Screening for depression at adolescent well visits
Adolescent Depression 3 increased from 0% to 84-90% post-intervention. Setting treatment goals upon detection of depression increased from 0% to 41% (p = .089). Providers appropriately administered active support 67% of the time when a patient was identified with mild depressive symptomology post-intervention. Providers complied with guideline recommendations with identified cases of moderate and severe depression (n = 2).

Conclusions: Pediatric primary care providers demonstrated some positive behavioral changes towards integrating behavioral healthcare into their practice after an educational session on the guidelines for adolescent depression.

Contributors

Agent

Created

Date Created
  • 2017-04-04