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Considerations to Support Use of Patient-Reported Outcomes Measurement Information System Pediatric Measures in Ambulatory Clinics

Considerations to Support Use of Patient-Reported Outcomes Measurement Information System Pediatric Measures in Ambulatory Clinics

Patient-reported outcome (PRO) measures quantify patient health and health-related experiences directly from the patient perspective, which is important for patient-centered care. PROs can be used to monitor trends in patients’ symptoms, function, or well-being; to inform decision-making; and to prompt additional patient education or referrals. Use of PRO scores in clinical practice has improved recall of patient concerns by clinicians, increased shared decision-making, and enhanced care processes and treatment planning.

The National Institutes of Health Patient-Reported Outcomes Measurement Information System (PROMIS) provides standardized PRO measures for use in clinical practice, with specific measures available for adults, children from 8 to 17 years of age, and parent proxies for children 5-17 years old. In this publication, HIP Investigator Dr. Elizabeth Cox et al. sought to find the benefits of using PROMIS measures in pediatric clinical settings, health system and clinician leaders must attend to how the measures are implemented and used, as well as the support required to achieve this goal.

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Asian doctor talking about medication to elderly patient

Comparative workflow modeling across sites: Results for nursing home prescribing

Comparative workflow modeling across sites: Results for nursing home prescribing

Workflows associated with health care delivery vary between settings, and understanding similarities and dissimilarities can inform context-sensitive practice change. Clinical workflows are complex, dynamic, and context-dependent, and comparing workflow across multiple settings can support tailored implementation of practice-change interventions.

In this publication, HIP Investigator Dr. Edmond Ramly et al. propose a methodology for comparative workflow modeling and evaluate its use through application to antibiotic prescribing in six nursing homes. Authors describe the steps of the methodology in general and then demonstrate how to use them in a challenging application context to help equip others to adopt the methodology to study or improve other workflows in other settings.

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Increasing Medicaid enrollment among formerly incarcerated adults

Increasing Medicaid enrollment among formerly incarcerated adults

Formerly incarcerated adults bear a disproportionate burden of disease, including substance use disorders, mental illness, and HIV, conditions that require timely and ongoing medical care. However, as they reenter the community from correctional facilities, the likelihood of receiving treatment for many chronic conditions declines relative to the incarceration period, and they experience high rates of emergency department use, substance use, and elevated rates of mortality particularly due to drug overdose.

Improved access to health care in the reentry period has the potential to mitigate these relatively high rates of morbidity and mortality. However, historically a key component of access, health insurance coverage, has been largely unavailable to this population. In this publication, HIP Investigator, Dr. Marguerite Burns et al. aimed to estimate the incremental associations between the implementation of expanded Medicaid eligibility and prerelease Medicaid enrollment assistance on Medicaid enrollment for recently incarcerated adults.

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Predictive Solutions in Learning Health Systems: The Critical Need to Systematize Implementation of Prediction to Action to Intervention

Predictive Solutions in Learning Health Systems: The Critical Need to Systematize Implementation of Prediction to Action to Intervention

The growth in the use of predictive models in health care continues as health systems adopt electronic health records and gain access to real-time digitized clinical data. Although health systems often have substantial experience in quality improvement related to care interventions, they have limited experience in implementing predictive models as part of the care process.

In this publication, authors, including HIP Investigators Dr. Maureen Smith and Dr. Brian Patterson, describe an approach to implementing predictive solutions that adapts the widely used Find-Organize-Clarify-Understand-Select–Plan-Do-Check-Act framework. This process can be used to bring together quality improvement teams and data analytics staff in leading a common process for organizational change and in supporting clinicians in adopting predictive solutions.

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To guide health systems through the process of selecting and implementing a predictive model within their system, the UW Health Applied Data Science team and the Health Innovation Program developed Predictive Models: A Toolkit to Guide Implementation in Health Systems to support planning for and implementation of a predictive model. This toolkit should be used by health system quality improvement leaders, project managers, and analytics staff who are responsible for developing and implementing a predictive model within their health system.

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Stakeholder Perspectives in Anticipation of Sharing Physicians’ Notes With Parents of Hospitalized Children

Stakeholder Perspectives in Anticipation of Sharing Physicians’ Notes With Parents of Hospitalized Children

Sharing honest, unbiased health information with parents is endorsed by the American Academy of Pediatrics as an important way to improve the quality and safety of pediatric care. To increase information transparency, a growing number of hospitals have adopted inpatient portals, online applications on tablet computers that provide parents with real-time clinical information from the electronic health record (EHR) at their hospitalized child's bedside.

In this publication, authors including HIP Investigator, Dr. Ryan Coller Coller identified the perspectives of parent, physician, nurse, and hospital administrator stakeholders on the anticipated benefits and challenges of giving parents access to physicians’ notes during hospitalization and strategies on how to implement the note sharing process most effectively.

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Quit smoking

Impact of a Rheumatology Clinic Protocol on Tobacco Cessation Quit Line Referrals

Impact of a Rheumatology Clinic Protocol on Tobacco Cessation Quit Line Referrals

Although smoking is a risk factor for patients with rheumatic conditions and contributes to greater symptom severity and cardiovascular disease risk, standard smoking cessation intervention is rare in rheumatology clinics. Primary care uses brief staff protocols to connect patients to free, state-run tobacco cessation quit line resources, but this approach had not been previously tested in rheumatology.

In this article, authors including HIP Investigators Dr. Christie Bartels and Dr. Edmond Ramly implemented a rheumatology staff-driven protocol, Quit Connect, to increase the rate of electronic referrals (e-referrals) to free, state-run tobacco quit lines (TQL). The group found that implementing Quit Connect in rheumatology clinics was feasible and improved referrals to a state-run TQL.

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Co-designing to advance community health and health equity in Wisconsin: Building the Neighborhood Health Partnerships Program

Co-designing to advance community health and health equity in Wisconsin: Building the Neighborhood Health Partnerships Program

Engaging communities can increase the speed of translating health and health equity research into practice. Effective engagement requires a shared understanding of neighborhood health care quality and outcomes. Creating this shared understanding can be challenging without timely and accurate local health data, or ways to provide the data that are directly applicable to improving community health.

In this publication, authors including HIP Investigator, Dr. Maureen Smith and Neighborhood Health Partnerships Program Director Jessica Bonham-Werling, discuss how an effective co-design strategy can lead to increased usability and adoption of CTSA resources, enabling a shared understanding of community health and ultimately leading to the successful translation of research into practice.

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After the Randomized Trial: Implementation of Community-Based Continence Promotion in the Real World

After the Randomized Trial: Implementation of Community-Based Continence Promotion in the Real World

Most women aged 65 and older have incontinence, associated with high healthcare costs, institutionalization, and negative quality of life, but few seek care. Mind over Matter: Healthy Bowels, Healthy Bladder (MOM) is a small-group self-management workshop, led by a trained facilitator in a community setting, proven to improve incontinence in older women.

The main objective of the study by HIP Investigator, Dr. Heidi Brown et al. was to quantify and understand barriers to and facilitators of implementation, adoption, and maintenance of the MOM intervention. The secondary objective was to engage study communities and WIHA staff in the development of a partner‐focused implementation package for MOM.

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Implementing parity for mental health and substance use treatment in Medicaid

Implementing parity for mental health and substance use treatment in Medicaid

Rates of mental health and substance use disorders (MHSUDs) in the adult Medicaid population are higher than for adults with Medicare or private health insurance. In this publication, HIP Investigator, Dr. Marguerite Burns et al. estimates the association between the implementation of parity in coverage for mental health and substance use disorder (MHSUD) services within the Medicaid program and MHSUD service use.

The author’s findings suggest that parity implementation in Medicaid could increase access to effective MHSUD services in a high‐need population.

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Predictors of Smoking Cessation in Patients With Rheumatoid Arthritis in Two Cohorts: Healthcare Factors Most Predictive

Predictors of Smoking Cessation in Patients With Rheumatoid Arthritis in Two Cohorts: Healthcare Factors Most Predictive

Smoking doubles the risk of developing rheumatoid arthritis (RA) and additionally contributes to cardiovascular, pulmonary, and oncologic diseases, the main causes of death in patients with RA. While patients are more likely to quit smoking after diagnosis of a smoking-related chronic disease, research shows most will continue to smoke.

HIP Investigator, Dr. Christie Bartels et al. identified predictors of smoking cessation in patients with RA in two health systems to guide future intervention implementation efforts. Authors found that emphasizing smoking cessation with new or seropositive RA patients and leveraging health system interventions could improve smoking cessation and outcomes in RA.

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