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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Elderly patient with nurse

Management of Fecal Incontinence

Management of Fecal Incontinence

Fecal incontinence negatively affects quality of life and mental health and is associated with increased risk of nursing home placement. Nine percent of adult women experience episodes of fecal incontinence at least monthly. Even among women with both urinary and fecal incontinence presenting for urogynecologic care, the rate of verbal disclosure of fecal incontinence symptoms remains low.

HIP Investigator, Dr. Heidi Brown et al. provides an overview of the evaluation and management of fecal incontinence for the busy obstetrician–gynecologist, incorporating existing guidance from the American College of Obstetricians and Gynecologists, the American College of Gastroenterology, and the American Society of Colon and Rectal Surgeons.

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Sick senior woman fallen

Comparing Strategies for Identifying Falls in Older Adult Emergency Department Visits Using EHR Data

Comparing Strategies for Identifying Falls in Older Adult Emergency Department Visits Using EHR Data

Emergency department (ED) visits for falls among older adults are often sentinel events for poor health trajectories; however, challenges exist in defining fall‐related visits in the ED. Authors including HIP Investigators Dr. Brian Patterson and Dr. Maureen Smith developed and validated a simple rules‐based Natural language processing system that accurately identified falls from the text of ED physician notes.

The goal of the study was to compare performance characteristics of several fall identification strategies using EHR data from ED visits using manual chart abstraction as a gold standard.

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Senior woman talking to lecturer

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 Wisconsin Institute for Healthy Aging (WIHA) staff in the development of a partner‐focused implementation package for MOM.

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Daily medications

Workflow Barriers and Strategies to Reduce Antibiotic Overuse in Nursing Homes

Workflow Barriers and Strategies to Reduce Antibiotic Overuse in Nursing Homes

Antibiotics are among the most commonly prescribed medications in nursing homes (NHs), being prescribed to two‐thirds of residents annually. Although often beneficial, their overuse is associated with avoidable adverse effects.

This article by HIP Investigator, Dr. Edmond Ramly et al. seeks to characterize the workflows performed in NHs before a prescriberʼs decision to prescribe antibiotics. By analyzing the preprescribing workflow across NHs, authors sought to identify barriers to reducing antibiotic overuse and strategies to address them to improve antibiotic prescribing.

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Bandaging amputee

Expect Delays: Poor Connections Between Rural and Urban Health Systems Challenge Multidisciplinary Care for Rural Americans With Diabetic Foot Ulcers

Expect Delays: Poor Connections Between Rural and Urban Health Systems Challenge Multidisciplinary Care for Rural Americans With Diabetic Foot Ulcers

Over 30 million people in the United States have diabetes, and up to 25% of them will develop a diabetic foot ulcer (DFU). Specific to DFUs, rural patients face 50% higher odds of major (above-ankle) amputation and 40% higher odds of death compared to their urban counterparts. A group of authors including HIP Investigators, Dr. Meghan Brennan and Dr. Christie Bartels sought to understand what health system factors contribute to the rural disparity in diabetic foot ulcer outcomes.

The authors concluded that future interventions focusing on mitigating the poor connections across rural and urban healthcare systems could reduce the rural disparity in major amputations.

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Skilled Nursing Facility Differences in Readmission Rates by the Diagnosis-Related Group Category of the Initial Hospitalization

Skilled Nursing Facility Differences in Readmission Rates by the Diagnosis-Related Group Category of the Initial Hospitalization

The US Health and Human Services Office of the Inspector General report on nursing homes found that skilled nursing facilities (SNFs) exhibit wide differences in overall hospital readmission rates. Because evidence has been found that hospital readmission rates can be lowered by discharging to specific SNFs, policy makers have started using hospital readmission rates by SNFs as a measure of quality of care patients receive at these facilities.

In a letter to the editor, a group of authors featuring HIP Investigator Dr. Maureen Smith, examined whether SNFs differed substantially in their readmission rates by the DRG category of the initial hospitalization (ie, medically uncomplicated, surgically uncomplicated, medically complicated, or surgically complicated). The authors’ results suggest considerable differences in readmission rates across SNFs by DRG category of the initial hospitalization, despite similar overall readmission rates.

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Senior women in classroom

Reasons Behind Preferences for Community-Based Continence Promotion

Reasons Behind Preferences for Community-Based Continence Promotion

More than 60% of women older than 65 years in the United States have urinary or bowel incontinence. Despite the existence of effective, minimally invasive therapies, more than half of women with urinary incontinence and two-thirds of women with bowel incontinence do not seek medical care.

In this study, HIP Investigator Dr. Heidi Brown et al. sought to understand the potential reach of 3 continence promotion formats: a single lecture, an interactive 3-session workshop, and an online program. Authors found that most incontinent women are willing to participate in continence promotion, especially online.

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Eye exam

Telemedicine for Glaucoma: Guidelines and Recommendations

Telemedicine for Glaucoma: Guidelines and Recommendations

Glaucoma is the leading cause of irreversible blindness worldwide, estimated to affect >60 million people. Access to glaucoma specialists is challenging and likely to become more difficult as the population ages. Glaucoma care guidelines are not as standardized as those for diabetic retinopathy, which allow for significant regional and provider variability in glaucoma diagnosis and management.

In these guidelines, co-authored by HIP Investigator Dr. Yao Liu, authors reviewed considerations and practice recommendations for teleglaucoma programs.

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Practice Guidelines for Ocular Telehealth-Diabetic Retinopathy, Third Edition

Practice Guidelines for Ocular Telehealth-Diabetic Retinopathy, Third Edition

The third edition of the Practice Guidelines for Ocular Telehealth-Diabetic Retinopathy includes fundamental requirements to be followed when providing medical and other health care services using telecommunication technologies, and any other electronic communications between patients, practitioners, and other health care providers, as well as “best practice” recommendations. These guidelines were co-authored by HIP Investigator, Dr. Yao Liu and aim to assist providers in pursuing a sound course of action in providing safe and effective medical care using telehealth tools based on current scientific knowledge, technological requirements, and patient needs.

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