Mother and child with doctor

Influences of health and environmental deprivation on family relationships among children with chronic disease

Influences of health and environmental deprivation on family relationships among children with chronic disease

Families are often the primary source of close, comforting relationships for children and adolescents. Among chronically ill children, families play a critical role in managing aspects of the disease, often on a daily basis.

In this publication, authors including HIP Investigator, Dr. Elizabeth Cox used the Patient-Reported Outcomes Measurement Information System (PROMIS) Family Relationships measure over time to understand how family relationships are influenced by these three factors—the characteristics of the child and parent, environmental deprivation, and health over time, among children 8–17 years of age with one of three chronic illnesses (asthma, type 1 diabetes [diabetes], and sickle cell disease).

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Patient and doctor discussion

Patients' roles in governance of learning: Results from a qualitative study of 16 learning healthcare systems

Patients' roles in governance of learning: Results from a qualitative study of 16 learning healthcare systems

Patient and family engagement has been identified as key to fulfilling Learning Healthcare Systems (LHSs) promise as a model for improving clinical care, catalyzing research, and controlling costs. Little is known, however, about the state of patient engagement in the learning mission of these systems or about what governance structures and processes facilitate such engagement.

In this publication, authors including HIP Investigator, Dr. Rachel Grob conducted a qualitative analysis of how patients and family members are engaged in the governance of systematic learning at 16 purposively sampled LHSs based on telephone interviews with 20 patient/family leaders and 79 employee leaders.

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Little girl sleeping hospital bed

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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Two people in business meeting

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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Decision Tree

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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Young female with phone

Problematic Internet Use: A Longitudinal Study Evaluating Prevalence and Predictor

Problematic Internet Use: A Longitudinal Study Evaluating Prevalence and Predictor

Problematic internet use has been associated with poor academic performance, stress, and fewer positive health behaviors. Studies also have suggested bidirectional relationships between problematic internet use and other mental health conditions, such as depression.

In this publication, authors including HIP Investigator Dr. Elizabeth Cox evaluated the prevalence estimate and predictors of problematic internet use over time among college students and identified an intermediate-risk PRIUSS score toward earlier identification of being at risk.

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Girl in wheelchair

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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Doctor working with mobile phone and stethoscope

Linking Parent Confidence and Hospitalization through Mobile Health: A Multisite Pilot Study

Linking Parent Confidence and Hospitalization through Mobile Health: A Multisite Pilot Study

In this publication, authors including HIP Investigator, Dr. Ryan Coller conducted a multisite pilot study of an mHealth platform with CMC caregivers (Assessing Confidence at Times of Increased Vulnerability [ACTIV]). ACTIV uses longitudinal text messaging to prospectively monitor parent confidence for their child to avoid hospitalization over the subsequent month. Their aim was to identify associations between ACTIV's repeated measures and CMC hospitalization, and to evaluate ACTIV's feasibility/acceptability when implemented within a complex care program.

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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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