A systematic review of multidisciplinary teams to reduce major amputations for patients with diabetic foot ulcers
A systematic review of multidisciplinary teams to reduce major amputations for patients with diabetic foot ulcers
Nearly 2 million Americans develop a diabetic foot ulcer each year; within 5 years of ulceration, 5% will undergo major amputation and 50% to 70% will die. Experts have recommended a multidisciplinary team approach to optimally address certain comorbidities in a coordinated manner and to reduce major amputations. Authors including HIP Investigators Dr. Meghan Brennan and Dr. Christie Bartels described multidisciplinary team composition and function using a systems engineering conceptual model and summarized the impact of multidisciplinary teams on major amputations. They hypothesized that multidisciplinary teams are associated with a reduced risk of major amputation.
The group found that multidisciplinary team composition was variable but reduced major amputations in 94% of studies.
Impact of family‐centered tailoring of pediatric diabetes self‐management resources
Impact of family‐centered tailoring of pediatric diabetes self‐management resources
Behavioral interventions to improve self‐management, glycemic control, or quality of life (QOL) for children with type 1 diabetes have small to moderate positive effects, but a host of challenges diminishes their effectiveness in practice. A group of authors including HIP Investigator, Dr. Elizabeth Cox evaluated the hypothesis that delivering self‐management resources in a family‐centered manner, using PRISM to guide resource selection, will result in better glycemic control and quality of life for children and their parents.
Authors found that tailored self‐management resources may improve outcomes among specific populations, suggesting the need to consider families' self‐management barriers and patient characteristics before implementing self‐management resources.
Earlier Hospital Discharge With Prospectively Designated Discharge Time in the Electronic Health Record
Earlier Hospital Discharge With Prospectively Designated Discharge Time in the Electronic Health Record
Hospital discharge requires multidisciplinary coordination. Insufficient coordination impacts patient flow, resource use, and postdischarge outcomes. A team of authors including HIP Investigator, Dr. Ryan Coller implemented a prospective, multidisciplinary discharge timing designation in the electronic health record (EHR) and evaluated its association with discharge timing.
The group found that the implementation of a prospective, multidisciplinary EHR discharge time designation was associated with more before-noon discharges. Next steps include replicating results in other settings and determining populations that are most responsive to discharge coordination efforts.
Access to Care Among Individuals Who Experienced Medicaid Lockouts After Premium Nonpayment
Access to Care Among Individuals Who Experienced Medicaid Lockouts After Premium Nonpayment
As of September 2019, 5 states have received federal waivers to temporarily suspend Medicaid eligibility for individuals who fail to pay required premiums. These periods, ranging from 3 to 12 months, are called lockouts, noneligibility periods, or restrictive reenrollment periods. Wisconsin received a Section 1115 waiver allowing the application of premiums enforced by lockouts among adults receiving transitional medical assistance (TMA), a federally required Medicaid category that provides time-limited coverage to parents and/or caretakers when their incomes increase to exceed the Medicaid program maximum. Wisconsin did not expand Medicaid under the Patient Protection and Affordable Care Act; TMA covers some individuals who would otherwise be eligible for the expansion.
A team of authors including HIP Investigator, Dr. Marguerite Burns conducted a survey study comparing the demographic characteristics, access to care, and health status of recent Medicaid enrollees in Wisconsin with and without experience of Medicaid lockouts.
Investigating lupus retention in care to inform interventions for disparities reduction: an observational cohort study
Investigating lupus retention in care to inform interventions for disparities reduction: an observational cohort study
Systemic lupus erythematosus (SLE) is an autoimmune disease that disproportionately impacts young women, patients of color, and the socioeconomically disadvantaged, making SLE an important target for health disparity measurement and research. HIP Investigator, Dr. Christie Bartels et al. applied WHO-endorsed metrics that helped reduce similar disparities in HIV to investigate relationships between race, disadvantage, and retention in care in an urban lupus cohort. The authors examined predictors of lupus retention in care, developed an SLE Care Continuum, and informed interventions to reduce disparities. Key findings include 40% of patients not being retained at one year, and neighborhood disadvantage was the leading predictor of retention gaps.
System Factors Influencing the Use of a Family-Centered Rounds Checklist
System Factors Influencing the Use of a Family-Centered Rounds Checklist
Checklists are used to operationalize care processes and enhance patient safety; however, checklist implementation is difficult within complex health systems. A family-centered rounds (FCR) checklist increased physician performance of key rounding activities, which were associated with improved parent engagement, safety perceptions, and behaviors. To inform FCR checklist implementation and dissemination, a team of authors including HIP Investigator, Dr. Elizabeth Cox assessed physician compliance with this checklist and factors influencing its use.
Authors found that multiple factors within hospital systems may influence FCR checklist use. Strategies, such as providing rounding schedules and mobile computers, may promote optimal engagement of families during rounds and promote pediatric patient safety.
Anxiety and Hypertension: Is There a Link? A Literature Review of the Comorbidity Relationship Between Anxiety and Hypertension
Anxiety and Hypertension: Is There a Link? A Literature Review of the Comorbidity Relationship Between Anxiety and Hypertension
There is increasing evidence of a positive association between comorbid anxiety and hypertension. This contemporaneous review by HIP Investigator, Dr. Heather Johnson supports similar findings in historical studies and provides mechanistic hypotheses for larger, longitudinal studies. The objective of this review is to summarize contemporaneous studies evaluating the relationship between prevalent anxiety and comorbid prevalent hypertension, or the development of incident (future) hypertension.
Development and validation of a pragmatic natural language processing approach to identifying falls in older adults in the emergency department
Development and validation of a pragmatic natural language processing approach to identifying falls in older adults in the emergency department
Falls among older adults are both a common reason for presentation to the emergency department, and a major source of morbidity and mortality. It is critical to identify fall patients quickly and reliably during, and immediately after, emergency department encounters in order to deliver appropriate care and referrals. Unfortunately, falls are difficult to identify without manual chart review, a time intensive process infeasible for many applications including surveillance and quality reporting. HIP Investigator, Dr. Brian Patterson described and validated a pragmatic, rules-based Natural Language Processing approach for identification of fall patients in the emergency department.
Using Stakeholder Values to Promote Implementation of an Evidence-Based Mobile Health Intervention for Addiction Treatment in Primary Care Settings
Using Stakeholder Values to Promote Implementation of an Evidence-Based Mobile Health Intervention for Addiction Treatment in Primary Care Settings
Most evidence-based practices (EBPs) do not find their way into clinical use, including evidence-based mobile health (mHealth) technologies. The literature offers implementers little practical guidance for successfully integrating mHealth into health care systems. HIP Investigator, Dr. Andrew Quanbeck describes a novel decision-framing model that gives implementers a method of eliciting the considerations of different stakeholder groups when they decide whether to implement an EBP.
This paper presents a model implementers may use to elicit stakeholders' considerations when deciding to adopt a new technology, considerations that may then be used to adapt the intervention and tailor implementation, potentially increasing the likelihood of implementation success.
Qualitative Research on Expanded Prenatal and Newborn Screening: Robust but Marginalized
Qualitative Research on Expanded Prenatal and Newborn Screening: Robust but Marginalized
Screening technologies are iteratively transforming how people experience pregnancy and early parenting. A new class of newborn patients are being created and particular forms of parental vigilance are emerging. HIP Investigator Dr. Rachel Grob wrote extensive qualitative literature that documents all of these social phenomena, and more, in connection with the spread of prenatal and newborn screening.
This essay uses qualitative research on prenatal and newborn screening as a case study for illustrating the broad methodological, ideological, and dialogical issues at stake.