Browsing by Author "Damush, Teresa"
Now showing 1 - 10 of 13
Results Per Page
Sort Options
Item 4227 Closing the cross-institutional referral loop: Applying human factors to improve consultations(Cambridge University Press, 2020) Savoy, April; Weiner, Michael; Damush, Teresa; Medicine, School of MedicineOBJECTIVES/GOALS: Although referrals for specialty consultations are a core clinical process, they are prone to coordination and communication breakdowns that have led to adverse clinical outcomes. This project’s objective is to improve timely documentation, transmission, access, and quality of consultation notes across healthcare systems. METHODS/STUDY POPULATION: There are two specific aims for this project. In Aim 1, we will characterize clinical workflows and information flow during cross-institutional referrals. In Aim 2, we will develop and test a prototype leveraging electronic health information exchange (HIE) to increase closing the loop for cross-institutional referrals and improve the quality of consultation notes. To accomplish these aims, we will use human factors methods, including data analytics, medical-record reviews, semi-structured interviews of consultants, rapid prototyping, and usability evaluations. RESULTS/ANTICIPATED RESULTS: Results will inform the design and integration of clinician-facing technologies into clinical workflows to close the referral loop and improve diagnostic processes. Aim 1 will provide quantitative evidence about the quality of cross-institutional referrals, inform the eventual implementation of our prototype, and identify user interface features required for successful electronic health information exchange. Based on the results from Aim 1, reports and visual representations will be generated to illustrate information flows and clinical workflows. This will prioritize design efforts for the intervention’s prototype. Aim 2 will translate clinicians’ requirements into prototype features and assess clinicians’ experience with the prototype. DISCUSSION/SIGNIFICANCE OF IMPACT: The use and usefulness of HIE has been limited due to usability and implementation issues. Cross-institutional referrals are complex and dependent on HIE due to EHRs’ lack of interoperability. This project will provide evidence-based recommendations for the use of Fast Healthcare Interoperability Resources (FHIR) to improve HIE during referrals.Item Comparative Responsiveness of the PROMIS Pain Interference Short Forms with Legacy Pain Measures: Results from Three Randomized Clinical Trials(Elsevier, 2019) Chen, Chen X.; Kroenke, Kurt; Stump, Timothy; Kean, Jacob; Krebs, Erin E.; Bair, Matthew J.; Damush, Teresa; Monahan, Patrick O.; School of NursingThe PROMIS Pain Interference (PROMIS-PI) scales are reliable and publicly accessible; however, little is known about how responsive they are to detect change in clinical trials and how their responsiveness compares to legacy measures. The study purpose was to evaluate responsiveness for the PROMIS-PI scales and to compare their responsiveness with legacy pain measures. We used data from three clinical trials totaling 759 participants. The clinical trials included patients with chronic low back pain (n= 261), chronic back or osteoarthritis pain (n = 240), and a history of stroke (n= 258). At both baseline and follow-up, participants completed PROMIS-PI scales and legacy pain measures (Brief Pain Inventory Interference scale, Pain/Enjoyment/General Activity (PEG) scale, SF-36 Bodily Pain scale, and Roland-Morris Disability Questionnaire). We measured global ratings of pain change, both prospectively and retrospectively, as anchors to identify patients as improved, unchanged, or worsened. Responsiveness was assessed with standardized response means, statistical tests comparing change groups, and area-under-curve analysis. The PROMIS-PI scales had largely comparable responsiveness with the Brief Pain Inventory Interference scale and PEG. The four PROMIS-PI short forms had comparable responsiveness. For all pain questionnaires, responsiveness varied based on the study population and whether pain improved or worsened.Item A critical synthesis of literature on the promoting action on research implementation in health services (PARIHS) framework(BMC, 2010-10-25) Helfrich, Christian D.; Damschroder, Laura J.; Hagedorn, Hildi J.; Daggett, Ginger S.; Sahay, Anju; Ritchie, Mona; Damush, Teresa; Guihan, Marylou; Ullrich, Philip M.; Stetler, Cheryl B.; Medicine, School of MedicineBackground: The Promoting Action on Research Implementation in Health Services framework, or PARIHS, is a conceptual framework that posits key, interacting elements that influence successful implementation of evidence-based practices. It has been widely cited and used as the basis for empirical work; however, there has not yet been a literature review to examine how the framework has been used in implementation projects and research. The purpose of the present article was to critically review and synthesize the literature on PARIHS to understand how it has been used and operationalized, and to highlight its strengths and limitations. Methods: We conducted a qualitative, critical synthesis of peer-reviewed PARIHS literature published through March 2009. We synthesized findings through a three-step process using semi-structured data abstraction tools and group consensus. Results: Twenty-four articles met our inclusion criteria: six core concept articles from original PARIHS authors, and eighteen empirical articles ranging from case reports to quantitative studies. Empirical articles generally used PARIHS as an organizing framework for analyses. No studies used PARIHS prospectively to design implementation strategies, and there was generally a lack of detail about how variables were measured or mapped, or how conclusions were derived. Several studies used findings to comment on the framework in ways that could help refine or validate it. The primary issue identified with the framework was a need for greater conceptual clarity regarding the definition of sub-elements and the nature of dynamic relationships. Strengths identified included its flexibility, intuitive appeal, explicit acknowledgement of the outcome of ‘successful implementation,’ and a more expansive view of what can and should constitute ‘evidence.’ Conclusions: While we found studies reporting empirical support for PARIHS, the single greatest need for this and other implementation models is rigorous, prospective use of the framework to guide implementation projects.There is also need to better explain derived findings and how interventions or measures are mapped to specific PARIHS elements; greater conceptual discrimination among sub-elements may be necessary first. In general, it may be time for the implementation science community to develop consensus guidelines for reporting the use and usefulness of theoretical frameworks within implementation studies.Item Development and Validation of Electronic Quality Measures to Assess Care for Patients With Transient Ischemic Attack and Minor Ischemic Stroke(AHA, 2017) Bravata, Dawn M.; Myers, Laura J.; Cheng, Eric; Reeves, Mathew; Baye, Fitsum; Zhangsheng, Yu; Damush, Teresa; Miech, Edward J.; Sico, Jason; Phipps, Michael; Zillich, Alan; Johanning, Jason; Chaturvedi, Seemant; Austin, Curt; Ferguson, Jared; Maryfield, Bailey; Snow, Kathy; Ofner, Susan; Graham, Glenn; Rhude, Rachel; Williams, Linda S.; Arling, Greg; Medicine, School of MedicineBackground—Despite interest in using electronic health record (EHR) data to assess quality of care, the accuracy of such data is largely unknown. We sought to develop and validate transient ischemic attack and minor ischemic stroke electronic quality measures (eQMs) using EHR data. Methods and Results—A random sample of patients with transient ischemic attack or minor ischemic stroke, cared for in Veterans Health Administration facilities (fiscal year 2011), was identified. We constructed 31 eQMs based on existing quality measures. Chart review was the criterion standard for validating the eQMs. To evaluate eQMs in terms of eligibility, we calculated the proportion of patients who were genuinely not eligible to receive a process (based on chart review) and who were correctly identified as not eligible by the EHR data (specificity). To assess eQMs about classification of whether patients received a process, we calculated the proportion of patients who actually received the process (based on chart review) and who were classified correctly by the EHR data as passing (sensitivity). Seven hundred sixty-three patients were included. About eligibility, specificity varied from 25% (brain imaging; carotid imaging) to 99% (anticoagulation quality). About pass rates, sensitivity varied from 30% (antihypertensive class) to 100% (coronary risk assessment; international normalized ratio measured). The 16 eQMs with ≥70% specificity in eligibility and ≥70% sensitivity in pass rates included coronary risk assessment, international normalized ratio measured, HbA1c measurement, speech language pathology consultation, anticoagulation for atrial fibrillation, discharge on statin, lipid management, neurology consultation, Holter, deep vein thrombosis prophylaxis, oral hypoglycemic intensification, cholesterol medication intensification, antihypertensive intensification, antihypertensive class, carotid stenosis intervention, and substance abuse referral for alcohol. Conclusions—It is feasible to construct valid eQMs for processes of transient ischemic attack and minor ischemic stroke care. Healthcare systems with EHRs should consider using electronic data to evaluate care for their patients with transient ischemic attack and to complement and expand quality measurement programs currently focused on patients with stroke.Item Frequency, Demographics, Comorbidities, and Health Care Utilization by Veterans With Migraine: A VA Nationwide Cohort Study(Wolters Kluwer, 2022) Seng, Elizabeth K.; Fenton, Brenda T.; Wang, Kaicheng; Lipton, Richard B.; Ney, John; Damush, Teresa; Grinberg, Amy S.; Skanderson, Melissa; Sico, Jason J.; Medicine, School of MedicineObjective: To describe the relative frequency, demographics, comorbidities, and healthcare utilization of veterans who receive migraine care at the Veteran's Health Administration (VHA) and to evaluate differences by gender. Methods: This study extracted data from VHA administrative sources. Veterans diagnosed with migraine by a healthcare provider between fiscal year 2008-2019 were included. Demographics and military exposures were extracted at cohort entry. Comorbidities were extracted within 18 months of the first migraine diagnosis. Health care utilization and headache comorbidities were extracted across the study period. Differences between men and women were evaluated using chi-square tests and student t-tests. Results: More than half a million (n = 567,121) veterans were diagnosed with migraine during the 12-year study period, accounting for 5.3% of the 10.8 million veterans served in the VHA; in the most recent year of the study period (2019), the annual incidence and one-year period prevalence of medically diagnosed migraine was 2.7% and 13.0% for women, and 0.7% and 2.5% for men. In the total cohort diagnosed with migraine, 27.8% were women and 72.2% men. Among those with diagnosed migraine, a higher proportion of men vs. women also had a TBI diagnosis (3.9% vs. 1.1%; p < 0.001). A higher proportion of women vs. men reported military sexual trauma (35.5% vs. 3.5%; p < 0.001). Participants with diagnosed migraine had an average of 1.44 (SD 1.73) annual encounters for headache. Primary care was the most common headache care setting (88.1%); almost one-fifth of veterans with diagnosed migraine sought care in the ED at least once during the study period. Common comorbidities were overweight/obesity (80.3%), non-headache pain disorders (61.7%), and mental health disorders (48.8%). Conclusions: Migraine is commonly treated in the VHA setting, but likely under ascertained. Most people treated for migraine in the VHA are men. Pain comorbidities and psychiatric disorders are common. Future research should identify methods to improve diagnosis and treatment and to reduce use of the emergency department.Item Have clinicians adopted the use of brain MRI for patients with TIA and minor stroke?(American Academy of Neurology, 2017-01-17) Chaturvedi, Seemant; Ofner, Susan; Baye, Fitsum; Myers, Laura J.; Phipps, Mike; Sico, Jason J.; Damush, Teresa; Miec, Edward; Reeves, Mat; Johanning, Jason; Williams, Linda S.; Arling, Greg; Cheng, Eric; Yu, Zhangsheng; Bravata, Dawn; Biostatistics, School of Public HealthBACKGROUND: Use of MRI with diffusion-weighted imaging (DWI) can identify infarcts in 30%-50% of patients with TIA. Previous guidelines have indicated that MRI-DWI is the preferred imaging modality for patients with TIA. We assessed the frequency of MRI utilization and predictors of MRI performance. METHODS: A review of TIA and minor stroke patients evaluated at Veterans Affairs hospitals was conducted with regard to medical history, use of diagnostic imaging within 2 days of presentation, and in-hospital care variables. Chart abstraction was performed in a subset of hospitals to assess clinical variables not available in the administrative data. RESULTS: A total of 7,889 patients with TIA/minor stroke were included. Overall, 6,694 patients (84.9%) had CT or MRI, with 3,396/6,694 (50.7%) having MRI. Variables that were associated with increased odds of CT performance were age >80 years, prior stroke, history of atrial fibrillation, heart failure, coronary artery disease, anxiety, and low hospital complexity, while blood pressure >140/90 mm Hg and high hospital complexity were associated with increased likelihood of MRI. Diplopia (87% had MRI, p = 0.03), neurologic consultation on the day of presentation (73% had MRI, p < 0.0001), and symptom duration of >6 hours (74% had MRI, p = 0.0009) were associated with MRI performance. CONCLUSIONS: Within a national health system, about 40% of patients with TIA/minor stroke had MRI performed within 2 days. Performance of MRI appeared to be influenced by several patient and facility-level variables, suggesting that there has been partial acceptance of the previous guideline that endorsed MRI for patients with TIA.Item The Impact of Yoga on Quality of Life after Stroke(Office of the Vice Chancellor for Research, 2012-04-13) Schmid, Arlene A.; Van Puymbroeck, Marieke; Miller, Kristine; Altenburger, Peter; Dierks, Tracy; Schalk, Nancy; DeBaun, Erin; Damush, Teresa; Williams, Linda; Chagdes, Stephanie; Dye, Lauren; Moore, Richelle; Racine, LisaAbstract Objective: Evaluate the effect of an innovative 8 week yoga-based rehabilitation intervention on 1) stroke specific quality of life (QoL) and 2) activity and participation scores in veterans with chronic stroke. Rationale/Background: Declines in Quality of Life (QoL), activity, and participation are common after stroke. Such declines are related to increased mortality, dependence, and costs. As more people live with long-term effects of stroke, it is necessary to develop innovative and evidence-based rehabilitation and occupational therapy interventions to improve QoL, activity, and participation in people with chronic stroke. Methods: • Participants- Participants included veterans with chronic stroke (>9 months) who had completed all occupational and physical therapy after stroke, reported some residual disability or functional loss after stroke; and scored >4 out of 6 on the Short Mini Mental Status Exam. • Setting- All data were collected in the Rehabilitation and Integrative Therapy lab at an urban university. • Design- This was a mixed methods pilot study of an 8 week yoga-based rehabilitation intervention. Data were collected before and after the 8 week yoga intervention. Data collection was completed by a trained research assistant. We used paired t-tests and Wilcoxon non-parametirc tests as appropriate to compare group change in scores over the 8-weeks. • Measure(s)- Measures included the Stroke Specific Quality of Life scale (SSQoL) (high score=better QoL) to measure QoL and activity and participation were measured with the ICF Measure of Participation and Activity (IMPACT) (low score=less limitations in activity and participation). Both are valid and reliable instruments. Qualitative comments were collected during focus groups after the intervention. Supportive qualitative comments regarding improved QoL and activity and participation are included. All qualitative comments were reviewed by two researchers, and exemplar quotes are included.Item Implementing a Mandated Program Across a Regional Health Care System: A Rapid Qualitative Assessment to Evaluate Early Implementation Strategies(Wolters Kluwer, 2019-09-01) Sperber, Nina R.; Bruening, Rebecca A.; Choate, Ashley; Mahanna, Elizabeth; Wang, Virginia; Powell, Byron J.; Damush, Teresa; Jackson, George L.; Van Houtven, Courtney H.; Allen, Kelli D.; Hastings, Susan N.; Medicine, School of MedicineRapid qualitative assessement was used to describe early strategies to implement an evidence-based walking program for hospitalized older adults, assiSTed eaRly mobIlity for hospitalizeD older vEterans (STRIDE), mandated by a regional Veterans Affairs health care system office (VISN). Data were collected from 6 hospital sites via semi-structured interviews with key informants, observations of telephone-based technical assistance (TA), and review of VISN-requested program documents (e.g., initial implementation plans). An overaching framework of actionable feedback for VISN leadership and specification of locally initiated implementation strategies, using the Expert Recommendations for Implementing Change (ERIC) compilation, was used. Actionable feedback was shared with VISN leadership one month after the initiative. ERIC implementation strategies identified were: 1) Promoting Adaptability- Four sites had physical therapists (PT)/ kinesiotherapists (KT) instead of assistants walk patients, 2) Promoting Network Weaving- Strengthening nursing and PT/ KT partnership with regular communication opportunities or a point person was important for implementation, 3) Distributing Educational Materials – Two sites distributed information about STRIDE via email and in-person, and 4) Organizing Clinician Implementation Team Meetings – Three sites used interdisciplinary team meetings to communicate with clinical staff about STRIDE. This qualitative study sheds light on early experiences with implementing STRIDE; the results have been instructive for ongoing implementation and future dissemination of STRIDE, and the approach can be applied across contexts to inform implementation of other programs.Item Pre-implementation Evaluation of PARTNER-MH: A Mental Healthcare Disparity Intervention for Minority Veterans in the VHA(Springer, 2021-01) Eliacin, Johanne; Matthias, Marianne S.; Burgess, Diana J.; Patterson, Scott; Damush, Teresa; Pratt-Chapman, Mandi; McGovern, Mark; Chinman, Matthew; Talib, Tasneem; O’Connor, Caitlin; Rollins, Angela; Psychology, School of ScienceTo design PARTNER-MH, a peer-led, patient navigation program for implementation in Veterans Health Administration (VHA) mental health care settings, we conducted a pre-implementation evaluation during intervention development to assess stakeholders’ views of the intervention and to explore implementation factors critical to its future adoption. This is a convergent mixed-methods study that involved qualitative semi-structured interviews and survey data. Data collection was guided by the Consolidated Framework for Implementation Research (CFIR). We interviewed and administered the surveys to 23 peers and 10 supervisors from 12 midwestern VHA facilities. We used deductive and inductive approaches to analyze the qualitative data. We also conducted descriptive analysis and Fisher Exact Test to compare peers and supervisors’ survey responses. We triangulated findings to refine the intervention. Overall, participants viewed PARTNER-MH favorably. However, they saw the intervention’s focus on minority Veterans and social determinants of health framework as potential barriers, believing this could negatively affect the packaging of the intervention, complicate its delivery process, and impact its adoption. They also viewed clinic structures, available resources, and learning climate as potential barriers. Peers and supervisors’ selections and discussions of CFIR items were similar. Our findings informed PARTNER-MH development and helped identify factors that could impact its implementation. This project is responsive to the increasing recognition of the need to incorporate implementation science in healthcare disparities research. Understanding the resistance to the intervention’s focus on minority Veterans and the potential barriers presented by contextual factors positions us to adjust the intervention prior to testing, in an effort to maximize implementation success.Item Proactive, Recovery-Oriented Treatment Navigation to Engage Racially Diverse Veterans in Mental Healthcare (PARTNER-MH), a Peer-Led Patient Navigation Intervention for Racially and Ethnically Minoritized Veterans in Veterans Health Administration Mental Health Services: Protocol for a Mixed Methods Randomized Controlled Feasibility Study(JMIR, 2022-09-06) Eliacin, Johanne; Burgess, Diana J.; Rollins, Angela L.; Patterson, Scott; Damush, Teresa; Bair, Matthew J.; Salyers, Michelle P.; Spoont, Michele; Slaven, James E.; O'Connor, Caitlin; Walker, Kiara; Zou, Denise S.; Austin, Emily; Akins, John; Miller, James; Chinman, Matthew; Matthias, Marianne S.; Psychology, School of ScienceBackground: Mental health care disparities are persistent and have increased in recent years. Compared with their White counterparts, members of racially and ethnically minoritized groups have less access to mental health care. Minoritized groups also have lower engagement in mental health treatment and are more likely to experience ineffective patient-provider communication, which contribute to negative mental health care experiences and poor mental health outcomes. Interventions that embrace recovery-oriented practices to support patient engagement and empower patients to participate in their mental health care and treatment decisions may help reduce mental health care disparities. Designed to achieve this goal, the Proactive, Recovery-Oriented Treatment Navigation to Engage Racially Diverse Veterans in Mental Healthcare (PARTNER-MH) is a peer-led patient navigation intervention that aims to engage minoritized patients in mental health treatment, support them to play a greater role in their care, and facilitate their participation in shared treatment decision-making. Objective: The primary aim of this study is to assess the feasibility and acceptability of PARTNER-MH delivered to patients over 6 months. The second aim is to evaluate the preliminary effects of PARTNER-MH on patient activation, patient engagement, and shared decision-making. The third aim is to examine patient-perceived barriers to and facilitators of engagement in PARTNER-MH as well as contextual factors that may inhibit or promote the integration, sustainability, and scalability of PARTNER-MH using the Consolidated Framework for Implementation Research. Methods: This pilot study evaluates the feasibility and acceptability of PARTNER-MH in a Veterans Health Administration (VHA) mental health setting using a mixed methods, randomized controlled trial study design. PARTNER-MH is tested under real-world conditions using certified VHA peer specialists (peers) selected through usual VHA hiring practices and assigned to the mental health service line. Peers provide PARTNER-MH and usual peer support services. The study compares the impact of PARTNER-MH versus a wait-list control group on patient activation, patient engagement, and shared decision-making as well as other patient-level outcomes. PARTNER-MH also examines organizational factors that could impact its future implementation in VHA settings. Results: Participants (N=50) were Veterans who were mostly male (n=31, 62%) and self-identified as non-Hispanic (n=44, 88%) and Black (n=35, 70%) with a median age of 45 to 54 years. Most had at least some college education, and 32% (16/50) had completed ≥4 years of college. Randomization produced comparable groups in terms of characteristics and outcome measures at baseline, except for sex. Conclusions: Rather than simply documenting health disparities among vulnerable populations, PARTNER-MH offers opportunities to evaluate a tailored, culturally sensitive, system-based intervention to improve patient engagement and patient-provider communication in mental health care for racially and ethnically minoritized individuals.