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Browsing by Author "Luckhurst, Cherie"
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Item Acceptance of a Risk Estimation Tool for Colorectal Cancer Screening(Office of the Vice Chancellor for Research, 2016-04-08) Luckhurst, Cherie; Imperiale, Tom; Matthias, Marianne S.Abstract: While colonoscopy is the most prevalent screening test for colorectal cancer (CRC), it is often too expensive, too uncomfortable, or too time-consuming for patients. Non-compliance is common. Recently, fecal immunochemical testing (FIT) has become a guideline-recommended alternative. The FIT is a non-invasive, inexpensive method that requires no uncomfortable preparation by patients. The decision to recommend the colonoscopy or the FIT is based on the patient’s estimated risk for CRC. Several countries have created risk prediction tools to help identify patients at high risk for advanced colorectal neoplasia (the combination of CRC and advanced, precancerous polyps). A U.S.-based prediction tool was recently published1 that uses five easily and reliably measured factors (age, sex, a first degree relative with CRC, waist circumference, and cigarette smoking history) to quantify risk. We aimed to learn the impressions of clinicians and patients to this risk estimation tool. In the first phase of this study, we used a semi-structured format to interview clinicians at a VA medical center and a non-VA hospital. Using a paper prototype of the risk estimation tool, we asked about its usefulness to estimate risk and to aid their selection of a CRC screening tool. Using a grounded theory approach, we analyzed the interview transcripts and identified major themes. We found that clinicians thought the tool was clear and easy to use. However, they are unlikely to use it as a decision aid until FIT is more widely-endorsed as an acceptable alternative screening test. In phase two of the study, we will interview patients to assess their responses to the tool.Item Barriers and facilitators to provide quality TIA care in the Veterans Healthcare Administration(American Academy of Neurology, 2017-12-12) Damush, Teresa M.; Miech, Edward J.; Sico, Jason J.; Phipps, Michael S.; Arling, Greg; Ferguson, Jared; Austin, Charles; Myers, Laura; Baye, Fitsum; Luckhurst, Cherie; Keating, Ava B.; Moran, Eileen; Bravata, Dawn M.; Medicine, School of MedicineObjective: To identify key barriers and facilitators to the delivery of guideline-based care of patients with TIA in the national Veterans Health Administration (VHA). Methods: We conducted a cross-sectional, observational study of 70 audiotaped interviews of multidisciplinary clinical staff involved in TIA care at 14 VHA hospitals. We de-identified and analyzed all transcribed interviews. We identified emergent themes and patterns of barriers to providing TIA care and of facilitators applied to overcome these barriers. Results: Identified barriers to providing timely acute and follow-up TIA care included difficulties accessing brain imaging, a constantly rotating pool of housestaff, lack of care coordination, resource constraints, and inadequate staff education. Key informants revealed that both stroke nurse coordinators and system-level factors facilitated the provision of TIA care. Few facilities had specific TIA protocols. However, stroke nurse coordinators often expanded upon their role to include TIA. They facilitated TIA care by (1) coordinating patient care across services, communicating across service lines, and educating clinical staff about facility policies and evidence-based practices; (2) tracking individual patients from emergency departments to inpatient settings and to discharge for timely follow-up care; (3) providing and referring TIA patients to risk factor management programs; and (4) performing regular audit and feedback of quality performance data. System-level facilitators included clinical service leadership engagement and use of electronic tools for continuous care across services. Conclusions: The local organization within a health care facility may be targeted to cultivate internal facilitators and a systemic infrastructure to provide evidence-based TIA care.Item Leadership Perspectives on Implementing Health Information Exchange: Qualitative Study in a Tertiary Veterans Affairs Medical Center(JMIR, 2021) Dixon, Brian E.; Luckhurst, Cherie; Haggstrom, David A.; Epidemiology, School of Public HealthBackground: The US Department of Veterans Affairs (VA) seeks to achieve interoperability with other organizations, including non-VA community and regional health information exchanges (HIEs). Objective: This study aims to understand the perspectives of leaders involved in implementing information exchange between VA and non-VA providers via a community HIE. Methods: We interviewed operational, clinical, and information technology leaders at one VA facility and its community HIE partner. Respondents discussed their experiences with VA-HIE, including barriers and facilitators to implementation, and the associated impact on health care providers. Transcribed interviews were coded and analyzed using immersion-crystallization methods. Results: VA and community HIE leaders found training to be a key factor when implementing VA-HIE and worked cooperatively to provide several styles and locations of training. During recruitment, a high-touch approach was successfully used to enroll patients and overcome their resistance to opting in. Discussion with leaders revealed the high levels of complexity navigated by VA providers and staff to send and retrieve information. Part of the complexity stemmed from the interconnected web of information systems and human teams necessary to implement VA-HIE information sharing. These interrelationships must be effectively managed to guide organizational decision making. Conclusions: Organizational leaders perceived information sharing to be of essential value in delivering high-quality, coordinated health care. The VA continues to increase access to outside care through the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act. Along with this increase in non-VA medical care, there is a need for greater information sharing between VA and non-VA health care organizations. Insights by leaders into barriers and facilitators to VA-HIE can be applied by other national and regional networks that seek to achieve interoperability across health care delivery systems.Item Prime movers: Advanced practice professionals in the role of stroke coordinator(Wiley, 2017-06) Rattray, Nicholas A.; Damush, Teresa M.; Luckhurst, Cherie; Bauer-Martinez, Catherine J.; Homoya, Barbara J.; Miech, Edward J.; Anthropology, School of Liberal ArtsBackground and purpose Following a stroke quality improvement clustered randomized trial and a national acute ischemic stroke (AIS) directive in the Veterans Health Administration in 2011, this comparative case study examined the role of advanced practice professionals (APPs) in quality improvement activities among stroke teams. Methods Semistructured interviews were conducted at 11 Veterans Affairs medical centers annually over a 3-year period. A multidisciplinary team analyzed interviews from clinical providers through a mixed-methods, data matrix approach linking APPs (nurse practitioners and physician assistants) with Consolidated Framework for Implementation Research constructs and a group organization measure. Conclusion Five of 11 facilities independently chose to staff stroke coordinator positions with APPs. Analysis indicated that APPs emerged as boundary spanners across services and disciplines who played an important role in coordinating evidence-based, facility-level approaches to AIS care. The presence of APPs was related to engaging in group-based evaluation of performance data, implementing stroke protocols, monitoring care through data audit, convening interprofessional meetings involving planning activities, and providing direct care. Implications for practice The presence of APPs appears to be an influential feature of local context crucial in developing an advanced, facility-wide approach to stroke care because of their boundary spanning capabilities.