Browsing by Author "Torke, Alexia"
Now showing 1 - 10 of 17
Results Per Page
Sort Options
Item Advance Care Planning in A Preoperative Clinic: A Retrospective Chart Review(Springer, 2019-01-02) Sinha, Shilpee; Gruber, Rachel N.; Cottingham, Ann H.; Nation, Barb; Lane, Kathleen A.; Bo, Na; Torke, Alexia; Medicine, School of MedicinePatients seen in preoperative testing clinics are at an increased risk of surgical complications and most are incapacitated for during anesthesia. Advance directives (ADs) are important to guide care in the event of emergencies when patients are unable to speak for themselves. The goal of this study was to determine the frequency with which ADs are completed for patients seen in preoperative clinics prior to elective surgery and identify demographic and clinical characteristics associated with having ADs available in the electronic medical record (EMR).Item Comparing Engagement in Advance Care Planning Between Stages of Heart Failure(2019-08) Catalano, Lori A.; Hickman, Susan; Von Ah, Diane; Torke, Alexia; Weaver, MichaelHeart failure is a terminal disease with an unpredictable trajectory. Family members of patients with heart failure are often called upon to make decisions about treatment and end of life care, sometimes with little guidance as to the patients’ wishes. Advance care planning (ACP) is an ongoing process by which patients make decisions about their future healthcare. Only about one-third of patients with heart failure have participated in ACP, which is a similar percentage to the overall population. Despite increased focus on ACP and interventions to improve it, the rates of ACP in the population remain relatively unchanged. There is a need to develop interventions that are targeted based on patient engagement in the process rather than the existing broad-based interventions. The purpose of this dissertation study is to examine the relationship between the American Heart Association stage of heart failure and readiness to engage in advance care planning. The study consisted of mailed surveys that consisted of demographic questionnaires and the Advance Care Planning Engagement Survey. Engagement was analyzed in relation to heart failure stage, heart failure class, comorbidities, perception of health status, recent hospitalizations, making healthcare decisions for others, and demographic variables. The results demonstrated that although there was no significant association between heart failure stage or class and engagement in advance care planning, there were significant associations between medical comorbidities and advance care planning engagement. Other significantly associated participant characteristics included age, gender, education, ethnicity, and income. Findings suggest that people with multiple comorbid conditions will be more likely to be ready to engage in ACP than those with fewer health conditions. The results from this study will contribute to the development of strategies to improve advance care planning that are targeted based on engagement level.Item Crucial Conversations for High-Risk Populations before Surgery: Advance Care Planning in a Preoperative Setting(Mary Ann Liebert, Inc., 2021-10-06) Patel, Roma; Torke, Alexia; Nation, Barb; Cottingham, Ann; Hur, Jennifer; Gruber, Rachel; Sinha, Shilpee; Medicine, School of MedicineBackground: High-risk patients undergoing elective surgery are at risk for perioperative complications, including readmissions and death. Advance care planning (ACP) may allow for preparation for such events. Objectives: (1) To assess the completion rate of advance directives (ADs) and their association with one year readmissions and mortality (2) to examine clinical events for decedents. Design: This is an observational cohort study conducted through chart review. Setting/Subjects: Subjects were 400 patients undergoing preoperative evaluation for elective surgery at two hospitals in the United States. Measurements: The prevalence of ADs at the time of surgery and at one year, readmissions, and mortality at one year were determined. Results: Three-hundred ninety patients were included. In total, 102 (26.4%) patients were readmitted, yet did not complete an AD. Seventeen (4.4%) patients filed an AD during follow-up. Nineteen patients died and mortality rate was 4.9%. There was a significant association between completing an AD before death. Of the decedents, seven (37%) underwent resuscitation, but only four had ADs. Conclusions: Many high-risk surgical patients would benefit from ADs before clinical decline. Preoperative clinics present a missed opportunity to ensure ACP occurs before complications arise.Item Development Of A Brief Measure Of Communication Quality: The 5- And 10-Item Family Inpatient Communication Surveys(Oxford University Press, 2022) Burke, Emily; Slaven, James; Taylor, Tracy; Monahan, Patrick; Sachs, Greg; Torke, Alexia; Biostatistics and Health Data Science, Richard M. Fairbanks School of Public HealthCommunication quality between clinical care teams and families impacts important outcomes like satisfaction, depression, and anxiety. Assessment tools must be efficient and reliable to be useful in the clinical environment. We report the development of 5 and 10-item versions of the validated 30-item Family Inpatient Communication Survey (FICS). Data were from 364 surrogate decision makers (SDMs) for incapacitated older adults in the ICU. Most SDMs were adult children (66.8%). SDMs were 70.9% female, 68.9% white, with a mean age of 58.3. Exploratory factor analysis revealed high internal reliability for the single-factor FICS5 (α= .88) and two-factor FICS10 (α= .93). The FICS10 reliably measures two subscales: information (α= .91) and emotional support (α=.81). Good discriminant and predictive validity were demonstrated when comparing total scores to outcomes at 6-8 weeks after hospital discharge, including anxiety (correlation coefficient (ρ)= -.13; p=.0234 ), depression (ρ =-.15; p=.0076), decision regret (ρ =--.15; p=.0066), and satisfaction (ρ =-..48; p<.0001). Repeating analysis with a new sample (n=188) revealed similar results with Cronbach’s alpha ranging from .81 to .93. The FICS5 revealed significant associations (p<.05) at 6-8 weeks after discharge with distress (-.22), while the FICS10 demonstrated significant associations with distress (-.28), anxiety (-.20), depression (-.19) and decision regret (-.27). Confirmatory factor analysis indicated adequate fit (CFI: FICS5= .994, FICS10= .994; RMSEA: FICS5= .093, FICS10= .103). The FICS provides clinicians and interventionists with a reliable, low burden tool to evaluate communication quality and respond quickly, which could impact satisfaction and other important outcomes for patients and families.Item Development of a Protocol for Successful Palliative Care Consultation in Population of Patients Receiving Mechanical Circulatory Support(Elsevier, 2017) Sinha, Shilpee; Belcher, Carey; Torke, Alexia; Howard, Joycelyn; Caccamo, Marco; Slaven, James A.; Gradus-Pizlo, Irmina; Department of Medicine, School of MedicineBackground In 2014, Joint Commission recommended palliative care (PC) engagement in ventricular assist device (VAD) implantation as destination therapy. Limited information is available on established PC protocols in the mechanical circulatory support (MCS) population. Measures The goals of our PC consultation were to document advance care planning (ACP) discussions and designate a surrogate decision maker (SDM) prior to MCS implantation. A retrospective analysis compared the frequency of PC consults, ACP discussion, and SDM before and after protocol implementation. Intervention A protocol was developed to conduct interdisciplinary PC consultations for the MCS population. Outcomes The percentage of PC consults placed prior to MCS implantation increased from 11 (17.2%) pre-protocol to 56 (96.6%) post-protocol (p<0.0001), and documented SDM increased from 26 (40.6%) pre-protocol to 57 (98.3%) post protocol (p<0.0001). Conclusion Close PC/cardiology collaboration can substantially improve ACP discussions and SDM documentation in the MCS population. This multidisciplinary protocol facilitates successful PC consultations.Item An educational video improves physician knowledge of a public health care law that affects patient care during hospital clinical practice(Sage, 2021-05-31) Comer, Amber R.; Salven, James; Torke, Alexia; Medicine, School of MedicineWhen public health laws are passed that affect clinical practice within hospitals, it is important to educate physicians about best practices in implementing these laws into routine patient care in hospitals. An educational video was developed to inform physicians about a new state public health care law. This study sought to determine whether an educational video about a new state public health care law improves physicians' knowledge of the law and how to implement the law during clinical practice. A total of n=33 internal medicine physicians participated in this study. This study found that an educational video was successful in increasing physician knowledge about a new public health care law that affects clinical practice. The utilization of validated educational videos may provide a useful resource when attempting to provide education about new public health laws that effect the provision of medical care.Item The effect of a state health care consent law on patient care in hospitals: A survey of physicians(Sciedu Press, 2018-03-05) Comer, Amber R.; Gaffney, Margaret; Stone, Cynthia; Torke, Alexia; Physical Therapy, School of Health and Human SciencesObjective: When a patient cannot make medical decisions for him or herself, and has not appointed a healthcare representative, default state healthcare consent laws determine who is able to make healthcare decisions for the patient. The narrow construction of some state laws leaves many patients in situations where the closest person to the patient does not qualify as a representative under the law, or where the patient has too many representatives and a consensus cannot be reached on the patient’s medical care. Methods: In order to determine how state healthcare consent laws affect patient care in hospitals, a survey of 412 Indiana physicians was conducted. Results: The data shows 53.8% of physicians experienced a delay in patient care because they were unable to identify a legally appropriate health care representative. Almost half (46.01%) of physicians experienced delay of patient care due to the inability to identify a final decision maker when disputes arose between multiple legal representatives. Conclusions: The results of this study have important implications for hospital administrators as a delay in patient care can be costly and unnecessarily utilizes hospital resources. Additionally, the results of this study have important implications for the status of state surrogate decision making laws. Amending state laws to include more potential surrogates, has the potential to minimize delays in patient care and ensure that appropriate surrogates are making medical care decisions for patients without the undue burden of court intervention.Item Effects of Dementia Diagnosis on Hospital Readmission After Discharge From a Skilled Nursing Home(Oxford University Press, 2024-12-31) Carnahan, Jennifer; Slaven, James; Fox Ludden, Emily; Bowditch, Corinne; Ryan, Healey; Jiangqiong, Li; Tu, Wanzhu; Torke, Alexia; Medicine, School of MedicineHigh acute care utilization has been associated with dementia, but the risk of repeat acute care use following a skilled nursing home (SNH) to home transition is not well understood. We examined the association of dementia with 30-day hospital readmission after leaving a SNH. Data from the Health and Retirement Study from 2000-2018 was linked to Medicare and SNH claims. We analyzed the events of hospital readmission following SNH discharge using logistic regression while controlling for repeated within-subject readmissions. There were 5,912 discharges to the community from an SNH and 941 hospital readmissions. ICD codes for dementia were present with 1,754 of the SNH-to-home transitions and 314 of the hospital readmissions. In bivariate analysis, people with dementia were more likely to be readmitted (p=0.0074). Post-SNH readmissions were also more likely among people who were Black, male, dual eligible beneficiaries, longer pre-SNH hospital stays, higher Charlson Comorbidity Index, and greater activities of daily living deficits. In the multivariable logistic regression model, the odds of readmissions were still greater among persons with dementia, but significance was attenuated (OR 1.09; 0.90, 1.32; p=0.4065). Significant associations with readmissions include the Charlson Comorbidity Index (OR 1.07; 1.04, 1.09; p< 0.0001) and activities of daily living deficits (OR 1.11 (1.04, 1.17; p=0.0005). People with dementia may be at greater risk of readmission after SNH discharge but not when controlling for factors such as socioeconomic status, activities of daily living, and other comorbidities.Item Feasibility Of Ecological Momentary Assessment Of Surrogates For Cognitively Impaired Icu Patients: A Pilot Study(Oxford University Press, 2022) Taylor, Tracy; Burke, Emily; Slaven, James; Pfeffer, Bruce; Varner Perez, Shelley; Banks, Sarah; Torke, Alexia; Biostatistics and Health Data Science, Richard M. Fairbanks School of Public HealthWe explore the feasibility of ecological momentary assessment (EMA) with surrogate decision makers (SDMs) of critically ill hospitalized adults, to obtain in-the-moment participant-reported data. In this small pilot, 23 SDMs were approached. 82.6% were white, 53.9% were female, and 53.9% were 55 years and older. 25% were spouse or partner, 25% were adult children, 30% were parents, and 20% were other relations. Average ICU length of stay was 13.46 days (range 1.73-77.79). 13 SDMs enrolled (56.52%). Using Twilio, an automated text was sent to SDMs containing a secure link to the surveys. Up to five questions about anxiety, depression, distress, communication, and spiritual well-being were sent up to twice per day. Most participants (84.62%) completed EMA surveys for 5 or more days. Most SDMs stated that the surveys were not burdensome. Of those who declined participation (n= 10), accessibility to a smartphone, stress, and availability to complete texted surveys were noted as barriers to participation. The data suggest that EMA is a valuable tool to inform clinical interventionists and care providers interacting with SDMs. Future research will assess EMA with a larger group of SDMs, utilizing questions that help identify gaps in communication and opportunities to provide support to SDMs. Although surrogates are often under high stress in the ICU setting, they are willing to provide real-time EMA feedback on their experiences. EMA can provide a “just in time” option for research and clinical intervention that focuses on bridging gaps that may contribute to better outcomes for SDMs.Item Glucose level decline precedes dementia in elderly African Americans with diabetes(Elsevier, 2017-02) Hendrie, Hugh C.; Zheng, Mengjie; Li, Wei; Lane, Kathleen; Ambuehl, Roberta; Purnell, Christianna; Unverzagt, Frederick W.; Torke, Alexia; Balasubramanyam, Ashok; Callahan, Chris M.; Gao, Sujuan; Psychiatry, School of MedicineINTRODUCTION: High blood glucose levels may be responsible for the increased risk for dementia in diabetic patients. METHODS: A secondary data analysis merging electronic medical records (EMRs) with data collected from the Indianapolis-Ibadan Dementia project (IIDP). Of the enrolled 4105 African Americans, 3778 were identified in the EMR. Study endpoints were dementia, mild cognitive impairment (MCI), or normal cognition. Repeated serum glucose measurements were used as the outcome variables. RESULTS: Diabetic participants who developed incident dementia had a significant decrease in serum glucose levels in the years preceding the diagnosis compared to the participants with normal cognition (P = .0002). They also had significantly higher glucose levels up to 9 years before the dementia diagnosis (P = .0367). DISCUSSION: High glucose levels followed by a decline occurring years before diagnosis in African American participants with diabetes may represent a powerful presymptomatic metabolic indicator of dementia.