Browsing by Author "Weaver, Christopher"

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    The Indiana Learning Health System Initiative: Early experience developing a collaborative, regional learning health system
    (Wiley, 2021-07) Schleyer, Titus; Williams, Linda; Gottlieb, Jonathan; Weaver, Christopher; Saysana, Michele; Azar, Jose; Sadowski, Josh; Frederick, Chris; Hui, Siu; Kara, Areeba; Ruppert, Laura; Zappone, Sarah; Bushey, Michael; Grout, Randall; Embi, Peter J.; Medicine, School of Medicine
    Introduction Learning health systems (LHSs) are usually created and maintained by single institutions or healthcare systems. The Indiana Learning Health System Initiative (ILHSI) is a new multi-institutional, collaborative regional LHS initiative led by the Regenstrief Institute (RI) and developed in partnership with five additional organizations: two Indiana-based health systems, two schools at Indiana University, and our state-wide health information exchange. We report our experiences and lessons learned during the initial 2-year phase of developing and implementing the ILHSI. Methods The initial goals of the ILHSI were to instantiate the concept, establish partnerships, and perform LHS pilot projects to inform expansion. We established shared governance and technical capabilities, conducted a literature review-based and regional environmental scan, and convened key stakeholders to iteratively identify focus areas, and select and implement six initial joint projects. Results The ILHSI successfully collaborated with its partner organizations to establish a foundational governance structure, set goals and strategies, and prioritize projects and training activities. We developed and deployed strategies to effectively use health system and regional HIE infrastructure and minimize information silos, a frequent challenge for multi-organizational LHSs. Successful projects were diverse and included deploying a Fast Healthcare Interoperability Standards (FHIR)-based tool across emergency departments state-wide, analyzing free-text elements of cross-hospital surveys, and developing models to provide clinical decision support based on clinical and social determinants of health. We also experienced organizational challenges, including changes in key leadership personnel and varying levels of engagement with health system partners, which impacted initial ILHSI efforts and structures. Reflecting on these early experiences, we identified lessons learned and next steps. Conclusions Multi-organizational LHSs can be challenging to develop but present the opportunity to leverage learning across multiple organizations and systems to benefit the general population. Attention to governance decisions, shared goal setting and monitoring, and careful selection of projects are important for early success.
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    Limited Data to Support Improved Outcomes after Community Paramedicine Intervention: A Systematic Review
    (Elsevier, 2019) Pang, Peter S.; Litzau, Megan; Liao, Mark; Herron, Jennifer; Weinstein, Elizabeth; Weaver, Christopher; O'Donnell, Dan; Miramonti, Charles; Emergency Medicine, School of Medicine
    Background Community paramedicine (CP) leverages trained emergency medical services personnel outside of emergency response as an innovative model of health care delivery. Often used to bridge local gaps in healthcare delivery, the CP model has existed for decades. Recently, the number of programs has increased. However, the level of robust data to support this model is less well known. Objective To describe the evidence supporting community paramedicine practice. Data sources OVID, PubMed, SCOPUS, EMBASE, Google Scholar-WorldCat, OpenGrey. Study appraisal and synthesis methods Three people independently reviewed each abstract and subsequently eligible manuscript using prespecified criteria. A narrative synthesis of the findings from the included studies, structured around the type of intervention, target population characteristics, type of outcome and intervention content is presented. Results A total of 1098 titles/abstracts were identified. Of these 21 manuscripts met our eligibility criteria for full manuscript review. After full manuscript review, only 6 ultimately met all eligibility criteria. Given the heterogeneity of study design and outcomes, we report a description of each study. Overall, this review suggests CP is effective at reducing acute care utilization. Limitations The small number of available manuscripts, combined with the lack of robust study designs (only one randomized controlled trial) limits our findings. Conclusions Initial studies suggest benefits of the CP model; however, notable evidence gaps remain.
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    Mobile integrated health to reduce post-discharge acute care visits: A pilot study
    (Elsevier, 2018) Siddle, Jennica; Pang, Peter S.; Weaver, Christopher; Weinstein, Elizabeth; O'Donnell, Daniel; Arkins, Thomas P.; Miramonti, Charles; Emergency Medicine, School of Medicine
    Background Mobile Integrated Health (MIH) leverages specially trained paramedics outside of emergency response to bridge gaps in local health care delivery. Study objective To evaluate the efficacy of a MIH led transitional care strategy to reduce acute care utilization. Methods This was a retrospective cohort analysis of a quality improvement pilot of patient patients from an urban, single county EMS, MIH transitional care initiative. We utilized a paramedic/social worker (or social care coordinator) dyad to provide in home assessments, medication review, care coordination, and improve access to care. The primary outcome compared acute care utilization (ED visits, observation stays, inpatient visits) 90 days before MIH intervention to 90 days after. Results Of the 203 patients seen by MIH teams, inpatient utilization decreased significantly from 140 hospitalizations pre-MIH to 26 post-MIH (83% reduction, p = 0.00). ED and observation stays, however, increased numerically, but neither was significant. (ED 18 to 19 stays, p = 0.98; observation stays 95 to 106, p = 0.30) Primary care visits increased 15% (p = 0.11). Conclusion In this pilot before/after study, MIH significantly reduces acute care hospitalizations.
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    Seroprevalence of SARS-CoV-2 Antibodies Among Healthcare Workers With Differing Levels of COVID-19 Patient Exposure
    (Cambridge University Press, 2020-08-03) Hunter, Benton R.; Dbeibo, Lana; Weaver, Christopher; Beeler, Cole; Saysana, Michele; Zimmerman, Michelle; Weaver, Lindsay; Emergency Medicine, School of Medicine
    Healthcare employees were tested for antibodies against SARS-CoV-2. Among 734 employees, the prevalence of SARS-CoV-2 antibodies was 1.6%. Employees with heavy COVID-19 exposure had similar antibody prevalence as those with limited or no exposure. Guidelines for PPE use seem effective for preventing COVID-19 infection in healthcare workers.