Browsing by Author "Williams, Linda"

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    2023 Inaugural Healthcare Delivery Science: Innovation and Partnerships for Health Equity Research (DESCIPHER) Symposium
    (Wiley, 2024-07-04) Orechwa, Allison Z.; Abhat, Anshu; Amezcua, Lilyana; Boden-Albala, Bernadette; Buchanan, Thomas A.; Chen, Steve; Daskivich, Lauren P.; Feldman, Brett; Gould, Michael K.; Lee, Wei-an; Lynch, Christopher; Meltzer, Carolyn C.; Mittman, Brian S.; Pereyda, Margarita; Raff, Evan; Robinson, Jehni; Saluja, Sonali; Turner, Barbara J.; Taira, Breena R.; Trotzky-Sirr, Rebecca; Williams, Linda; Wu, Shinyi; Yee, Hal, Jr.; Towfighi, Amytis; Neurology, School of Medicine
    Introduction: This article provides an overview of presentations and discussions from the inaugural Healthcare Delivery Science: Innovation and Partnerships for Health Equity Research (DESCIPHER) Symposium. Methods: The symposium brought together esteemed experts from various disciplines to explore models for translating evidence-based interventions into practice. Results: The symposium highlighted the importance of disruptive innovation in healthcare, the need for multi-stakeholder engagement, and the significance of family and community involvement in healthcare interventions. Conclusions: The article concluded with a call to action for advancing healthcare delivery science to achieve health equity.
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    Impact of Telestroke Implementation on Emergency Department Transfer Rate
    (AAN, 2022-04) Lyerly, Michael; Daggy, Joanne; LaPradd, Michelle; Martin, Holly; Edwards, Brandon; Graham, Glenn D.; Martini, Sharyl; Anderson, Jane; Williams, Linda; Biostatistics, School of Public Health
    Background and Objectives Telestroke networks are associated with improved outcomes from acute ischemic stroke (AIS) and facilitate greater access to care, particularly in underserved regions. These networks also have the potential to influence patient disposition through avoiding unnecessary interhospital transfers. This study examines the effect of implementation of the VA National Telestroke Program (NTSP) on interhospital transfer among Veterans. Methods We analyzed patients with AIS presenting to the emergency departments of 21 VA hospitals before and after telestroke implementation. Transfer rates were determined through review of administrative data and chart review and patient and facility-level characteristics were collected to identify predictors of transfer. Comparisons were made using t test, Wilcoxon rank sum, and χ2 analysis. Multivariable logistic regression with sensitivity analysis was conducted to assess the influence of telestroke implementation on transfer rates. Results We analyzed 3,488 stroke encounters (1,056 pre-NTSP and 2,432 post-NTSP). Following implementation, we observed an absolute 14.4% decrease in transfers across all levels of stroke center designation. Younger age, higher stroke severity, and shorter duration from symptom onset were associated with transfer. At the facility level, hospitals with lower annual stroke volume were more likely to transfer; 1 hospital saw an increase in transfer rates following implementation. After adjusting for patient and facility characteristics, the implementation of VA NTSP resulted in a nearly 60% reduction in odds of transfer (odds ratio 0.39 [0.19, 0.77]). Discussion In addition to improving treatment in acute stroke, telestroke networks have the potential to positively affect the efficiency of interhospital networks through disposition optimization and the avoidance of unnecessary transfers.
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    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, Lisa
    Abstract 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.
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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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    Persistence With Stroke Prevention Medications 3 Months After Hospitalization
    (American Medical Association, 2010) Bushnell, Cheryl D.; Zimmer, Louise O.; Pan, Wenqin; Olson, Daiwai M.; Zhao, Xin; Meteleva, Tatiana; Schwamm, Lee; Ovbiagele, Bruce; Williams, Linda; Labresh, Kenneth A.; Peterson, Eric D.; Adherence Evaluation After Ischemic Stroke–Longitudinal Investigators; Neurology, School of Medicine
    Objective: To measure longitudinal use of stroke prevention medications following stroke hospital discharge. We hypothesized that a combination of patient-, provider-, and system-level factors influence medication-taking behavior. Design: Observational cohort design. Setting: One hundred six US hospitals participating in the American Heart Association Get With The Guidelines-Stroke program. Patients: Two thousand eight hundred eighty-eight patients 18 years or older admitted with ischemic stroke or transient ischemic attack. Main outcome measure: Regimen persistence, including use of antiplatelet therapies, warfarin, antihypertensive therapies, lipid-lowering therapies, or diabetes medications, from discharge to 3 months. Reasons for nonpersistence were also ascertained. Results: Two thousand five hundred ninety-eight patients (90.0%) were eligible for analysis. At 3 months, 75.5% of subjects continued taking all secondary prevention medications prescribed at discharge. Persistence at 3 months was associated with decreasing number of medication classes prescribed, increasing age, medical history, less severe stroke disability, having insurance, working status, understanding why medications are prescribed and how to refill them, increased quality of life, financial hardship, geographic region, and hospital size. Conclusions: One-quarter of stroke patients reported discontinuing 1 or more of their prescribed regimen of secondary prevention medications within 3 months of hospitalization for an acute stroke. Several modifiable factors associated with regimen persistence were identified and could be targets for improving long-term secondary stroke prevention.