Browsing by Subject "Screening tool"

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    Community Transition: Addressing Factors that Lead to Readmission in Inpatient Psychiatric Units
    (2021-05-07) Chim, Chhattrah; Wasmuth, Sally; Department of Occupational Therapy, School of Health and Human Sciences; Button, Jo
    Psychiatric readmission is a common problem for individuals with psychiatric illness worldwide. Approximately one in seven individuals hospitalized for psychiatric illness are readmitted within 30 days of discharge. 30-day readmission is a common outcome measure to indicate quality of patient care. Frequent readmission for patients decreases their quality of life, disrupts their recovery, and fosters dependence on psychiatric services. The purpose of this doctoral capstone experience is to develop a clinically useful screening tool used to identify at-risk patients for readmission to improve transition into the community. In doing so, effective patient-centered interventions focused on individualized needs can be provided to possibly decrease the risk of readmission. The screening tool was developed using retrospective clinical data collected from electronic medical records of all patients readmitted to SEMHRC within 30 days of discharge in 2020. The screening tool examines 5 domains which include previous admissions, risk of harm to self and others, individual factors, community barriers, and engagement in treatment. In 2020, Sandra Eskenazi Mental Health Recovery Center discharged 1,119 patients. Of those patients discharged, 10.3% readmitted within 30 days at least one or more times. A bivariate analysis was done using the developed screening tool on 19 patients that were first time users of the psychiatric unit comparing their hospital index admission to following hospital readmissions. These patients averaged a score of seven on the screening tool for risk of readmission. Individuals with 3+ readmissions within 30 days of prior hospitalization had an average score of 12.7 upon assessment. The study showed that the higher score on the screening tool increased the probability of readmission. The study shows the use of a screening tool to assess patients' risk of readmission on a psychiatric unit has the potential to improve delivery of mental health services.
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    Expert Clinical Interpretation of Continuous Glucose Monitor Reports From Individuals Without Diabetes
    (Sage, 2025-02-12) Spartano, Nicole L.; Prescott, Brenton; Walker, Maura E.; Shi, Eleanor; Venkatesan, Guhan; Fei, David; Lin, Honghuang; Murabito, Joanne M.; Ahn, David; Battelino, Tadej; Edelman, Steven V.; Fleming, G. Alexander; Freckmann, Guido; Galindo, Rodolfo J.; Joubert, Michael; Lansang, M. Cecilia; Mader, Julia K.; Mankovsky, Boris; Mathioudakis, Nestoras N.; Mohan, Viswanathan; Peters, Anne L.; Shah, Viral N.; Spanakis, Elias K.; Waki, Kayo; Wright, Eugene E.; Zilbermint, Mihail; Wolpert, Howard A.; Steenkamp, Devin W.; Medicine, School of Medicine
    Background: Clinical interpretation of continuous glucose monitoring (CGM) data for people without diabetes has not been well established. This study aimed to investigate concordance among CGM experts in recommending clinical follow-up for individuals without diabetes, based upon their independent review of CGM data. Methods: We sent a survey out to expert clinicians (n = 18) and asked them to evaluate 20 potentially challenging Dexcom G6 Pro CGM reports (and hemoglobin A1c [HbA1c] and fasting venous blood glucose levels) from individuals without diabetes. Clinicians reported whether they would recommend follow-up and the reasoning for their decision. We performed Fleiss Kappa interrater reliability to determine agreement among clinicians. Results: More than half of expert clinicians (56-100%, but no clear consensus) recommended follow-up to individuals who spent >2% time above range (>180 mg/dL), even if HbA1c <5.7% and fasting glucose <100 mg/dL. There were no observed trends for recommending follow-up based on mean glucose or glucose management indicator. Overall, we observed poor agreement in recommendations for who should receive follow-up based on their CGM report (Fleiss Kappa = 0.36). Conclusions: High discordance among expert clinicians when interpreting potentially challenging CGM reports for people without diabetes highlights the need for more research in developing normative data for people without diabetes. Future work is required to develop CGM criteria for identifying potentially high-risk individuals who may progress to prediabetes or type 2 diabetes.