Browsing by Subject "interdisciplinary"

Now showing 1 - 3 of 3
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    Adjusting ventilator settings to avoid air trapping in extremely premature infants reduces the need for tracheostomy and length of stay
    (Frontiers, 2022-12-30) Sammour, Ibrahim; Conlon, Steven M.; Bauer, Sarah E.; Montgomery, Gregory S.; Cristea, A. Ioana; Rose, Rebecca S.; Pediatrics, School of Medicine
    Despite the improving understanding of how lung mechanics and tidal volume requirements evolve during the evolution of bronchopulmonary dysplasia (BPD), clinical management continues to be heterogeneous and inconsistent at many institutions. Recent reports have examined the use of high tidal-volume low respiratory rate strategies in these patients once disease has been well established to help facilitate their eventual extubation and improve their long-term neurodevelopmental outcomes. In this retrospective observational research study, we describe how intentional adjustment of ventilator settings based on patient lung mechanics by an interdisciplinary BPD team improved the care of the at-risk population of infants, reduced the need for tracheostomies, as well as length of stay over a period of over 3 years. The team aimed to establish consistency in the management of these children using a high tidal volume, low-rate approach, and titrating PEEP to address the autoPEEP and bronchomalacia that is frequently observed in this patient population.
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    Shifting the Lens: A Primer for Incorporating Social Work Theory and Practice to Improve Outcomes for Clients with Mental Health Issues and the Law Students who Represent Them
    (2014) McGraugh, Susan; Hagan, Carrie A.; Choate, Lauren; Robert H. McKinney School of Law
    This Essay is an effort to promote the inclusion of interdisciplinary practice in our work as attorneys and in our roles as clinical legal professors. As the legal community continues its renewed emphasis on skills training, law schools should look to other professions in order to produce more lasting solutions for our clients and for more satisfactory outcomes for our lawyers. In this Essay, the authors discuss their work incorporating social work theory and practice into clinical legal education when dealing with clients who have serious mental illness. With some studies reporting up to 64.2% of inmates in the United States having a diagnosed mental illness, it is becoming imperative that law students acquire the skills necessary to adequately represent them. Two pillars of social work practice, Strengths Theory and Systems Theory, are discussed with an emphasis on the role they play in working with this demographic of clients.
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    Three Essays in Health Economics: The Role of Coordination in Improving Outcomes and Increasing Value in Health Care
    (2022-06) Sheff, Zachary Thompson; Ottoni-Wilhelm, Mark; Royalty, Anne; Tennekoon, Vidhura; Morrison, Gwendolyn; Dixon, Brian E.
    Hospital costs are the largest contributor to US health expenditures, making them a common target for cost containment policies. Policies that reduce fragmentation in health care and related systems could increase the value of these expenditures while improving outcomes. Efforts to address fragmentation of health care services, such as Accountable Care Organizations, have typically been enacted at the scale of health systems. However, coordination within health care facilities should also be explored. In three essays, I analyze the role of coordination in several forms. First, I examine the introduction of interdisciplinary care teams within a hospital. This analysis features care coordination within a health care facility with the potential to reduce resource utilization through improved communication between team members and between patients and their care providers. I find that care coordination reduced length of stay for some patients while maintaining care quality. This combination results in higher value care for patients and hospitals. Second, I explore whether these interdisciplinary care teams impact resource utilization and patient flow throughout the hospital. The primary outcome is reduction in patient transfers to the ICU. Here, care coordination includes interdisciplinary teams as well as coordination between interdisciplinary teams and intensivists in ICUs. Findings from this analysis suggest that ICU transfers were unaffected by care coordination. Finally, I examine coordination on a larger scale. I leverage data from a national database of trauma patients to compare mortality among adolescent patients with isolated traumatic brain injury between adult trauma centers and pediatric trauma centers. Previous work has shown that younger pediatric patients with this injury benefit from treatment at pediatric trauma centers. However, it is unclear whether this benefit extends to older pediatric patients on the cusp of adulthood. I find that, after adjusting for differences in injury severity, adolescent patients have no difference in mortality risk when treated at adult or pediatric trauma centers. This finding supports the current regionalized model of trauma care where severely injured patients are taken to the nearest trauma center, regardless of designation as pediatric or adult.