Jonathan N. Hawley

Patient Activation Is Associated With Healthy Behaviors and Ease in Managing Diabetes in an Indigent Population

Purpose The purpose of this study is to assess the validity of the patient activation construct as measured by the Patient Activation Measure (PAM) survey by correlating PAM scores with diabetes self-management behaviors, attitudes, and knowledge in a predominantly minority and uninsured population. Methods A convenience sample of patients presenting to an urban public hospital diabetes clinic was surveyed and contacted by phone 6 months later. The survey included questions about activation, health behaviors, and health care utilization. Results A total of 287 patients agreed to participate. Most were African American, female, and uninsured. Most respondents (62.2%) scored in the highest category of activation according to the PAM. Activated patients were more likely to perform feet checks, receive eye examinations, and exercise regularly. Activation was consistently associated with less reported difficulty in managing diabetes care but not with A1C knowledge. PAM scores at the initial interview were highly correlated with scores at 6-month follow-up. Activation level did not predict differences in health care utilization during the 6 months following the survey. Conclusions Higher scores on the PAM were associated with higher rates of self-care behaviors and ease in managing diabetes; however, the indigent urban population reported higher activation scores than found in previous studies. The relationship between activation and outcomes needs to be explored further prior to expanding use of this measure in this patient population.

Implementation and Evaluation of a Nursing Home Fall Management Program

OBJECTIVES: To evaluate the feasibility and effectiveness of a falls management program (FMP) for nursing homes (NHs).

Designing Insurance to Promote Use of Childhood Obesity Prevention Services

Childhood obesity is a recognized public health crisis. This paper reviews the lessons learned from a voluntary initiative to expand insurance coverage for childhood obesity prevention and treatment services in the United States. In-depth telephone interviews were conducted with key informants from 16 participating health plans and employers in 2010-11. Key informants reported difficulty ensuring that both providers and families were aware of the available services. Participating health plans and employers are beginning new tactics including removing enrollment requirements, piloting enhanced outreach to selected physician practices, and educating providers on effective care coordination and use of obesity-specific billing codes through professional organizations. The voluntary initiative successfully increased private health insurance coverage for obesity services, but the interviews described variability in implementation with both best practices and barriers identified. Increasing utilization of obesity-related health services in the long term will require both family- and provider-focused interventions in partnership with improved health insurance coverage.

Effectiveness of a patient and practice-level colorectal cancer screening intervention in health plan members: the CHOICE trial.

Colorectal cancer (CRC) screening reduces CRC incidence and mortality but is underused. Effective interventions to increase screening that can be implemented broadly are needed.

Is the Availability of Hospital IT Applications Associated with a Hospital's Risk Adjusted Incidence Rate for Patient Safety Indicators: Results from 66 Georgia Hospitals

This study examines the associations between the availability of IT applications in a hospital and that hospital’s risk adjusted incidence rate per 1,000 hospitalizations for Agency for Healthcare Research and Quality’s (AHRQ) 15 Patient Safety Indicators (PSIs). The study population consists of a convenience sample of 66 community hospitals in Georgia that completed a Hospital IT survey by December 2003 and provided data to Georgia Hospital Discharge Data Set during 2004. AHRQ’s PSI software was used to estimate risk adjusted incidence rates. Differences in means, Pearson correlation coefficients, and multivariate regression analysis were used to determine if the availability of IT applications were associated with better PSI outcomes. This study finds very little statistically significant correlation between the availability of IT applications and risk adjusted PSI incident rate per 1,000 hospitalizations. In the multivariate regression models, the overall availability of IT applications in a hospital was significantly and negatively associated with the risk adjusted incident rate for only postoperative hemorrhage or hematoma. The count of functional applications available was negatively associated with postoperative hemorrhage or hematoma and foreign body left during procedure, while the count of technological devices was only associated with postoperative hemorrhage or hematoma. This study finds that the overall number of functional applications and technological devices available in a hospital is not associated with improved risk adjusted PSI outcomes. Future research is needed to examine if specific IT applications in specific clinical areas of the hospital are associated with improved PSI outcomes.

A Two-Pronged Quality Improvement Training Program for Leaders and Frontline Staff

BACKGROUND A unique two-pronged QI training program was developed at Emory Healthcare (Atlanta), which encompasses five hospitals and a multispecialty physician practice. One two-day program, Leadership for Healthcare Improvement, is offered to leadership, and a four-month program, Practical Methods for Healthcare Improvement, is offered to frontline staff and middle managers. KNOWLEDGE ASSESSMENT: Participants in the leadership program completed self-assessments of QI competencies and pre- and postcourse QI knowledge tests. Semistructured interviews with selected participants in the practical methods program were performed to assess QI project sustainability and short-term outcomes. RESULTS More than 600 employees completed one of the training programs in 2008 and 2009. Leadership course participants significantly improved knowledge in all content areas, and self-assessments revealed high comfort levels with QI principles following the training. All practical methods participants were able to initiate and implement QI projects. Participants described significant challenges with team functionality, but a majority of the QI projects made progress toward achieving their aim statement goals. A review of completed projects shows that a significant number were sustained up to one year after program completion. Quality leaders continue to modify the program based on learner feedback and institutional goals. CONCLUSIONS This initiative shows the feasibility of implementing a broad-based in-house QI training program for multidisciplinary staff across an integrated health system. Initial assessment shows knowledge improvements and successful QI project implementations, with many projects active up to one year following the courses.

Impact of a Statewide Reporting System on Medication Error Reduction

Objectives: The Partnership for Health and Accountability, a voluntary and peer-review protected statewide hospital patient safety program, was established in Georgia in 2001. One component of this program focuses on safe medication use (SMU) in acute care hospitals. This study evaluated hospital participation in the SMU program, evidence of error reductions, and effectiveness of the program across different types of hospitals. Methods: Participating hospitals performed a self-assessment, developed an improvement plan to address a specific type of medication error, and then reassessed their results after 9 months of implementation. This study reviewed participating hospital surveys from 2001, 2002, and 2003. Results: Hospital participation rates were high (more than 90% of eligible hospitals) in each year. Dose omission was the most common error type addressed by participating hospitals. Human factors, frequent interruptions, and communication issues were identified as the most common contributors to errors. Most hospitals relied on incident reports to identify errors; however, a small but growing number of hospitals are using automated or computer-generated reports. Most hospitals did reduce the targeted medication error, with a mean error reduction of 28% in 2002 and 34% in 2003. Improvement was seen across all types of hospitals, with no statistically significant differences between urban, rural, large, small, or academic hospitals. Overall participation in the statewide patient safety program was the only significant predictor of both the likelihood and magnitude of error reduction. Conclusions: Hospital participation rates were high in this voluntary program. Institutional commitment to the overall patient safety initiative was the only hospital characteristic that predicted success in reducing medication errors. Hospital willingness to share negative results is a strong validation of the nonpunitive environment. The SMU program was effective across a diverse mix of hospitals, including small and rural hospitals, and should be considered in other states.

Caregiver measures for seizure control, efficacy, and tolerability of antiepileptic drugs for childhood epilepsy: Results of a preference survey

We sought to identify and quantify caregiver-defined characteristics of efficacy related to the perceived success of antiepileptic drug (AED) use. A 22-question survey was designed using physician input, focus groups, and clinical trial endpoints. Responses were pooled and analyzed with regard to seizure type and treatment, categorized as controlled (exposure to 1 AED), adjunctive (exposure to 2 AEDs), or refractory (exposure to ≥3 AEDs). Two hundred ninety-five surveys were completed: 109 (37%) controlled, 84 (28%) adjunctive, and 102 (35%) refractory. Seizure freedom and median seizure reduction >90% maintained for >1 year were reported as the most important indicators of medication efficacy by the majority of respondents. These measures were the same regardless of seizure type or treatment category. Our results demonstrate that current trial design may be inadequate to address the expectations of patients. Incorporating patient-defined AED efficacy measures may improve satisfaction and informed decision making regarding epilepsy treatment.

Implementation of Florida Long Term Care Emergency Preparedness Portal Web Site, 2015–2017

We built an online emergency preparedness Web site for Florida nursing homes after an earlier study revealed gaps in information and a lack of available preparedness resources for long-term care providers. The Long Term Care Emergency Preparedness Portal ( www.ltcprepare.org ) was launched in January 2015. We assessed its use and sought suggestions for improvement. Findings indicate that long-term care providers in Florida regularly use the Web site, and they welcome the opportunity to further leverage technology to aid their disaster planning.

Abstract C07: Transitions to Medicare for Cancer Care Services: A Study of Safety Net Clinics in Georgia

Background: Advanced age and low socioeconomic status are major risk factors for cancer among women in the United States. Beginning at age 50, the probability of developing invasive cancer increases for women for almost every major type of cancer, including breast, colon, lung, and uterine cancer. Furthermore, uninsured patients and those from many ethnic minority groups are substantially more likely to be diagnosed with cancer at a later stage. Safety net health care providers offer primary care as well as cancer screening services for medically underserved patients. Publicly funded programs, such as the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), offer breast and cervical cancer screening services in many of these safety net settings. Little is known, however, about whether and to what extent safety net providers prepare older women for transitions to cancer care once they become eligible for Medicare and age out of publicly funded cancer screening programs like the NBCCEDP. To better inform future research, policy, and intervention programs designed to promote a coordinated transition to cancer screening and treatment among older women using safety net services, this study explored safety net provider practices about transitions to cancer care in Georgia. Study Purpose: The purpose of this study was to: 1) assess the extent to which safety net clinics in Georgia provide cancer screening services to medically underserved women ages 50 and older; and (2) explore safety net provider policies and practices for assisting older women to transition to Medicare for their cancer care services. Methods: This study applied an explanatory sequential mixed methods design. The quantitative phase included an online-survey with safety net providers who offer breast and cervical cancer screening services to older, uninsured and medically vulnerable women in Georgia. The survey addressed clinic and client characteristics, provision of cancer care services, health education and patient navigation services, and policies and practices specific to care transitions. In-depth interviews with a purposive sample of participating providers were conducted as the following explanatory qualitative phase to explore the survey results in greater detail. Results and Implications: Quantitative survey results from 193 safety net clinic providers in Georgia indicate about 20% of their clientele are uninsured women ages 50-64. A large majority of clinics offer breast and cervical cancer screening services (95%), as well as referrals for diagnostic follow-up (80%) and referrals for cancer treatment via the Georgia Women9s Health Medicaid Program (82%). Most safety net clinics (57%) do not provide cancer screening services to women older than age 65 and do not have a formal policy in place to help these older women transition to Medicare for their cancer care (51%). However, about one-third of safety net clinics offer some information or informal counseling to older women about how to enroll in Medicare and find a Medicare-participating provider. Qualitative findings suggest that providers support the development of a care coordination model, such as patient navigation, to assist older women in their transition from safety net clinics to private, Medicare providers for cancer care services. Enhanced provider education and training regarding Medicare benefits and policies was also recommended. Considered together, these strategies offer an opportunity to enhance safety net provision of cancer screening services for older women and to create new models of transition cancer care for the medically underserved in Georgia Citation Format: Sarah Blake, Jonathan Hawley, Susanne Erni, Arpita Mehrotra. Transitions to Medicare for Cancer Care Services: A Study of Safety Net Clinics in Georgia. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C07.