Browsing by Subject "Outcome Assessment, Health Care"
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Item Analysis of Resident Conducted Social Determinants of Health Informed Home Visits(2020-01-21) Cline, Matthew; Day, Philip; Gimpel, Nora; Pagels, PattiCONTEXT: Home visits can improve quality of care, save money, improve health outcomes, and provide a unique opportunity for residents to learn more about patients' social context and assess the various social determinants of health (SDH) that impact patients' health and wellbeing. In order to facilitate a SDH-focused visit, the Department of Family and Community Medicine at UT Southwestern implemented a brief SDH questionnaire in all home visits. OBJECTIVE: The objective of this study is to assess patient self-reported SDH and resident reflections on patient social status, the utility of a SDH survey during home visits, and resident comfort levels with addressing patient SDH HUMAN SUBJECTS REVIEW: This study was approved as an "exempt" study by the UTSW IRB DESIGN: Mixed methods pilot study utilizing patient self-reported data and open- ended reflection questions SETTINGS: Home health visits for patients from an urban safety-net clinic in Dallas, TX. Participants: Adult patients >18 years of age, selected by the resident INTERVENTION/INSTRUMENT (AS PERTINENT): Quantitative survey domains include: demographics, financial status, social support, safety, employment, and living conditions. Open response questions queried resident impressions of the survey, comfort during the interview, new insights about the patient, impact on future practice, and ability to address SDH concerns. ANTICIPATED RESULTS: 42 surveys collected from 42 home visits. Most patients were female (61.9%) and African-American (45.2%), aging from 25 to 88 years (mean=60.24). Prevalence of adverse SDH were relatively low. Common themes of resident responses: positive utility of the survey as a guide for understanding and assessing patient SDH; wide variation in comfort level when inquiring about patient SDH with positive influence from prior experience, assistance from colleagues, or prior good relations with patients; and expressed intention to include SDH assessment in their continuing career. CONCLUSIONS: Residents recognized the value of assessing SDH during home visits and expressed implement a standardized process for selecting patients for home visits as this was largely left to the discretion of the resident. More thorough assessment of patient SDH may help to craft a more robust and standardized system to prioritize patients that would most benefit from receiving home visits.Item Donald W. Seldin, M.D., Research Symposium finalist presentations(2021-04-23) Arvind, Ashwini; Elias, Roy; McAdams, Meredith; Salazar, Alonso Pezo; Rao, Shreya; Sheth, RahulThis edition of the UT Southwestern Internal Medicine Grand Rounds features presentations by the six Foster Fellows selected as finalists from the Sixth Annual Donald W. Seldin, M.D. Research Symposium, which was held on April 23, 2021. These Foster Fellows presented work that spanned the breadth and depth of scholarly activity across the department, and at the close of Grand Rounds, one will be selected as the 2021 Seldin Scholar, in honor of Dr. Donald W. Seldin. The Grand Rounds presentation also includes additional awards honoring Clinical Vignettes and an award for work in Quality and Education at Parkland Hospital.Item Predictors of Attrition in an Interdisciplinary Pain Management Program(2019-07-08) Chong, Jeanette Lee; Robinson, Richard C.; Jarrett, Robin B.; Hynan, Linda S.; Noe, Carl; Zafereo, JasonBACKGROUND: Chronic pain is a debilitating condition that affects millions of adults in the United States. In recent years, particularly with the growing concerns about opioid use, there has been a steady increase in the use of interdisciplinary pain programs (IPP) to treat chronic pain. The effectiveness of such programs has been well-documented; however, attrition has also been identified as a neglected topic in outcome studies. OBJECTIVE: This study aimed to investigate the extent to which demographic/clinical characteristics predict attrition in an IPP. Study aims also included examining longitudinal changes in score for the completion group for a variety of clinical measures, and an exploratory analysis comparing changes between non/completion groups. METHOD: Participants included one hundred and seventy-eight patients receiving treatment for chronic pain conditions in an IPP at the Eugene McDermott Center for Pain Management at UT Southwestern Medical Center. Participants completed measures related to pain and psychosocial functioning at baseline, mid-intervention (2 weeks post-enrollment), and post-intervention (4 weeks post-enrollment). ANALYSIS: This study used logistic regression analyses to identify variables most predictive of attrition in five domains: 1) selected demographic variables, 2) number of medical diagnoses [psychiatric and non-psychiatric], 3) opioid use/risk of misuse, 4) pain-related cognition and behavior, and 5) physical, social, and mental well-being. Mixed models analyses were also conducted to examine longitudinal changes in score on a variety of clinical measures for the completion group. RESULTS: Participants who were of younger age, unemployed, and not on opioids pre-intervention had higher odds of dropping out. The completion group demonstrated improvement pre- to post-intervention on each of the measures assessed in the 1) pain-related cognition and behavior domain and 2) physical, social, and mental well-being domain, except for one measure. DISCUSSION: Mean age of non-completers was 48.72 years (SD = 13.44); these patients may have had difficulty with program compliance due to more outside stressors (e.g., younger children, demanding jobs). Participants may have been unemployed due to a number of potential contributing factors (e.g., lack of transportation, lower motivation, physical mobility), which would create barriers to program completion. Previous findings suggest opioid dependency contributes to higher odds of dropout; however, results from the current study suggest pre-intervention opioid use--not dependency--does not contribute to higher odds of attrition.Item Reflections on a Single Institution Cochlear Implant Experience(2020-05-01T05:00:00.000Z) Schauwecker, Natalie Marie-Rose; Hunter, Jacob B.; Kutz, J. Walter; Isaacson, BrandonOBJECTIVE: To utilize cochlear implant (CI) outcomes to further explore health disparities, hearing preservation (HP) surgery, and standardization of pre- and post-operative CI assessment, with the goal of predicting and improving CI outcomes, including quality of life. STUDY DESIGN: Retrospective chart review of adult patients who underwent CI evaluation and surgery at a single institution between 2009 and 2018. MAIN OUTCOME MEASURES: Improvement in open sentence testing postoperatively, according to patient marital status, race, and gender, as well as HP status. RESULTS: Post-operative performance: Of the 402 total patients who underwent CI during the study period, 372 were followed and programmed at the institution. A total of 87% of these patients achieved "good performance" with their CI, based upon an improvement in post-operative open sentence testing ≥10%. Patient demographics, including gender, age, marital status, and race did not significantly affect whether a patient achieved higher post-operative performance levels. Unmarried patients saw poorer outcomes, but this did not reach significance (37.5% vs 24.3%, p = 0.2123). HEARING PRESERVATION: HP surgery evolved during the study period, with modern "soft surgery" technique defined by perioperative steroids, round window cochleostomy, and atraumatic CI insertion. A slight majority of HP surgical patients maintained low frequency hearing postoperatively (54.2%). However, documentation of preserved hearing was limited, with only 53.7% of patients with recorded unaided audiograms. Analyzing speech perception outcomes, HP candidates, and patients who underwent "soft surgery," did not demonstrate significantly larger improvements with their post-operative open sentence testing when compared to patients who underwent standard CI, and were concurrently not HP candidates, during the study period (overall improvement: 41% vs 53% respectively, p = 0.10). Additionally, non-white hearing preservation candidates were less likely to retain low frequency hearing post-operatively, but this did not reach significance in the study population (22.2% vs 8.5%, p=0.0992). However, HP surgery, and overall CI surgery outcomes assessment was limited by lack of standardized documentation. CONCLUSIONS: Unmarried patients and non-white patients continue to warrant special attention post-operatively to ensure equability in CI. HP surgery has evolved over the past decade. All, patients, should also have their quality of life evaluated, with standard assessment through open sentence testing failing to demonstrate the added benefit of HP, and likely the overall benefit of any CI. There continues to be a need for standardization in CI evaluation, documentation, and follow-up to allow for larger outcomes based research. IRB: STU 032018-085 PROFESSIONAL PRACTICE GAP AND EDUCATIONAL NEED: The field of CI is in need of large outcome based studies to better predict which patient factors, including demographics and HP status, may predict CI success. DESIRED RESULT: Systematic review of a decade of cochlear implantation outcomes in order to identify areas in which improvement will result in increased ability to assess outcomes, and augmented cochlear implant success leading to improved CI patient quality of life.