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Article ; Online: Primary Care Population Management for COVID-19 Patients.

Blazey-Martin, Deborah / Barnhart, Elizabeth / Gillis, Joseph / Vazquez, Gabriela Andujar

2020 Volume 35, Issue 10, Page(s) 3077–3080

Abstract: Background: Most patients infected with SARS-CoV-2 have mild to moderate symptoms manageable at home; however, up to 20% develop severe illness requiring additional support. Primary care practices performing population management can use these tools to ... ...

Abstract	Background: Most patients infected with SARS-CoV-2 have mild to moderate symptoms manageable at home; however, up to 20% develop severe illness requiring additional support. Primary care practices performing population management can use these tools to remotely assess and manage COVID-19 patients and identify those needing additional medical support before becoming critically ill. Aim: We developed an innovative population management approach for managing COVID-19 patients remotely. Setting: Development, implementation, and evaluation took place in April 2020 within a large urban academic medical center primary care practice. Participants: Our panel consists of 40,000 patients. By April 27, 2020, 305 had tested positive for SARS-CoV-2 by RT-qPCR. Outreach was performed by teams of doctors, nurse practitioners, physician assistants, and nurses. Program description: Our innovation includes an algorithm, an EMR component, and a twice daily population report for managing COVID-19 patients remotely. Program evaluation: Of the 305 patients with COVID-19 in our practice at time of submission, 196 had returned to baseline; 54 were admitted to hospitals, six of these died, and 40 were discharged. Discussion: Our population management strategy helped us optimize at-home care for our COVID-19 patients and enabled us to identify those who require inpatient medical care in a timely fashion.
MeSH term(s)	Academic Medical Centers ; Betacoronavirus ; COVID-19 ; Coronavirus Infections/epidemiology ; Coronavirus Infections/therapy ; Hospitalization/statistics & numerical data ; Humans ; Pandemics ; Pneumonia, Viral/epidemiology ; Pneumonia, Viral/therapy ; Primary Health Care/organization & administration ; Program Development ; Program Evaluation ; SARS-CoV-2 ; Telemedicine/organization & administration
Keywords	covid19
Language	English
Publishing date	2020-07-27
Publishing country	United States
Document type	Journal Article
ZDB-ID	639008-0
ISSN	1525-1497 ; 0884-8734
ISSN (online)	1525-1497
ISSN	0884-8734
DOI	10.1007/s11606-020-05981-1
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Article ; Online: Primary Care Population Management for COVID-19 Patients

Blazey-Martin, Deborah / Barnhart, Elizabeth / Gillis, Joseph / Vazquez, Gabriela Andujar

Journal of General Internal Medicine ; ISSN 0884-8734 1525-1497

2020

Keywords	Internal Medicine ; covid19
Language	English
Publisher	Springer Science and Business Media LLC
Publishing country	us
Document type	Article ; Online
DOI	10.1007/s11606-020-05981-1
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Primary Care Population Management for COVID-19 Patients

Blazey-Martin, Deborah / Barnhart, Elizabeth / Gillis, Joseph / Vazquez, Gabriela Andujar

J. gen. intern. med

Abstract: BACKGROUND: Most patients infected with SARS-CoV-2 have mild to moderate symptoms manageable at home; however, up to 20% develop severe illness requiring additional support. Primary care practices performing population management can use these tools to ... ...

Abstract	BACKGROUND: Most patients infected with SARS-CoV-2 have mild to moderate symptoms manageable at home; however, up to 20% develop severe illness requiring additional support. Primary care practices performing population management can use these tools to remotely assess and manage COVID-19 patients and identify those needing additional medical support before becoming critically ill. AIM: We developed an innovative population management approach for managing COVID-19 patients remotely. SETTING: Development, implementation, and evaluation took place in April 2020 within a large urban academic medical center primary care practice. PARTICIPANTS: Our panel consists of 40,000 patients. By April 27, 2020, 305 had tested positive for SARS-CoV-2 by RT-qPCR. Outreach was performed by teams of doctors, nurse practitioners, physician assistants, and nurses. PROGRAM DESCRIPTION: Our innovation includes an algorithm, an EMR component, and a twice daily population report for managing COVID-19 patients remotely. PROGRAM EVALUATION: Of the 305 patients with COVID-19 in our practice at time of submission, 196 had returned to baseline; 54 were admitted to hospitals, six of these died, and 40 were discharged. DISCUSSION: Our population management strategy helped us optimize at-home care for our COVID-19 patients and enabled us to identify those who require inpatient medical care in a timely fashion.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #680288
Database	COVID19

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Article: A multicomponent intervention to improve adherence to opioid prescribing and monitoring guidelines in primary care.

Huang, Kristin T L / Blazey-Martin, Deborah / Chandler, Daniel / Wurcel, Alysse / Gillis, Joseph / Tishler, Julie

Journal of opioid management

2019 Volume 15, Issue 6, Page(s) 445–453

Abstract: Objective: Guidelines for appropriate management of chronic opioid therapy are underutilized by primary care physicians (PCPs). The authors hypothesized that developing a multicomponent, team-based opioid management system with electronic health record ( ...

Abstract	Objective: Guidelines for appropriate management of chronic opioid therapy are underutilized by primary care physicians (PCPs). The authors hypothesized that developing a multicomponent, team-based opioid management system with electronic health record (EHR) support would allow our clinicians to improve adherence to chronic opioid prescribing and monitoring guidelines. Design: This was a retrospective pre-post study. Setting: The authors performed this intervention at our large, urban, academic primary care practice. Patients, participants: All patients with the diagnosis of "chronic pain, opioid requiring (ICD-10 F11.20)" on their primary care EHR problem lists were included in this study. Intervention: The authors implemented a five-pronged strategy to improve our system of opioid prescribing, including (1) a patient registry with regular dissemination of reports to PCPs; (2) standardization of policies regarding opioid prescribing and monitoring; (3) development of a risk-assessment algorithm and riskstratified monitoring guidelines; (4) a team-based approach to care with physician assistant care managers; and (5) an EHR innovation to facilitate communication and guideline adherence. Main outcome measures: The authors measured percent adherence to opioid prescribing guidelines, including annual patient-provider agreements, biannual urine drug screens (UDSs), and prescription monitoring program (PMP) verification. Results: Between September 2015 and September 2016, the percentage of patients on chronic opioid therapy with a signed controlled substances agreement within the preceding year increased from 46 to 76 percent (p < 0.0001), while the percentage of patients with a UDS done within the past 6 months rose from 23 to 79 percent (p < 0.0001). The percentage of patients whose state PMPs profile had been checked by a primary care team member in the past year rose from 45 to 97 percent (p < 0.0001). Conclusion: A comprehensive strategy to standardize chronic opioid prescribing in our primary care practice coincided with an increase in adherence to opioid management guidelines.
MeSH term(s)	Analgesics, Opioid/administration & dosage ; Chronic Pain/drug therapy ; Guideline Adherence ; Humans ; Practice Patterns, Physicians' ; Primary Health Care/standards ; Retrospective Studies
Chemical Substances	Analgesics, Opioid
Language	English
Publishing date	2019-12-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	2397614-7
ISSN	1551-7489
ISSN	1551-7489
DOI	10.5055/jom.2019.0535
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Article: Effect of the Implementation of Barcode Technology and an Electronic Medication Administration Record on Adverse Drug Events.

Truitt, Erin / Thompson, Ross / Blazey-Martin, Deborah / NiSai, Danna / Salem, Deeb

Hospital pharmacy

2016 Volume 51, Issue 6, Page(s) 474–483

Abstract: Background: Hospitals have attempted to reduce adverse drug events (ADEs) by investing in new technologies, but data regarding their efficacy are lacking.: Objectives: This study evaluates the effects of the implementation of barcode medication ... ...

Abstract	Background: Hospitals have attempted to reduce adverse drug events (ADEs) by investing in new technologies, but data regarding their efficacy are lacking. Objectives: This study evaluates the effects of the implementation of barcode medication administration (BCMA) and electronic medication administration record (eMAR) technology on the profile of ADEs in a hospital setting. Methods: We conducted a before-and-after study examining the effects of the implementation of BCMA and eMAR technology on the profile of ADEs at a 400-bed academic medical center by using incident reports. We compared reported ADEs in pre- and post-implementation periods of 5 months to determine whether there was a reduction in the rate of ADEs within medication use phases. We further examined the severity of errors and described changes in the distribution of types of errors. Results: A total of 775 electronic error-reporting system reports were included in this study: 397 (51%) in the pre-implementation period and 378 (49%) in the post-implementation period. The rate of ADEs significantly decreased from 0.26% to 0.20% after implementation of the technology (relative risk [RR], 0.78; 95% CI, 0.67-0.89). The rate of transcription errors decreased from 0.089% to 0.036% (RR, 0.40; 95% CI, 0.30-0.54), which was largely attributed to reduction of "wrong time" errors. The rate of administration errors was identical in both groups at 0.017% (RR, 0.98; 95% CI 0.58-1.66). The mean severity level of administration errors significantly decreased from 4.44 to 3.23 (p = .005). Conclusion: The implementation of eMAR and BCMA technology improved patient safety by decreasing the overall rate of ADEs and the rate of transcription errors. These technologies also reduced the harmful impact to patients caused by administration errors.
Language	English
Publishing date	2016-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	1468893-1
ISSN	0018-5787
ISSN	0018-5787
DOI	10.1310/hpj5106-474
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Article: Primary Care Population Management for COVID-19 Patients

Blazey-martin, Deborah / Author, Corresponding / Barnhart, Elizabeth / Tufts, F. N. P. / Gillis, Joseph / Medical, Tufts / Vazquez, Andujar

Journal of General Internal Medicine

Abstract: Background: Most patients infected with SARS-CoV-2 have mild to moderate symptoms manageable at home;however, up to 20% develop severe illness requiring additional support Primary care practices performing population management can use these tools to ... ...

Abstract	Background: Most patients infected with SARS-CoV-2 have mild to moderate symptoms manageable at home;however, up to 20% develop severe illness requiring additional support Primary care practices performing population management can use these tools to remotely assess and manage COVID-19 patients and identify those needing additional medical support before becoming critically ill Aim: We developed an innovative population management approach for managing COVID-19 patients remotely Setting: Development, implementation, and evaluation took place in April 2020 within a large urban academic medical center primary care practice Participants: Our panel consists of 40,000 patients By April 27, 2020, 305 had tested positive for SARS-CoV-2 by RT-qPCR Outreach was performed by teams of doctors, nurse practitioners, physician assistants, and nurses Program Description: Our innovation includes an algorithm, an EMR component, and a twice daily population report for managing COVID-19 patients remotely Program Evaluation: Of the 305 patients with COVID-19 in our practice at time of submission, 196 had returned to baseline;54 were admitted to hospitals, six of these died, and 40 were discharged Discussion: Our population management strategy helped us optimize at-home care for our COVID-19 patients and enabled us to identify those who require inpatient medical care in a timely fashion
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #691753
Database	COVID19

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Article ; Online: Lower Rates of Promotion of Generalists in Academic Medicine: A Follow-up to the National Faculty Survey.

Blazey-Martin, Deborah / Carr, Phyllis L / Terrin, Norma / Breeze, Janis L / Luk, Carolyn / Raj, Anita / Freund, Karen M

Journal of general internal medicine

2017 Volume 32, Issue 7, Page(s) 747–752

Abstract: Background: Prior cross-sectional research has found that generalists have lower rates of academic advancement than specialists and basic science faculty.: Objective: Our objective was to examine generalists relative to other medical faculty in ... ...

Abstract	Background: Prior cross-sectional research has found that generalists have lower rates of academic advancement than specialists and basic science faculty. Objective: Our objective was to examine generalists relative to other medical faculty in advancement and academic productivity. Design: In 2012, we conducted a follow-up survey (n = 607) of 1214 participants in the 1995 National Faculty Survey cohort and supplemented survey responses with publicly available data. Participants: Participants were randomly selected faculty from 24 US medical schools, oversampling for generalists, underrepresented minorities, and senior women. Main measures: The primary outcomes were (1) promotion to full professor and (2) productivity, as indicated by mean number of peer-reviewed publications, and federal grant support in the prior 2 years. When comparing generalists with medical specialists, surgical specialists, and basic scientists on these outcomes, we adjusted for gender, race/ethnicity, effort distribution, parental and marital status, retention in academic career, and years in academia. When modeling promotion to full professor, we also adjusted for publications. Key results: In the intervening 17 years, generalists were least likely to have become full professors (53%) compared with medical specialists (67%), surgeons (66%), and basic scientists (78%, p < 0.0001). Generalists had a lower number of publications (mean = 44) than other faculty [medical specialists (56), surgeons (57), and basic scientists (83), p < 0.0001]. In the prior 2 years, generalists were as likely to receive federal grant funding (26%) as medical (21%) and surgical specialists (21%), but less likely than basic scientists (51%, p < 0.0001). In multivariable analyses, generalists were less likely to be promoted to full professor; however, there were no differences in promotion between groups when including publications as a covariate. Conclusions: Between 1995 and 2012, generalists were less likely to be promoted than other academic faculty; this difference in advancement appears to be related to their lower rate of publication.
MeSH term(s)	Career Mobility ; Faculty, Medical/trends ; Female ; Follow-Up Studies ; General Practitioners/trends ; Humans ; Male ; Random Allocation ; Schools, Medical/trends ; Surveys and Questionnaires ; United States/epidemiology
Language	English
Publishing date	2017-01-24
Publishing country	United States
Document type	Journal Article
ZDB-ID	639008-0
ISSN	1525-1497 ; 0884-8734
ISSN (online)	1525-1497
ISSN	0884-8734
DOI	10.1007/s11606-016-3961-2
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Article: Where is the leak in the pipeline? Investigating gender differences in academic promotion at an academic medical centre.

Paulus, Jessica K / Switkowski, Karen M / Allison, Geneve M / Connors, Molly / Buchsbaum, Rachel J / Freund, Karen M / Blazey-Martin, Deborah

Perspectives on medical education

2016 Volume 5, Issue 2, Page(s) 125–128

Abstract: Background: Women are still under-represented in the senior ranks of academic medicine. As local surveys represent a critical initial step in addressing the challenges of gender disparities in academic promotion within institutions, we surveyed faculty ... ...

Abstract	Background: Women are still under-represented in the senior ranks of academic medicine. As local surveys represent a critical initial step in addressing the challenges of gender disparities in academic promotion within institutions, we surveyed faculty at an academic medical centre to identify factors to improve the academic advancement of women. Methods: We conducted an electronic survey of all full-time faculty members in a Department of Medicine assessing academic rank and factors important in consideration for promotion. Results: 106 faculty members (46 %) responded to the survey; 40 % of the respondents were women. There was a statistically significant gender gap in faculty rank (p = 0.002), with only 2 of 17 full professor positions occupied by women. Among faculty who had not yet requested promotion, women were more likely to report that they did not think an academic promotion would benefit them (69 vs. 32 % in men, p = 0.01), and to report a lack of encouragement for requesting promotion (50 vs. 29 %, p = 0.08). Conclusions: Targeting the perceived value of academic promotion among women faculty, increasing junior faculty mentorship and modifying annual review processes could address gender disparities in academic medicine ranks.
Language	English
Publishing date	2016-03-17
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2670231-9
ISSN	2212-277X ; 2212-2761
ISSN (online)	2212-277X
ISSN	2212-2761
DOI	10.1007/s40037-016-0263-7
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Article: Prevalence and cost of imaging in inpatient falls: the rising cost of falling.

Fields, Jessica / Alturkistani, Tahani / Kumar, Neal / Kanuri, Arjun / Salem, Deeb N / Munn, Samson / Blazey-Martin, Deborah

ClinicoEconomics and outcomes research : CEOR

2015 Volume 7, Page(s) 281–286

Abstract: Objective: To quantify the type, prevalence, and cost of imaging following inpatient falls, identify factors associated with post-fall imaging, and determine correlates of positive versus negative imaging.: Design: Single-center retrospective cohort ... ...

Abstract	Objective: To quantify the type, prevalence, and cost of imaging following inpatient falls, identify factors associated with post-fall imaging, and determine correlates of positive versus negative imaging. Design: Single-center retrospective cohort study of inpatient falls. Data were collected from the hospital's adverse event reporting system, DrQuality. Age, sex, date, time, and location of fall, clinical service, Morse Fall Scale/fall protocol, admitting diagnosis, and fall-related imaging studies were reviewed. Cost included professional and facilities fees for each study. Setting: Four hundred and fifteen bed urban academic hospital over 3 years (2008-2010). Patients: All adult inpatient falls during the study period were included. Falls experienced by patients aged <18 years, outpatient and emergency patients, visitors to the hospital, and staff were excluded. Measurements and main results: Five hundred and thirty inpatient falls occurred during the study period, average patient age 60.7 years (range 20-98). More than half of falls were men (55%) and patients considered at risk of falls (56%). Falls were evenly distributed across morning (33%), evening (34%), and night (33%) shifts. Of 530 falls, 178 (34%) patients were imaged with 262 studies. Twenty percent of patients imaged had at least one positive imaging study attributed to the fall and 82% of studies were negative. Total cost of imaging was $160,897, 63% ($100,700) from head computed tomography (CT). Conclusion: Inpatient falls affect patients of both sexes, all ages, occur at any time of day and lead to expensive imaging, mainly from head CTs. Further study should be targeted toward clarifying the indications for head CT after inpatient falls and validating risk models for positive and negative imaging, in order to decrease unnecessary imaging and thereby limit unnecessary cost and radiation exposure.
Language	English
Publishing date	2015-06-03
Publishing country	New Zealand
Document type	Journal Article
ZDB-ID	2520698-9
ISSN	1178-6981
ISSN	1178-6981
DOI	10.2147/CEOR.S80104
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Article ; Online: Health Outcomes of Obtaining Housing Among Older Homeless Adults.

Brown, Rebecca T / Miao, Yinghui / Mitchell, Susan L / Bharel, Monica / Patel, Mitkumar / Ard, Kevin L / Grande, Laura J / Blazey-Martin, Deborah / Floru, Daniella / Steinman, Michael A

American journal of public health

2015 Volume 105, Issue 7, Page(s) 1482–1488

Abstract: Objectives: We determined the impact of obtaining housing on geriatric conditions and acute care utilization among older homeless adults.: Methods: We conducted a 12-month prospective cohort study of 250 older homeless adults recruited from shelters ... ...

Abstract	Objectives: We determined the impact of obtaining housing on geriatric conditions and acute care utilization among older homeless adults. Methods: We conducted a 12-month prospective cohort study of 250 older homeless adults recruited from shelters in Boston, Massachusetts, between January and June 2010. We determined housing status at follow-up, determined number of emergency department visits and hospitalizations over 12 months, and examined 4 measures of geriatric conditions at baseline and 12 months. Using multivariable regression models, we evaluated the association between obtaining housing and our outcomes of interest. Results: At 12-month follow-up, 41% of participants had obtained housing. Compared with participants who remained homeless, those with housing had fewer depressive symptoms. Other measures of health status did not differ by housing status. Participants who obtained housing had a lower rate of acute care use, with an adjusted annualized rate of acute care visits of 2.5 per year among participants who obtained housing and 5.3 per year among participants who remained homeless. Conclusions: Older homeless adults who obtained housing experienced improved depressive symptoms and reduced acute care utilization compared with those who remained homeless.
MeSH term(s)	Aged ; Boston/epidemiology ; Depression/epidemiology ; Emergency Service, Hospital/utilization ; Female ; Health Status ; Homeless Persons/psychology ; Homeless Persons/statistics & numerical data ; Hospitalization/statistics & numerical data ; Housing/statistics & numerical data ; Humans ; Male ; Middle Aged
Language	English
Publishing date	2015-07
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	121100-6
ISSN	1541-0048 ; 0090-0036 ; 0002-9572
ISSN (online)	1541-0048
ISSN	0090-0036 ; 0002-9572
DOI	10.2105/AJPH.2014.302539
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