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Article ; Online: Quality improvement initiative to improve infant safe sleep practices in the newborn nursery.

Shaikh, Sophie Kay / Chamberlain, Lauren / Nazareth-Pidgeon, Kristina Marie / Boggan, Joel C

BMJ open quality

2022 Volume 11, Issue 3

Abstract: The American Academy of Pediatrics recommends that healthcare professionals model their safe infant sleeping environment recommendations, yet adherence to safe sleep practices within our community hospital mother-baby unit was low. We used quality ... ...

Abstract	The American Academy of Pediatrics recommends that healthcare professionals model their safe infant sleeping environment recommendations, yet adherence to safe sleep practices within our community hospital mother-baby unit was low. We used quality improvement (QI) methodology to increase adherence to infant safe sleep practices, with a goal to improve the proportion of infants sleeping in an environment that would be considered 'perfect sleep' to 70% within a 1-year period. The project occurred while the hospital was preparing for Baby Friendly certification, with increased emphasis on rooming in and skin to skin at the same time.Multiple Plan-Do-Study-Act cycles were performed. Initial cycles targeted nurse and parental education, while later cycles focused on providing sleep sacks/wearable blankets for the infants.While we did not meet our goal, the percentage of infants with 'perfect sleep' increased from a baseline of 41.9% to 67.3%, and we also saw improvement in each of the individual components that contribute to this composite measure. Improvements were sustained over 12 months later, suggesting that QI interventions targeting infant safe sleep in this inpatient setting can have long-lasting results. This project also suggests that infant safe sleep QI initiatives and preparation towards Baby Friendly Hospital Certification can be complementary.
MeSH term(s)	Child ; Humans ; Infant ; Infant Care/methods ; Infant, Newborn ; Patient Safety ; Quality Improvement ; Sleep ; Sudden Infant Death/prevention & control ; United States
Language	English
Publishing date	2022-08-03
Publishing country	England
Document type	Journal Article
ISSN	2399-6641
ISSN (online)	2399-6641
DOI	10.1136/bmjoq-2022-001834
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Article ; Online: No Quick Fixes: Integrating Population Health Education and Quality Improvement in a Large Residency Program.

Shoup, John Paul / Kim, Azalea / Wilson, Jonathan / Pendergast, Jane / Ranard, Benjamin L / Boggan, Joel C

Journal for healthcare quality : official publication of the National Association for Healthcare Quality

2022 Volume 44, Issue 5, Page(s) 286–293

Abstract: Abstract: The intersection of population health (PH), quality improvement (QI), and health disparities is increasingly a focus in graduate medical education. However, it remains unclear how trainees may best improve disparities within clinical training ... ...

Abstract	Abstract: The intersection of population health (PH), quality improvement (QI), and health disparities is increasingly a focus in graduate medical education. However, it remains unclear how trainees may best improve disparities within clinical training environments. We integrated PH education for residents participating in a practical QI experience in a continuity clinic serving an underserved population. We analyzed whether PH education increased confidence in creating care plans and implementing team-based care strategies after selection of one of three QI metrics with known health disparities led to improvement. Posteducational session, attendees had odds of confidence in creating care plans 10.0 (95% confidence interval [CI] 4.6-21.7) times the presession period, whereas nonattendees' confidence was unchanged (OR 1.63, 95% CI 0.78-3.4). Residents participating in the QI project did not have higher confidence in creating a care plan at baseline (20% vs. 9.6%, p = .09) nor any additional shift in confidence versus other residents (p = .57). There were no differences in QI metric performance rate trends for residents choosing a specific QI metric versus those that did not (p > .33 for all comparisons). PH didactics can increase resident confidence around PH topics. However, translating such learning into outcomes and improved health equity may require dedicated efforts across residency training.
MeSH term(s)	Curriculum ; Education, Medical, Graduate ; Humans ; Internship and Residency ; Population Health ; Quality Improvement
Language	English
Publishing date	2022-09-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	1472097-8
ISSN	1945-1474 ; 1062-2551
ISSN (online)	1945-1474
ISSN	1062-2551
DOI	10.1097/JHQ.0000000000000352
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Zs.A 5029: Show issues

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Article ; Online: Learning by Doing: Practical Strategies to Integrate Resident Education and Quality Improvement Initiatives.

Clemo, Rebecca / Parsons, Andrew S / Boggan, Joel C / Shieh, Lisa / Miller, Bahnsen P

Journal of graduate medical education

2021 Volume 13, Issue 5, Page(s) 631–634

MeSH term(s)	Curriculum ; Education, Medical, Graduate ; Humans ; Internship and Residency ; Learning ; Quality Improvement
Language	English
Publishing date	2021-10-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	2578612-X
ISSN	1949-8357 ; 1949-8357
ISSN (online)	1949-8357
ISSN	1949-8357
DOI	10.4300/JGME-D-21-00381.1
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Article ; Online: Triaging Admissions: A Survey of Internal Medicine Resident Experiences and Perceptions and Recommendations on Inpatient Triage Education.

Wang, Emily S / Velásquez, Sadie Trammell / Mader, Michael / Boggan, Joel C / Liao, Jeff E / Leykum, Luci K / Pugh, Jacqueline

The American journal of medicine

2022 Volume 135, Issue 7, Page(s) 919–924.e6

MeSH term(s)	Clinical Competence ; Curriculum ; Education, Medical, Graduate ; Humans ; Inpatients ; Internship and Residency ; Triage
Language	English
Publishing date	2022-04-04
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, Non-P.H.S. ; Research Support, Non-U.S. Gov't
ZDB-ID	80015-6
ISSN	1555-7162 ; 1873-2178 ; 0002-9343 ; 1548-2766
ISSN (online)	1555-7162 ; 1873-2178
ISSN	0002-9343 ; 1548-2766
DOI	10.1016/j.amjmed.2022.03.023
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Article ; Online: Splenectomy as a Destination: Improving Quality of Care Among Asplenic Veterans Through a Travel Clinic.

Mitchell, Aaron P / Boggan, Joel C / Lau, Karen / Simel, David L

The American journal of medicine

2017 Volume 130, Issue 7, Page(s) 856–861

Abstract: Background: Asplenic patients are at risk for severe infections, but adherence to recommended preventive education and vaccination is poor. The goal of this study was to demonstrate that a targeted intervention can improve vaccination rates in a ... ...

Abstract	Background: Asplenic patients are at risk for severe infections, but adherence to recommended preventive education and vaccination is poor. The goal of this study was to demonstrate that a targeted intervention can improve vaccination rates in a population of asplenic veterans. Methods: Surgically asplenic patients actively receiving care in our health care system were identified via a database search. Patients were contacted via mailed letters and encouraged to attend an existing travel clinic with a new process designed for asplenic patients. In the clinic, patients were educated on the risks of asplenia and proper preventive precautions, a vaccination history was taken, and patients were administered any additional indicated vaccines. Results: The database search yielded 113 patients; an additional 14 asplenic patients were identified and referred to the clinic by providers, and 2 were referred prior to planned splenectomy. Among all asplenic patients, the first-year referral rate to clinic was 38/129 (29%). During the first year of the intervention, there were increases in the rates of 3 of 4 recommended vaccinations: pneumococcal conjugate, 19% to 55% (P <.001); Haemophilus influenzae type B, 19% to 35% (P = .007); and meningococcal vaccine, 24% to 43% (P = .002). The pneumococcal polysaccharide vaccination rate increased from 91% to 93% (P = .62). Conclusions: Targeted interventions can improve guideline-based care for asplenic patients. The creation of a clinic designed for asplenic patients led to increases in 3 of 4 recommended vaccinations. This strategy may be applicable to other health care systems with similar numbers of asplenic patients.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Ambulatory Care Facilities/standards ; Humans ; Infection/etiology ; Infection Control ; Middle Aged ; Patient Compliance ; Patient Education as Topic ; Quality Improvement ; Splenectomy/adverse effects ; Vaccination/statistics & numerical data ; Veterans
Language	English
Publishing date	2017-02-14
Publishing country	United States
Document type	Journal Article
ZDB-ID	80015-6
ISSN	1555-7162 ; 1873-2178 ; 0002-9343 ; 1548-2766
ISSN (online)	1555-7162 ; 1873-2178
ISSN	0002-9343 ; 1548-2766
DOI	10.1016/j.amjmed.2017.01.024
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Article ; Online: Guideline-based decision support has a small, non-sustained effect on transthoracic echocardiography ordering frequency.

Boggan, Joel C / Schulteis, Ryan D / Donahue, Mark / Simel, David L

BMJ quality & safety

2016 Volume 25, Issue 1, Page(s) 57–62

Abstract: Background: Guidance for appropriate utilisation of transthoracic echocardiograms (TTEs) can be incorporated into ordering prompts, potentially affecting the number of requests.: Methods: We incorporated data from the 2011 Appropriate Use Criteria ... ...

Abstract	Background: Guidance for appropriate utilisation of transthoracic echocardiograms (TTEs) can be incorporated into ordering prompts, potentially affecting the number of requests. Methods: We incorporated data from the 2011 Appropriate Use Criteria for Echocardiography, the 2010 National Institute for Clinical Excellence Guideline on Chronic Heart Failure, and American College of Cardiology Choosing Wisely list on TTE use for dyspnoea, oedema and valvular disease into electronic ordering systems at Durham Veterans Affairs Medical Center. Our primary outcome was TTE orders per month. Secondary outcomes included rates of outpatient TTE ordering per 100 visits and frequency of brain natriuretic peptide (BNP) ordering prior to TTE. Outcomes were measured for 20 months before and 12 months after the intervention. Results: The number of TTEs ordered did not decrease (338±32 TTEs/month prior vs 320±33 afterwards, p=0.12). Rates of outpatient TTE ordering decreased minimally post intervention (2.28 per 100 primary care/cardiology visits prior vs 1.99 afterwards, p<0.01). Effects on TTE ordering and ordering rate significantly interacted with time from intervention (p<0.02 for both), as the small initial effects waned after 6 months. The percentage of TTE orders with preceding BNP increased (36.5% prior vs 42.2% after for inpatients, p=0.01; 10.8% prior vs 14.5% after for outpatients, p<0.01). Conclusions: Ordering prompts for TTEs initially minimally reduced the number of TTEs ordered and increased BNP measurement at a single institution, but the effect on TTEs ordered was likely insignificant from a utilisation standpoint and decayed over time.
MeSH term(s)	Decision Making, Computer-Assisted ; Echocardiography/statistics & numerical data ; Guideline Adherence/statistics & numerical data ; Humans ; Natriuretic Peptide, Brain/blood ; Practice Patterns, Physicians'/standards ; Practice Patterns, Physicians'/statistics & numerical data ; Tertiary Care Centers/statistics & numerical data ; Unnecessary Procedures/statistics & numerical data
Chemical Substances	Natriuretic Peptide, Brain (114471-18-0)
Language	English
Publishing date	2016-01
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2592912-4
ISSN	2044-5423 ; 2044-5415
ISSN (online)	2044-5423
ISSN	2044-5415
DOI	10.1136/bmjqs-2015-004284
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Article ; Online: Interstitial lung disease in a veterans affairs regional network; a retrospective cohort study.

Bedoya, Armando / Pleasants, Roy A / Boggan, Joel C / Seaman, Danielle / Reihman, Anne / Howard, Lauren / Kundich, Robert / Welty-Wolf, Karen / Tighe, Robert M

PloS one

2021 Volume 16, Issue 3, Page(s) e0247316

Abstract: Background: The epidemiology of Interstitial Lung Diseases (ILD) in the Veterans Health Administration (VHA) is presently unknown.: Research question: Describe the incidence/prevalence, clinical characteristics, and outcomes of ILD patients within ... ...

Abstract	Background: The epidemiology of Interstitial Lung Diseases (ILD) in the Veterans Health Administration (VHA) is presently unknown. Research question: Describe the incidence/prevalence, clinical characteristics, and outcomes of ILD patients within the Veteran's Administration Mid-Atlantic Health Care Network (VISN6). Study design and methods: A multi-center retrospective cohort study was performed of veterans receiving hospital or outpatient ILD care from January 1, 2008 to December 31st, 2015 in six VISN6 facilities. Patients were identified by at least one visit encounter with a 515, 516, or other ILD ICD-9 code. Demographic and clinical characteristics were summarized using median, 25th and 75th percentile for continuous variables and count/percentage for categorical variables. Characteristics and incidence/prevalence rates were summarized, and stratified by ILD ICD-9 code. Kaplan Meier curves were generated to define overall survival. Results: 3293 subjects met the inclusion criteria. 879 subjects (26%) had no evidence of ILD following manual medical record review. Overall estimated prevalence in verified ILD subjects was 256 per 100,000 people with a mean incidence across the years of 70 per 100,000 person-years (0.07%). The prevalence and mean incidence when focusing on people with an ILD diagnostic code who had a HRCT scan or a bronchoscopic or surgical lung biopsy was 237 per 100,000 people (0.237%) and 63 per 100,000 person-years respectively (0.063%). The median survival was 76.9 months for 515 codes, 103.4 months for 516 codes, and 83.6 months for 516.31. Interpretation: This retrospective cohort study defines high ILD incidence/prevalence within the VA. Therefore, ILD is an important VA health concern.
MeSH term(s)	Aged ; Cohort Studies ; Female ; Humans ; Incidence ; International Classification of Diseases ; Kaplan-Meier Estimate ; Lung/pathology ; Lung Diseases, Interstitial/diagnosis ; Lung Diseases, Interstitial/epidemiology ; Lung Diseases, Interstitial/mortality ; Male ; Middle Aged ; North Carolina/epidemiology ; Prevalence ; Retrospective Studies ; United States ; United States Department of Veterans Affairs ; Veterans ; Veterans Health Services ; Virginia/epidemiology
Language	English
Publishing date	2021-03-18
Publishing country	United States
Document type	Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
ISSN	1932-6203
ISSN (online)	1932-6203
DOI	10.1371/journal.pone.0247316
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Article ; Online: Contemporary Management and Outcomes of Veterans Hospitalized With Alcohol Withdrawal: A Multicenter Retrospective Cohort Study.

Ronan, Matthew V / Gordon, Kirsha S / Skanderson, Melissa / Krug, Michael / Godwin, Patrick / Heppe, Daniel / Hoegh, Matthew / Boggan, Joel C / Gutierrez, Jeydith / Kaboli, Peter / Pescetto, Micah / Guidry, Michelle / Caldwell, Peter / Mitchell, Christine / Ehlers, Erik / Allaudeen, Nazima / Cyr, Jessica / Smeraglio, Andrea / Yarbrough, Peter /

Rose, Richard / Jagannath, Anand / Vargas, Jaclyn / Cornia, Paul B / Shah, Meghna / Tuck, Matthew / Arundel, Cherinne / Laudate, James / Elzweig, Joel / Rodwin, Benjamin / Akwe, Joyce / Trubitt, Meredith / Gunderson, Craig G

Journal of addiction medicine

2024

Abstract: Objectives: Few studies describe contemporary alcohol withdrawal management in hospitalized settings or review current practices considering the guidelines by the American Society of Addiction Medicine (ASAM).: Methods: We conducted a retrospective ... ...

Abstract	Objectives: Few studies describe contemporary alcohol withdrawal management in hospitalized settings or review current practices considering the guidelines by the American Society of Addiction Medicine (ASAM). Methods: We conducted a retrospective cohort study of patients hospitalized with alcohol withdrawal on medical or surgical wards in 19 Veteran Health Administration (VHA) hospitals between October 1, 2018, and September 30, 2019. Demographic and comorbidity data were obtained from the Veteran Health Administration Corporate Data Warehouse. Inpatient management and hospital outcomes were obtained by chart review. Factors associated with treatment duration and complicated withdrawal were examined. Results: Of the 594 patients included in this study, 51% were managed with symptom-triggered therapy alone, 26% with fixed dose plus symptom-triggered therapy, 10% with front loading regimens plus symptom-triggered therapy, and 3% with fixed dose alone. The most common medication given was lorazepam (87%) followed by chlordiazepoxide (33%), diazepam (14%), and phenobarbital (6%). Symptom-triggered therapy alone (relative risk [RR], 0.68; 95% confidence interval [CI], 0.57-0.80) and front loading with symptom-triggered therapy (RR, 0.75; 95% CI, 0.62-0.92) were associated with reduced treatment duration. Lorazepam (RR, 1.20; 95% CI, 1.02-1.41) and phenobarbital (RR, 1.28; 95% CI, 1.06-1.54) were associated with increased treatment duration. Lorazepam (adjusted odds ratio, 4.30; 95% CI, 1.05-17.63) and phenobarbital (adjusted odds ratio, 6.51; 95% CI, 2.08-20.40) were also associated with complicated withdrawal. Conclusions: Overall, our results support guidelines by the ASAM to manage patients with long-acting benzodiazepines using symptom-triggered therapy. Health care systems that are using shorter acting benzodiazepines and fixed-dose regimens should consider updating alcohol withdrawal management pathways to follow ASAM recommendations.
Language	English
Publishing date	2024-03-07
Publishing country	Netherlands
Document type	Journal Article
ISSN	1935-3227
ISSN (online)	1935-3227
DOI	10.1097/ADM.0000000000001297
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Article ; Online: Improving Timely Resident Follow-Up and Communication of Results in Ambulatory Clinics Utilizing a Web-Based Audit and Feedback Module.

Boggan, Joel C / Swaminathan, Aparna / Thomas, Samantha / Simel, David L / Zaas, Aimee K / Bae, Jonathan G

Journal of graduate medical education

2017 Volume 9, Issue 2, Page(s) 195–200

Abstract: Background: Failure to follow up and communicate test results to patients in outpatient settings may lead to diagnostic and therapeutic delays. Residents are less likely than attending physicians to report results to patients, and may face additional ... ...

Abstract	Background: Failure to follow up and communicate test results to patients in outpatient settings may lead to diagnostic and therapeutic delays. Residents are less likely than attending physicians to report results to patients, and may face additional barriers to reporting, given competing clinical responsibilities. Objective: This study aimed to improve the rates of communicating test results to patients in resident ambulatory clinics. Methods: We performed an internal medicine, residency-wide, pre- and postintervention, quality improvement project using audit and feedback. Residents performed audits of ambulatory patients requiring laboratory or radiologic testing by means of a shared online interface. The intervention consisted of an educational module viewed with initial audits, development of a personalized improvement plan after Phase 1, and repeated real-time feedback of individual relative performance compared at clinic and program levels. Outcomes included results communicated within 14 days and prespecified "significant" results communicated within 72 hours. Results: A total of 76 of 86 eligible residents (88%) reviewed 1713 individual ambulatory patients' charts in Phase 1, and 73 residents (85%) reviewed 1509 charts in Phase 2. Follow-up rates were higher in Phase 2 than Phase 1 for communicating results within 14 days and significant results within 72 hours (85% versus 78%, Conclusions: Participation in a shared audit and feedback quality improvement project can improve rates of resident follow-up and communication of results, although communication gaps remained.
Language	English
Publishing date	2017-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	2578612-X
ISSN	1949-8357 ; 1949-8349
ISSN (online)	1949-8357
ISSN	1949-8349
DOI	10.4300/JGME-D-16-00460.1
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Article ; Online: The Burden of Burnout.

Elmariah, Hany / Thomas, Samantha / Boggan, Joel C / Zaas, Aimee / Bae, Jonathan

American journal of medical quality : the official journal of the American College of Medical Quality

2017 Volume 32, Issue 2, Page(s) 156–162

Abstract: This study sought to determine burnout prevalence and factors associated with burnout in internal medicine residents after introduction of the 2011 ACGME duty hour rules. Burnout was evaluated using an anonymized, abbreviated version of the Maslach ... ...

Abstract	This study sought to determine burnout prevalence and factors associated with burnout in internal medicine residents after introduction of the 2011 ACGME duty hour rules. Burnout was evaluated using an anonymized, abbreviated version of the Maslach Burnout Inventory. Surveys were collected biweekly for 48 weeks during the 2013-2014 academic year. Burnout severity was compared across subgroups and time. A score of 3 or higher signified burnout. Overall, 944 of 3936 (24%) surveys were completed. The mean burnout score across all surveys was 2.8. Categorical residents had higher burnout severity than noncategorical residents (2.9 vs 2.7, P = .005). Postgraduate year 2 residents had the highest burnout severity by year (3.1, P < .001). Residents on inpatient rotations had higher burnout severity than residents on outpatient or consultation rotations (3.1 vs 2.2 vs 2.2, P < .001). Night float rotations had the highest severity (3.8). Burnout remains a significant problem even with recent duty hour modifications.
Language	English
Publishing date	2017-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	1131772-3
ISSN	1555-824X ; 1062-8606
ISSN (online)	1555-824X
ISSN	1062-8606
DOI	10.1177/1062860615625802
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