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Article ; Online: Improving Care for People Aging with HIV: A Collaborative Quality Improvement Approach.

Belanger, Daniel / Wikiera, John / Albarran, Marz / Zhu, Anita / Fera, Nicole / Glassman, Rebecca / Hartigan, John / Siegler, Eugenia L

Journal of community health

2024

Abstract: Nearly 60% of people with HIV in New York State are over 50 years of age. After town halls and a statewide survey of long-term survivors, older people living with HIV, and their providers, the Quality of Care Program of the AIDS Institute in the New York ...

Abstract	Nearly 60% of people with HIV in New York State are over 50 years of age. After town halls and a statewide survey of long-term survivors, older people living with HIV, and their providers, the Quality of Care Program of the AIDS Institute in the New York State Department of Health developed a statewide quality improvement project that aimed to improve screening for functional impairments among people aging with HIV. Thirteen sites reported outcomes of a pilot project using a modification of the World Health Organization's Integrated Care of Older People (ICOPE) intrinsic capacity screen in small scale, short cycle tests of change. A total of 1,629 people were found to be eligible for screening, and of these, 638 people were screened. Both clinical and non-clinical sites were able to identify significant areas of need. Positive screens ranged from a low of 17% for the identification of hearing issues to 49% for vision concerns. Only 11% of people with memory or nutritional concerns were referred for services; hearing loss was the domain with the largest number of referrals, at 27%. Although in many cases, when referrals were not made, patients/clients were already under care for the identified functional deficit, in other cases no services were available for referral or patients/clients declined to use the offered service. Sites also responded to the findings of the screen by initiating process changes, and many reported continuing to screen for functional impairments after the close of the pilot. The modified ICOPE screen is still in use in sites throughout the state. This pilot demonstrated that a collaboration between people with lived HIV experience, the New York State Department of Health, clinicians, and service providers could result in improved quality of care for people aging with HIV.
Language	English
Publishing date	2024-04-26
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	426631-6
ISSN	1573-3610 ; 0094-5145
ISSN (online)	1573-3610
ISSN	0094-5145
DOI	10.1007/s10900-024-01362-5
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Zs.A 1386: Show issues

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Article ; Online: "Patient Lost to Follow-up": Opportunities and Challenges in Delivering Primary Care in Academic Medical Centers.

Amat, Maelys / Duralde, Erin / Masutani, Rebecca / Glassman, Rebecca / Shen, Changyu / Graham, Kelly L

Journal of general internal medicine

2022 Volume 37, Issue 11, Page(s) 2678–2683

Abstract: Background: Academic health centers (AHCs) face unique challenges in providing continuity to a medically and socially complex patient population. Little is known about what drives patient loss in these settings.: Objective: Determine physician- and ... ...

Abstract	Background: Academic health centers (AHCs) face unique challenges in providing continuity to a medically and socially complex patient population. Little is known about what drives patient loss in these settings. Objective: Determine physician- and patient-based factors associated with patient loss in AHCs. Design: Retrospective cohort study, embedded qualitative analysis. Setting: Academic health center. Participants: All visits from 7/1/2014 to 6/30/2019; 89 physicians (51%) participated in a qualitative analysis. Measures: Physician-based factors (gender, years of service, hours of practice per week, trainee status, and departure during the study period) and patient-based factors (age, gender, race, limited English proficiency, public health insurance, chronic illness burden, and severe psychiatric illness burden) and their association with patient loss to follow-up, defined as a lapse in provider visit greater than 3 years. Results: We identified 402,415 visits for 41,876 distinct patients. A total of 9332 (22.3%) patients were lost to follow-up. Patient factors associated with loss to follow-up included patient age < 40 (HR 3.12 (2.94-3.33)), identification as non-white (HR 1.07 (1.10-1.13)), limited English proficiency (HR 1.18 (1.04-1.33)), and use of public insurance (HR 1.12 (1.04-1.21)). Provider factors associated with patient loss included trainee status (HR 3.74 (2.43-5.75)) and having recently departed from the practice (HR 1.98, 1.66-2.35). Structured interviews with clinical providers revealed unfavorable relationships with providers and staff (35%), inconvenience accessing primary care (23%), unreliable health insurance (18%), difficulty accessing one's primary care provider (14%), and patient/provider transitions (10%) as reasons for patient loss. Conclusions: Younger patient age, markers of social vulnerability, and physician transiency are associated with patient loss at AHCs, providing targets to improve continuity of care within these settings.
MeSH term(s)	Academic Medical Centers ; Child, Preschool ; Humans ; Lost to Follow-Up ; Physicians ; Primary Health Care ; Retrospective Studies
Language	English
Publishing date	2022-01-28
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	639008-0
ISSN	1525-1497 ; 0884-8734
ISSN (online)	1525-1497
ISSN	0884-8734
DOI	10.1007/s11606-021-07216-3
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Article ; Online: Mpox in the New York metropolitan area, Summer 2022.

Gnanaprakasam, Rachel / Keller, Marina / Glassman, Rebecca / El-Khoury, Marc Y / Chen, Donald S / Feola, Nicholas / Feldman, Jared / Chaturvedi, Vishnu

Journal of medical virology

2023 Volume 95, Issue 4, Page(s) e28699

Abstract: Early in the 2022 Mpox (MPX) global outbreak, caseloads in the New York Metropolitan area climbed rapidly before other US urban areas. This case series summarizes the authors' clinical experience detecting and treating MPX, during a quickly evolving ... ...

Abstract	Early in the 2022 Mpox (MPX) global outbreak, caseloads in the New York Metropolitan area climbed rapidly before other US urban areas. This case series summarizes the authors' clinical experience detecting and treating MPX, during a quickly evolving outbreak. Clinical outcomes were recorded with a focus on varied clinical presentation and outcomes such as complications and response to experimental tecovirimat therapy. A focal or multifocal rash was the most common presenting symptom in 91% of patients. Almost two-thirds (62%) of patients had anogenital involvement. Proctitis was one of the most painful presentations with 75% requiring antiviral treatment and three patients needing hospitalization for pain management. Most patients responded promptly to antiviral treatment with tecovirimat. Five out of 10 patients treated with tecovirimat reported symptom resolution within 48-72 h of therapy and another three saw resolution within first 96 h. Two patients had poor response to tecovirimat. This series includes the only reported case of an HIV positive, immunocompetent patient who experienced recurrent anal ulcers due to Mpox and required a second course of tecovirimat. Other unique presentations included urethritis, abscess formation and MPX infection postvaccination. Control of this current Mpox outbreak was possible due to timely diagnosis and the availability of both a licensed vaccine and an investigational drug.
MeSH term(s)	Humans ; Mpox (monkeypox) ; New York ; Antiviral Agents/therapeutic use ; Benzamides ; Isoindoles
Chemical Substances	Antiviral Agents ; Benzamides ; Isoindoles
Language	English
Publishing date	2023-03-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	752392-0
ISSN	1096-9071 ; 0146-6615
ISSN (online)	1096-9071
ISSN	0146-6615
DOI	10.1002/jmv.28699
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Article ; Online: Re-purposed drive-through vaccination set-up for Mpox, New York Metropolitan Area.

Keller, Marina / Chaturvedi, Vishnu / Glassman, Rebecca / Chen, Donald S / El-Khoury, Marc / Dundas, Mary / Feola, Nicholas / Thankachen, Varghese / Yezzo, Marie / Tone, Keri / Williams, Justin / Garrick, Renee

Infection prevention in practice

2023 Volume 5, Issue 4, Page(s) 100316

Abstract: Background: This report details how one large medical center in the Metropolitan New York area re-purposed a drive-through COVID-19 vaccination structure to handle a surge in Mpox cases in July 2022.Methods/Results: Simultaneous to on-going COVID -19 ... ...

Abstract	Background: This report details how one large medical center in the Metropolitan New York area re-purposed a drive-through COVID-19 vaccination structure to handle a surge in Mpox cases in July 2022.Methods/Results: Simultaneous to on-going COVID -19 vaccination and testing, Mpox vaccination was rolled out in the same drive through structure. More than 1,820 Jynneos (Smallpox and Monkeypox Vaccine, Live, Non-replicating) vaccine dosages were delivered subcutaneously and then intradermally to 1,123 individuals through the open window of their vehicles, averaging 8-10 patients an hour. Five vaccine recipients suffered Mpox rash; there was no exposure among healthcare providers. Conclusion: Drive-through vaccination is an efficient model to be redeployed for future unexpected vaccine initiatives.
Language	English
Publishing date	2023-11-02
Publishing country	England
Document type	Journal Article
ISSN	2590-0889
ISSN (online)	2590-0889
DOI	10.1016/j.infpip.2023.100316
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Article ; Online: Headache in Petrous Apicitis: A Case Report of Chronic Migraine-like Headache Due to Peripheral Pathology.

Mancini, Alyssa J / Glassman, Rebecca D / Chang, Yu-Ming / Burstein, Rami / Ashina, Sait

Headache

2019 Volume 59, Issue 10, Page(s) 1821–1826

Abstract: Objective: To report a case of petrous apicitis that manifested as chronic migraine without aura and to discuss the pathophysiological mechanisms behind this presentation.: Background: Petrous apicitis is a rare complication of acute otitis media ... ...

Abstract	Objective: To report a case of petrous apicitis that manifested as chronic migraine without aura and to discuss the pathophysiological mechanisms behind this presentation. Background: Petrous apicitis is a rare complication of acute otitis media with varied clinical presentations that stem from the close proximity of the petrous apex to numerous neurovascular structures. Headache is among the common symptoms of petrous apicitis. Methods: A case of new onset headache in the setting of petrous apicitis with symptomatic response to antibiotic therapy was reported. We provided a brief review of peripheral pathophysiological mechanisms of migraine and correlated to mechanism of headache in petrous apicitis. Results: A 65-year-old man with chronic otitis externa/media presented with ongoing headache fulfilling International Classification of Headache Disorders 3rd edition (ICHD-3) criteria for chronic migraine without aura that persisted despite undergoing right mastoidectomy and tympanoplasty with multiple courses of oral antibiotic therapy for his chronic otitis. MRI brain revealed petrous apicitis, otomastoiditis, and clival osteomyelitis. His imaging findings improved and his migraine-like headache completely resolved after treatment with a prolonged course of antibiotics. Conclusions: Petrous apicitis can present as a headache with features of migraine, and in this case in particular, as chronic migraine without aura. The pathophysiological mechanisms that may underlie the generation of migraine-like headache in petrous apicitis may include the activation of nociceptive fibers within the periosteum of the petrous apex and clivus whose cell bodies originate in the trigeminal ganglion and upper cervical dorsal root ganglia. By treating the peripheral pathology, resolution of the headache may be achieved.
MeSH term(s)	Aged ; Anti-Bacterial Agents/therapeutic use ; Headache/diagnostic imaging ; Headache/drug therapy ; Headache/etiology ; Humans ; Magnetic Resonance Imaging ; Male ; Petrositis/complications ; Petrositis/diagnostic imaging ; Petrositis/drug therapy ; Treatment Outcome
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2019-09-18
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	410130-3
ISSN	1526-4610 ; 0017-8748
ISSN (online)	1526-4610
ISSN	0017-8748
DOI	10.1111/head.13643
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Article ; Online: Defining the Resident Continuity Clinic Panel Along Patient Outcomes: a Health Equity Opportunity.

Amat, Maelys / Glassman, Rebecca / Basu, Nisha / Doolin, Jim / Flier, Lydia / Gonzalez, Mariana R / Gosselin, Jeanne / Knapp, Sarah / Yun, Phillip / Graham, Kelly L

Journal of general internal medicine

2021 Volume 36, Issue 9, Page(s) 2615–2621

Abstract: Background: Continuity clinics are a critical component of outpatient internal medicine training. Little is known about the population of patients cared for by residents and how these physicians perform.: Objectives: To compare resident and faculty ... ...

Abstract	Background: Continuity clinics are a critical component of outpatient internal medicine training. Little is known about the population of patients cared for by residents and how these physicians perform. Objectives: To compare resident and faculty performance on standard population health measures. To identify potential associations with differences in performance, specifically medical complexity, psychosocial vulnerability, and rates of patient loss. Setting and participants: Large academic primary care clinic caring for 40,000 patients. One hundred ten internal medicine residents provide primary care for 9,000 of these patients; the remainder are cared for by faculty. Study design: Descriptive analysis using review of the medical record and hospital administrative data. Main measures: We compared resident and faculty performance on standard population health measures, including cancer screening rates, chronic disease care, acute and chronic medical complexity, psychosocial vulnerability, and rates of patient loss. We evaluated the success of resident transition by measuring rates of kept continuity visits 18 months after graduation. Key results: Performance on all clinical outcomes was significantly better for faculty compared to residents. Despite similar levels of medical complexity compared to faculty patients, resident patients had significantly higher levels of psychosocial vulnerability across all measured domains, including health literacy, economic vulnerability, psychiatric illness burden, high-risk behaviors, and patient engagement. Resident patients experienced higher rates of patient loss than faculty patients (38.5 vs. 18.8%) with only 46.5% of resident patients with a kept continuity appointment in the practice 18 months after graduation. Conclusions: In this large academic practice, resident performance on standard population health measures was significantly lower than faculty. This may be explained in part by the burden of psychosocial vulnerability of their patients and systems that do not effectively transition patients after graduation. These findings present an opportunity to improve structural equity for these vulnerable patients and developing physicians.
MeSH term(s)	Ambulatory Care Facilities ; Continuity of Patient Care ; Health Equity ; Humans ; Internal Medicine ; Internship and Residency ; Primary Health Care
Language	English
Publishing date	2021-01-21
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	639008-0
ISSN	1525-1497 ; 0884-8734
ISSN (online)	1525-1497
ISSN	0884-8734
DOI	10.1007/s11606-020-06420-x
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Article ; Online: Meeting the needs of the resident trainee during an elective subspecialty rotation.

Hale, Andrew / Glassman, Rebecca / Fessler, David / Mukamal, Kenneth J / Stead, Wendy

International journal of medical education

2016 Volume 7, Page(s) 115–118

Abstract: Objective: To examine and compare perceptions between resident-trainees and faculty-educators on goals and reasons why resident trainees choose certain subspecialty elective rotations.: Methods: In June 2013 residents and faculty-educators at a large ...

Abstract	Objective: To examine and compare perceptions between resident-trainees and faculty-educators on goals and reasons why resident trainees choose certain subspecialty elective rotations. Methods: In June 2013 residents and faculty-educators at a large tertiary care academic medical center were surveyed regarding perceived resident goals for subspecialty electives. Each group was sent a different electronic survey of parallel questions assessing agreement on an ordered scale with statements about which factors impacted resident choice. Results: The survey was sent to 154 residents and had 75 (49%) respondents, as well as 20 faculty-educators with 12 (60%) respondents. Residents and faculty did not differ in their responses that electives were chosen to fill perceived knowledge gaps (exact Cochran-Armitage p = .51). However, educators and residents significantly varied in the degree to which they thought resident choice was based on networking within the field (exact Cochran-Armitage p = .01), auditioning for fellowship (exact Cochran-Armitage p < .01), or exploring career options (exact Cochran-Armitage p = .01), with educators overestimating the degree to which these impacted resident choice. Conclusions: Resident trainees and faculty educators agree that subspecialty electives are most frequently chosen in order to meet resident educational goals, highlighting the importance of developing and delivering high quality subspecialty curricular content for the internal medicine resident learner during electives. Many residents choose electives for career development reasons, but faculty educators overestimate this motivation.
MeSH term(s)	Academic Medical Centers ; Career Choice ; Faculty, Medical ; Humans ; Internal Medicine/education ; Internship and Residency ; Specialization ; Students, Medical/statistics & numerical data ; Surveys and Questionnaires
Language	English
Publishing date	2016-04-10
Publishing country	England
Document type	Journal Article
ISSN	2042-6372
ISSN (online)	2042-6372
DOI	10.5116/ijme.56f5.c7ec
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