Building a Community-Academic Partnership to Improve Screening for Intimate Partner Violence: Integrating Advocates in Healthcare Clinic Settings

Aims To develop an innovative community-academic partnership to advance, test and promote intimate partner violence screening and referral protocols by comparing the effect of integrating intimate partner violence advocates versus enhancing medical training in medical clinic settings serving women from vulnerable populations. Detecting intimate partner violence in healthcare settings allows for survivors to connect to safety and referral resources prior to violence escalating. Screening for intimate partner violence and connecting patients to referral resources requires creating a safe and trusting relationship between healthcare providers and patients. Developing screening and referral protocols responsive to survivors\u27 needs requires involvement of clinic staff, survivors and community agencies that support survivors. Design Three phases of the project include Discovery, Implementation and Dissemination. Mixed-methodology will help in understanding current practices and effects of interventions. Methods Actions included in each phase: Discovery: 1) nurse-led focus groups of clinic staff, providers and survivors to understand current clinic practices; 2) retrospective chart review of the number of screens performed, positive screens detected and interventions performed. Implementation: 1) randomization of patients to be interviewed by a trained advocate or by healthcare provider with enhanced training; and 2) assess the number of screenings and referrals performed in each arm and 3) evaluate outcomes of intervention. Dissemination through: presentations, manuscripts and policy recommendations at the institutional and regional level. This IRB-approved proposal was funded in July 2021 by an Advancing a Healthier Wisconsin grant. Discussion The partnership has improved channels of communication and understanding between diverse clinical care providers, survivors and community agency staff as they navigate the complex challenges to the development and integration of screening and referral protocols. Impact This project will provide evidence of the most effective intimate partner violence screening and referral methodology that can be utilized in a wide variety of medical settings

Goals of care conversations: an evaluation

Background: Growing evidence suggests that physician and patient discussions about goals of care improve quality of life, quality of dying, and decrease end-of-life intensity of care. However, these conversations do not occur at the frequency desired by seriously ill and dying patients. Practitioners recommend new approaches to increase the frequency and quality of such conversations. The “Teaching Primary Palliative Care” training offered through Aurora Health Care’s continuing professional development office is one new approach aimed to equip physicians with skills to increase the frequency and quality of goals of care conversations. Purpose: To evaluate the Teaching Primary Palliative Care (TPPC) training to determine if physicians report increased comfort in engaging in goals of care conversations with seriously ill and dying patients posttraining. Methods: TPPC training occurs in three stages. Stage A: Initial self-assessment completed online. Participants complete a survey in which they answer a series of questions designed to measure comfort level in engaging in goals of care communications with their seriously ill and dying patients. Stage B: Attend an in-person training session on communication skills and techniques on having goals of care conversations with patients. Stage C: Second self-assessment completed online within about 3 months after physicians practiced and applied skills in their clinical practice. In fall 2018, 78 Aurora physicians completed stages A and B of the training, resulting in 37 completed stage A and stage C selfassessments. To assess for increased comfort level, the stage A and stage C assessments were statistically analyzed using the 1-sided sign test. Results: Compared to their reported comfort level prior to completing TPPC training, physicians’ comfort level after training increased in 4 out of 5 circumstances related to engaging in goals of care conversations with patients: discussing CPR/do not resuscitate (P=0.018); discussing hospice or palliative care referral (P\u3c0.001); discussing artificial hydration or nutrition (P=0.001); and discussing prognosis specifics (P=0.002). Conclusion: Findings suggest that TPPC training increases the comfort level of physicians to engage in goals of care conversations with seriously ill and dying patients. Next steps for this project include a longitudinal study to determine whether physicians continue to be more comfortable in these circumstances 6–9 months after completing the training

Goals of care conversations: A training program evaluation

Background: Patients benefit when their health care providers engage in conversations about treatment options and goals of care. However, these conversations frequently do not occur. Researchers have called for new approaches to increase such conversations. The Teaching Primary Palliative Care Training program is one such approach. Purpose: To determine whether Teaching Primary Palliative Care Training increases participant comfort engaging in goals of care conversations with seriously ill and dying patients shortly after the training and 1 year after the training. Methods: 78 health care providers participated in Teaching Primary Palliative Care Training during the fall of 2018. Participants completed a self-assessment in which they reported on their comfort level in various circumstances related to the management of seriously ill and dying patients at baseline before the training, shortly after completing the training, and again 1 year later. We used the 1-sided sign test to assess for statistically significant improvement in self-reported comfort. Results:At the first follow-up, self-assessments reflected significant improvement in comfort, compared to baseline, in all 5 circumstances related to the management of seriously ill and dying patients. These circumstances included: delivering bad news (P=004); discussing CPR/DNR (P=003); discussing hospice or palliative care referral (P=001); discussing artificial hydration or nutrition (eg, percutaneous endoscopic gastrostomy tubes) (P Conclusion: In this sample, participation in the Teaching Primary Palliative Care Training program increased health care provider comfort in patient communication of various circumstances related to the management of seriously ill and dying patients. Improvements continued 1 year after the training. Next steps include determining whether increased comfort translates into changes in provider behavior such as conducting goals of care conversations with patients

Factors Associated with Increase in COVID-19 Cases in Nursing Homes: A Study of Nursing Homes in Midwestern States

Background: The COVID-19 pandemic disproportionately affects older adults, especially, those in nursing homes (NHs) with over 27% of deaths attributed to COVID-19. However, some nursing homes fare better than others. This study examined the following factors: nursing home ratings, quality of care, staff shortage, PPE shortage, and ownership status to understand the association between them and COVID-19 cases. Methods: Three datasets were combined from Centers for Medicare & Medicaid Services (CMS): 1. Star rating; 2. Provider information and 3. COVID-19 nursing home. The time period examined is from Jan 1 – Oct 25, 2020 for the 12 Midwestern states in the population set. There were 4525 free-standing NHs for the analysis after removing cases with missing values. The measures used were self-reported information on ratings, quality of care, staff shortages, PPE shortage, occupancy rate and ownership. Ordinal logistic regression was used to examine the association between nursing home ratings on health inspections, quality measures, and staffing domains with COVID-19 cases. Results: Of the 4525 NHs in 12 Midwestern states, high performing NHs were less likely to have more than 30 COVID-19 cases than were low-performing facilities for two of the CMS domain (health inspections, 179 [11.6%] vs 542 [18.2%]; and staffing 175 [9.1%] vs 546 [20%]). There was also statistically significant association between high- vs low-performing NHs in overall rating and COVID19 cases and a statistically significant association between NH ownership, occupancy rate, RN, LPN and CNA staffing in NHs having ≤10 CV cases vs 11-30 CV cases vs \u3e30 CV cases (all p ≤ 0.01). Conclusions: Our findings show a statistically significant association between ownership and COVID-19 cases among residents. Of the NHs that had more than 30 COVID-19 cases, 70.2% were for-profit nursing homes, 5.9% were government owned and 23.9% were non-profit. There was no statistically significant association between PPE shortages and COVID-19 cases. Finally, there was a significant negative association between RN and CNA staffing i.e. more staffing hours of RNs and CNA correlated with fewer number of COVID-19 cases