Cutline: 1981-82 scholarship winner - Ronan

Background: Self-management support has been shown to improve clinical outcomes. Health coaching, one form of self-management support, empowers patients within the health care system by providing information and through collaboratively developed care plans. Purpose: Assess the impact of The Lifestyle Initiative, a coaching-based health program utilized by Aurora Health Care caregivers or family members. Methods: The Lifestyle Initiative is a coaching-based approach for Aurora caregivers or family members enrolled in Aurora’s health insurance network. Individuals were recruited from the care management database, and all participants had an Aurora primary care provider. Participation was limited to those ≥ 18 years of age who had a diagnosis of type 2 diabetes or hypertension (or both), had glycated hemoglobin (A1c) ≤ 8.0, and were not on insulin. The Lifestyle Initiative was rolled out in three phases. Phase I: health coaching sessions through a standard web- and app-based platform (Noom Health), and access to a stress-management program (HeartMath). Phase II: health coaching sessions through a standard web- and app-based platform co-created by Aurora’s Department of Integrative Medicine and Noom Health, and access to HeartMath; Phase III: health coaching sessions through a standard web- and app-based platform (Noom Health), and a customized web- and app-based platform. Those enrolled in each phase acted as their own controls. Paired t-tests were used to compare pre- and postintervention results of each phase. Results: The majority of Phase I participants (n = 23; mean age 54.4 years) were female (91.3%) and white (52.2%). Preintervention A1c and blood pressure were not statistically different postintervention. However, pre- vs postintervention weights were statistically different (228.2 vs 218.5 lb; P \u3c 0.01), as well as pre- vs postintervention body mass index (37.3 vs 35.7 kg/m2; P \u3c 0.01). The majority of Phase II participants (n = 63; mean age 54.8 years) also were female (81.0%) and white (88.9%). Pre- and postintervention blood pressures were not statistically different. However, pre- vs postintervention A1c (7.2 vs 6.6; P \u3c 0.02), weights (229.6 vs 225.7 lb; P \u3c 0.05), and body mass index (37.1 vs 36.5 kg/m2; P \u3c 0.05) were statistically improved. Phase III data collection is underway. Conclusion: The Lifestyle Initiative health coaching program significantly improves certain health metrics when applied to health system employees and family members with diabetes or hypertension. Further study is needed to explore sustainability and the effects of more robust programs

Cutlines: UM Graduates

Background: Prenatal care/deliveries within our family medicine clinics have declined, perhaps because patients are unaware that our clinics provide these services. With lower volumes, clinicians may feel less comfortable with current skills/knowledge of obstetric (OB) care. Purpose: Increase family medicine clinic OB numbers, patient awareness, and clinician comfort/knowledge in OB. Methods: English-facile patients (18–50 years), residents and faculty at Aurora family medicine residency clinics were included. Patients were provided preintervention surveys upon check-in. Residents/faculty were surveyed via Survey Monkey. Changes made based on initial survey results were: 1) increasing systemwide awareness that our caregivers provide OB care, through fliers at emergency departments/urgent cares or posters in clinic waiting rooms; 2) keeping at least one same-day visit for OB patients; 3) distributing standard OB note templates to residents/faculty; and 4) placing patient educational handouts at each clinic. Patients, residents and faculty were reassessed at 9 months postintervention. Surveys were analyzed with Fisher’s exact tests. Results: Respondents to the preintervention survey included 83 patients, 26 residents and 19 faculty; 61 patients, 23 residents and 21 faculty responded to the postintervention survey. On both pre- and post-surveys, patients knew that their providers delivered babies (59% vs 57%, respectively; P = 0.86). However, only 22% and 33% of patients, respectively, had a doctor at our clinics deliver their baby or partner’s baby (P = 0.25). Even so, 95% and 100% of patients, respectively, would recommend their friends or family to our family practice clinics if they became pregnant (P = 0.14). On the pre-survey, 38% of residents felt clinic OB numbers were adequate versus 70% following intervention (P \u3c 0.05). On both pre- and post-surveys, residents planned on incorporating obstetric or prenatal care into their future practice (42% vs 52%, respectively; P = 0.57). On both pre- and post-surveys, faculty felt comfortable with OB skills and knowledge (53% vs 62%, respectively; P = 0.75). Lifestyle was the most common reason faculty gave for why they stopped doing deliveries (37% vs 33%, respectively). Conclusion: Implementation of changes to our OB workflow resulted in non-statistically significant improvements in viewpoints toward OB. Resident feelings of OB number adequacy significantly improved following intervention. Further study in multiple clinics could confirm the effectiveness and reasons for success of our interventions

Geographic Distribution of Maternal Group B Streptococcus Colonization and Infant Death During Birth Hospitalization: Eastern Wisconsin

Purpose: Maternal group B Streptococcus (GBS) can be transmitted from a colonized mother to newborn during vaginal delivery and may or may not contribute to infant death. This study aimed to explore the geographic distribution and risk factors of maternal GBS colonization and infant death during birth hospitalization. Methods: We retrospectively studied mothers with live birth(s) in a large eastern Wisconsin hospital system from 2007 through 2013. Associations between maternal and neonatal variables, GBS colonization and infant death were examined using chi-squared, Mann-Whitney U and t-tests. Multivariable logistic regression models also were developed. Results: Study population (N = 99,305) had a mean age of 28.1 years and prepregnancy body mass index (BMI) of 26.7 kg/m2; 64.0% were white, 59.2% married, 39.3% nulliparous and 25.7% cesarean delivery. Mean gestational age was 39.0 weeks. Rate of maternal GBS colonization (22.3% overall) was greater in blacks (34.1% vs. 20.1% in whites, P < 0.0001), unmarried women (25.5% vs. 20.0% married, P < 0.0001), women with sexually transmitted or other genital infections (P < 0.0001) and residents of ZIP code group 532XX (P < 0.0001), and was associated with increasing BMI (P < 0.0001). All predictors of colonization were significant on multivariable analysis. Rate of infant death was 5.7 deaths/1,000 live births (n = 558 excluding lethal anomalies and stillbirths) and was negatively associated with maternal GBS colonization (P < 0.0001). On multivariable analysis, 532XX ZIP code group, lower gestational age, preterm labor, hyaline membrane disease, normal spontaneous vaginal delivery, hydramnios, oligohydramnios and absence of maternal GBS were associated with infant death. Conclusions: Geographic characteristics were associated with infant death and maternal GBS colonization. Further research is needed to determine if increased surveillance or treatment of mothers colonized with GBS decreases the risk of infant demise at birth

Health Care Transitions for Adolescents and Young Adults With Special Health Care Needs: Where Are We Now?

Eventually, all adolescents must “graduate” from pediatric-oriented to adult-oriented health care. This transition, most often occurring during young adulthood, is especially important for adolescents with special health care needs and involves not only primary care physicians, but also both pediatric and adult subspecialists. Several studies support the benefit of transitional programs for adolescents and young adults with special health care needs. Additionally, the American Academy of Pediatrics named transitional care as one of its top priorities. However, transitional programs have yet to become an established norm among hospitals and providers, specifically outside of children’s hospitals. This topic synopsis aims to draw attention to this important issue, review the rationale behind current recommendations and report the current status of transitional programs in North America. Moreover, the steps that individual clinicians, practices and health systems may take to plan for successful health care transitions are discussed

Geodemographic Features of Human Blastomycosis in Eastern Wisconsin

Purpose: Blastomycosis is an endemic fungal infection. In rural northern Wisconsin, blastomycosis cases are associated with certain environmental features including close proximity to waterways. Other studies have associated blastomycosis with particular soil chemicals. However, blastomycosis also occurs in urban and suburban regions. We explored the geodemographic associations of blastomycosis cases in the more urban/suburban landscape of eastern Wisconsin. Methods: We conducted a retrospective study of 193 laboratory-identified blastomycosis cases in a single eastern Wisconsin health system, 2007–2015. Controls were 250 randomly selected cases of community-diagnosed pneumonia from a similar time period. Geographic features of home addresses were explored using Google Maps. Categorical variables were analyzed with chi-square or Fisher’s exact tests and continuous variables by two-sample t-tests. Stepwise regression followed by binary logistic regression was used for multivariable analysis. Results: Compared to pneumonia cases, blastomycosis cases were younger (47.7 vs. 55.3 years) and more likely to be male (67.9% vs. 45.6%), nonwhite (23.2% vs. 9.7%) and machinists, automobile workers/mechanics or construction workers (32.7% vs. 7.2%); P 0.5 acres (30.4% vs. 14.2%, P = 0.0002), be < 0.25 miles from an automobile repair facility or junkyard (35.9% vs. 19.4%, P = 0.0005), and be < 0.1 miles from a park, forest or farm field (54.9% vs. 39.6%, P = 0.002). Only the latter association remained on multivariable analysis. Conclusions: Eastern Wisconsin blastomycosis case subjects were younger, more often male and more likely to live near parks/forests/fields. Novel associations of blastomycosis cases with machinery- and automobile-related occupations and/or facilities should be further explored

Histopathologic chorioamnionitis: geodemographic and clinical predictors

Conclusion: A number of pregnancy variables are predictive of HCA [histopathologic chorioamnionitis] in our births, including Milwaukee 532 zip residence. Fever was absent in nearly half of all deliveries with HCA and in a majority of preterm deliveries with HCA. Following birth, clinician suspicion of CA may help guide neonatal antiobiotic use

Effect of code status handout on resident physician comfort during the admission process

Conclusion: Use of the handout did not show significant improvements to resident comfort in this small pilot. While residents identified that they would use the handout again, several remarked the handout was too long for them or patients to read. Given that the handout was one page and in patient friendly language, it is concerning that residents have such limited time for code status discussions. Future quality improvement studies should be conducted to standardize the code status discussion. Doing so will ensure that every patient is being properly educated on this important topic

Foley catheter placement for induction of labor in the setting of ruptured membranes

Conclusions: Similar to other studies, our case series suggested that the use of Foley catheter for cervical ripening in the state of ruptured membrane is safe and effective. We hope that our case series encourages randomized prospective clinical trials that will further investigate the complications of Foley catheter placement in the state of ruptured membranes, specifically as it relates to: The rate of intrapartum infection when compared to other induction methods The correlation between positive GBS status and Foley catheter placement The effectiveness of Foley catheters as a cervical ripening agent for the induction of labor in PPROM for gestation ages \u3e34 week