Teaching First-year Medical Students to Apply Evidence-based Practices to Patient Care

Evidence-based medicine (EBM) is the integration of individual clinical expertise with the best available evidence from systematic research. 1-2 Most teaching of EBM for medical students currently takes place in classroom settings that feature teacher-centered didactic activities. When EBM is taught in this manner, the teaching appears not to influence patient care or to ensure that medical students are prepared to apply EBM at the point of care. 7 It is not surprising, then, that there is a continuing need to introduce and sharpen EBM skills among faculty who teach medical students in ambulatory clinical settings while managing the care of patients. 8 Earlier studies of EBM suggest that even at the preclinical level of training, medical students can learn EBM principles, formulate clinical questions, and receive evidence-based feedback from their teachers. Methods This EBM module is the third in a series of educational interventions that we implemented in the Texas Statewide Family Medicine Preceptorship Program (TSFMPP) between years one and two of medical training. Internal Review Board approval was obtained for the interventions used in this study. During the first year of each intervention, the educational materials were tested, and the students' participation was voluntary. In the following two summers

Using Electronic Reminders to Improve Human Papillomavirus (HPV) Vaccinations among Primary Care Patients

The COVID-19 pandemic led to delays in routine preventative primary care and declines in HPV immunization rates. Providers and healthcare organizations needed to explore new ways to engage individuals to resume preventive care behaviors. Thus, we evaluated the effectiveness of using customized electronic reminders with provider recommendations for HPV vaccination to increase HPV vaccinations among adolescents and young adults, ages 9-25. Using stratified randomization, participants were divided into two groups: usual care (control) (N = 3703) and intervention (N = 3705). The control group received usual care including in-person provider recommendations, visual reminders in exam waiting rooms, bundling of vaccinations, and phone call reminders. The intervention group received usual care and an electronic reminder (SMS, email or patient portal message) at least once, and up to three times (spaced at an interval of 1 reminder per month). The intervention group had a 17% statistically significantly higher odds of uptake of additional HPV vaccinations than the usual care group (Adjusted Odds Ratio: 1.17, 95% CI: 1.01-1.36). This work supports previous findings that electronic reminders are effective at increasing immunizations and potentially decreasing healthcare costs for the treatment of HPV-related cancers

Creating and Activating an Implementation Community to Drive HPV Vaccine Uptake in Texas: The Role of an NCI-Designated Cancer Center

The University of Texas MD Anderson Cancer Center, a comprehensive cancer center designated by the National Cancer Institute (NCI), defines its service population area as the State of Texas (29.1 M), the second most populous state in the country and the state with the greatest number of uninsured residents in the United States. Consistent with a novel and formal commitment to prevention as part of its core mission, alongside clear opportunities in Texas to drive vaccine uptake, MD Anderson assembled a transdisciplinary team to develop an institutional Framework to increase adolescent HPV vaccination and reduce HPV-related cancer burden. The Framework was developed and activated through a four-phase approach aligned with the NCI Cancer Center Support Grant Community Outreach and Engagement component. MD Anderson identified collaborators through data-driven outreach and constructed a portfolio of collaborative multi-sector initiatives through review processes designed to assess readiness, impact and sustainability. The result is an implementation community of 78 institutions collaboratively implementing 12 initiatives within a shared measurement framework impacting 18 counties. This paper describes a structured and rigorous process to set up the implementation of a multi-year investment in evidence-based strategies to increase HPV vaccination that solves challenges preventing implementation of recommended strategies and to encourage similar initiative replication

Readiness of primary care clinicians to implement lung cancer screening programs

We examined the readiness of primary care clinicians to implement lung cancer screening programs in their practice settings in light of recent policy changes in the U.S. Attendees of two large continuing medical education events in Texas held in October and November of 2014 completed surveys about their current lung cancer screening practices and implementation needs. Surveys were completed by 350 participants (57.2% of registered attendees). Although 89.5% of participants routinely screened their patients for tobacco use, only 10.1% had a formal lung cancer screening program in their practice. More than half (56.0%) planned to refer eligible patients for lung cancer screening, 35.6% were not sure, and 8.3% did not plan to refer. Priority areas for implementing lung cancer screening programs in their settings included 1) greater clarity about coverage by private insurance and Medicare, 2) information about available screening centers offering low-dose computed tomography, 3) patient education and shared decision-making tools, 4) implementation toolkits and training for clinic staff, 5) integrating screening programs in electronic health records, and 6) more clarity about clinical guidelines. Practical needs related to identifying eligible patients, referral to screening centers, and tools for shared decision-making must be addressed before lung cancer screening can be implemented on a national scale

Chapter 08: Work that Takes Eternal Optimism

Dr. Foxhall responds to a question about those particular gifts that suit him and others to policy work. He explains that a focus on outreach beyond the institution is key, as well as a comfort with collaboration. He also talks about the commitment to the institution and to its mission to cure cancer and a commitment to a sense of equity in reaching out to all patients. It’s a challenge financially to do that in an environment of limited funding and requires a high level of patience, persistence, and optimism to move issues forward.https://openworks.mdanderson.org/mchv_interviewchapters/1854/thumbnail.jp

Lewis E. Foxhall, MD, Oral History Interview, March 11, 2014

Major Topics Covered: Personal and educational background; a Texas upbringing and education Interests in primary clinical care, health populations, cancer prevention, and tobacco The Physician Relations Program Health policy work at MD Anderson Charity care programs External networks and initiatives with health care providers Texas state law, health care delivery, the Affordable Care Act, healthcare economics Survivorship Programs Value based carehttps://openworks.mdanderson.org/mchv_interviewsessions/1137/thumbnail.jp

Chapter 10: The Texas Cancer Data Center

He explains the funding and mission to collect information from the state cancer registry and convert it to a searchable system that includes statistics on patients and other information. He explains how the system evolved, shifts in its management, and the programs it includes. He notes that a related education program has reached about 500 nurses and 1000 social workers with information about programs for patients. He notes that this was one of the first data centers of this type in the country. Dr. Foxhall notes partnerships with the American Cancer Society and with other public health agencies to educate patients about cancer risk. He also notes the work with the Harris County Healthcare Alliance to support prevention programs in community clinics and improve access to healthcare for low income patients. (Additional information on the Texas Cancer Data Center is presented in Segment 09.)https://openworks.mdanderson.org/mchv_interviewchapters/1856/thumbnail.jp

Chapter 16: Projects in Cancer Prevention; the Lung Cancer Moonshot; CYCORE

In this segment, Dr. Foxhall talks a cancer prevention programs and the place of the lung cancer screening trial in the Lung Cancer Moon Shot. He then talks about CYCORE, a program that uses electronic devices to address patient needs and treatments. This project was funded by stimulus money and uses a tele-monitoring device created by Time Warner. He describes some of the benefits and also mentions the video conferencing systems that can support patients. Dr. Foxhall notes that the Office tries to keep up with the latest electronic advances that can help patients.https://openworks.mdanderson.org/mchv_interviewchapters/1862/thumbnail.jp

Chapter 22: The Future Under the Affordable Care Act: the Value of Prevention Services

In this segment, Dr. Foxhall sketches what the future looks like under the Affordable Care Act, noting that a change in leadership in Texas might change any predictive scenario and the state will continue to have poor and undocumented individuals to cover. Dr. Foxhall explains that the focus on preventive services is a very positive feature of the ACA. He explains the requirements and notes the benefits that can come from screening services and tobacco cessation programs. He cites statistics for the increase cancer risk that comes with smoking and obesity. He explains why institutions tend not to invest in prevention, noting that the ACA is unusual in adding this to its requirements. In conclusion, Dr. Foxhall notes that the ACA is “still a political football” and that politics has an impact on each decision connected with it.https://openworks.mdanderson.org/mchv_interviewchapters/1868/thumbnail.jp

Chapter 21: MD Anderson’s Response to the Affordable Care Act; ACA Requirements; Value-Based Purchasing

In this segment, Dr. Foxhall continues discussion of the Affordable Care Act. He sketches MD Anderson’s programs to help with financial assistance. He then talks about the requirement that institutions report on the quality of care. He gives examples to explain what is involved in this process, noting that historically, medical practices have not had enough transparency in care and outcomes. Reporting enables consumers to have a better idea of how well providers are doing. In addition, this information will be used as a basis for determining payment. Next Dr. Foxhall explains that the ACA requires that institutions participate in an Accountable Care Organization. He explains the reasoning for this, and notes that it is not clear how a specialized hospital will engage with them. Next Dr. Foxhall talks about the ACA’s requirement for Value-Based Purchasing, giving examples of how examining processes has revealed unnecessary costs in deliver of care.https://openworks.mdanderson.org/mchv_interviewchapters/1867/thumbnail.jp