Enhancing Sexually Transmitted Infection Notification: A Quality Improvement Collaborative Case Report

This case study illustrates how a quality improvement (QI) Collaborative supports an implementation study of using mobile phone texting technology for notification of sexually transmitted infections (STI) test results. The County Health Departments making up the QI Collaborative meet monthly to discuss their progress in using QI to advance the use of texting for STI test results. The main purpose of QI Collaboratives is to maximize implementation outcomes through sharing of successes and challenges. The case study report describes how implementation research can adapt to the context of each unique CHD and the users of new knowledge rather than emphasizing the creation of new knowledge

Seeing the quality improvement forest through the quality improvement trees: A meta-synthesis of case studies in Florida and Georgia

Objectives: To identify important characteristics of quality improvement applications for population health and healthcare settings and to explore the use of quality improvement as a model for implementing and disseminating evidence-based or best practices. Methods: A meta-synthesis was used to examine published quality improvement case studies. A total of 10 published studies that were conducted in Florida and Georgia were examined and synthesized using meta-synthesis (a qualitative research methodology) for meaningful insights and lessons learned using defined meta-synthesis inclusion criteria. The primary focus of the analysis and synthesis were the reported processes and findings that included responses to structured questioning in addition to emergent results from direct observation and semi-structured open-ended interviewing. Results: The key insights for the use of quality improvement in public health and healthcare settings included (1) the essential importance of data monitoring, analysis, and data-based decision making; (2) the need to focus on internal mutable factors within organizations; (3) the critical role of quality improvement team group dynamics; (4) the value of using a quality improvement collaborative or multi-clinic quality council/committee for sharing and comparing performance on key metrics; and (5) the need to identify a quality improvement approach and methods for clarification as a structured quality improvement intervention. Conclusion: In addition to the advantages of using quality improvement to enhance or improve healthcare and public health services, there is also potential for quality improvement to serve as a model for enhancing the adoption of evidence-based practices within the context of dissemination and implementation research

Project Save Lives: Rapid treatment protocol using peer recovery specialists in the emergency department

Background: Overdose deaths involving opioids, heroin, and fentanyl-class drugs have dramatically increased in the United States in the last decade. In response to the epidemic, the City of Jacksonville (Florida) and local providers came together and developed a plan to reduce repeat overdoses and deaths called Project Save Lives (PSL). PSL utilized Certified Recovery Peer Specialists (CRPS) to engage overdose victims immediately following opioid overdose reversal and offered medication-assisted treatment, recovery support, overdose prevention services, and transportation to detox/treatment services all initiated within the Emergency Department (ED).&nbsp;Methods: This is an observational study of opioid related overdose victims who presented at a local health system’s two emergency departments from 11/16/2017 to 05/31/2018 and were tracked for 6 months after their initial index visit. Patients were tracked as 2 separate groups: those who were approached by a CRPS during their ED visit and those who did not have contact with a CRPS due to the staffing schedule (intake days versus non-intake days). Data collected included repeat overdoses, substance use treatment services received, and opioid related deaths from the initial index visit.Results: There were 45 individuals seen in the two participating EDs for an opioid related overdose on non-intake days (comparison group) and 101 individuals were seen on intake days (cases). Of the 101 patients that were approached by the CRPS in the ED during the 6 month evaluation period, 32 individuals accessed some type of substance use treatment and of those, 24 received medication assisted treatment. Both groups experienced a decrease in repeat overdoses during the post index visit 6 month period; however, those who declined to participate in PSL included individuals who had multiple overdoses during their post index visit period as compared to those who received treatment through the PSL program.&nbsp;Conclusions: The PSL program resulted in increasing access to and participation in substance use treatment programs. Immediate engagement by a CRPS with direct linkage to substance use treatment services in the ED is demonstrating to be an effective method in addressing the opioid epidemic. Additional research is needed to evaluate the long-term impact of ED engagement programs.&nbsp;</p

Socioeconomic Status, Race and Parental Initial Response to Children’s Mental Illness

To examine how socioeconomic status (SES) and race affect parents\u27 initial response (IR) to their child’s mental illness (MI) including 1. Parental confidant(s); 2. Lag time in professional help-seeking; and 3. Referral source. 70 parents of patients new to a Child Psychiatry clinic completed a survey to assess their IR to their child’s MI. SES was determined using the United States Census Bureau median income by zip codes. Summary statistics are frequencies and percentages for categorical data, and medians and quartiles for continuous data. Twenty-five percent of parents reported low SES and 31% Non-Caucasian Children (NCC). Confidants of Caucasian and NCC were Pediatrician (77% vs 50%, p = 0.03), and family (73% vs 32%, p = 0.002). Comparing help-seeking Lag Times 66% reported a delay of 1 year or more (p = 0.040). Overall Pediatricians were the leading confidant. Lag times were one year or more with stronger trends in NCC

Gunshot wound incidence as a persistent, tragic symptom of area deprivation

Background: More than 30,000 Americans die every year of firearm-related injuries. Gun violence is frequently addressed by law enforcement and policing, as opposed to public health interventions that might address poverty or deprivation. Our goal was to evaluate the past 20 years of gunshot wound injury demographics seen at our level I academic trauma center and create a risk map model correlating gunshot wound incidence with area deprivation. Methods: Patients admitted for gunshot wound-related injuries between 1996 and 2017 were identified using our trauma registry. Demographic and injury data were extracted and analyzed. Multivariable logistic regression models were created to identify predictors of mortality. Geographic information system mapping of incident location and home address was completed to identify zip code hot spots of high gunshot wound incidence. Area Deprivation Indices, which reflect local income or poverty, housing, education, and employment were used as a marker of relative economic disadvantage. Spearman rank correlation was used to determine the relationship between Area Deprivation Indices score and gunshot wound rate. Results: A total of 2,413 patients with gunshot wounds were evaluated. The cohort had a mean age of 28.8 ± 11.5 and was 89.6% male. Mean Injury Severity Score was 11 ± 12.5. gunshot wounds were most frequently a result of assault (91.1%), followed by unintentional injury (3.4%). Geographic information systems mapping revealed significant clustering of gunshot wounds. The areas with highest per capita incidence of gunshot wounds was strongly correlated with Area Deprivation Indices (0.594, P \u3c .001). Conclusion: Geographic regions of known lower socioeconomic resources have higher incidence of gunshot wounds in our community. Both Area Deprivation Indices and gunshot wound incidents in these distressed communities remained unchanged throughout the past 20 years, despite law enforcement crime suppression efforts. Gunshot wounds appear to be a symptom of area deprivation, similar to failing schools and poor health outcomes. Efforts to decrease poverty and community capacity-building may help alleviate this area deprivation

An Elephant in the Emergency Department: Symptom of Disparities in Cancer Care

Reliance on emergency departments (EDs) by economically disadvantaged people for initial cancer diagnosis in place of primary care and early diagnosis and treatment is 1 obvious plausible explanation for cancer disparities. Claims data from a safety net hospital for the years 2009–2010 were merged with hospital tumor registry data to compare hospitalizations for ED-associated initial cancer diagnoses to non–ED associated initial diagnoses. The proportion of initial cancer diagnoses associated with hospital admissions through the ED was relatively high (32%) for all safety net hospital patients, but disproportionately higher for African Americans and residents of the impoverished urban core. Use of the ED for initial diagnosis was associated with a 75% higher risk of stage 4 versus stage 1 cancer diagnosis, and a 176% higher risk of dying during the 2-year study period. Findings from this study of ED use within a safety net hospital documented profound disparities in cancer care and outcomes with major implications for monitoring disparities, Affordable Care Act impact, and safety net hospital utilization