Education and referral criteria: impact on oncology referrals to palliative care.

OBJECTIVE: To describe a quality improvement project involving education and referral criteria to influence oncology provider referrals to a palliative care service. METHODS: A single group post-test only quasi-experimental design was used to evaluate palliative care service (PCS) referrals following an intervention consisting of a didactic presentation, education outreach visits (EOV) to key providers, and referral criteria. Data on patient demographics, cancer types, consult volume, reasons for referral, pre-consult length of stay, overall hospital stay, and discharge disposition were collected pre-intervention, then post-intervention for 7.5 months and compared. SETTING AND SAMPLE: Attending oncologists, nurse practitioner, and house staff from the solid tumor division at a 700-bed urban teaching hospital participated in the project. Two geriatricians, a palliative care nurse practitioner, and rotating geriatric fellows staffed the PCS. RESULTS: The percentage of oncology referrals to PCS increased significantly following the intervention (χ(2) = 6.108, p = .013). 24.9% (390) patients were referred in the 4.6 years pre-intervention and 31.5% (106) patients were referred during 7.5 months post-intervention. The proportion of consults for pain management was significantly greater post-intervention (χ(2) = 5.378, p = .02), compared to pre-intervention, when most referrals were related to end-of-life issues. Lung, pancreatic, and colon were the most common cancer types at both periods, and there were no significant differences in patient demographics, pre-referral length of hospitalization or overall hospital days. There was a trend toward more patients being discharged alive following the intervention. CONCLUSION: A quality improvement project supported the use of education and referral criteria to influence both the frequency and reasons for palliative care referral by oncology providers

College Within A College (CwiC) – Population Health

Seminar presentation (55 PowerPoint Slides) The development of programmatic tracks providing students with academic opportunities outside of the traditional medical curriculum represents a national trend in medical education. With HRSA Interdisciplinary and Interprofessional Joint Graduate Degree five-year funding, the Department of Family and Community Medicine at ThomasJeffersonUniversitycreated an Inter-professional Primary Care Dual Degree Program (IPCDDP), which builds on JeffersonMedicalCollege’s College within a College (CwiC) Scholarly Concentrations Program in Population Health. The mission of the IPCDDP is to provide outstanding training in primary care and innovative education in chronic care management and population and public health in order to prepare primary care leaders to serve as future change agents working to improve the health of Americans, especially its most vulnerable and underserved populations. Key CwiC-PH components include: Year 1 – enhanced population health components of Introduction to Clinical Medicine (ICM) I, participation in community health initiatives, journal club, and twice monthly seminars Summer – population health related programs Year 2 – case studies in Fundamentals of Clinical Medicine, twice monthly seminars emphasizing application of the social and behavioral foundations of Public Health Year 3 – On going advising, enhanced clerkship experiences, Capstone planning Year 4 – Two community electives and completion of a Capstone Project Benefits to students include a certificate upon completion of the program, and 15 credits applied to the MPH program at Jefferson. The development, institutional collaboration, and a detailed description of the CwiC – PH program will be presented along with implementation, evaluation, and sustainability plans. Learning Objectives: Participants attending this session will be able to: 1. Organize an approach to integrating population health into health professional’s curriculum 2. Apply a methodology to recruit students into an area of concentration in population health 3. Identify the challenges in curricular reform and innovatio

Association between convalescent plasma treatment and mortality in COVID-19: a collaborative systematic review and meta-analysis of randomized clinical trials.

Funder: laura and john arnold foundationBACKGROUND: Convalescent plasma has been widely used to treat COVID-19 and is under investigation in numerous randomized clinical trials, but results are publicly available only for a small number of trials. The objective of this study was to assess the benefits of convalescent plasma treatment compared to placebo or no treatment and all-cause mortality in patients with COVID-19, using data from all available randomized clinical trials, including unpublished and ongoing trials (Open Science Framework, https://doi.org/10.17605/OSF.IO/GEHFX ). METHODS: In this collaborative systematic review and meta-analysis, clinical trial registries (ClinicalTrials.gov, WHO International Clinical Trials Registry Platform), the Cochrane COVID-19 register, the LOVE database, and PubMed were searched until April 8, 2021. Investigators of trials registered by March 1, 2021, without published results were contacted via email. Eligible were ongoing, discontinued and completed randomized clinical trials that compared convalescent plasma with placebo or no treatment in COVID-19 patients, regardless of setting or treatment schedule. Aggregated mortality data were extracted from publications or provided by investigators of unpublished trials and combined using the Hartung-Knapp-Sidik-Jonkman random effects model. We investigated the contribution of unpublished trials to the overall evidence. RESULTS: A total of 16,477 patients were included in 33 trials (20 unpublished with 3190 patients, 13 published with 13,287 patients). 32 trials enrolled only hospitalized patients (including 3 with only intensive care unit patients). Risk of bias was low for 29/33 trials. Of 8495 patients who received convalescent plasma, 1997 died (23%), and of 7982 control patients, 1952 died (24%). The combined risk ratio for all-cause mortality was 0.97 (95% confidence interval: 0.92; 1.02) with between-study heterogeneity not beyond chance (I2 = 0%). The RECOVERY trial had 69.8% and the unpublished evidence 25.3% of the weight in the meta-analysis. CONCLUSIONS: Convalescent plasma treatment of patients with COVID-19 did not reduce all-cause mortality. These results provide strong evidence that convalescent plasma treatment for patients with COVID-19 should not be used outside of randomized trials. Evidence synthesis from collaborations among trial investigators can inform both evidence generation and evidence application in patient care

College Within A College (CwiC) – Population Health

The development of programmatic tracks providing students with academic opportunities outside of the traditional medical curriculum represents a national trend in medical education. With HRSA Interdisciplinary and Interprofessional Joint Graduate Degree five-year funding, the Department of Family and Community Medicine at ThomasJeffersonUniversitycreated an Inter-professional Primary Care Dual Degree Program (IPCDDP), which builds on JeffersonMedicalCollege’s College within a College (CwiC) Scholarly Concentrations Program in Population Health. The mission of the IPCDDP is to provide outstanding training in primary care and innovative education in chronic care management and population and public health in order to prepare primary care leaders to serve as future change agents working to improve the health of Americans, especially its most vulnerable and underserved populations. Key CwiC-PH components include: Year 1 – enhanced population health components of Introduction to Clinical Medicine (ICM) I, participation in community health initiatives, journal club, and twice monthly seminars Summer – population health related programs Year 2 – case studies in Fundamentals of Clinical Medicine, twice monthly seminars emphasizing application of the social and behavioral foundations of Public Health Year 3 – On going advising, enhanced clerkship experiences, Capstone planning Year 4 – Two community electives and completion of a Capstone Project Benefits to students include a certificate upon completion of the program, and 15 credits applied to the MPH program atJefferson. The development, institutional collaboration, and a detailed description of the CwiC – PH program will be presented along with implementation, evaluation, and sustainability plans. Learning Objectives: Participants attending this session will be able to: 1. Organize an approach to integrating population health into health professional’s curriculum 2. Apply a methodology to recruit students into an area of concentration in population health 3. Identify the challenges in curricular reform and innovatio

Moving From Street to Home: Health Status of Entrants to a Housing First Program

Housing First (HF) is an evidence-based practice that ends chronic homelessness for individuals with serious mental illness by providing immediate access to permanent independent housing and team-based community supports. Little is known about the health status of homeless individuals entering HF programs. Through a cross-sectional analysis, this paper reports on the chronic physical disease burden of people entering a newly established HF program and examines whether these individuals recognize and request support for ongoing health-related issues. The authors’ evaluation confirmed significantly higher rates of chronic disease (60%) and fair/poor self-reported health status (47%) than the general urban population of Philadelphia. The majority of clients reported they wanted to address both medical (67%) and mental health (68%) problems, but a much lower percentage reported wanting to reduce substance use (23%) or take psychiatric medications (25%). The authors conclude that formerly homeless entrants to HF programs have a high burden of chronic disease with complex health-related needs. Additionally, these individuals look to the program for health-related assistance. As the HF model is disseminated throughout the United States to end chronic homelessness, these findings support the development of flexible, integrated, person-centered health services within the HF service delivery system as a potentially effective method to address complex health needs

Individual agency, community capacity building, and chronic illness care: Using participatory methods to implement the Stanford Chronic Disease Self Management Program in a Housing First Program

Research questions: Is a standardized chronic disease self management program (CDSMP) experienced as a valuable intervention by Pathways\u27 consumers? What is the impact of collaborative inquiry into health program development on participant\u27s critical agency

Public Health in Undergraduate Medical Education—An Innovative Four-Year Area of Concentration

The development of programmatic tracks providing students with academic opportunities outside of the traditional medical curriculum represents a national trend in medical education. With five-year HRSA funding, TJUSKMC created a four year longitudinal area of concentration in Population Health. Key components include: Year 1 – enhanced population health components of Introduction to Clinical Medicine, community immersions Summer – population health related programs locally and globally Year 2 – case studies linked to Fundamentals of Clinical Medicine applying social and behavioral foundations of Public Health Year 3 – enhanced clerkship experiences Year 4 – community-based electives and completion of a Capstone Project. Five cohorts (180 students) have entered the program with benefits including a certificate upon program completion, recognition in Dean’s letters, and 15 credits applied to the Jefferson MPH program. A description of the program will be presented along with characteristics of enrolled students, implementation, evaluation, and sustainability plans in the SKMC’s Second Centennial Curriculum. Objectives: Participants viewing this poster should be able to: 1. Organize an approach to integrating population health content into a health professional curriculum. 2. Apply a methodology to recruit students into an area of concentration in population health. 3. Identify the challenges inherent in curricular reform and innovation

College within the College: Population Health

Rationale: The current approach to educating health professionals has not kept pace with the needs of our growingly diverse population. -Health Professional Education for the 21st Century-The Lancet -Institute of Medicine -APTR/CDC/AAMC-Patients and Populations. Public Health in Medical Education JMC Leadership and Curriculum Committee-one year planning process-2009-201