Searched for: person:mahowc01
HERE A CLOT, THERE A CLOT, EVERYWHERE A CLOT: A CASE OF VENOUS AND ARTERIAL THROMBI IN A PATIENT WITH COVID-19 [Meeting Abstract]
Li-Geng, Tony; Mahowald, Carrie
ISI:000709108700261
ISSN: 0012-3692
CID: 5527202
ACUTE MANIA: AN UNUSUAL PRESENTATION OF SMALL CELL LUNG CANCER [Meeting Abstract]
Li, P.; Hayon, J.; Mahowald, C.
ISI:000546434900262
ISSN: 0012-3692
CID: 4573302
Promoting high-value practice by standardizing communication between the hospitalist and primary care provider during hospitalization [Meeting Abstract]
Moussa, M; Mahowald, C; Okamura, C; Ksovreli, O; Aye, M; Weerahandi, H
Statement of Problem Or Question (One Sentence): The increasing complexity of admitted patients, shorter hospital stays and post-acute care adverse events demand a more sophisticated and effective coordination of care between hospitalists and Primary care providers (PCPS). Objectives of Program/Intervention (No More Than Three Objectives): 1. Standardizing communication between Hospitalist and PCP during hospitalization will lower the rate of readmission due to lack of PCP follow up and post-acute care adverse events. 2. Implementing this practice into our daily workflow will improve PCP satisfaction and increase referrals to our institution. Description of Program/Intervention, Including Organizational Context (E.G. Inpatient Vs. Outpatient, Practice or Community Characteristics): We reviewed a root-cause survey of 30 day readmissions between 1/2018-4/2018 as well as readmission rates for each of our hospitalists. We surveyed our PCPS' satisfaction with communication experiences with our hospitalist group. Finally, we conducted a semi-structured interview of the hospitalist with the lowest readmission (8% vs 12% average for other hospitalists) and highest PCP satisfaction rates, Dr. A, to develop best practices for closed loop communication. Based on this data, we designed a protocol and piloted on 5/1/2018, where the hospitalist contacts the PCP via phone call on admission and delivers a discharge narrative to the PCP via our EMR's routing capability. We used a trackable smart phrase to document the communication. For the prospective phase, we will operationalize these best practices in a study group, Family Health Center PCPS. A control group (community PCPS) will receive usual practice. Measures of Success (Discuss Qualitative And/Or Quantitative Metrics Which Will Be Used To Evaluate Program/Intervention): We will compare readmission rates between the study group and control group, monitoring the proportion and absolute number of readmissions attributed to no PCP follow up or medication errors. Follow up satisfaction surveys will be sent to the PCPS 6 months after our revised communication practice. Finally, we will monitor the hospitalists' compliance with the smart phrase. Findings To Date (It Is Not Sufficient To State Findings Will Be Discussed): A review of our institution's 30 day readmissions between 1/2018-4/2018 found that 19% were attributed to lack of PCP/outpatient provider follow-up. Surveys of our community PCPS showed 70% reported being contacted by the hospitalist group in less than 25% of the time. Results from Dr. A's interview revealed that after her encounter with the patient, she calls the patient's PCP highlighting the admitting diagnosis, significant events, pertinent labs, imaging and medications. Dr. A then delivers a discharge narrative to the PCP on the day of discharge highlighting any medication changes, incidental findings and follow up. On a random audit of 100 charts between 5/1/2018-10/30/2018 our preliminary data show that there was 88% compliance with using the smart phrase by the hospitalists. Key Lessons For Dissemination (What Can Others Take Away For Implementation To Their Practice Or Community?): Using a "positive deviance" approach, we identified best practices for hospitalist-PCP closed loop communication to develop an intervention to improve this aspect of care. If we are successful in reducing readmission rates and improving PCP satisfaction, we will expand to all of our PCPS and ultimately expand to other services to implement this program as best practice
EMBASE:629003928
ISSN: 1525-1497
CID: 4052712
A primary care residency's core DNA inserted at program outset to bloom into a tight spiral curriculum [Meeting Abstract]
Greene, R E; Adams, J; Zabar, S; Caldwell, R; Chuang, L; Mahowald, C; Aliabadi, N; Hanley, K; Chang, A A; Cameron, J; Lipkin, M
NEEDS AND OBJECTIVES: Our annual residency retreat brainstorms innovations to meet needs. In 2010 needs were: to introduce foundation concepts and enable primary care (PC) residents to feel/be competent in clinic earlier; to spiral learning of core concepts, skills and attitudes from the start; and to have residents and faculty connect from the outset.We aim to equip PC clinicians to deliver bio-psychosocial, comprehensive, best evidence-based systems savvy care and to become change agents, leaders, and scholars. To meet these aims we designed a learner centered, team oriented, skills-based Essentials for PC Clinicians (EPIC) curriculum utilizing an initial, rigorous 4 week block with spiral reinforcement through 3 years. The innovation is a comprehensive, reproducible, effective method to ensure residents' progress on paths of clinical, humanistic, and intellectual excellence consistent with the generalist paradigm. SETTING AND PARTICIPANTS: EPIC is part of the NYU Internal Medicine PC Residency. Residents attend public hospital and community continuity clinics. 8 interns take the EPIC block and 24 residents spiral through the curriculum. DESCRIPTION: EPIC begins with a 4 week intern block dedicated to core topics in PC; is reinforced in precepting and subsequent blocks; and has a weekly EPIC conference where these topics are deepened and extended. EPIC Block: The overarching themes throughout the 4 weeks focus on understanding and practice of core skills: workshops/precepting on time management, efficient use of EHR, obtaining best practices, consultation, how one learns best, practice in the medical home and engaging community resources. Week 1 focuses on diabetes, and introduces the pillars: psychosocial medicine, evidence-based practice, and systems-based policy awareness and skill. The second week focuses on hypertension. The last 2 weeks introduce 7 common, high-risk high gain conditions from smoking to hepatitis B. Teaching methods combine group learning and reflective written exercises!
EMBASE:71297542
ISSN: 0884-8734
CID: 783112