Try a new search

Format these results:

Searched for:



Total Results:


Addressing social determinants of health in primary care: a quasi-experimental study using unannounced standardised patients to evaluate the impact of audit/feedback on physicians' rates of identifying and responding to social needs

Gillespie, Colleen; Wilhite, Jeffrey A; Hanley, Kathleen; Hardowar, Khemraj; Altshuler, Lisa; Fisher, Harriet; Porter, Barbara; Wallach, Andrew; Zabar, Sondra
BACKGROUND:Although efforts are underway to address social determinants of health (SDOH), little is known about physicians' SDOH practices despite evidence that failing to fully elicit and respond to social needs can compromise patient safety and undermine both the quality and effectiveness of treatment. In particular, interventions designed to enhance response to social needs have not been assessed using actual practice behaviour. In this study, we evaluate the degree to which providing primary care physicians with feedback on their SDOH practice behaviours is associated with increased rates of eliciting and responding to housing and social isolation needs. METHODS:Unannounced standardised patients (USPs), actors trained to consistently portray clinical scenarios, were sent, incognito, to all five primary care teams in an urban, safety-net healthcare system. Scenarios involved common primary care conditions and each included an underlying housing (eg, mould in the apartment, crowding) and social isolation issue and USPs assessed whether the physician fully elicited these needs and if so, whether or not they addressed them. The intervention consisted of providing physicians with audit/feedback reports of their SDOH practices, along with brief written educational material. A prepost comparison group design was used to evaluate the intervention; four teams received the intervention and one team served as a 'proxy' comparison (no intervention). Preintervention (February 2017 to December 2017) rates of screening for and response to the scripted housing and social needs were compared with intervention period (January 2018 to March 2019) rates for both intervention and comparison teams. RESULTS:108 visits were completed preintervention and 183 during the intervention period. Overall, social needs were not elicited half of the time and fully addressed even less frequently. Rates of identifying the housing issue increased for teams that received audit/feedback reports (46%-60%; p=0.045) and declined for the proxy comparison (61%-42%; p=0.174). Rates of responding to housing needs increased significantly for intervention teams (15%-41%; p=0.004) but not for the comparison team (21%-29%; p=0.663). Social isolation was identified more frequently postintervention (53%) compared with baseline (39%; p=0.041) among the intervention teams but remained unchanged for the comparison team (39% vs 32%; p=0.601). Full exploration of social isolation remained low for both intervention and comparison teams. CONCLUSIONS:Results suggest that physicians may not be consistently screening for or responding to social needs but that receiving feedback on those practices, along with brief targeted education, can improve rates of SDOH screening and response.
PMID: 35623722
ISSN: 2044-5423
CID: 5284022

Correction: Educational training to improve opioid overdose response among health center staff: a quality improvement initiative

Stephenson, Audrey; Calvo-Friedman, Alessandra; Altshuler, Lisa; Zabar, Sondra; Hanley, Kathleen
PMID: 37533047
ISSN: 1477-7517
CID: 5618962

Educational training to improve opioid overdose response among health center staff: a quality improvement initiative

Stephenson, Audrey; Calvo-Friedman, Alessandra; Altshuler, Lisa; Zabar, Sondra; Hanley, Kathleen
BACKGROUND:There were seven opioid overdoses in this New York City (NYC) federally qualified health center from December 2018 through February 2019, reflecting the rising rate of overdose deaths in NYC overall at the time. In response to these overdoses, we sought to increase the readiness of health center staff to recognize and respond to opioid overdoses and decrease stigmatizing attitudes around opioid use disorder (OUD). METHODS:An hour-long training focusing on opioid overdose response was administered to clinical and non-clinical staff of all levels at the health center. This training included didactic education on topics such as the overdose epidemic, stigma around OUD, and opioid overdose response, as well as discussion. A structured assessment was administered immediately before and following the training to evaluate change in knowledge and attitudes. Additionally, participants completed a feedback survey immediately after the training to assess acceptability. Paired t-tests and analysis of variance tests were used to assess changes in pre- and post-test scores. RESULTS:Over 76% of the health center staff participated in the training (N = 310). There were large and significant increases in mean knowledge and attitudinal scores from pre- to post-test (p < .001 and p < .001, respectively). While there was no significant effect of profession on attitudinal change scores, profession did have a significant effect on knowledge change scores, with administrative staff, non-clinical support staff, other healthcare staff, and therapists learning significantly more than providers (p < .001). The training had high acceptability among participants from diverse departments and levels. CONCLUSIONS:An interactive educational training increased staff's knowledge and readiness to respond to an overdose as well as improved attitudes toward individuals living with OUD. TRIAL REGISTRATION/BACKGROUND:This project was undertaken as a quality improvement initiative at the health center and as such was not formally supervised by the Institutional Review Board per their policies. Further, per the guidelines of the International Committee of Medical Journal Editors, registration is not necessary for clinical trials whose sole purpose is to assess an intervention's effect on providers.
PMID: 37391790
ISSN: 1477-7517
CID: 5538762

Comparison of Primary Care Patients"™ and Unannounced Standardized Patients"™ Perceptions of Care

Altshuler, Lisa; Fisher, Harriet; Wilhite, Jeffrey; Phillips, Zoe; Holmes, Isaac; Greene, Richard E.; Wallach, Andrew B.; Smith, Reina; Hanley, Kathleen; Schwartz, Mark D.; Zabar, Sondra
The objective of this study was to compare unannounced standardized patient (USP) and patient reports of care. Patient satisfaction surveys and USP checklist results collected at an urban, public hospital were compared to identify items included in both surveys. Qualitative commentary was reviewed to better understand USP and patient satisfaction survey data. Analyses included χ2 and Mann-Whitney U test. Patients provided significantly higher ratings on 10 of the 11 items when compared to USPs. USPs may provide a more objective perspective on a clinical encounter than a real patient, reinforcing the notion that real patients skew overly positive or negative.
ISSN: 2374-3735
CID: 5446962

Understanding medical student paths to communication skills expertise using latent profile analysis

Altshuler, Lisa; Wilhite, Jeffrey A.; Hardowar, Khemraj; Crowe, Ruth; Hanley, Kathleen; Kalet, Adina; Zabar, Sondra; Gillespie, Colleen; Ark, Tavinder
Purpose: To describe patterns of clinical communication skills that inform curriculum enhancement and guide coaching of medical students. Materials and methods: Performance data from 1182 consenting third year medical students in 9 cohorts (2011"“2019), on a 17-item Clinical Communication Skills Assessment Tool (CCSAT) completed by trained Standardized Patients as part of an eight case high stakes Comprehensive Clinical Skills Exam (CCSE) were analyzed using latent profile analysis (LPA). Assessment domains included: information gathering (6 items), relationship development (5 items), patient education (3 items), and organization/time management (3 items). LPA clustered learners with similar strength/weakness into profiles based on item response patterns across cases. One-way analysis of variance (ANOVA) assessed for significant differences by profile for CCSAT items. Results: Student performance clustered into six profiles in three groups, high performing (HP1 and HP2-Low Patient Education, 15.7%), average performing (AP1 and AP2-Interrupters, 40.9%), and lower performing profiles (LP1-Non-interrupters and LP2, 43.4%) with adequate model fit estimations and similar distribution in each cohort. We identified 3 CCSAT items that discriminated among learner"™s skill profiles. Conclusion: Clinical communication skill performance profiles provide nuanced, benchmarked guidance for curriculum improvement and tailoring of communication skills coaching.
ISSN: 0142-159x
CID: 5460042

Study design of BETTER-BP: Behavioral economics trial to enhance regulation of blood pressure

Dodson, John A; Schoenthaler, Antoinette; Fonceva, Ana; Gutierrez, Yasmin; Shimbo, Daichi; Banco, Darcy; Maidman, Samuel; Olkhina, Ekaterina; Hanley, Kathleen; Lee, Carson; Levy, Natalie K; Adhikari, Samrachana
BACKGROUND/UNASSIGNED:Nonadherence to antihypertensive medications remains a persistent problem that leads to preventable morbidity and mortality. Behavioral economic strategies represent a novel way to improve antihypertensive medication adherence, but remain largely untested especially in vulnerable populations which stand to benefit the most. The Behavioral Economics Trial To Enhance Regulation of Blood Pressure (BETTER-BP) was designed in this context, to test whether a digitally-enabled incentive lottery improves antihypertensive adherence and reduces systolic blood pressure (SBP). DESIGN/UNASSIGNED:BETTER-BP is a pragmatic randomized trial conducted within 3 safety-net clinics in New York City: Bellevue Hospital Center, Gouveneur Hospital Center, and NYU Family Health Centers - Park Slope. The trial will randomize 435 patients with poorly controlled hypertension and poor adherence (<80% days adherent) in a 2:1 ratio (intervention:control) to receive either an incentive lottery versus passive monitoring. The incentive lottery is delivered via short messaging service (SMS) text messages that are delivered based on (1) antihypertensive adherence tracked via a wireless electronic monitoring device, paired with (2) a probability of lottery winning with variable incentives and a regret component for nonadherence. The study intervention lasts for 6 months, and ambulatory systolic blood pressure (SBP) will be measured at both 6 and 12 months to evaluate immediate and durable lottery effects. CONCLUSIONS/UNASSIGNED:BETTER-BP will generate knowledge about whether an incentive lottery is effective in vulnerable populations to improve antihypertensive medication adherence. If successful, this could lead to the implementation of this novel strategy on a larger scale to improve outcomes.
PMID: 36573193
ISSN: 2772-4875
CID: 5395042

Using Latent Profile Analysis to Describe and Understand Medical Student Paths to Communication Skills Expertise

Altshuler, Lisa; Ark, Tavinder; Wilhite, Jeffrey; Hardowar, Khemraj; Crowe, Ruth; Hanley, Kathleen; L Kalet, Adina; Zabar, Sondra; Gillespie, Colleen
PMID: 36287681
ISSN: 1938-808x
CID: 5358002

Using Latent Profile Analysis to Describe and Understand Medical Student Paths to Communication Skills Expertise

Altshuler, Lisa; Ark, Tavinder; Wilhite, Jeffrey; Hardowar, Khemraj; Crowe, Ruth; Hanley, Kathleen; L Kalet, Adina; Zabar, Sondra; Gillespie, Colleen
PMID: 37460497
ISSN: 1938-808x
CID: 5535522

Does it get better? An ongoing exploration of physician experiences with and acceptance of telehealth utilization

Wilhite, Jeffrey A; Phillips, Zoe; Altshuler, Lisa; Fisher, Harriet; Gillespie, Colleen; Goldberg, Eric; Wallach, Andrew; Hanley, Kathleen; Zabar, Sondra
INTRODUCTION/BACKGROUND:COVID-19 forced health systems to rapidly implement telehealth for routine practice, often without sufficient training or standards. We conducted a longitudinal survey of physicians to explore changes in their perceptions of the challenges and benefits of telehealth and identify recommendations for future practice. METHODS:An anonymous online survey was distributed to a cohort of internal medicine physicians in May to June 2020 and March to June 2021. Changes in responses between 2020 and 2021 and by site (private vs. public) were described. These findings, along with those of a thematic analysis of open-ended responses to questions on telehealth experiences, informed a set of recommendations. RESULTS: = 0.027). Physicians' open-ended responses identified recommendations for further improving the design and use of telehealth. DISCUSSION/CONCLUSIONS:Results suggest that physician experience with telehealth improved but opportunities for training and improved integration remain. Longitudinal assessment can deepen understanding of the evolution of telehealth care.
PMID: 36221982
ISSN: 1758-1109
CID: 5360972

"I Don't Trust It": Use of a Routine OSCE to Identify Core Communication Skills Required for Counseling a Vaccine-Hesitant Patient

Wilhite, Jeffrey A; Zabar, Sondra; Gillespie, Colleen; Hauck, Kevin; Horlick, Margaret; Greene, Richard E; Hanley, Kathleen; Adams, Jennifer
BACKGROUND:Vaccine hesitancy is challenging for clinicians and of increasing concern since COVID-19 vaccination rollout began. Standardized patients (SPs) provide an ideal method for assessing resident physicians' current skills, providing opportunity to practice and gain immediate feedback, while also informing evaluation of curriculum and training. As such, we designed and implemented an OSCE station where residents were tasked with engaging and educating a vaccine-hesitant patient. AIM/OBJECTIVE:Describe residents' vaccine counseling practices, core communication and interpersonal skills, and effectiveness in meeting the objectives of the case. Explore how effectiveness in overcoming vaccine hesitancy may be associated with communication and interpersonal skills in order to inform educational efforts. SETTING/METHODS:Annual OSCE at a simulation center. PARTICIPANTS/METHODS:106 internal medicine residents (51% PGY1, 49% PGY2). PROGRAM DESCRIPTION/METHODS:Residents participated in an annual residency-wide, multi-station OSCE, one of which included a Black, middle-aged, vaccine-hesitant male presenting for a routine video visit. Residents had 10 min to complete the encounter, during which they sought to educate, explore concerns, and make a recommendation. After each encounter, faculty gave residents feedback on their counseling skills and reviewed best practices for effective communication on the topic. SPs completed a behaviorally anchored checklist (30 items across 7 clinical skill domains and 2 measures of trust in the vaccine's safety and resident) which will inform future curriculum. PROGRAM EVALUATION/RESULTS:Fifty-five percent (SD: 43%) of the residents performed well on the vaccine-specific education domain. PGY2 residents scored significantly higher on two of the seven domains compared to PGY1s (patient education/counseling-PGY1: 35% (SD: 36%) vs. PGY2: 52% (SD: 41%), p = 0.044 and activation-PGY1: 37% (SD: 45%) vs. PGY2: 59% (SD: 46%), p = 0.016). In regression analyses, education/counseling and vaccine-specific communication skills were strongly, positively associated with trust in the resident and in the vaccine's safety. A review of qualitative data from the SPs' perspective suggested that low performers did not use patient-centered communication skills. DISCUSSION/CONCLUSIONS:This needs assessment suggests that many residents needed in-the-moment feedback, additional education, and vaccine-specific communication practice. Our program plans to reinforce evidence-based practices physicians can implement for vaccine hesitancy through ongoing curriculum, practice, and feedback. This type of needs assessment is replicable at other institutions and can be used, as we have, to ultimately shed light on next steps for programmatic improvement.
PMID: 35710665
ISSN: 1525-1497
CID: 5277892