OU-Tulsa Research Forum 2020

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https://hdl.handle.net/11244/324958
The OU-Tulsa Research Forum 2020 was held virtually Monday, April 6 to Friday, April 10. The OU-Tulsa Research Forum is an annual event to showcase research conducted by current OU-Tulsa fellows, residents, students, or staff and University of Tulsa students. The event was presented by the OU-Tulsa Assistant Vice President for Research, the Office for Research Development and Scholarly Activity, the OU-Tulsa Schusterman Library, and the Tulsa County Medical Society

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Browsing OU-Tulsa Research Forum 2020 by Subject "Quality Improvement"

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    Emergency Department Utilization and Hierarchical Condition Category Risk Scores
    (2020-04) Duncan, Ashten; Lesselroth, Blake; Van Cain, Melissa; Aran, Peter; Homco, Juell
    BACKGROUND: The Centers for Medicare and Medicaid Services (CMS) introduced Comprehensive Primary Care Plus (CPC+) to improve the quality of primary care services nationwide. CPC+ utilization measures use a risk-adjustment model to predict utilization for different patient populations. Risk is determined using Hierarchical Condition Categories (HCCs), which are based on ICD-10 codes and patient demographics. Since patients with higher HCC scores are expected to have higher utilization rates, CMS uses these calculations to compare practices and categorize patients into “risk tiers,” which guide payments. OUSCM participates in CPC+ (Track 2). In order to track our patients’ emergency department utilization (EDU), search for patterns of use, and identify opportunities for quality improvement, we sought to determine (1) what associations exist between HCC risk tiers and patterns of EDU and (2) what patient characteristics are associated with HCC risk scores. METHODS: We analyzed cross-sectional CPC+ data for fiscal year 2018 provided by CMS. We performed multiple linear regression, Tukey’s method, and independent-samples t-tests to explore possible relationships between EDU, HCC risk score and associated risk tiers (range 1-5), and patient characteristics, such as dual-eligibility status and age. The study population included 906 Medicare-only and 1173 dual-eligible patients aged 18 years and older attributed to the OUSCM Internal Medicine (n=1122) or Family Medicine (n=957) practice. RESULTS: Our patient population had a median HCC risk score of 0.93 (CMS-reported Oklahoma median risk score = 0.74). We found that 56.4% of our patients were dual-eligible compared to the national average of 19.4%. Tukey multiple comparison test demonstrated significant differences between risk tiers and ED visits (p < .05). Dual-eligible patients had a higher average HCC risk score than Medicare-only patients (t(2072) = 8.491; p < .00001) and a higher average number of ED visits (t(2077) = 3.9577; p < .00001). Age was weakly correlated with HCC risk scores (r = .074, p = .0228). Density analysis of HCC scores by age revealed evidence of low-risk clustering for adults between 45 and 75 years of age. CONCLUSION: HCC risk tier classifications are predictive of EDU rates in our patient population. However, our overall HCC score was lower than anticipated given the complexity of our patient population. Dual-eligible status was associated with higher risk and EDU rates. However, age–typically an independent predictor of morbidity and mortality–was only weakly correlated with HCC scores, suggesting clinicians may be undercoding encounters for adults between the ages of 45 and 75 years, which decreases revenue.
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    Improving Primary Care Follow-Up After Pediatric Hospitalization
    (2020-04) Kahler, Anna; Suhag, Sunaina; Stuemky, Laura; Fleming, Gabby; McIntosh, Heather; Condren, Michelle
    BACKGROUND: Transitioning patient care to primary care physicians after pediatric hospitalization plays a critical role in children’s health. Follow-up appointments are an ideal time to provide education, address concerns, and arrange for continuity of care. This quality improvement (QI) study aimed to improve the percentages of primary care clinic follow-up within 7 days of hospital discharge. METHODS: Using the Plan-Do-Study-Act (PDSA) Model for Improvement, a multidisciplinary team examined pre-implementation data for patients discharged from the children’s hospital in February 2018. Electronic medical record (EMR) review was performed to determine if follow-up appointments were scheduled and attended within 7 days of discharge. Four week PDSA cycles were then completed by the medical residents, pediatric hospitalists and a care transition coordinator. Cycle 1 (n=25) involved developing an EMR-based shared patient list to identify all patients needing follow-up. In Cycle 2 (n=69), monthly standardized resident education was implemented to optimize use of the shared patient list. In Cycle 3 (n=81), a discharge appointment template was used to schedule appointments for patients discharged on weekends. RESULTS: Percent of appointments scheduled increased throughout the PDSA cycles from baseline (baseline - 60%; cycle 1 - 72%; cycle 2 - 74%; cycle 3 - 85%), as well as percent of appointments attended (baseline - 56%; cycle 1 - 56%; cycle 2 - 61%; cycle 3 - 70%) with p<0.001. Clinic follow-up was lower for patients with chronic illnesses but did improve from cycle 1 (42%) to cycle 3 (67%). The percentage of appointments scheduled for weekend discharges was not significantly different from weekday discharges, and increased from baseline over the course of the PDSA cycles. CONCLUSION: The number of follow-up appointments both scheduled and attended increased throughout the study, suggesting that the QI measures implemented were effective. Further interventions will focus on patient and system barriers to appointment attendance.
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    An Informational Letter's Impact on Parent Perceptions and Understanding of Adolescent Confidentiality
    (2020-04) Kaminski, Jake; Ramirez-Cueva, Fatima; Studebaker, Susan
    BACKGROUND: Adolescence is a period of rapid emotional, behavioral, social, and physiological change in a child’s development. Evidence is conclusive that teens are more likely to engage and revisit their provider in a confidential setting. Parents frequently express hesitancy or opposition when asked to leave the room for the confidential portion of the visit. Studies have shown that while 89% of parents believe that adolescents should speak to a provider one-on-one, about 61% of parents wish to be in the exam room for the entire visit. The goal of this quality improvement project was to determine if parental perceptions and understanding of confidentiality in the adolescent visit could be improved by providing an informational letter before the clinical visit. METHODS: A letter that defined adolescent confidentiality was created and addressed to parents regarding their child(ren)’s transition to adolescent care. This letter, along with a pre- and post-letter survey, was given to parents at annual adolescent well-visits. The survey assessed attitudes and knowledge related to adolescent confidentiality. The knowledge section asked parents to define confidentiality in the adolescent context. The responses were graded as “correct,” “partially correct,” and “incorrect.” Three Plan-Do-Study-Act (PDSA) cycles were completed, revising the succinctness and clarity of the letter and the survey in between each cycle. This yielded a total of 64 responses between spring 2018 and fall 2019. RESULTS: Across all PDSA cycles, the letter was reportedly easy to read. A 60% and 17% increase in parental favorability regarding adolescent confidentiality was seen in cycles 1 and 2. Letter clarity and succinctness were not correlated with parental perceptions, indicating little association between letter “improvements” and parental perceptions. Parental understanding of confidentiality was mixed. With each cycle, there was no significant correlation between reading the letter and likelihood of choosing the most “correct” answer. However, a 25% and 100% increase in combined “slightly correct” and “correct” answers in 2 of 3 cycles was seen. There was also an average 34% decrease of “incorrect” answers across all 3 cycles. CONCLUSION: An explanatory letter may advance parents’ understanding and appreciation for adolescent autonomy; however, there is room for improvement in both areas, which will require alternative interventions.