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55. Sex and Race Differences in the Evaluation and Treatment of Young Adults Presenting to the Emergency Department With Chest Pain

Author

Banco, Darcy, primary, Chang, Jerway, additional, Talmor, Nina, additional, Wadhera, Priya, additional, Mukhopadhyay, Amrita, additional, Lu, Xinlin, additional, Dong, Siyuan, additional, Lu, Yukun, additional, Betensky, Rebecca A., additional, Blecker, Saul, additional, Safdar, Basmah, additional, and Reynolds, Harmony R., additional

Published
2022
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65. Comparison of Care Provided to Underserved Patients With Diabetes by a Telementoring Model of Care to Care Provided by a Specialty Clinic: Endo ECHO Versus an Academic Specialty Clinic

Author

Berry, Carolyn A., Dávila Saad, Andrea, Blecker, Saul, Billings, John, Bouchonville, Matthew F., Arora, Sanjeev, and Paul, Margaret M.

Abstract

Purpose: The purpose of the study was to examine differences among adult patients with diabetes who receive care through a telementoring model versus care at an academic specialty clinic on guideline-recommended diabetes care and self-management behaviors.Methods: Endocrinology-focused Extension for Community Healthcare Outcomes (ECHO Endo) patients completed surveys assessing demographics, access to care, health care quality, and self-management behaviors at enrollment and 1 year after program enrollment. Diabetes Comprehensive Care Center (DCCC) patients completed surveys at comparable time points.Results: At baseline, ECHO patients were less likely than DCCC patients to identify English as their primary language, have postsecondary education, and private insurance. One year postenrollment, ECHO patients visited their usual source of diabetic care more frequently. There were no differences in A1C testing or feet checking by health care professionals, but ECHO patients were less likely to report eye exams and smoking status assessment. ECHO and DCCC patients did not differ in consumption of high-fat foods and soda, physical activity, or home feet checks. ECHO patients were less likely to space carbohydrates evenly and test glucose levels and more likely to have smoked cigarettes.Conclusions: Endo ECHO is a suitable alternative to specialty care for patients in underserved communities with restricted access to specialty care. Results support the value of the Project ECHO telementoring model in addressing barriers to high-quality care for underserved communities.

Published
2023
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78. User-Centered Development of a Behavioral Economics Inspired Electronic Health Record Clinical Decision Support Module

Author

Chokshi, Sara Kuppin, Troxel, Andrea, Belli, Hayley, Schwartz, Jessica, Blecker, Saul, Blaum, Caroline, Szerencsy, Adam, Testa, Paul, and Mann, Devin

Subjects
clinical decision support, user computer interface, Economics, Behavioral, Decision Making, Electronic Health Records, Humans, behavioral economics, electronic health record, Decision Support Systems, Clinical, Article
Abstract

Changing physician behaviors is difficult. Electronic health record (EHR) clinical decision support (CDS) offers an opportunity to promote guideline adherence. Behavioral economics (BE) has shown success as an approach to supporting evidence-based decision-making with little additional cognitive burden. We applied a user-centered approach to incorporate BE "nudges" into a CDS module in two "vanguard" sites utilizing: (1) semi-structured interviews with key informants (n = 8); (2) a design thinking workshop; and (3) semi-structured group interviews with clinicians. In the 133 day development phase at two clinics, the navigator section fired 299 times for 27 unique clinicians. The inbasket refill alert fired 124 times for 22 clinicians. Fifteen prescriptions for metformin were written by 11 clinicians. Our user-centered approach yielded a BE-driven CDS module with relatively high utilization by clinicians. Next steps include the addition of two modules and continued tracking of utilization, and assessment of clinical impact of the module.

Published
2019

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