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PubMed | The Joint Commission, Northwestern University and Erie Family Health Center
Type: | Journal: Patient education and counseling | Year: 2017

This study aimed to develop and refine a patient education video about pneumococcal polysaccharide vaccination (PPSV23) and to assess patient perceptions regarding video content and receipt of video during a clinic visit.Focus groups were conducted to obtain patient feedback on a brief video focusing on personal susceptibility to pneumonia and highlighting the importance of both childhood and adult vaccines. Subsequently, interviews were conducted with patients ages 65 and 66 who were shown the revised video at an office visit. We assessed attitudes toward the video and perceptions about its presentation at the point of care. Participants responded to open-ended items as well as Likert-type items with responses from 1 (strongly disagree) to 5 (strongly agree).Focus group participants (n=26) had positive reactions to the video, but suggested reducing the intensity of messages about pneumonia severity. Participants (n=73) shown the revised video during a clinic visit perceived it to be easy to understand (M=4.83, SD=0.58) and informative (M=4.8, SD=0.75).Target audience feedback helped refine a video promoting PPSV23 vaccination; the video was well received by patients.This video may be an effective educational tool to increase rates of PPSV23 vaccination.


Lurslurchachai L.,Mount Sinai School of Medicine | Krauskopf K.,Mount Sinai School of Medicine | Roy A.,Erie Family Health Center | Halm E.A.,University of Texas Southwestern Medical Center | And 2 more authors.
Clinical Respiratory Journal | Year: 2014

Introduction: Inhaled medications, critical for asthma treatment, are self-administered through metered dose inhalers (MDI). Asthma self-management hinges on adherence to these medications and to proper MDI technique. Objective: To assess predictors of proper MDI technique, and MDI technique as a tool to identify patients with low adherence to inhaled medications. Methods: Prospective cohort of asthmatics from clinics in New York, NY and New Brunswick, NJ. MDI technique was assessed using a standardized checklist. Adherence to inhaled asthma controller medication was evaluated with the Medication Adherence Report Scale. Predictors of MDI technique were evaluated using regression analyses. The distribution of number of MDI technique steps missed was compared in adherent vs. non-adherent asthmatics. Results: Overall, 326 patients were included (55% Hispanic, 27% Black). In adjusted analyses, age<55 years was significantly associated with MDI technique (P=0.03). Overall, 12%, 34%, 40% of asthmatics missed 5-6, 3-4, or 1-2 MDI steps; 16% received a perfect MDI technique score. Adherence rates were 20%, 39%, 48%, and 62% among those who missed 5-6, 3-4, 1-2, or none of the steps in the MDI technique checklist (P<0.001). Conclusion: Poor MDI technique is common among inner-city patients with asthma and is associated with poor adherence to controller medications. Older patients with asthma are at higher risk of improper MDI technique. Assessment of MDI technique may be a simple clinical aid to identify patients with low adherence to controller medications. © 2013 John Wiley & Sons Ltd.


PubMed | North Country HealthCare, Alliance of Chicago Community Health Services, Community Wellness Center, Northwestern University and Erie Family Health Center
Type: Journal Article | Journal: Cancer causes & control : CCC | Year: 2016

Fecal occult blood testing (FOBT) is a pragmatic screening option for many community health centers (CHCs), but FOBT screening programs will not reduce mortality if patients with positive results do not undergo diagnostic colonoscopy (DC). This study was conducted to investigate DC completion among CHC patients.This retrospective cohort study used data from three CHCs in the Midwest and Southwest. The primary study outcome was DC completion within 6months of positive FOBT among adults age 50-75. Patient data was collected using automated electronic queries. Manual chart reviews were conducted if queries produced no evidence of DC. Poisson regression models described adjusted relative risks (RRs) of DC completion.The study included 308 patients; 63.3% were female, 48.7% were Spanish speakers and 35.7% were uninsured. Based on combined query and chart review findings, 51.5% completed DC. Spanish speakers were more likely than English speakers to complete DC [RR 1.19; 95% confidence interval (CI) 1.04-1.36; P=0.009], and DC completion was lower among patients with 0 visits than those with 1-2 visits (RR 2.81; 95% CI 1.83-4.33; P<0.001) or 3 visits (RR 3.06; 95% CI 1.57-5.95; P=0.001).DC completion was low overall, which raises concerns about whether FOBT can reduce CRC mortality in practice. Further research is needed to understand whether CHC navigator programs can achieve very high DC rates. If organizations use FOBT as their primary CRC screening approach and a substantial number of patients receive positive results, both screening rates and DC rates should be measured.


Sheffield P.,Mount Sinai School of Medicine | Roy A.,Erie Family Health Center | Wong K.,Mount Sinai School of Medicine | Trasande L.,Mount Sinai School of Medicine
Health Affairs | Year: 2011

There has been little research to date on the linkages between air pollution and infectious respiratory illness in children, and the resulting health care costs. In this study we used data on air pollutants and national hospitalizations to study the relationship between fine particulate air pollution and health care charges and costs for the treatment of bronchiolitis, an acute viral infection of the lungs. We found that as the average exposure to fine particulate matter over the lifetime of an infant increased, so did costs for the child's health care. If the United States were to reduce levels of fine particulate matter to 7 percent below the current annual standard, the nation could save $15 million annually in reduced health care costs from hospitalizations of children with bronchiolitis living in urban areas. These findings reinforce the need for ongoing efforts to reduce levels of air pollutants. They should trigger additional investigation to determine if the current standards for fineparticulate matter are sufficiently protective of children's health. © 2011 Project HOPE-The People-to-People Health Foundation, Inc.


Steglitz J.,Northwestern University | Sommers M.,Erie Family Health Center | Talen M.R.,Erie Family Health Center | Thornton L.K.,University of Newcastle | Spring B.,Northwestern University
Journal of the American Medical Informatics Association : JAMIA | Year: 2015

OBJECTIVE: Primary care clinicians are well-positioned to intervene in the obesity epidemic. We studied whether implementation of an obesity intake protocol and electronic health record (EHR) form to guide behavior modification would facilitate identification and management of adult obesity in a Federally Qualified Health Center serving low-income, Hispanic patients.MATERIALS AND METHODS: In three studies, we examined clinician and patient outcomes before and after the addition of the weight management protocol and form. In the Clinician Study, 12 clinicians self-reported obesity management practices. In the Population Study, BMI and order data from 5000 patients and all 40 clinicians in the practice were extracted from the EHR preintervention and postintervention. In the Exposure Study, EHR-documented outcomes for a sub-sample of 46 patients actually exposed to the obesity management form were compared to matched controls.RESULTS: Clinicians reported that the intake protocol and form increased their performance of obesity-related assessments and their confidence in managing obesity. However, no improvement in obesity management practices or patient weight-loss was evident in EHR records for the overall clinic population. Further analysis revealed that only 55 patients were exposed to the form. Exposed patients were twice as likely to receive weight-loss counseling following the intervention, as compared to before, and more likely than matched controls. However, their obesity outcomes did not differ.CONCLUSION: Results suggest that an obesity intake protocol and EHR-based weight management form may facilitate clinician weight-loss counseling among those exposed to the form. Significant implementation barriers can limit exposure, however, and need to be addressed. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.


PubMed | University of Newcastle, Northwestern University and Erie Family Health Center
Type: Evaluation Studies | Journal: Journal of the American Medical Informatics Association : JAMIA | Year: 2015

Primary care clinicians are well-positioned to intervene in the obesity epidemic. We studied whether implementation of an obesity intake protocol and electronic health record (EHR) form to guide behavior modification would facilitate identification and management of adult obesity in a Federally Qualified Health Center serving low-income, Hispanic patients.In three studies, we examined clinician and patient outcomes before and after the addition of the weight management protocol and form. In the Clinician Study, 12 clinicians self-reported obesity management practices. In the Population Study, BMI and order data from 5000 patients and all 40 clinicians in the practice were extracted from the EHR preintervention and postintervention. In the Exposure Study, EHR-documented outcomes for a sub-sample of 46 patients actually exposed to the obesity management form were compared to matched controls.Clinicians reported that the intake protocol and form increased their performance of obesity-related assessments and their confidence in managing obesity. However, no improvement in obesity management practices or patient weight-loss was evident in EHR records for the overall clinic population. Further analysis revealed that only 55 patients were exposed to the form. Exposed patients were twice as likely to receive weight-loss counseling following the intervention, as compared to before, and more likely than matched controls. However, their obesity outcomes did not differ.Results suggest that an obesity intake protocol and EHR-based weight management form may facilitate clinician weight-loss counseling among those exposed to the form. Significant implementation barriers can limit exposure, however, and need to be addressed.


Liss D.T.,Northwestern University | Petit-Homme A.,Northwestern University | Feinglass J.,Northwestern University | Buchanan D.R.,Northwestern University | And 2 more authors.
Journal of Community Health | Year: 2013

Annual fecal occult blood testing (FOBT) has the potential to reduce colorectal cancer mortality, but in practice it is challenging to complete FOBT every year. Repeat FOBT adherence may be especially low in community health center (CHC) settings, where many patients face barriers to annual FOBT completion. We conducted a retrospective cohort analysis to investigate adherence to annual FOBT in an urban CHC network that serves a predominantly Spanish-speaking, uninsured adult patient population. This study used data from the two-year period between January 2010 and December 2011, and included adults aged 50-74 who completed a screening FOBT with a negative result during the first 6 months of 2010. We examined whether each patient completed a second FOBT between 9 and 18 months after the initial negative FOBT, and tested whether repeat FOBT adherence was associated with patient characteristics or the number of clinic visits after the initial negative FOBT. Only 69 of 281 included patients completed repeat FOBT (24.6 % adherence), and none of 62 patients (0 %) with 0 clinic visits completed repeat FOBT. We detected no significant differences in adherence by age, sex, preferred language, insurance status, or number of chronic conditions. In multivariable regression, the adjusted relative risk of repeat FOBT was 1.66 (95 % CI 1.09-2.54; p = 0.02) among patients with 3 or more clinic visits (referent: patients with 1-2 visits). The observed low rate of adherence greatly diminishes the effectiveness of FOBT in reducing CRC mortality. Findings demonstrate the need for systems-based interventions that increase adherence without requiring face-to-face encounters. © 2013 Springer Science+Business Media New York.


Baker D.W.,Northwestern University | Brown T.,Northwestern University | Buchanan D.R.,Northwestern University | Buchanan D.R.,Erie Family Health Center | And 10 more authors.
JAMA Internal Medicine | Year: 2014

IMPORTANCE Colorectal cancer (CRC) screening rates are lower among Latinos and people living in poverty. Fecal occult blood testing (FOBT) is one recommended screening modality that may overcome cost and access barriers. However, the ability of FOBT to reduce CRC mortality depends on high rates of adherence to annual screening. OBJECTIVE To determine whether a multifaceted intervention increases adherence to annual FOBT compared with usual care. DESIGN, SETTING, AND PARTICIPANTS Patient-level randomized controlled trial conducted in a network of community health centers. Included were 450 patients who had previously completed a home FOBT from March 2011 through February 2012 and had a negative test result: 72%of participants were women; 87%were Latino; 83%stated that Spanish was their preferred language; and 77%were uninsured. INTERVENTIONS Usual care at participating health centers included computerized reminders, standing orders for medical assistants to give patients home fecal immunochemical tests (FIT), and clinician feedback on CRC screening rates. The intervention group also received (1) a mailed reminder letter, a free FIT with low-literacy instructions, and a postage-paid return envelope; (2) an automated telephone and text message reminding them that they were due for screening and that a FIT was being mailed to them; (3) an automated telephone and text reminder 2 weeks later for those who did not return the FIT; and (4) personal telephone outreach by a CRC screening navigator after 3 months. MAIN OUTCOMES AND MEASURES Completion of FOBT within 6 months of the date the patient was due for annual screening. RESULTS Intervention patients were much more likely than those in usual care to complete FOBT (82.2%vs 37.3%; P < .001). Of the 185 intervention patients completing screening, 10.2%completed prior to their due date (intervention was not given), 39.6%within 2 weeks (after initial intervention), 24.0%within 2 to 13 weeks (after automated call/text reminder), and 8.4%between 13 and 26 weeks (after personal call). CONCLUSIONS AND RELEVANCE This intervention greatly increased adherence to annual CRC screening; most screenings were achieved without personal calls. It is possible to improve annual CRC screening for vulnerable populations with relatively low-cost strategies that are facilitated by health information technologies. © 2014 American Medical Association.


PubMed | Northwestern University and Erie Family Health Center
Type: Journal Article | Journal: Cancer causes & control : CCC | Year: 2015

We previously found that a multifaceted outreach intervention achieved 82 % annual adherence to colorectal cancer (CRC) screening with fecal occult blood testing (FOBT). This study assessed adherence to FOBT after a second outreach.We followed 225 patients in community health centers in Chicago, Illinois, who were randomized to the intervention group. Our primary analysis focused on 124 patients who completed FOBT during the first outreach and were due again for annual FOBT; 90% were Latino, 87% preferred to speak Spanish, and 77% were uninsured. Second outreach consisted of (1) a mailed reminder letter, a free fecal immunochemical test (FIT) with postage-paid return envelope, (2) automated phone and text messages, (3) automated reminders 2 weeks later if the FIT was not returned, and (4) a telephone call after 3 months. Our main outcome was completion of FIT within 6 months of the due date. We also analyzed the proportion of the original 225 patients who were fully screened for CRC over the 2-year study period.A total of 88.7% of patients completed a FIT within 6 months of their second outreach. Over the 2 years since the first outreach, 71.6% of the 225 patients assigned to the intervention group were fully up to date on CRC screening, another 11.1% had been screened suboptimally, and 17.3% were inadequately screened or not screened.It is possible to achieve high rates of CRC screening over a 2-year period for vulnerable populations using outreach with FIT as a primary strategy.


Place S.,Erie Family Health Center | Talen M.,Erie Family Health Center
International Journal of Psychiatry in Medicine | Year: 2013

Burnout and depression across the career life cycle of healthcare providers are increasing at alarming rates. We need to devote our resources and efforts to bolster the next generation of healthcare providers who have the capacity for resiliency and well-being - the antidote to burnout and depression. A handful of organizations have implemented general wellness programs to combat burnout but there are surprisingly few documented, well-researched interventions to build resiliency. Wellness provides an alternative framework to approach the epidemic rates of burnout and depersonalization within the healthcare profession. In this article we describe our rationale for developing a culture of wellness among primary care physicians along with the specific activities and initiatives for creating a culture of wellness throughout medical educational training. Examples of the four core components of a residency wellness program - concrete resources, positive conversations, curriculum, and control - are described with regard to our Family Medicine Residency. A brief description of early efforts to empirically examine the impact of the wellness initiative across systemwide residency programs (Family Medicine and other programs) is described. © 2013, Baywood Publishing Co., Inc.

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