Akron, OH, United States
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Von Gruenigen V.E.,Summa Akron City Hospital | Powell D.M.,Summa Akron City Hospital | Sorboro S.,Summa Akron City Hospital | McCarroll M.L.,Summa Center for Womens Health Research | Kim U.,Summa Akron City Hospital
American Journal of Obstetrics and Gynecology | Year: 2013

Hospitals and health care systems are already seeing the effect of health care reform with declining dollars. Hospital services, which had narrow financial margins in the past, will have further challenges. This article will review definitions, challenges, and potential financial solutions for labor and delivery units. Improving quality, efficiency, and cost requires substantial physician cooperation in the changing paradigm from physiciancentric care to the transparent safety of teams. The financial contribution margin should increase the net revenue, but significant volumes are also needed. The challenge of this model for obstetrics is the slowing birth rate with the ultimate limitation for growth. Therefore, cost containment is imperative for sustainability. Standardization of hospital policies and procedures can improve quality and cost-savings with new incentive models. Examples include decreasing expensive pharmaceuticals, minimizing elective inductions of labor, and encouraging breast-feeding. As providers of health care to women, we all must engage in the triple aim of (1) improving the experience of care, (2) improving the health of populations, and (3) reducing per capita costs of health care. Although accountable care organizations presently are focused on Medicare populations for cost containment, all health care providers and institutions must be vigilant on both quality costeffective care for sustainability, especially in obstetrics. © 2013 Mosby, Inc. All rights reserved.


McCarroll M.L.,Summa Center for Womens Health Research | Armbruster S.D.,Summa Center for Womens Health Research | Chung J.E.,Kent State University | Kim J.,Kent State University | And 2 more authors.
Health Communication | Year: 2014

The objective of this article is to illustrate user characteristics of a hospital's social media structure using analytics and user surveys. A 1-year retrospective analysis was conducted along with an Internet survey of users of the hospital's Facebook, Twitter, and blog. Of the survey respondents (n = 163), 95.7% are female and 4.3% are male; most are ages 50-59 years (31.5%) and 40-49 years (27.8%); and 93.2% are Caucasian. However, the hospital system database revealed 55% female and 37% minority population, respectively. Of the survey respondents, 61.4% reported having a bachelor's degree or higher, whereas only 11.7% reported having a high school degree/equivalent or lower. However, within the hospital patient databases, 93% of patients have a high school degree/equivalent or lower and only 3% have a bachelor's degree or higher in our women's services population. Social media were used to seek personal health information 68.7% (n = 112), to learn about hospital programming 27.6% (n = 45), and to seek family health information 25.2% (n = 41). Respondents younger than 49 years of age were more likely to seek personal health information using social media compared to those 50 years of age and older (p =.02). Respondents with a bachelor's degree or higher education were statistically less likely to search for physician information compared to those less educated individuals (p =.04). We conclude that social media may play an important role in personal health information, especially for young female respondents; however, the survey provides strong evidence that further research is needed to ensure that social network sites provided by hospitals are reaching the full spectrum of health system patients. © Taylor & Francis Group, LLC.


Mendise T.J.,Summa Health System | Ferris E.M.,Summa Health System | McCarroll M.L.,Summa Health System | McCarroll M.L.,Summa Center for Womens Health Research | von Gruenigen V.E.,Summa Health System
Journal of Robotic Surgery | Year: 2013

During challenging gynecologic (GYN) procedures, the conventional robotic set-up can limit a surgeon's ability to effectively and efficiently perform these procedures. We present a novel set-up using a parallel-docking approach of the da Vinci® Surgical System with only three robotic arms and incorporating two patient side assist ports to overcome the difficulties presented during challenging GYN procedures. The Summa Set-up (SS) uses 4 ports actively, 2 assist ports and 2 robotic ports, compared to the traditional set-up which uses 4 ports: 1 assist port and 3 robotic ports. With the SS format, the patient-side assistant stands at the head of the bed and can simultaneously retract the uterus and aide in surgical dissection along with the console surgeon. While there are many possibilities of da Vinci® docking, port placement and assistant placement during robotic-assisted GYN surgery, we believe the SS can be an alternative for many GYN surgeons, especially those in teaching hospitals, for increased mobility and efficiency during complex GYN procedures. © 2012 Springer-Verlag London.


McCarroll M.L.,Summa Center for Womens Health Research | McCarroll M.L.,Northeast Ohio Medical University | Armbruster S.,Summa Center for Womens Health Research | Pohle-Krauza R.J.,Summa Center for Womens Health Research | And 10 more authors.
Gynecologic Oncology | Year: 2015

Objective The study aimed to assess a one-month lifestyle intervention delivered via a web- and mobile-based weight-loss application (app) (LoseIt!) using a healthcare-provider interface. Methods Early-stage overweight/obese (body mass index [BMI] 25 kg/m2) cancer survivors (CS) diagnosed in the past three years, and without recurrent disease were enrolled and received exercise and nutrition counseling using the LoseIt! app. Entry and exit quality of life (FACT-G) and Weight Efficacy Lifestyle Questionnaire (WEL) measuring self-efficacy were measured along with anthropometrics, daily food intake, and physical activity (PA) using the app. Results Mean participant age was 58.4 ± 10.3 years (n = 50). Significant reductions (p < 0.0006) in anthropometrics were noted between pre- and post-intervention weight (105.0 ± 21.8 kg versus 98.6 ± 22.5 kg); BMI (34.9 ± 8.7 kg/m2 versus 33.9 ± 8.4 kg/m2); and waist circumference (108.1 ± 14.9 cm versus 103.7 ± 15.1 cm). A significant improvement in pre- and post-intervention total WEL score was noted (99.38 ± 41.8 versus 120.19 ± 47.1, p = 0.043). No significant differences were noted in FACT-G, macronutrient consumption, and PA patterns. Conclusion These results indicate that a lifestyle intervention delivered via a web- and mobile-based weight-loss app is a feasible option by which to elicit short-term reductions in weight. Though these results parallel the recent survivors of uterine cancer empowered by exercise and healthy diet (SUCCEED) trial, it is notable that they were achieved without encumbering significant cost and barrier-access issues (i.e. time, transportation, weather, parking, etc.). © 2015 Elsevier Inc. All rights reserved.


McCarroll M.L.,Summa Center for Womens Health Research | Pohle-Krauza R.J.,Youngstown State University | Volsko T.A.,Akron Children’s Hospital | Martin J.L.,Summa Health System | And 2 more authors.
Open Respiratory Medicine Journal | Year: 2013

Background: In pulmonary rehabilitation (PR) effective measures have been taken while in analyzing a patient's intervention with the help of entry to exit evaluations. The absence of an objective and quantifiable scale are limitations of PR that allow analyzing of a patient's self reported symptoms throughout PR. The Breathlessness, Cough and Sputum Scale (BCSS©) is used to predict patient exacerbations by evaluating common symptoms identified in the COPD population. This study used the BCSS© survey to track complex symptom changes throughout the course of PR intervention. The BCSS© tool measured the patient's self reported symptoms in real time for each visit when patient enrolled in PR. Methods: Thirty-five patients with COPD from three outpatient PR centers were asked to report the severity of breathlessness, cough, and sputum prior to each PR session using the BCSS© survey. Results: There was a significant decrease in self reported symptoms of the mean BCSS© score from entry 4.6(± 2.9) to exit 2.3 (± 2.5), p < 0.001. The results showed variable decrease in the self reported symptoms with more PR visits. The secondary outcome showed high correlations with quality of life measures using the Pulmonary Function Status Scale (PFSS) on entry and exit to PR. Conclusions: The BCSS© tool is an effective means for measuring the impact of PR on improving patient tolerance and self-reported symptoms as a result of COPD. More research is needed to better assess the complex symptoms of COPD patients in PR to enhance programmatic outcomes. © McCarroll et al.


McCarroll M.L.,Summa Center for Womens Health Research | Armbruster S.,Summa Center for Womens Health Research | Frasure H.E.,Case Western Reserve University | Gothard M.D.,Biostats Inc. | And 4 more authors.
Gynecologic Oncology | Year: 2014

Objective More patient-centered programming is essential for endometrial cancer (EC) survivors needing to lose weight to reduce cardiovascular disease risk (CVD). The purpose of this study was to improve self-efficacy (SE) and quality of life (QOL) using a lifestyle intervention program designed for weight loss. Methods Overweight and obese early-stage EC survivors, n = 75, were randomized into two groups: 1) Survivors of Uterine Cancer Empowered by Exercise and Healthy Diet (SUCCEED), a six-month lifestyle intervention or 2) a usual care group (UC). Participants completed the Weight Efficacy Lifestyle Questionnaire (WEL) to assess SE and the Functional Assessment of Cancer Therapy - General (FACT-G) to measure QOL, and their body mass index (BMI) was calculated at baseline, 3, 6, and 12 months. Mixed, repeated-measures ANCOVA models with baseline covariates were employed using SPSS 20.0. Results Positive effects in every WEL domain, including the total score, were statistically significant in the SUCCEED group versus the UC group. A linear regression model demonstrated that, if BMI decreased by 1 unit, the total WEL score increased by 4.49 points. Significant negative correlations were found in the total WEL score and a change in BMI of R = - 0.356 (p = 0.006). Between-group differences in the FACT-G were significant from baseline in the fatigue domain at three months (p =.008) and in the physical domain at six months (p =.048). No other significant differences were found. Conclusion Overall, this study shows promise for targeted interventions to help improve SE, thus improving BMI. © 2013 Elsevier Inc. All rights reserved.


PubMed | Medical Simulation, Summa Health System, Summa Center for Womens Health Research and Biostats Inc.
Type: | Journal: Critical care research and practice | Year: 2016

Objective. To evaluate confidence, knowledge, and competence after a simulation-based curriculum on maternal cardiac arrest in an Obstetrics & Gynecologic (OBGYN) residency program. Methods. Four simulations with structured debriefing focusing on high yield causes and management of maternal cardiac arrest were executed. Pre- and post-individual knowledge tests (KT) and confidence surveys (CS) were collected along with group scores of critical performance steps evaluated by content experts for the first and final simulations. Results. Significant differences were noted in individual KT scores (pre: 58.9 8.9 versus post: 72.8 6.1, p = 0.01) and CS total scores (pre: 22.2 6.4 versus post: 29.9 3.4, p = 0.007). Significant differences were noted in airway management, p = 0.008; appropriate cycles of drug/shock-CPR, p = 0.008; left uterine displacement, p = 0.008; and identifying causes of cardiac arrest, p = 0.008. Nonsignificant differences were noted for administration of appropriate drugs/doses, p = 0.074; chest compressions, p = 0.074; bag-mask ventilation before intubation, p = 0.074; and return of spontaneous circulation identification, p = 0.074. Groups remained noncompetent in team leader tasks and considering therapeutic hypothermia. Conclusion. This study demonstrated improved OBGYN resident knowledge, confidence, and competence in the management of third trimester maternal cardiac arrest. Several skills, however, will likely require more longitudinal curricular exposure and training to develop and maintain proficiency.


PubMed | Summa Center for Womens Health Research
Type: | Journal: The open respiratory medicine journal | Year: 2013

In pulmonary rehabilitation (PR) effective measures have been taken while in analyzing a patients intervention with the help of entry to exit evaluations. The absence of an objective and quantifiable scale are limitations of PR that allow analyzing of a patients self reported symptoms throughout PR. The Breathlessness, Cough and Sputum Scale (BCSS()) is used to predict patient exacerbations by evaluating common symptoms identified in the COPD population. This study used the BCSS() survey to track complex symptom changes throughout the course of PR intervention. The BCSS() tool measured the patients self reported symptoms in real time for each visit when patient enrolled in PR.Thirty-five patients with COPD from three outpatient PR centers were asked to report the severity of breathlessness, cough, and sputum prior to each PR session using the BCSS() survey.There was a significant decrease in self reported symptoms of the mean BCSS() score from entry 4.6( 2.9) to exit 2.3 ( 2.5), p < 0.001. The results showed variable decrease in the self reported symptoms with more PR visits. The secondary outcome showed high correlations with quality of life measures using the Pulmonary Function Status Scale (PFSS) on entry and exit to PR.The BCSS() tool is an effective means for measuring the impact of PR on improving patient tolerance and self-reported symptoms as a result of COPD. More research is needed to better assess the complex symptoms of COPD patients in PR to enhance programmatic outcomes.


PubMed | Kent State University and Summa Center for Womens Health Research
Type: Journal Article | Journal: Journal of robotic surgery | Year: 2015

To address surgical complications, the World Health Organization (WHO) developed the Safe Surgery Saves Lives Checklist. With the foundation of the WHOs checklist, a robotic-specific checklist (RORCC) was developed using standardized content and face validity methods. The RORCC was implemented in a high volume gynecological (GYN) specialty group using minimally invasive robotic-assisted surgery. Data were abstracted from patients undergoing GYN procedures from four GYN surgeons at an urban, community hospital during November 16, 2010 to May 15, 2011 (pre-RORCC) n = 89 and from the period May 16, 2011 to November 16 2011 (post-RORCC) n = 121. Thirty-day readmissions pre-checklist and post-checklist were 12 and 5, respectively, which is a significant (p = 0.02) reduction. The duration of surgery was not significantly affected (p = 0.40) with pre-RORCC surgery time at 110.1 (35.7) min versus post-RORCC surgery time at 112.9 (37.4) min. This study demonstrated the feasibility of integrating an electronic, interactive, and robotic-specific checklist for gynecologic robotic-assisted surgery which resulted in a significant reduction in readmissions at the 30-day without significantly impacting operating room times.


PubMed | Summa Center for Womens Health Research
Type: Journal Article | Journal: Health communication | Year: 2014

The objective of this article is to illustrate user characteristics of a hospitals social media structure using analytics and user surveys. A 1-year retrospective analysis was conducted along with an Internet survey of users of the hospitals Facebook, Twitter, and blog. Of the survey respondents (n = 163), 95.7% are female and 4.3% are male; most are ages 50-59 years (31.5%) and 40-49 years (27.8%); and 93.2% are Caucasian. However, the hospital system database revealed 55% female and 37% minority population, respectively. Of the survey respondents, 61.4% reported having a bachelors degree or higher, whereas only 11.7% reported having a high school degree/equivalent or lower. However, within the hospital patient databases, 93% of patients have a high school degree/equivalent or lower and only 3% have a bachelors degree or higher in our womens services population. Social media were used to seek personal health information 68.7% (n = 112), to learn about hospital programming 27.6% (n = 45), and to seek family health information 25.2% (n = 41). Respondents younger than 49 years of age were more likely to seek personal health information using social media compared to those 50 years of age and older (p = .02). Respondents with a bachelors degree or higher education were statistically less likely to search for physician information compared to those less educated individuals (p = .04). We conclude that social media may play an important role in personal health information, especially for young female respondents; however, the survey provides strong evidence that further research is needed to ensure that social network sites provided by hospitals are reaching the full spectrum of health system patients.

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