Background/Objective: As a part of the Affordable Care Act of 2010, the Medicare Annual Wellness Visit (AWV) was intended to reduce health disparities and improve health outcomes through providing wellness visits for all Medicare recipients at no cost. However, adoption has been minimal since its inception, particularly in rural populations Study Design: A top priority of a rural federally qualified healthcare organization (FQHC) was to improve utilization of the AWV due to a patient response well below the national average. A six-week trial was conducted that examined a patient information campaign combined with a strategic workflow that encouraged interoffice collaboration. Methods: The office staff of a pilot medical clinic was selected by the FQHC quality improvement committee as the project site. A Relational Coordination survey (RC) was administered before and after the intervention to determine if the intervention improved interoffice collaboration regarding the AWV. Descriptive questions were used to determine which aspects of the intervention proved useful. Reliability of the survey results was verified by a Crohnbach’s ? > 0.08. An independent samples t test was used with p value < 0.05 to determine statistical significance and confidence intervals. Results: The patient information brochure demonstrated improved patient understanding of the AWV from the office staff perspective as demonstrated by an independent samples t test comparing pre and post survey responses (t(32) = -4.14, p < .001, CI 95%). The RC survey results identified an area for collaborative for improvement between the front office and medical staff.

Background: This quality improvement project examined the effect an educational intervention focused on the psychosocial needs of cancer patients had on knowledge, attitudes, and behaviors (KAB) of a group of nurses. While nurses understand the physical toll of cancer, they may forget the impact cancer has on mental health. The project was guided by the Health Belief Model. Methods: Consent was obtained from 15 participants working as nurse advocates for a large insurance company. Nurse advocates are tasked with improving the health of patients and connecting them to additional resources. A twenty-minute educational intervention focused on the impact cancer has on mental health and the benefit of multiple psychosocial supportive resources was delivered to the participants. Education included a comprehensive review of the resources available for cancer patients at the project site. Participants were then given 10 minutes to complete a retrospective post-then-pre survey, based on a Likert Scale. Results: Statistically significant improvements in survey scores were observed in each of the three KAB domains. Statistical analysis confirmed improvements in survey scores were significant and not likely due to random variation. Participants also referred more patients into a cancer support program following the intervention. Conclusion: A brief educational intervention was able to improve KAB scores among nurses. There was also an increase in the number of patients these nurses referred into a psychosocial supportive program. Nurses that better understand the mental health needs of cancer patients are more likely to connect them with psychosocial resources. This intervention will become part of standard training for new nurse advocates at the project site.

Hospital visitation policies have continued to evolve throughout the pandemic resulting in visitation restrictions for COVID patients. To positively shape the experience for patients, families, and care providers a new communication plan utilizing virtual visiting emerged. The purpose of this quality improvement project, developed based on the caring theory, is to explore if implementing iPads with virtual visiting capabilities is effective in increasing patient and family satisfaction. IPads were deployed throughout a large, emergency department located in the southwest United States to enable virtual communication among patients, families, and healthcare workers to measure the patient and family’s satisfaction. After the virtual visit the patient and family member had the option to complete a satisfaction survey. The anonymous post-visit Likert-scale surveys measured (1) ease of iPad use, (2) staff engagement, and (3) mental health - coping and stress. Participants were recruited via the electronic medical record that displayed patients being ruled out for COVID. Data was analyzed using descriptive analysis and the results showed high levels of satisfaction among the patients and families in all areas. There is sufficient evidence to suggest that the availability of virtual visits is beneficial for patients and families. The implementation of video communication via iPad showed high levels of patient and family satisfaction, mental health outcomes and increased family involvement.

Background: An evidence-based project was performed to train and increase skills among healthcare providers to perform advance care planning. Training decreases barriers and improves attitudes and confidence to perform advance care planning. Advance care planning can include the Physician Order for Life-sustaining Treatment, an out-of-hospital order that directs emergency medical services of a patient’s wishes. Internal evidence found that many providers are unfamiliar with the Physician Order for Life-Sustaining Treatment form. The Theory of Planned Behavior was used to guide the project. Objectives: To improve advanced care planning processes in a healthcare organization. Design: A quality improvement project was performed at a medical center with outpatient provider groups. Virtual training was provided by the Arizona Hospital and Healthcare Association on the Physician Order for Life-Sustaining Treatment. Participants completed a three-part survey to measure skills for advance care planning after a training event. Setting/Subjects: Five (n=5) American palliative and primary care providers at a medical center. Measurements: The East Midlands Evaluation Toolkit is a validated survey tool that measures confidence and competence in advance care planning after training. Results: Descriptive statistics, Friedman’s test, and the Kruskal-Wallis test were used for data analysis. Results provided evidence to the healthcare facility that there is a significant need to train their healthcare professionals on advance care planning. Conclusions: Recommendations are made to focus research on larger studies looking at the types of advance care planning, and differences in disciplines and specialties.

Medicare implemented a yearly Annual Wellness Visit (AWV) to improve quality patient care through early detection of declining health. However, there has been only partial provider participation since its inception, which potentially delays treatment and negatively impacts patient outcomes. The aim of this quality improvement project was to assess the feasibility of implementing a standardized electronic AWV template into private primary care practices to improve the consistency of delivery and documentation. The project designer utilized the theory of transitions (TOT) to facilitate the project execution. An electronic Excel-based template was designed to capture and calculate all aspects of the AWV, including billing codes, to allow for ease and consistency of use within a small primary care practice over two weeks. A provider performed the AWVs using the electronic template after completing a hands-on tutorial and reviewing an educational handout. Data were retrieved from a 7-question, 5-point Likert scale questionnaire given to the provider to assess the effectiveness of the electronic template versus a paper assessment. The results of this study indicated overall satisfaction with using leveraged technology to provide consistency of AWVs to improve patient outcomes, provider satisfaction, and increase revenue through uniform charting and billing. The outcomes of this project provide a basis of existing evidence for using standardized methods to perform and track Medicare AWVs.

Objective: Chronic low back pain in adults is a global health and economic problem. Many with back pain experience compromised sleep. While Cognitive Behavioral Therapy (CBT) is a gold standard in improving sleep among individuals with pain, this approach requires trained staff. The sleep hygiene education and meditation techniques, components of CBT, were utilized in patients with chronic low back pain to improve sleep quality. Methods: Twenty patients with chronic back pain volunteered to receive sleep hygiene education and meditation videos to practice for 12 weeks and participate in 4-weekly phone calls. Participants were assessed at baseline and post-treatment with the Pittsburgh Sleep Quality Index (PSQI). Participants were patients at a local pain clinic with chronic low back pain without untreated mental illness, sleep apnea, or restless leg syndrome. Informed consent was obtained from participants, along with demographic data. Participants received a brochure with education information to engage daily for 12 weeks. Participants were then contacted weekly by phone to review the learned information. Results: 13 participants completed the post-intervention questionnaire (35 % attrition rate). Mean age was 55.15 yrs. and most were female (n=11). Paired t-test demonstrated that change in pre and post PSQI score, and Medication Use did not show statistical significance (p=0.372; p=0.502). However, Subjective Sleep Quality had clinical significance (p=.022) suggesting individuals thought their sleep have improved. Discussion: Sleep hygiene education and meditation techniques is an approach for individuals considering non-invasive and cost-effective approach to improve sleep

Sleep deprivation is linked to poor mental and physical health outcomes for professional firefighters. The importance of sleep hygiene practices and health promotional activities may increase the amount of quality sleep firefighters get on their days off. As the adverse outcomes of circadian misalignment due to sleep deprivation becomes more apparent in firefighter wellbeing, the need for a sleep health program becomes more evident. The purpose of this paper is to examine and assess the effects of a sleep health program for firefighter wellness. Research emphasizing the relevance of poor health outcomes related to sleep disturbances is prevalent in the literature. The findings have prompted the development of an evidence-based sleep coaching program for firefighters in a local fire department guided by The Cognitive Behavioral Therapy Model (Brewin, C.R., 1996). and a knowledge-to-Action process framework for evidence-based-practice (Graham et al., 2006).

Although estimated to be 50-60% more than in heteronormative populations, intimate partner violence (IPV) in LGBTQ+ populations is often unrecognized. This project aims to increase nurse practitioner (NP) IPV screening to facilitate early intervention and decrease LGBTQ+ IPV rates. The researcher gathered information from 1:1 interview with LGBTQ+ IPV survivors (n=3) and produced a dramatization narrating experiences. Subjects were required to preregister and consent. Nurse practitioners (n=6) participated in a 1.5hr online educational intervention, viewing the video and a 45-min webinar. The Physician Readiness to Manage Intimate Partner Violence Scale (PREMIS) and the LGBT Development of Clinical Skills Scale (LGBT-DOCCS) were administered as test-retest. The PREMIS measures (? =.963) readiness to screen for IPV, the LGBT-DOCCS measures attitude (?=.80), clinical preparedness (?=.88) and knowledge (?=.83). All participants in both groups were voluntary and recruited from e-lists and special interest groups. Cox’s Theory of Interaction and the Minority Stress Theory were the dual framework along with the ACE model of transformational knowledge to support methodology and outcomes. Results Statistically significant (p<0.05) improvements in readiness to screen for IPV, knowledge, and attitudes as measured by PREMIS domains (p= .006; p=.012) and LGBT-DOCSS (p = .028). Clinically significant improvement in mean scores for likelihood to screen for SOGI. Supported by the theoretical framework and implementation model, increased readiness to screen, improved knowledge and improved attitude, will lead to better NP-patient interactions, decreased minority stress, increased NP screening and intervention, and decreased rates of IPV in LGBTQ+ populations.

The number of adolescents who are overweight are suffering from diseases once thought to only occur in adults, such as diabetes mellitus type 2, coronary heart disease, and liver disease with cases increasing exponentially. This may be correlated with adolescents making unhealthy choices in life resulting in depression in obese adolescents. Healthcare providers must continuously explore novel ways to empower teens to make healthy lifestyle changes. The Creating Opportunities for Personal Empowerment (COPE) Thinking, Emotions, Exercise, and Nutrition (TEEN) program was delivered to three adolescent participants in a primary care pediatric clinic in Southwest Arizona. The 15 sessions were provided weekly in the pediatrician’s office using the COPE TEEN manual. The participants completed the HABITS questionnaire and the Patient Health Questionnaire-9 (PHQ-9) before starting the program and after program cessation and kept confidential. The survey results were compared using descriptive analysis and paired t-tests to analyze the data collected. Due to a small sample size (n=3), statistical significance could not be calculated. However, clinical significance was found as evidenced by lower depression scores and improvement in healthy habits. A cognitive behavior skills-building program such as the COPE TEEN program has the potential to empower adolescents to make healthy decisions in life. These healthy choices lead to a long, happy life free from diseases caused by unhealthy choices. This program positively impacts the clinical care of adolescents who are overweight or obese by offering providers an alternative manner of educating adolescents.

Objective: To understand and prevent adverse discharge events, the project assesses the needs and gaps of discharge care coordination for child(ren) with medical complexities (CMC). The National Survey of Children’s Health show 87.4% of CMC does not receive care in a well-functioning system, and 47.4% did not receive adequate care coordination 1. Therefore, does initiating measurement tools and communication before and after discharge identify and prevent discharge related adverse events? Methods: After IRB approval, a mixed-methods approach project occurred at southwestern pediatric free-standing hospital. Through eight weeks of convenience sampling, CMC caregivers were recruited in the inpatient setting (n=5). Qualitative and quantitative data were obtained through: [Pediatric] Care Transitions Measurement Tool – 15 (CTM- 15), with a Cronbach’s alpha of .932; a demographics survey; a post-discharge survey; and electronic health records. Results: The CTM-15 post-discharge score was 83.3 (N = 4, SD = 9.83, SE¬M = 4.92). CTM-15 qualitative data included: communication issues; rushed discharge; poor discharge anticipatory guidance; hospital policy concerns; follow-up appointment issues; and prescription errors. LOS average for all participants was 137.8 days (SD = 102.75, SEM = 45.95) with 40 unintended hospital days (SD = 41.55, SEM = 18.51). Issues encountered 30 days post-discharge included: prescription errors, follow-up issues, and home health issues. Conclusion: Hospitalized CMC have an increased risk to encounter a discharge adverse event because of a complex intertwining of disciplines, services, medications, and needs. Communication, tools, and surveys did not capture all the problems encountered by families with CMC; however, it did identify areas of notable concern.