Browsing by Author "Bae, Jonathan"
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Item Open Access A Novel Approach to Practice-Based Learning and Improvement Using a Web-Based Audit and Feedback Module.(Journal of Graduate Medical Education, 2014-09) Boggan, Joel C; Cheely, George; Shah, Bimal R; Heffelfinger, Randy; Springall, Deanna; Thomas, Samantha M; Zaas, Aimee; Bae, JonathanSystematically engaging residents in large programs in quality improvement (QI) is challenging.To coordinate a shared QI project in a large residency program using an online tool.A web-based QI tool guided residents through a 2-phase evaluation of performance of foot examinations in patients with diabetes. In phase 1, residents completed reviews of health records with online data entry. Residents were then presented with personal performance data relative to peers and were prompted to develop improvement plans. In phase 2, residents again reviewed personal performance. Rates of performance were compared at the program and clinic levels for each phase, with data presented for residents. Acceptability was measured by the number of residents completing each phase. Feasibility was measured by estimated faculty, programmer, and administrator time and costs.Seventy-nine of 86 eligible residents (92%) completed improvement plans and reviewed 1471 patients in phase 1, whereas 68 residents (79%) reviewed 1054 patient charts in phase 2. Rates of performance of examination increased significantly between phases (from 52% to 73% for complete examination, P < .001). Development of the tool required 130 hours of programmer time. Project analysis and management required 6 hours of administrator and faculty time monthly.An online tool developed and implemented for program-wide QI initiatives successfully engaged residents to participate in QI activities. Residents using this tool demonstrated improvement in a selected quality target. This tool could be adapted by other graduate medical education programs or for faculty development.Item Open Access Clinician Burnout Associated With Sex, Clinician Type, Work Culture, and Use of Electronic Health Records.(JAMA network open, 2021-04) McPeek-Hinz, Eugenia; Boazak, Mina; Sexton, J Bryan; Adair, Kathryn C; West, Vivian; Goldstein, Benjamin A; Alphin, Robert S; Idris, Sherif; Hammond, W Ed; Hwang, Shelley E; Bae, JonathanImportance
Electronic health records (EHRs) are considered a potentially significant contributor to clinician burnout.Objective
To describe the association of EHR usage, sex, and work culture with burnout for 3 types of clinicians at an academic medical institution.Design, setting, and participants
This cross-sectional study of 1310 clinicians at a large tertiary care academic medical center analyzed EHR usage metrics for the month of April 2019 with results from a well-being survey from May 2019. Participants included attending physicians, advanced practice providers (APPs), and house staff from various specialties. Data were analyzed between March 2020 and February 2021.Exposures
Clinician demographic characteristics, EHR metadata, and an institution-wide survey.Main outcomes and measures
Study metrics included clinician demographic data, burnout score, well-being measures, and EHR usage metadata.Results
Of the 1310 clinicians analyzed, 542 (41.4%) were men (mean [SD] age, 47.3 [11.6] years; 448 [82.7%] White clinicians, 52 [9.6%] Asian clinicians, and 21 [3.9%] Black clinicians) and 768 (58.6%) were women (mean [SD] age, 42.6 [10.3] years; 573 [74.6%] White clinicians, 105 [13.7%] Asian clinicians, and 50 [6.5%] Black clinicians). Women reported more burnout (survey score ≥50: women, 423 [52.0%] vs men, 258 [47.6%]; P = .008) overall. No significant differences in EHR usage were found by sex for multiple metrics of time in the EHR, metrics of volume of clinical encounters, or differences in products of clinical care. Multivariate analysis of burnout revealed that work culture domains were significantly associated with self-reported results for commitment (odds ratio [OR], 0.542; 95% CI, 0.427-0.688; P < .001) and work-life balance (OR, 0.643; 95% CI, 0.559-0.739; P < .001). Clinician sex significantly contributed to burnout, with women having a greater likelihood of burnout compared with men (OR, 1.33; 95% CI, 1.01-1.75; P = .04). An increased number of days spent using the EHR system was associated with less likelihood of burnout (OR, 0.966; 95% CI, 0.937-0.996; P = .03). Overall, EHR metrics accounted for 1.3% of model variance (P = .001) compared with work culture accounting for 17.6% of variance (P < .001).Conclusions and relevance
In this cross-sectional study, sex-based differences in EHR usage and burnout were found in clinicians. These results also suggest that local work culture factors may contribute more to burnout than metrics of EHR usage.Item Open Access Development and assessment of a web-based clinical quality improvement curriculum.(Journal of graduate medical education, 2014-03) Yanamadala, Mamata; Hawley, Jeffrey; Sloane, Richard; Bae, Jonathan; Heflin, Mitchell T; Buhr, Gwendolen TBackground
Understanding quality improvement (QI) is an important skill for physicians, yet educational interventions focused on teaching QI to residents are relatively rare. Web-based training may be an effective teaching tool in time-limited and expertise-limited settings.Intervention
We developed a web-based curriculum in QI and evaluated its effectiveness.Methods
During the 2011-2012 academic year, we enrolled 53 first-year internal medicine residents to complete the online training. Residents were provided an average of 6 hours of protected time during a 1-month geriatrics rotation to sequentially complete 8 online modules on QI. A pre-post design was used to measure changes in knowledge of the QI principles and self-assessed competence in the objectives of the course.Results
Of the residents, 72% percent (37 of 51) completed all of the modules and pretests and posttests. Immediate pre-post knowledge improved from 6 to 8.5 for a total score of 15 (P < .001) and pre-post self-assessed competence in QI principles on paired t test analysis improved from 1.7 to 2.7 on a scale of 5 for residents who completed all of the components of the course.Conclusions
Web-based training of QI in this study was comparable to other existing non-web-based curricula in improving learner confidence and knowledge in QI principles. Web-based training can be an efficient and effective mode of content delivery.Item Open Access Doctor Who? A Quality Improvement Project to Assess and Improve Patients' Knowledge of Their Inpatient Physicians.(Journal of Graduate Medical Education, 2016-05) Broderick-Forsgren, Kathleen; Hunter, Wynn G; Schulteis, Ryan D; Liu, Wen-Wei; Boggan, Joel C; Sharma, Poonam; Thomas, Steven; Zaas, Aimee; Bae, JonathanBackground Patient-physician communication is an integral part of high-quality patient care and an expectation of the Clinical Learning Environment Review program. Objective This quality improvement initiative evaluated the impact of an educational audit and feedback intervention on the frequency of use of 2 tools-business cards and white boards-to improve provider identification. Methods This before-after study utilized patient surveys to determine the ability of those patients to name and recognize their physicians. The before phase began in July 2013. From September 2013 to May 2014, physicians received education on business card and white board use. Results We surveyed 378 patients. Our intervention improved white board utilization (72.2% postintervention versus 54.5% preintervention, P < .01) and slightly improved business card use (44.4% versus 33.7%, P = .07), but did not improve physician recognition. Only 20.3% (14 of 69) of patients could name their physician without use of the business card or white board. Data from all study phases showed the use of both tools improved patients' ability to name physicians (OR = 1.72 and OR = 2.12, respectively; OR = 3.68 for both; P < .05 for all), but had no effect on photograph recognition. Conclusions Our educational intervention improved white board use, but did not result in improved patient ability to recognize physicians. Pooled data of business cards and white boards, alone or combined, improved name recognition, suggesting better use of these tools may increase identification. Future initiatives should target other barriers to usage of these types of tools.Item Open Access Implementation of a Hospital Medicine Morbidity and Mortality Conference and Mortality Review Using a Structured Mortality Instrument.(2013-03-01) Bae, Jonathan; Acker, Yvonne; Govert, Joseph; Hester, Jason; Kachalia, Allen; Owens, Thomas; Snider, Wendy; Rohan, Shannon; Gallagher, DavidItem Open Access IMPLEMENTATION OF HOSPITAL BASED CLINICAL PERFORMANCE METRICS TEACHING SESSIONS FOR MEDICINE RESIDENTS ON DUKE GENERAL MEDICINE(JOURNAL OF GENERAL INTERNAL MEDICINE, 2013-06-01) Gallagher, David; Setji, Noppon P; Bae, JonathanItem Open Access Patient Acuity Scores to Prevent Rapid Responses(The Ochsner journal) O'Donnell, Christopher; Thomas, Samantha; Johnson, Crystal; Verma, Lalit; Bae, Jonathan; Gallagher, DavidBackground: In the last 10 years, patient safety committees nationwide have focused on creating taskforces such as rapid response teams (RRTs) that can intervene when patients start to decompensate prior to a code. At Duke Regional Hospital, approximately 50% of RRT activations were found to occur during the first 24 hours of a patient’s stay. Unlike critical care medicine, internal medicine does not have a widely accepted scale to grade the severity of illness. A scale was developed by Edelson et al in 2011 to quantify the likelihood of decompensation. The Duke hospitalists adapted this scale and used it prospectively to determine whether there was a correlation in the presenting acuity of illness and the number of RRT interventions in the first 24 hours and to see if there would be a decrease from year to year. Methods: A patient acuity score was adapted with permission, and patients were graded prospectively from admission. Patient data from June to December 2013 was summarized using N (%) for categorical variables and mean (standard deviation) for continuous variables. Patients transferred to resident service were excluded from the analysis, making the effective sample size 4,322 patients. The differences in mean severity score by occurrence of an RRT intervention in multiple categories were examined using analysis of variance. The total number of RRT interventions (at any time, within 12 hours, and within 24 hours) and unplanned transfers for June to December in 2012 and 2013 were compared using Wilcoxon rank sum tests for independent nonparametric samples. Additionally RRT interventions were grouped by score of 5 and above vs 4 and below and analyzed via chi square test. Results: From June to December 2013, there were a total of 4,577 encounters by the hospitalists. A total of 4,322 patients met inclusion criteria. Ninety-two percent of the patients had a recorded acuity score. An RRT intervention occurred in 113 patients. Mean acuity scores were compared between subgroups. There were significant differences in mean acuity scores between patients who experienced an RRT intervention at any time and those who did not, patients who experienced an RRT intervention within 12 hours of admission and those who did not, patients who experienced an RRT intervention within 24 hours of admission and those who did not, and patients who underwent an unplanned transfer and those who did not (all P<0.007). It is notable that 100% of the level 7 scores that had a rapid response were transferred to the critical care unit, as well as 79% of the level 6 scores. There were no significant differences in the number of rapid responses between 2012 and 2013. Patients were then analyzed via chi square test in grouped distribution of scores of ‡5 and <5. Significant differences were seen in the total number of RRT interventions, the number of unplanned transfers and the number of RRTs within 24 hours. However, when looking at the grouping among patients with only RRT intervention, there was no significant difference between groups with a score ‡5 and those 4. Conclusion: A patient acuity scale to quantify how likely a patient is to have an adverse event has been shown to correlate with rapid responses and transfers to a higher level of care within the first 24 hours. Patients who had an RRT intervention had a higher score overall with a trend toward increasing transfer rates with elevated scores. Using this scoring system did not lead to a lower amount of rapid responses in comparing years; however, it could be used for selective monitoring to prevent sentinel events.Item Open Access Residents Finding Their Roots: Resident Workshops to Improve Patient Safety on the Wards while Teaching Residents Root Cause Analysis(2014-04-01) Boole, Lindsay; Seidelman, Jessica; Zaas, Aimee; Cheely, George; Chudgar, Saumil; Clarke, Jeffrey; Gallagher, David; Jolly Graham, Aubrey; O'Brien, Cara; Setji, Noppon; Shah, Bimal; Thomas, Samantha; Bae, JonathanItem Open Access Safety Culture and Workforce Well-Being Associations with Positive Leadership WalkRounds.(Joint Commission journal on quality and patient safety, 2021-07) Sexton, J Bryan; Adair, Kathryn C; Profit, Jochen; Bae, Jonathan; Rehder, Kyle J; Gosselin, Tracy; Milne, Judy; Leonard, Michael; Frankel, AllanBackground
Interventions to decrease burnout and increase well-being in health care workers (HCWs) and improve organizational safety culture are urgently needed. This study was conducted to determine the association between Positive Leadership WalkRounds (PosWR), an organizational practice in which leaders conduct rounds and ask staff about what is going well, and HCW well-being and organizational safety culture.Methods
This study was conducted in a large academic health care system in which senior leaders were encouraged to conduct PosWR. The researchers used data from a routine cross-sectional survey of clinical and nonclinical HCWs, which included a question about recall of exposure of HCWs to PosWR: "Do senior leaders ask for information about what is going well in this work setting (e.g., people who deserve special recognition for going above and beyond, celebration of successes, etc.)?"-along with measures of well-being and safety culture. T-tests compared work settings in the first and fourth quartiles for PosWR exposure across SCORE (Safety, Communication, Operational Reliability, and Engagement) domains of safety culture and workforce well-being.Results
Electronic surveys were returned by 10,627 out of 13,040 possible respondents (response rate 81.5%) from 396 work settings. Exposure to PosWR was reported by 63.1% of respondents overall, with a mean of 63.4% (standard deviation = 20.0) across work settings. Exposure to PosWR was most commonly reported by HCWs in leadership roles (83.8%). Compared to work settings in the fourth (< 50%) quartile for PosWR exposure, those in the first (> 88%) quartile revealed a higher percentage of respondents reporting good patient safety norms (49.6% vs. 69.6%, p < 0.001); good readiness to engage in quality improvement activities (60.6% vs. 76.6%, p < 0.001); good leadership accessibility and feedback behavior (51.9% vs. 67.2%, p < 0.001); good teamwork norms (36.8% vs. 52.7%, p < 0.001); and good work-life balance norms (61.9% vs. 68.9%, p = 0.003). Compared to the fourth quartile, the first quartile had a lower percentage of respondents reporting emotional exhaustion in themselves (45.9% vs. 32.4%, p < 0.001), and in their colleagues (60.5% vs. 47.7%, p < 0.001).Conclusion
Exposure to PosWR was associated with better HCW well-being and safety culture.Item Open Access The associations between work-life balance behaviours, teamwork climate and safety climate: cross-sectional survey introducing the work-life climate scale, psychometric properties, benchmarking data and future directions.(BMJ quality & safety, 2017-08) Sexton, J Bryan; Schwartz, Stephanie P; Chadwick, Whitney A; Rehder, Kyle J; Bae, Jonathan; Bokovoy, Joanna; Doram, Keith; Sotile, Wayne; Adair, Kathryn C; Profit, JochenImproving the resiliency of healthcare workers is a national imperative, driven in part by healthcare workers having minimal exposure to the skills and culture to achieve work-life balance (WLB). Regardless of current policies, healthcare workers feel compelled to work more and take less time to recover from work. Satisfaction with WLB has been measured, as has work-life conflict, but how frequently healthcare workers engage in specific WLB behaviours is rarely assessed. Measurement of behaviours may have advantages over measurement of perceptions; behaviours more accurately reflect WLB and can be targeted by leaders for improvement.1. To describe a novel survey scale for evaluating work-life climate based on specific behavioural frequencies in healthcare workers.2. To evaluate the scale's psychometric properties and provide benchmarking data from a large healthcare system.3. To investigate associations between work-life climate, teamwork climate and safety climate.Cross-sectional survey study of US healthcare workers within a large healthcare system.7923 of 9199 eligible healthcare workers across 325 work settings within 16 hospitals completed the survey in 2009 (86% response rate). The overall work-life climate scale internal consistency was Cronbach α=0.790. t-Tests of top versus bottom quartile work settings revealed that positive work-life climate was associated with better teamwork climate, safety climate and increased participation in safety leadership WalkRounds with feedback (p<0.001). Univariate analysis of variance demonstrated differences that varied significantly in WLB between healthcare worker role, hospitals and work setting.The work-life climate scale exhibits strong psychometric properties, elicits results that vary widely by work setting, discriminates between positive and negative workplace norms, and aligns well with other culture constructs that have been found to correlate with clinical outcomes.Item Open Access The Burden of Burnout: An Assessment of Burnout Among Internal Medicine Residents After the 2011 Duty Hour Changes.(Am J Med Qual, 2016-02-25) Elmariah, Hany; Thomas, Samantha; Boggan, Joel C; Zaas, Aimee; Bae, JonathanThis study sought to determine burnout prevalence and factors associated with burnout in internal medicine residents after introduction of the 2011 ACGME duty hour rules. Burnout was evaluated using an anonymized, abbreviated version of the Maslach Burnout Inventory. Surveys were collected biweekly for 48 weeks during the 2013-2014 academic year. Burnout severity was compared across subgroups and time. A score of 3 or higher signified burnout. Overall, 944 of 3936 (24%) surveys were completed. The mean burnout score across all surveys was 2.8. Categorical residents had higher burnout severity than noncategorical residents (2.9 vs 2.7, P = .005). Postgraduate year 2 residents had the highest burnout severity by year (3.1, P < .001). Residents on inpatient rotations had higher burnout severity than residents on outpatient or consultation rotations (3.1 vs 2.2 vs 2.2, P < .001). Night float rotations had the highest severity (3.8). Burnout remains a significant problem even with recent duty hour modifications.Item Open Access Work-life balance behaviours cluster in work settings and relate to burnout and safety culture: a cross-sectional survey analysis.(BMJ quality & safety, 2019-02) Schwartz, Stephanie P; Adair, Kathryn C; Bae, Jonathan; Rehder, Kyle J; Shanafelt, Tait D; Profit, Jochen; Sexton, J BryanBACKGROUND:Healthcare is approaching a tipping point as burnout and dissatisfaction with work-life integration (WLI) in healthcare workers continue to increase. A scale evaluating common behaviours as actionable examples of WLI was introduced to measure work-life balance. OBJECTIVES:(1) Explore differences in WLI behaviours by role, specialty and other respondent demographics in a large healthcare system. (2) Evaluate the psychometric properties of the work-life climate scale, and the extent to which it acts like a climate, or group-level norm when used at the work setting level. (3) Explore associations between work-life climate and other healthcare climates including teamwork, safety and burnout. METHODS:Cross-sectional survey study completed in 2016 of US healthcare workers within a large academic healthcare system. RESULTS:10 627 of 13 040 eligible healthcare workers across 440 work settings within seven entities of a large healthcare system (81% response rate) completed the routine safety culture survey. The overall work-life climate scale internal consistency was α=0.830. WLI varied significantly among healthcare worker role, length of time in specialty and work setting. Random effects analyses of variance for the work-life climate scale revealed significant between-work setting and within-work setting variance and intraclass correlations reflected clustering at the work setting level. T-tests of top versus bottom WLI quartile work settings revealed that positive work-life climate was associated with better teamwork and safety climates, as well as lower personal burnout and burnout climate (p<0.001). CONCLUSION:Problems with WLI are common in healthcare workers and differ significantly based on position and time in specialty. Although typically thought of as an individual difference variable, WLI appears to operate as a climate, and is consistently associated with better safety culture norms.