Browsing by Author "Lewinski, Allison"
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Item Open Access eConsults' Impact on Care Access and Wait Times in Rheumatology.(Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases, 2022-04) Malcolm, Elizabeth J; Brandon, Zachary; Wilson, Lauren E; Shoup, John Paul; King, Heather A; Lewinski, Allison; Greiner, Melissa A; Malone, Shauna; Miller, Julie; Keenan, Robert T; Tarrant, Teresa K; Phinney, Donna; Cho, Alex; Bosworth, Hayden B; Shah, KevinBackground/objective
A growing number of health systems have implemented eConsults to improve access to specialty advice, but few studies have described their use in rheumatology or impact on visit wait times. We evaluated the uptake of an eConsult program and its impact on wait times for in-person rheumatology visits.Methods
In this quality improvement project, we analyzed electronic health record data from 4 intervention clinics and 4 comparison clinics, 12 months before and after implementation of an eConsult program. We compared median wait time for rheumatology appointments using a pre-post difference-in-differences analysis and quantile regression, adjusting for patient age, race, sex, clinic pair, and primary insurance payer. We also interviewed 11 primary care providers from the intervention clinics and conducted a rheumatology provider focus group (n = 4) to elucidate experiences with the program.Results
Rheumatologists recommended management in primary care or referral to another specialty for 41% of eConsults, reducing initial demand for in-person visits. The median wait times dropped in the intervention and the comparison clinics (42 and 25 days, respectively). Intervention clinic median wait time dropped 17 days more than comparison clinics, and this was nonstatistically significant (p = 0.089). eConsults fit provider care tasks best for triage or initial workup for diagnosis, and less well when tests required interpretation, or when back and forth communication was needed to manage the patient's condition.Conclusions
Implementation of eConsults for rheumatology was associated with reduced wait times for rheumatology appointments and supported primary care providers in the triage and workup for a substantial portion of patients.Item Open Access EXpanding Technology-Enabled, Nurse-Delivered Chronic Disease Care (EXTEND): Protocol and Baseline Data for a Randomized Trial.(Contemporary clinical trials, 2024-08) German, Jashalynn; Yang, Qing; Hatch, Daniel; Lewinski, Allison; Bosworth, Hayden B; Kaufman, Brystana G; Chatterjee, Ranee; Pennington, Gina; Matters, Doreen; Lee, Donghwan; Urlichich, Diana; Kokosa, Sarah; Canupp, Holly; Gregory, Patrick; Roberson, Cindy Leslie; Smith, Benjamin; Huber, Sherry; Doukellis, Katheryn; Deal, Tammi; Burns, Rose; Crowley, Matthew J; Shaw, Ryan JBackground
Approximately 10-15 % of individuals with type 2 diabetes have persistently poorly-controlled diabetes mellitus (PPDM) despite receiving available care, and frequently have comorbid hypertension. Mobile monitoring-enabled telehealth has the potential to improve outcomes in treatment-resistant chronic disease by supporting self-management and facilitating patient-clinician contact but must be designed in a manner amenable to real-world use.Methods
Expanding Technology-Enabled, Nurse-Delivered Chronic Disease Care (EXTEND) is an ongoing randomized trial comparing two 12-month interventions for comorbid PPDM and hypertension: 1) EXTEND, a mobile monitoring-enabled self-management intervention; and 2) EXTEND Plus, a comprehensive, nurse-delivered telehealth program incorporating mobile monitoring, self-management support, and pharmacist-supported medication management. Both arms leverage a novel platform that uses existing technological infrastructure to enable transmission of patient-generated health data into the electronic health record. The primary study outcome is difference in HbA1c change from baseline to 12 months. Secondary outcomes include blood pressure, weight, implementation barriers/facilitators, and costs.Results
Enrollment concluded in June 2023 following randomization of 220 patients. Baseline characteristics are similar between arms; mean age is 54.5 years, and the cohort is predominantly female (63.6 %) and Black (68.2 %), with a baseline HbA1c of 9.81 %.Conclusion
The EXTEND trial is evaluating two mobile monitoring-enabled telehealth approaches that seek to improve outcomes for patients with PPDM and hypertension. Critically, these approaches are designed around existing infrastructure, so may be amenable to implementation and scaling. This study will promote real-world use of telehealth to maximize benefits for those with high-risk chronic disease.Item Open Access How can equitable video visit access be delivered in primary care? A qualitative study among rural primary care teams and patients(BMJ Open, 2022-08) Goldstein, Karen M; Perry, Kathleen R; Lewinski, Allison; Walsh, Conor; Shepherd-Banigan, Megan E; Bosworth, Hayden B; Weidenbacher, Hollis; Blalock, Dan V; Zullig, Leah LObjectiveThe COVID-19 pandemic sparked exponential growth in video visit use in primary care. The rapid shift to virtual from in-person care exacerbated digital access disparities across racial groups and rural populations. Moving forward, it is critical to understand when and how to incorporate video visits equitably into primary care. We sought to develop a novel clinical algorithm to guide primary care clinics on how and when to employ video visits as part of care delivery.DesignQualitative data collection: one team member conducted all patient semistructured interviews and led all focus groups with four other team members taking notes during groups.Setting3 rural primary care clinics in the USA.Participants24 black veterans living in rural areas and three primary care teams caring for black veterans living in rural areas.Primary and secondary outcome measuresFindings from semistructured interviews with patients and focus groups with primary care teams.ResultsKey issues around appropriate use of video visits for clinical teams included having adequate technical support, encouraging engagement during video visits and using video visits for appropriate clinical situations. Patients reported challenges with broadband access, inadequate equipment, concerns about the quality of video care, the importance of visit modality choice, and preferences for in-person care experience over virtual care. We developed an algorithm that requires input from both patients and their care team to assess fit for each clinical encounter.ConclusionsInformed matching of patients and clinical situations to the right visit modality, along with individual patient technology support could reduce virtual access disparities.Item Open Access The puzzle of medication nonadherence among individuals with hypertension.(Patient education and counseling, 2019-06) Lewinski, Allison; Bosworth, Hayden B