Effectiveness of Acute Care Remote Triage Systems: a Systematic Review.

I am a hospital medicine physician interested in quality improvement, patient safety, and medical education across the UME, GME, and CME environments. My current QI and research projects include work on readmissions, inpatient ORYX and patient experience measures, clinical documentation improvement, medication reconciliation, and appropriate utilization of inpatient resources. Alongside this work, I serve as the lead mentor for our Durham VA Chief Resident in Quality and Safety within the Department of Medicine and the Program Director for the Duke University Hospital CRQS.

As Associate Program Director for Quality Improvement and Patient Safety in the Duke Internal Medicine Residency Program, I oversee QI and safety education and projects for our residents and help co-lead our Residency Patient Safety and Quality Council. Additionally, I supervise housestaff and students on our general medicine wards, precept housestaff evidence-based medicine resident reports, and serve as a small group leader for our second-year medical student Clinical Skills Course. Finally, I lead our Innovation Sciences committee as part of the ongoing School of Medicine Curriculum Innovation Initiative.

Interest in understanding mechanisms and advancing treatment of anger and aggression in veterans with trauma-related psychopathology, including posttraumatic stress disorder.  Specific interests in integrating mHealth applications and sensor technology into the therapeutic process; sex/gender differences in the experience, expression, and treatment of anger and aggression associated with trauma; and “moral injury” associated with trauma.   

Sharron "Shari" Rushton, DNP, MS, RN, CCM, CNE joined the Duke University School of Nursing (DUSON) faculty in 2011.  She earned her Bachelor of Science in Nursing from the University of Iowa, a Master of Biomedical Science in Physiology from the Mayo Graduate School, and both an Master of Science in Nursing and Doctor of Nursing Practice from DUSON.

She has clinical experience as a staff nurse and nurse manager. Additionally, she has practiced in a broad range of clinical settings including the areas of cardiac care, critical care, float staff and post transplant care. Her care coordination experience includes discharge planning and utilization review as well as rehab admissions. 

Her scholarly interests include translation of evidence in practice, care coordination/case management, population health, interprofessional education and educational strategies. She teaches population health across graduate programs and evidence-based practice in the MSN Core.

As a nurse scientist and health services researcher, with a joint appointment between the Duke University School of Nursing (DUSON) and the Durham Veterans Affairs Health Care System (VHA), I have acquired expertise in the areas of diabetes distress, qualitative research methods, and virtual care (e.g., telehealth, digital health) as a method of care delivery. My research focuses on the current and potential ability of virtual care interventions to reduce distress, improve self-management, increase access to evidence-based care delivery, and improve patient and population health outcomes. My collaborative and interdisciplinary research focuses on how patient-, provider-, and system-level factors influence virtual care use and outcomes. As evidence of its growing significance and impact at DUSON and the VHA, my work has been well funded, published in high-impact journals, presented at select conferences, and used to guide health system decision-making. I am a sought-after teacher and mentor because I connect my research interests to teaching students and mentees rigorous and systematic research approaches. I am frequently asked by local and national colleagues to provide guidance on distress, qualitative research methods, and virtual care approaches used in grants, projects, and manuscripts.  

My research contributions have focused on alleviating psychosocial distress, developing and implementing multi-level virtual care interventions, and enhancing qualitative methods. As a staff nurse, I witnessed the psychosocial distress of patients who experience challenges in obtaining care which led to my interest in diabetes distress. I aspire and work to improve health outcomes for individuals with chronic illness by developing equitable and sustainable multi-level virtual care interventions and assessing their implementation and adaptation. Virtual care describes any remote interaction between a patient and/or members of their care team. To achieve these goals, I use qualitative methods and implementation science approaches to enhance alignment between patient, modality, disease state, and social and environmental context; my collective assessments address for whom and what purposes, in what situations and contexts, when in a disease course or clinical activity, and in what specific ways such interventions are effective. My focus on the uptake and adoption of virtual care to address psychosocial distress considers interactions with patients, between patients and clinicians, and within health care systems and the larger population.

Clinical Practice:

I specialize in the assessment and treatment of issues common in patients and family members of patients with chronic, life-threatening, or terminal illness focusing on symptom management (e.g., pain, depression, anxiety) and end-of-life issues (e.g., suffering, anticipatory grief, existential angst). Additionally, I have expertise in the assessment and treatment of behavioral and psychological aspects of disability and chronic health conditions with interventions focused on increasing meaning, independence and choice, functional abilities, and social role participation.

Clinical Teaching:

I offer clinical training to Duke psychology and psychiatry trainees and am a member of the Durham VA Medical Center Psychology Training Program, supervising psychology residents on the Rehabilitation, Geriatric, Palliative, and Hospice Care Rotation. 

Research interests:

• Health policy and systems research related to rehabilitation and palliative mental health services

• Psychological, sociocultural, interpersonal, and spiritual factors in chronic disease and life-threatening or terminal illness

• Prevention of and adjustment to amputation/limb loss

Statistical methodology for evaluation of diagnostic tests
Adjustment for misclassification
Missing data
Clinical trials
Analysis of cardiovascular and stroke data

John Williams, MD, MHS, is a Professor of Medicine at Duke University Medical Center and a past recipient of VA Health Services Career Development and a Robert Wood Johnson Foundation Generalist Faculty Scholar Awards. He received his bachelor and MD degrees from the University of North Carolina. Dr. Williams completed residency training at the University of Iowa and a research fellowship at Duke University. He is a primary care internist who is trained in epidemiology, biostatistics, and literature synthesis. Dr. Williams’ topical interests include depression, mental health services, dementia and implementation of best practices. He is a medical editor for the Patient Centered Outcomes Research Institute and the Evidence-base Practice Program. Dr. Williams is Senior Science Advisor to the Durham VA Evidence Synthesis Program and has led numerous systematic reviews, many focusing on mental health services. Dr. Williams is board certified in Internal Medicine and active in clinical practice and resident physician education at the Durham VAMC.

Dr. Goldstein's research interests include women's health, cardiovascular risk reduction, evidence synthesis methodology and peer support.

Jennifer Gierisch, PhD,  is behavioral scientist and health services researcher. She is an Associate Professor in the Department of Population Heath Sciences and the Department of Medicine at Duke University. She is a core investigator with the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT)  where she serves as the leader of the Partnered Research Methods Core (PRESTO)  and Director of the VA OAA Health Services Research Postdoctoral Fellowship. Dr. Gierisch also is the Co-Director of the Evidence Synthesis Program (VA ESP) at the Durham Veteran Affairs Health Care System. She also served as a faculty director of the Duke Clinical Translational Science Institute's  Community Engaged Research Initiative (CeRi) for five years

Dr. Gierisch’s research focuses on three overarching areas: 1) behavioral research on the psychosocial factors that influence appropriate uptake and maintenance of complex health behaviors (eg., weight management, smoking cessation, cancer screening); 2) evidence synthesis on key health and healthcare topics to enhance uptake of evidence-based interventions to improve patient and health system outcomes; and 3) participatory and  community engaged research approaches.

Area of expertise: health behavior, community-engaged research, evidence synthesis, intervention development,  qualitative research