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102. Impact of Revised Infectious Diseases Society of America and Society for Healthcare Epidemiology of America Clinical Practice Guidelines on the Treatment of Clostridium difficile Infections in the United States.

Author

Clancy, Cornelius J, Buehrle, Deanna, Vu, Michelle, Wagener, Marilyn M, and Nguyen, M Hong

Subjects
COMMUNICABLE diseases, COMBINATION drug therapy, ORAL drug administration, VANCOMYCIN, MEDICAL protocols, CLOSTRIDIUM diseases, METRONIDAZOLE, TREATMENT effectiveness, DRUGS, TIME series analysis, DESCRIPTIVE statistics, FIDAXOMICIN
Abstract

Background Our objective was to determine if oral vancomycin, fidaxomicin, and oral metronidazole use in the United States changed after publication of revised clinical practice guidelines for Clostridium difficile infection (CDI) in February 2018. Methods We obtained US antibiotic prescription data (IQVIA) from 2006–August 2019 and used guideline-recommended dosing regimens to estimate monthly numbers of 10-day treatment courses of vancomycin, fidaxomicin and metronidazole. Interrupted time-series analyses were performed, adjusted by month. We compared linear trends for monthly numbers of treatment courses in different time periods. Results Cumulative treatment courses of oral vancomycin and fidaxomicin increased by 54% (n = 226 166) and 48% (n = 18 518), respectively, in 18 months following guidelines compared with 18 months before; those of oral metronidazole decreased by 3% (n = 238 372). Monthly vancomycin and fidaxomicin use significantly increased throughout the period following revised guidelines (P <.0001 and P =.0002, respectively), whereas that of metronidazole decreased significantly (P <.0001). Monthly vancomycin use increased and metronidazole use decreased to a significantly greater extent after publication of revised guidelines than after publication of clinical trials establishing superiority of vancomycin over metronidazole (P <.0001). Conclusions Revised practice guidelines have had a significant impact on CDI treatment in the US. Clinical trial data used for the revised guidelines were available since 2007–2014 and 2011–2012 for oral vancomycin and fidaxomicin, respectively. Guidelines or guidance documents for treating CDI and other infections should be updated in more timely fashion. [ABSTRACT FROM AUTHOR]

Published
2021
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103. Effectiveness of a Student Pharmacist–Led Telephone Follow-Up Intervention to Improve Hemoglobin A1C in Diabetic Patients.

Author

Peasah, Samuel K., Granitz, Kathryn, Vu, Michelle, and Jacob, Bobby

Subjects
GLYCOSYLATED hemoglobin, HEALTH occupations students, PATIENT aftercare, LONGITUDINAL method, PHARMACISTS, PHARMACY education, TELEMEDICINE, TELEPHONES, PILOT projects, RANDOMIZED controlled trials, DATA analysis software, DESCRIPTIVE statistics
Abstract

Objective: To evaluate the effectiveness of a student pharmacist–led telephone follow-up intervention to improve hemoglobin A1c (HbA1c) in diabetic patients. Methods: This was a prospective, randomized, pilot study to implement a telephone follow-up intervention for diabetic patients with HbA1c ≥7%. Patients were recruited and randomized into intervention and control groups. All patients received standard of care. Patients in the intervention group additionally received weekly phone calls from a student pharmacist for 12 weeks to encourage medication adherence. HbA1c at baseline and end of study were measured and the data were analyzed using SAS version 9.4. Analysis included descriptive statistics and a multiple regression model to assess the association between the end of study and baseline HbA1c while controlling for demographics. Results: Seventy-eight patients participated and the average age was 62 (±11) years. Baseline HbA1c was 8.2% (±1.4%) in the intervention group and 7.9% (±1.3%) in the control group. HbA1c decreased by 0.35% in the intervention group (P =.027) and increased by 0.338% in the control group (P =.013). The end of study HbA1c were higher in the control group even after controlling for baseline HbA1cs (0.5547, P value.002) in the regression model. Conclusion: Incorporating student pharmacists in physician offices to provide clinical care services could lead to improved patient outcomes and students' clinical and research skills. [ABSTRACT FROM AUTHOR]

Published
2020
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104. Sustainable implementation of innovative, technology-based health care practices: A qualitative case study from stroke telemedicine.

Author

Bagot, Kathleen L, Moloczij, Natasha, Barclay-Moss, Karen, Vu, Michelle, Bladin, Christopher F, and Cadilhac, Dominique A

Subjects
MEDICAL technology, STROKE treatment, TELEMEDICINE, MEDICAL innovations, CEREBROVASCULAR disease
Abstract

Introduction: Technology-based innovation requires long-term changes to workforce routines, otherwise practices will not be sustained. The aim of this study was to identify influential factors in the ongoing use of an acute stroke telemedicine programme.Methods: A new acute stroke telemedicine programme in a regional hospital receiving 375 patients with stroke or transient ischaemic attack per year was used as an exploratory case study. Semi-structured interviews with acute care and emergency department clinicians (n = 25) were conducted at two time-points: after a six-month pilot and then after a further 12-month implementation phase. Interviews (between 12-60 min) were recorded, transcribed and analysed inductively using descriptive thematic analysis. Reported barriers and facilitators were compared with those previously reported pre-implementation (deductive analysis) to identify changes over time. Using an implementation framework and a behaviour change taxonomy, strategies were developed to address influential factors on sustainability.Results: New facilitators were identified including hospital system changes, benefits to clinicians and telemedicine becoming standard practice. New and ongoing barriers included infrequent use, competing demands and the continued resistance to a specific treatment.Discussion: Understanding the factors supporting a health service in successfully implementing change can accelerate population benefits. The innovation itself may include barriers to be addressed, and barriers and facilitators can change over time. Individual attitudes remain critical to initial and ongoing success. Strategies proposed included promoting benefits across the organisation and allaying uncertainties with site-specific evidence. The effectiveness of these strategies, however, needs to be evaluated. Strategies sustaining change post-implementation should be considered. [ABSTRACT FROM AUTHOR]

Published
2020
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110. Integrating acute stroke telemedicine consultations into specialists' usual practice: a qualitative analysis comparing the experience of Australia and the United Kingdom

Author

Bagot, Kathleen L., Cadilhac, Dominique A, Bladin, Christopher F, Watkins, Caroline Leigh, Vu, Michelle, Donnan, Geoffrey A, Dewey, Helen M, Emsley, Hedley C A, Davies, D Paul, Day, Elaine, Ford, Gary A, Price, Christopher I, May, Carl R, Mcloughlin, Alison Sarah rachel, Gibson, Josephine, Lightbody, Catherine Elizabeth, Bagot, Kathleen L., Cadilhac, Dominique A, Bladin, Christopher F, Watkins, Caroline Leigh, Vu, Michelle, Donnan, Geoffrey A, Dewey, Helen M, Emsley, Hedley C A, Davies, D Paul, Day, Elaine, Ford, Gary A, Price, Christopher I, May, Carl R, Mcloughlin, Alison Sarah rachel, Gibson, Josephine, and Lightbody, Catherine Elizabeth

Abstract

Stroke telemedicine can reduce healthcare inequities by increasing access to specialists. Successful telemedicine networks require specialists adapting clinical practice to provide remote consultations. Variation in experiences of specialists between different countries is unknown. To support future implementation, we compared perceptions of Australian and United Kingdom specialists providing remote acute stroke consultations. Specialist participants were identified using purposive sampling from two new services: Australia's Victorian Stroke Telemedicine Program (n = 6; 2010-13) and the United Kingdom's Cumbria and Lancashire telestroke network (n = 5; 2010-2012). Semi-structured interviews were conducted pre- and post-implementation, recorded and transcribed verbatim. Deductive thematic and content analysis (NVivo) was undertaken by two independent coders using Normalisation Process Theory to explore integration of telemedicine into practice. Agreement between coders was M = 91%, SD = 9 and weighted average κ = 0.70. Cross-cultural similarities and differences were found. In both countries, specialists described old and new consulting practices, the purpose and value of telemedicine systems, and concerns regarding confidence in the assessment and diagnostic skills of unknown colleagues requesting telemedicine support. Australian specialists discussed how remote consultations impacted on usual roles and suggested future improvements, while United Kingdom specialists discussed system governance, policy and procedures. Australian and United Kingdom specialists reported telemedicine required changes in work practice and development of new skills. Both groups described potential for improvements in stroke telemedicine systems with Australian specialists more focused on role change and the United Kingdom on system governance issues. Future research should examine if cross-cultural variation reflects different models of care and extends to other networks.

Published
2017

111. Hospital and Health Plan Partnerships: The Affordable Care Act's Impact on Promoting Health and Wellness

Author

Vu, Michelle, White, Annesha, Kelley, Virginia P., Hopper, Jennifer Kuca, and Liu, Cathy

Subjects
Business
Abstract

The Affordable Care Act (ACA) healthcare reforms, centered on achieving the Centers for MedicareMedicaid Services (CMS) Triple Aim goals of improving patient care quality and satisfaction, improving population health, and reducing costs, have led to increasing partnerships between hospitals and insurance companies and the implementation of employee wellness programs. Hospitals and insurance companies have opted to partner to distribute the risk and resources and increase coordination of care.To examine the ACA's impact on the health and wellness programs that have resulted from the joint ventures of hospitals and health plans based on the published literature.We conducted a review of the literature to identify successful mergers and best practices of health and wellness programs. Articles published between January 2007 and January 2015 were compiled from various search engines, using the search terms "corporate," "health and wellness program," "health plan," "insurance plan," "hospital," "joint venture," and "vertical merger." Publications that described consolidations or wellness programs not tied to health insurance plans were excluded. Noteworthy characteristics of these programs were summarized and tabulated.A total of 44 eligible articles were included in the analysis. The findings showed that despite rising healthcare costs, joint ventures prevent hospitals from trading-off quality and services for cost reductions. Administrators believed that partnering would allow the companies to meet ACA standards for improving clinical outcomes at reduced costs. Before the implementation of the ACA, some employers had wellness programs, but these were not standardized and did not need to produce measurable results. The ACA encouraged improvement of employee wellness programs by providing funding for expanded health services and by mandating quality care. Successful workplace health and wellness programs have varying components, but all include monetary incentives and documented outcomes.The concurrent growth of hospital health plans (especially those emerging from vertical mergers and partnerships) and wellness programs in the United States provides a unique opportunity for employees and patient populations to promote wellness and achieve the Triple Aim goals as initiated by CMS.

Published
2016

112. Transitioning from a single-site pilot project to a state-wide regional telehealth service: The experience from the Victorian Stroke Telemedicine programme

Author

Bagot, Kathleen L, primary, Cadilhac, Dominique A, additional, Kim, Joosup, additional, Vu, Michelle, additional, Savage, Mark, additional, Bolitho, Les, additional, Howlett, Glenn, additional, Rabl, Justin, additional, Dewey, Helen M, additional, Hand, Peter J, additional, Denisenko, Sonia, additional, Donnan, Geoffrey A, additional, and Bladin, Christopher F, additional

Published
2017
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114. Developmental dysplasia of the hip

Author

Donnan, Leo, Vu, Michelle, and Angliss, Richard

Subjects
Business, Business, international, Health care industry
Published
2009

123. Su1288 Intestinal Cathelicidin Level Indicates Inflammatory Bowel Disease Activity and Mediates Anti-Inflammatory Effects in Colitis

Author

Ho, Samantha, primary, Cheng, Michelle, additional, Shih, David Q., additional, Vu, Michelle, additional, Hing, Tressia, additional, Kubota, Yuzu, additional, Ichikawa, Ryan, additional, Tran, Deanna H., additional, Gallo, Richard, additional, Targan, Stephan, additional, Pothoulakis, Charalabos, additional, and Koon, Hon Wai, additional

Published
2014
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126. Hospital and Health Plan Partnerships: The Affordable Care Act's Impact on Promoting Health and Wellness... [including commentary by F. Randy Vogenberg].

Author

Vu, Michelle, White, Annesha, Kelley, Virginia P., Kuca Hopper, Jennifer, and Liu, Cathy

Abstract

BACKGROUND: The Affordable Care Act (ACA) healthcare reforms, centered on achieving the Centers for Medicare & Medicaid Services (CMS) Triple Aim goals of improving patient care quality and satisfaction, improving population health, and reducing costs, have led to increasing partnerships between hospitals and insurance companies and the implementation of employee wellness programs. Hospitals and insurance companies have opted to partner to distribute the risk and resources and increase coordination of care. OBJECTIVE: To examine the ACA's impact on the health and wellness programs that have resulted from the joint ventures of hospitals and health plans based on the published literature. METHOD: We conducted a review of the literature to identify successful mergers and best practices of health and wellness programs. Articles published between January 2007 and January 2015 were compiled from various search engines, using the search terms "corporate," "health and wellness program," "health plan," "insurance plan," "hospital," "joint venture," and "vertical merger." Publications that described consolidations or wellness programs not tied to health insurance plans were excluded. Noteworthy characteristics of these programs were summarized and tabulated. RESULTS: A total of 44 eligible articles were included in the analysis. The findings showed that despite rising healthcare costs, joint ventures prevent hospitals from trading-off quality and services for cost reductions. Administrators believed that partnering would allow the companies to meet ACA standards for improving clinical outcomes at reduced costs. Before the implementation of the ACA, some employers had wellness programs, but these were not standardized and did not need to produce measurable results. The ACA encouraged improvement of employee wellness programs by providing funding for expanded health services and by mandating quality care. Successful workplace health and wellness programs have varying components, but all include monetary incentives and documented outcomes. CONCLUSION: The concurrent growth of hospital health plans (especially those emerging from vertical mergers and partnerships) and wellness programs in the United States provides a unique opportunity for employees and patient populations to promote wellness and achieve the Triple Aim goals as initiated by CMS. [ABSTRACT FROM AUTHOR]

Published
2016

132. Sa1148 Development of a Novel “No-Show” Predictive Overbooking Algorithm for Colonoscopy Scheduling

Author

Wang, Hank S., primary, Thepyasuwan, Nattapaun N., additional, Ocampo, Luis H., additional, Kubomoto, Scott, additional, Lee, Aaron, additional, Baek, Michael D., additional, Sharma, Gobind N., additional, Liu, Jessica, additional, Modi, Rusha, additional, Levy, Alexander, additional, Vu, Michelle, additional, Snyder, Bradley J., additional, Poysophon, Poyrung, additional, and Spiegel, Brennan M., additional

Published
2012
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133. Tu1363 Evidence for Post-Diverticulitis Irritable Bowel Syndrome (Pdv-IBS): Longitudinal Analysis Reveals Higher Incidence of IBS in DV Cases vs. Controls

Author

Cohen, Erica R., primary, Fuller, Garth, additional, Bolus, Roger, additional, Snyder, Bradley J., additional, Vu, Michelle, additional, Shahedi, Kamyar, additional, Shah, Rena, additional, Modi, Rusha, additional, Atia, Mary A., additional, Kurzbard, Nicole, additional, Sheen, Victoria, additional, Agarwal, Nikhil, additional, Kaneshiro, Marc, additional, Yen, Linnette, additional, Hodgkins, Paul, additional, Erder, Moshe H., additional, Poysophon, Poyrung, additional, and Spiegel, Brennan M., additional

Published
2012
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134. Su1001 Comparing Patients Who Show vs. No-Show for Outpatient Colonoscopy: Differences in Cognitive, Environmental, and Demographic Characteristics

Author

Reynolds, Justin A., primary, Wang, Hank S., additional, Ocampo, Luis H., additional, Kubomoto, Scott, additional, Thepyasuwan, Nattapaun N., additional, Baek, Michael D., additional, Sharma, Gobind N., additional, Lee, Aaron, additional, Liu, Jessica, additional, Modi, Rusha, additional, Levy, Alexander, additional, Vu, Michelle, additional, Poysophon, Poyrung, additional, and Spiegel, Brennan M., additional

Published
2012
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135. 847 Progression From Incidental Diverticulosis to Acute Diverticulitis

Author

Shahedi, Kamyar, primary, Fuller, Garth, additional, Bolus, Roger, additional, Snyder, Bradley J., additional, Cohen, Erica R., additional, Vu, Michelle, additional, Shah, Rena, additional, Modi, Rusha, additional, Atia, Mary A., additional, Kurzbard, Nicole, additional, Sheen, Victoria, additional, Agarwal, Nikhil, additional, Kaneshiro, Marc, additional, Yen, Linnette, additional, Hodgkins, Paul, additional, Erder, Moshe H., additional, Poysophon, Poyrung, additional, and Spiegel, Brennan M., additional

Published
2012
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136. Tu1919 Anti-Inflammatory Effects of Anti-Microbial Peptide Cathelicidin in Mice With Acute Colitis

Author

Koon, Hon Wai, primary, Chen, Jeremy, additional, Ichikawa, Ryan, additional, Shih, David Q., additional, Ho, Samantha, additional, Cheng, Michelle, additional, Hing, Tressia, additional, Vu, Michelle, additional, Law, Ivy, additional, Zhao, Dezheng, additional, Gallo, Richard, additional, Targan, Stephan R., additional, and Pothoulakis, Charalabos, additional

Published
2012
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137. Mo1030 Less Experienced Endoscopists are More Likely to Report “Sub-Optimal” Bowel Preparation Quality vs. More Experienced Endoscopists

Author

Wang, Hank S., primary, Kubomoto, Scott, additional, Lee, Aaron, additional, Ocampo, Luis H., additional, Baek, Michael D., additional, Sharma, Gobind N., additional, Liu, Jessica, additional, Modi, Rusha, additional, Thepyasuwan, Nattapaun N., additional, Levy, Alexander, additional, Vu, Michelle, additional, Sheen, Victoria, additional, Atia, Mary A., additional, Shahedi, Kamyar, additional, Snyder, Bradley J., additional, Poysophon, Poyrung, additional, and Spiegel, Brennan M., additional

Published
2012
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138. Mo1036 Post Diverticulitis (DV) Depression: Longitudinal Analysis Reveals Higher Incidence in Cases vs. Controls

Author

Vu, Michelle, primary, Fuller, Garth, additional, Bolus, Roger, additional, Snyder, Bradley J., additional, Cohen, Erica R., additional, Shahedi, Kamyar, additional, Shah, Rena, additional, Modi, Rusha, additional, Atia, Mary A., additional, Kurzbard, Nicole, additional, Sheen, Victoria, additional, Agarwal, Nikhil, additional, Kaneshiro, Marc, additional, Yen, Linnette, additional, Hodgkins, Paul, additional, Erder, Moshe H., additional, Poysophon, Poyrung, additional, and Spiegel, Brennan M., additional

Published
2012
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139. 911 Development of an Online Calculator to Predict Sub-Optimal Bowel Preparation Among Patients Scheduled for Colonoscopy

Author

Modi, Rusha, primary, Wang, Hank S., additional, Sharma, Gobind N., additional, Ocampo, Luis H., additional, Baek, Michael D., additional, Lee, Aaron, additional, Liu, Jessica, additional, Kubomoto, Scott, additional, Thepyasuwan, Nattapaun N., additional, Levy, Alexander, additional, Vu, Michelle, additional, Sheen, Victoria, additional, Atia, Mary A., additional, Shahedi, Kamyar, additional, Snyder, Bradley J., additional, Poysophon, Poyrung, additional, and Spiegel, Brennan M., additional

Published
2012
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142. Direct Costs and Resource Utilization for Inpatient Diverticulitis Admissions

Author

Spiegel, Brennan, primary, Poysophon, Poyrung, additional, Snyder, Bradley, additional, Agarwal, Nikhil, additional, Yen, Linette, additional, Hodgkins, Paul, additional, Cohen, Erica, additional, Vu, Michelle, additional, Kurzbard, Nicole, additional, Atia, Mary, additional, Sheen, Victoria, additional, Kaneshiro, Marc, additional, Fuller, Garth, additional, and Bolus, Roger, additional

Published
2011
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145. No fair!!

Author

Short, Elaine, primary, Hart, Justin, additional, Vu, Michelle, additional, and Scassellati, Brian, additional

Published
2010
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148. Telemedicine in the acute health setting: A disruptive innovation for specialists (an example from stroke).

Author

Bagot, Kathleen L., Cadilhac, Dominique A., Vu, Michelle, Moss, Karen, Bladin, Christopher F., and VST collaborators

Subjects
TELEMEDICINE, DISRUPTIVE innovations, MEDICAL innovations, FACE-to-face communication, EMERGENCY medical services
Abstract

Introduction: Telemedicine is a disruptive innovation within health care settings as consultations take place via audio-visual technology rather than traditional face-to-face. Specialist perceptions and experiences of providing audio-visual consultations in emergency situations, however, are not well understood. The aim of this exploratory study was to describe the experience of medical specialists providing acute stroke decision-making support via telemedicine.Methods: Data from the Victorian Stroke Telemedicine (VST) programme were used. The experiences of specialists providing an acute clinical telemedicine service to rural emergency departments were explored, drawing on disruptive innovation theory. Document analysis of programme consultation records, meeting minutes and in-depth individual interviews with three neurologists were analysed using triangulation.Results: Since February 2014, 269 stroke telemedicine consultations with 12 neurologists have occurred. Retention on the roster has varied between 1 and >4 years. Overall, neurologists reported benefits of participation, as they were addressing health equity gaps for rural patients. Negative effects were the unpredictability of consultations impacting on their personal life, the mixed level of experience of colleagues initiating the consult and not knowing patient outcomes since follow-up communication was not routine.Conclusions: Insights into workforce experience and satisfaction were identified to inform strategies to support specialists to adapt to the disruptive innovation of telemedicine. [ABSTRACT FROM AUTHOR]

Published
2015
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