Publications by authors named "Vineet Arora"

326 Publications

Integrating Physicians Into Lean Quality Improvement Through a Structured Educational Program: The ECLIPSE Program.

Am J Med Qual 2021 Jul 21. Epub 2021 Jul 21.

Chicago Department of Public Health, Chicago, IL University of Chicago Medical Center, Chicago, IL Emory University Medical Center, Atlanta, GA URochester Medicine at Highland Hospital, Rochester, NY New York University Langone Health, New York, NY.

In the increasingly complex health care system, physicians require skills and knowledge to participate with multidisciplinary team members in quality improvement (QI) that adds value to health care organizations. The Educational and Clinical Leaders Improving Performance with Structured E3L training (ECLIPSE) program was developed to address this challenge. Clinically relevant components of lean management were leveraged to create an online, flipped-classroom curriculum, and this was paired with Kaizen adapted specifically for physicians and multidisciplinary clinicians to promote experiential skills utilization. The focus of each adapted Kaizen was a topic of institutional QI priority, such as improving patient throughput or reducing readmission rates. Participants were awarded certification in the E3 Leadership management system-a patient-centered, equity-focused system based on lean principles. After 4 years, 50 E3 Leadership certificates were awarded to multidisciplinary clinicians, including 30 to physicians; participants scored an average 85% on module quizzes. The ECLIPSE program has improved physician participation in multidisciplinary QI projects with institutional alignment.
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http://dx.doi.org/10.1097/01.JMQ.0000750804.54998.16DOI Listing
July 2021

Toward Gender Equity in Academic Promotions.

JAMA Intern Med 2021 Jul 12. Epub 2021 Jul 12.

Department of Medicine, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts.

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http://dx.doi.org/10.1001/jamainternmed.2021.3471DOI Listing
July 2021

Gender Disparities in Journal Citations-Another Metric of Inequity in Academia.

JAMA Netw Open 2021 Jul 1;4(7):e2114787. Epub 2021 Jul 1.

Department of Medicine, Pritzker School of Medicine, University of Chicago, Chicago, Illinois.

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http://dx.doi.org/10.1001/jamanetworkopen.2021.14787DOI Listing
July 2021

The National Institutes of Health Should Extend the Systems-Level Approach to Include Extramural Research.

Acad Med 2021 Jul;96(7):934

Associate professor, Departments of Medicine and Pediatrics, University of Chicago Pritzker School of Medicine, Chicago, Illinois.

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http://dx.doi.org/10.1097/ACM.0000000000004086DOI Listing
July 2021

The impact of the COVID-19 pandemic on nighttime room entries and sleep disruptions for pediatric patients.

Sleep Med 2021 May 28;84:76-81. Epub 2021 May 28.

Pritzker School of Medicine, University of Chicago, Chicago, IL, USA; Section of Pediatric Hospital Medicine, University of Chicago Medical Center, Chicago, IL, USA. Electronic address:

Objectives/background: Sleep is critical to recovery, but inpatient sleep is often disrupted. During the COVID-19 pandemic, social distancing efforts to minimize spread may have improved hospitalized children's sleep by decreasing unnecessary overnight disruptions. This study aimed to describe the impact of these efforts on pediatric inpatient sleep using objective and subjective metrics.

Methods: Sleep disruptions for pediatric inpatients admitted prior to and during the COVID-19 pandemic were compared. Hand hygiene sensors tracking room entries were utilized to measure objective overnight disruptions for 69 nights pre-pandemic and 154 pandemic nights. Caregiver surveys of overnight disruptions, sleep quantity, and caregiver mood were adopted from validated tools: the Karolinska Sleep Log, Potential Hospital Sleep Disruptions and Noises Questionnaire, and Visual Analog Mood Scale.

Results: Nighttime room entries initially decreased 36% (95% CI: 30%, 42%, p < 0.001), then returned towards baseline, mirroring the COVID-19 hospital census. However, surveyed caregivers (n_pre = 293, n_post = 154) reported more disrupted sleep (p < 0.001) due to tests (21% vs. 38%), anxiety (23% vs. 41%), and pain (23% vs. 48%). Caregivers also reported children slept 61 fewer minutes (95% CI: -12 min, -110 min, p < 0.001). Caregivers self-reported feeling more sad, weary, and worse overall (p < 0.001 for all).

Conclusions: Despite a decrease in objective room entries during the pandemic, caregivers reported their children were disrupted more and slept less. Caregivers also self-reported worse mood. This highlights the effects of the COVID-19 pandemic on subjective experiences of hospitalized children and their caregivers. Future work targeting stress and anxiety could improve pediatric inpatient sleep.
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http://dx.doi.org/10.1016/j.sleep.2021.05.020DOI Listing
May 2021

Prevalence and Characteristics of Advocacy Curricula in U.S. Medical Schools.

Acad Med 2021 May 25. Epub 2021 May 25.

T.D. Brender is a medical student, Oregon Health & Science University, Portland, Oregon. W. Plinke is a me student, Oregon Health & Science University, Portland, Oregon. V.M. Arora is the Herbert T. Abelson Professor of Medicine and assistant dean, Scholarship and Discovery, University of Chicago School of Medicine in Chicago, Illinois; ORCID: http://orcid.org/0000-0002-4745-7599. J.M. Zhu is assistant professor of medicine, Division of General Internal Medicine, Oregon Health & Science University in Portland, Oregon; ORCID: http://orcid.org/0000-0002-4868-6078.

Purpose: Recent national events, including the COVID-19 pandemic and protests of racial inequities, have drawn attention to the role of physicians in advocating for improvements in the social, economic, and political factors that affect health. Characterizing the current state of advocacy training in U.S. medical schools may help set expectations for physician advocacy and predict future curricular needs.

Method: Using the members school directory provided by the Association of American Medical Colleges, the authors compiled a list of 154 MD-granting medical schools in the United States in 2019-2020. They used multiple search strategies to identify online course catalogues and advocacy-related curricula using variations of the terms "advocacy," "policy," "equity," and "social determinants of health." They used an iterative process to generate a preliminary coding schema and to code all course descriptions, conducting content analysis to describe the structure of courses and topics covered.

Results: Of 134 medical schools with any online course catalogue available, 103 (76.9%) offered at least one advocacy course. Required courses were typically survey courses focused on general content in health policy, population health, or public health/epidemiology, whereas elective courses were more likely to focus specifically on advocacy skills building and to feature field experiences. Of 352 advocacy-specific courses, 93 (26.4%) concentrated on a specific population (e.g., children or persons with low socioeconomic status). Few courses (n = 8) focused on racial/ethnic minorities and racial inequities.

Conclusions: Findings suggest that while most U.S. medical schools offer at least one advocacy course, the majority are elective rather than required, and the structure and content of advocacy-related courses vary substantially. Given the urgency to address social, economic, and political factors affecting health and health equity, this study provides an important and timely overview of the prevalence and content of advocacy curricula at U.S. medical schools.
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http://dx.doi.org/10.1097/ACM.0000000000004173DOI Listing
May 2021

Gender Differences in Physician Use of Social Media for Professional Advancement.

JAMA Netw Open 2021 May 3;4(5):e219834. Epub 2021 May 3.

Division of Hematology and Oncology, University of Illinois at Chicago, Chicago.

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http://dx.doi.org/10.1001/jamanetworkopen.2021.9834DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8120326PMC
May 2021

Impact of an Educational Comic to Enhance Patient-Physician-Electronic Health Record Engagement: Prospective Observational Study.

JMIR Hum Factors 2021 Apr 28;8(2):e25054. Epub 2021 Apr 28.

Department of Medicine, University of Chicago, Chicago, IL, United States.

Background: Electronic health record (EHR) use can impede or augment patient-physician communication. However, little research explores the use of an educational comic to improve patient-physician-EHR interactions.

Objective: To evaluate the impact of an educational comic on patient EHR self-advocacy behaviors to promote patient engagement with the EHR during clinic visits.

Methods: We conducted a prospective observational study with adult patients and parents of pediatric patients at the University of Chicago General Internal Medicine (GIM) and Pediatric Primary Care (PPC) clinics. We developed an educational comic highlighting EHR self-advocacy behaviors and distributed it to study participants during check-in for their primary care visits between May 2017 and May 2018. Participants completed a survey immediately after their visit, which included a question on whether they would be interested in a follow-up telephone interview. Of those who expressed interest, 50 participants each from the adult and pediatric parent cohorts were selected at random for follow-up telephone interviews 8 months (range 3-12 months) post visit.

Results: Overall, 71.0% (115/162) of adult patients and 71.6% (224/313) of pediatric parents agreed the comic encouraged EHR involvement. African American and Hispanic participants were more likely to ask to see the screen and become involved in EHR use due to the comic (adult P=.01, P=.01; parent P=.02, P=.006, respectively). Lower educational attainment was associated with an increase in parents asking to see the screen and to be involved (ρ=-0.18, P=.003; ρ=-0.19, P<.001, respectively) and in adults calling for physician attention (ρ=-0.17, P=.04), which was confirmed in multivariate analyses. Female GIM patients were more likely than males to ask to be involved (median 4 vs 3, P=.003). During follow-up phone interviews, 90% (45/50) of adult patients and all pediatric parents (50/50) remembered the comic. Almost half of all participants (GIM 23/50, 46%; PPC 21/50, 42%) recalled at least one best-practice behavior. At subsequent visits, adult patients reported increases in asking to see the screen (median 3 vs 4, P=.006), and pediatric parents reported increases in asking to see the screen and calling for physician attention (median 3 vs 4, Ps<.001 for both). Pediatric parents also felt that the comic had encouraged them to speak up and get more involved with physician computer use since the index visit (median 4 vs 4, P=.02) and that it made them feel more empowered to get involved with computer use at future visits (median 3 vs 4, P<.001).

Conclusions: Our study found that an educational comic may improve patient advocacy for enhanced patient-physician-EHR engagement, with higher impacts on African American and Hispanic patients and patients with low educational attainment.
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http://dx.doi.org/10.2196/25054DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8116991PMC
April 2021

Let's Not Sleep on It: Hospital Sleep Is a Health Issue Too.

Jt Comm J Qual Patient Saf 2021 Jun 27;47(6):337-339. Epub 2021 Mar 27.

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http://dx.doi.org/10.1016/j.jcjq.2021.03.008DOI Listing
June 2021

Weak Handgrip at Index Admission for Acute Exacerbation of COPD Predicts All-Cause 30-Day Readmission.

Front Med (Lausanne) 2021 7;8:611989. Epub 2021 Apr 7.

Department of Medicine, University of Chicago, Chicago, IL, United States.

Identifying patients hospitalized for acute exacerbations of COPD (AECOPD) who are at high risk for readmission is challenging. Traditional markers of disease severity such as pulmonary function have limited utility in predicting readmission. Handgrip strength, a component of the physical frailty phenotype, may be a simple tool to help predict readmission. To investigate if handgrip strength, a component of the physical frailty phenotype and surrogate for weakness, is a predictive biomarker of COPD readmission. This was a prospective, observational study of patients admitted to the inpatient general medicine unit at the University of Chicago Medicine, US. This study evaluated age, sex, ethnicity, degree of obstructive lung disease by spirometry (FEV percent predicted), and physical frailty phenotype (components include handgrip strength and walk speed). The primary outcome was all-cause hospital readmission within 30 days of discharge. Of 381 eligible patients with AECOPD, 70 participants agreed to consent to participate in this study. Twelve participants (17%) were readmitted within 30 days of discharge. Weak grip at index hospitalization, defined as grip strength lower than previously established cut-points for sex and body mass index (BMI), was predictive of readmission (OR 11.2, 95% CI 1.3, 93.2, = 0.03). Degree of airway obstruction (FEV percent predicted) did not predict readmission (OR 1.0, 95% CI 0.95, 1.1, = 0.7). No non-frail patients were readmitted. At a single academic center weak grip strength was associated with increased 30-day readmission. Future studies should investigate whether geriatric measures can help risk-stratify patients for likelihood of readmission after admission for AECOPD.
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http://dx.doi.org/10.3389/fmed.2021.611989DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8058414PMC
April 2021

: Integrating Clinical Learning Environment Staff and Learners Into the Pursuit of Quality, Safety, Equity, and Value.

J Grad Med Educ 2021 Apr 16;13(2):294-300. Epub 2021 Apr 16.

is Professor of Obstetrics and Gynecology, Associate Dean for Graduate Medical Education, and Designated Institutional Official, University of Chicago Medicine.

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http://dx.doi.org/10.4300/JGME-D-21-00197.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8054589PMC
April 2021

Sleep Disturbances in Frontline Health Care Workers During the COVID-19 Pandemic: Social Media Survey Study.

J Med Internet Res 2021 05 19;23(5):e27331. Epub 2021 May 19.

Department of Medicine, University of Chicago Medical Center, Chicago, IL, United States.

Background: During the COVID-19 pandemic, health care workers are sharing their challenges, including sleep disturbances, on social media; however, no study has evaluated sleep in predominantly US frontline health care workers during the COVID-19 pandemic.

Objective: The aim of this study was to assess sleep among a sample of predominantly US frontline health care workers during the COVID-19 pandemic using validated measures through a survey distributed on social media.

Methods: A self-selection survey was distributed on Facebook, Twitter, and Instagram for 16 days (August 31 to September 15, 2020), targeting health care workers who were clinically active during the COVID-19 pandemic. Study participants completed the Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI), and they reported their demographic and career information. Poor sleep quality was defined as a PSQI score ≥5. Moderate-to-severe insomnia was defined as an ISI score >14. The Mini-Z Burnout Survey was used to measure burnout. Multivariate logistic regression tested associations between demographics, career characteristics, and sleep outcomes.

Results: A total of 963 surveys were completed. Participants were predominantly White (894/963, 92.8%), female (707/963, 73.4%), aged 30-49 years (692/963, 71.9%), and physicians (620/963, 64.4%). Mean sleep duration was 6.1 hours (SD 1.2). Nearly 96% (920/963, 95.5%) of participants reported poor sleep (PSQI). One-third (288/963, 30%) reported moderate or severe insomnia. Many participants (554/910, 60.9%) experienced sleep disruptions due to device use or had nightmares at least once per week (420/929, 45.2%). Over 50% (525/932, 56.3%) reported burnout. In multivariable logistic regressions, nonphysician (odds ratio [OR] 2.4, 95% CI 1.7-3.4), caring for patients with COVID-19 (OR 1.8, 95% CI 1.2-2.8), Hispanic ethnicity (OR 2.2, 95% CI 1.4-3.5), female sex (OR 1.6, 95% CI 1.1-2.4), and having a sleep disorder (OR 4.3, 95% CI 2.7-6.9) were associated with increased odds of insomnia. In open-ended comments (n=310), poor sleep was mapped to four categories: children and family, work demands, personal health, and pandemic-related sleep disturbances.

Conclusions: During the COVID-19 pandemic, nearly all the frontline health care workers surveyed on social media reported poor sleep, over one-third reported insomnia, and over half reported burnout. Many also reported sleep disruptions due to device use and nightmares. Sleep interventions for frontline health care workers are urgently needed.
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http://dx.doi.org/10.2196/27331DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8136405PMC
May 2021

LEAPFROG Rounds: Maximizing the Rounding Experience for the Interprofessional Team During the COVID-19 Pandemic.

Acad Pediatr 2021 07 16;21(5):917-919. Epub 2021 Apr 16.

Pritzker School of Medicine (NM Orlov and VM Arora), University of Chicago, Chicago, Ill; Section of General Internal Medicine (VM Arora), University of Chicago Medical Center, Chicago, Ill.

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http://dx.doi.org/10.1016/j.acap.2021.04.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8051005PMC
July 2021

Association of Vitamin D Levels, Race/Ethnicity, and Clinical Characteristics With COVID-19 Test Results.

JAMA Netw Open 2021 03 1;4(3):e214117. Epub 2021 Mar 1.

The University of Chicago, Chicago, Illinois.

Importance: Deficient (ie, <20 ng/mL) or insufficient (ie, 20 to <30 ng/mL) 25-hydroxyvitamin D (also known as calcifediol) levels are more common in Black individuals than White individuals and are associated with increased coronavirus disease 2019 (COVID-19) risk. Whether COVID-19 risk is associated with differences in vitamin D levels of 30 ng/mL or greater is not known.

Objective: To examine whether COVID-19 test results are associated with differences in vitamin D levels of 30 ng/mL or greater, including for White individuals and for Black individuals.

Design, Setting, And Participants: This retrospective cohort study was conducted at an academic medical center in Chicago, Illinois. Participants included individuals with data on vitamin D level within 365 days before COVID-19 testing, which was conducted from March 3 to December 30, 2020. Data were analyzed from September 11, 2020, to February 5, 2021.

Exposures: The last vitamin D level before COVID-19 testing was categorized as less than 20 ng/mL (ie, deficient), 20 to less than 30 ng/mL (ie, insufficient), 30 to less than 40 ng/mL, or 40 ng/mL or greater. Treatment was defined by vitamin D type and dose 14 days before COVID-19 testing and treatment changes after last vitamin D level.

Main Outcomes And Measures: The main outcome was a positive result for COVID-19 in polymerase chain reaction testing. Multivariable analyses tested whether previously measured vitamin D level was associated with having test results positive for COVID-19 in White individuals and in Black individuals, controlling for months and treatment changes since the vitamin D level was measured, as well as demographic characteristics and comorbidity indicators.

Results: A total of 4638 individuals (mean [SD] age 52.8 [19.5] years; 3205 [69%] women) had data for a vitamin D level within 1 year before COVID-19 testing, including 2288 (49%) Black individuals, 1999 (43%) White individuals, and 351 individuals (8%) who were another race/ethnicity (eg, Asian, Mideast Indian, >1 race). Stratified by vitamin D level, 1251 individuals (27%) had less than 20 ng/mL, 1267 individuals (27%) had 20 to less than 30 ng/mL, 1023 individuals (22%) had 30 to less than 40 ng/mL, and 1097 individuals (24%) had 40 ng/mL or greater. Lower vitamin D levels were more common in Black individuals (<20 ng/mL: 829 of 2288 Black individuals [36%]) than White individuals (<20 ng/mL: 315 of 1999 White individuals [16%]). A total of 333 individuals (7%) had test results positive for COVID-19, including 102 White individuals (5%) and 211 Black individuals (9%). Multivariate analysis controlling for time since last vitamin D level measurement was used to estimate the outcomes associated with levels 14 days before COVID-19 testing. A positive test result for COVID-19 was not significantly associated with vitamin D levels in White individuals but was associated with vitamin D levels in Black individuals (compared with ≥40 ng/mL: <20 ng/mL incidence rate ratio [IRR], 2.55 [95% CI, 1.26-5.15]; P = .009; 20 to <30 ng/mL IRR, 1.69 [95% CI, 0.75-3.84]; P = .21; 30 to <40 ng/mL IRR, 2.64 [95% CI, 1.24-5.66]; P = .01). Stratified by vitamin D level, estimated COVID-19 positivity rates in Black individuals were 9.72% (95% CI, 6.74%-13.41%) for individuals with a vitamin D level less than 20 ng/mL, 6.47% (95% CI, 3.33%-10.28%) for individuals with a vitamin D level of 20 to less than 30 ng/mL, 10.10% (95% CI, 6.00%-15.47%) for individuals with a vitamin D level of 30 to less than 40 ng/mL, and 3.82% (95% CI, 1.78%-6.68%) for individuals with a vitamin D level of 40 ng/mL or higher. Multivariate analysis in individuals with a vitamin D level of 30 ng/mL or greater found that the IRR of a positive COVID-19 test result was 0.97 (95% CI, 0.94-0.99; P = .008) per 1-ng/mL increase in vitamin D overall and 0.95 (95% CI, 0.91-0.98; P = .003) per 1-ng/mL increase in vitamin D in Black individuals.

Conclusions And Relevance: In this single-center retrospective cohort study, COVID-19 risk increased among Black individuals with vitamin D level less than 40 ng/mL compared with those with 40 ng/mL or greater and decreased with increasing levels among individuals with levels greater than 30 ng/mL. No significant associations were noted for White individuals. Randomized clinical trials should examine whether increasing vitamin D level to greater than 40 ng/mL affects COVID-19 risk.
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http://dx.doi.org/10.1001/jamanetworkopen.2021.4117DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7980095PMC
March 2021

Optimizing Oral Medication Schedules for Inpatient Sleep: A Quality Improvement Intervention.

Hosp Pediatr 2021 Apr 17;11(4):327-333. Epub 2021 Mar 17.

Pritzker School of Medicine, The University of Chicago, Chicago, Illinois;

Objectives: Hospitalized children experience frequent nighttime awakenings. Oral medications are commonly administered around the clock despite the comparable efficacy of daytime administration schedules, which promote sleep. With this study, we evaluated the effectiveness of a quality improvement initiative to increase the proportion of sleep-friendly antibiotic administration schedules.

Methods: Interprofessional stakeholders modified computerized provider order entry defaults for 4 oral antibiotic medications, from around the clock to administration occurring exclusively during waking hours. Additionally, care-team members received targeted education. Outcome measures included the proportion of sleep-friendly administration schedules and patient caregiver-reported disruptions to sleep. Pre- and posteducation surveys were used to evaluate education effectiveness. Balancing measures were missed antibiotic doses and related escalations of care.

Results: Interrupted time series analysis revealed a 72% increase (intercept: 18%; intercept: 90%; 95% confidence interval: 65%-79%; < .001) in intercept for percentage of orders with sleep-friendly administration schedules (orders: = 1014 and = 649). Compared with preeducation surveys, care-team members posteducation were more likely to agree that oral medications scheduled around the clock cause sleep disruption (resident: 71% pre, 90% post [ = .01]; nurse: 63% pre, 79% post [ = .03]). Although sleep-friendly orders increased, patient caregivers reported an increase in sleep disruption due to medications (pre 28%, post 46%; < .001).

Conclusions: A simple, low-cost intervention of computerized provider order entry default modifications and education can increase the proportion of sleep-friendly oral antibiotic administration schedules for hospitalized children. Patient perception of sleep is impacted by multiple factors and often does not align with objective data. An increased focus on improving sleep during hospitalization may result in heightened awareness of disruptions.
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http://dx.doi.org/10.1542/hpeds.2020-002261DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8006200PMC
April 2021

Patient Characteristics Associated with and Changes Over Time in Trust in Inpatient Physicians.

J Gen Intern Med 2021 Feb 25. Epub 2021 Feb 25.

Department of Medicine, The University of Chicago, Chicago, IL, USA.

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http://dx.doi.org/10.1007/s11606-021-06649-0DOI Listing
February 2021

Representation of Women on National Institutes of Health Study Sections.

JAMA Netw Open 2021 02 1;4(2):e2037346. Epub 2021 Feb 1.

Section of General Internal Medicine, Department of Medicine, The University of Chicago, Chicago, Illinois.

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http://dx.doi.org/10.1001/jamanetworkopen.2020.37346DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7885038PMC
February 2021

Point-of-care naloxone distribution in the emergency department: A pilot study.

Am J Health Syst Pharm 2021 02;78(4):360-366

Pritzker School of Medicine, University of Chicago Medicine, Chicago, IL.

Purpose: Opioid overdose education and naloxone distribution (OEND) for use by laypersons has been shown to be safe and effective, but implementation in the emergency department (ED) setting is challenging. Recent literature has shown a discouragingly low rate of obtainment of naloxone that is prescribed in the ED setting. We conducted a study to evaluate the feasibility of point-of-care (POC) distribution of naloxone in an ED, hypothesizing a rate of obtainment higher than prescription fill rates reported in previous studies.

Summary: A multidisciplinary team of experts, including pharmacists, physicians, nurses, and case management professionals used an iterative process to develop a protocol for POC OEND in the ED. The protocol includes 5 steps: (1) patient screening, (2) order placement in the electronic health record (EHR), (3) a patient training video, (4) dispensing of naloxone kit, and (5) written discharge instructions. The naloxone kits were assembled, labeled to meet requirements for a prescription, and stored in an automated dispensing cabinet. Two pharmacists, 30 attending physicians, 65 resident physicians, and 108 nurses were trained. In 8 months, 134 orders for take-home naloxone were entered and 117 naloxone kits were dispensed, resulting in an obtainment rate of 87.3%. The indication for take-home naloxone kit was heroin use for 61 patients (92.4%).

Conclusion: POC naloxone distribution is feasible and yielded a rate of obtainment significantly higher than previous studies in which naloxone was prescribed. POC distribution can be replicated at other hospitals with low rates of obtainment.
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http://dx.doi.org/10.1093/ajhp/zxaa409DOI Listing
February 2021

A Mobile App to Facilitate Socially Distanced Hospital Communication During COVID-19: Implementation Experience.

JMIR Mhealth Uhealth 2021 02 23;9(2):e24452. Epub 2021 Feb 23.

Section of General Internal Medicine, University of Chicago, Chicago, IL, United States.

Background: COVID-19 has significantly altered health care delivery, requiring clinicians and hospitals to adapt to rapidly changing hospital policies and social distancing guidelines. At our large academic medical center, clinicians reported that existing information on distribution channels, including emails and hospital intranet posts, was inadequate to keep everyone abreast with these changes. To address these challenges, we adapted a mobile app developed in-house to communicate critical changes in hospital policies and enable direct telephonic communication between clinical team members and hospitalized patients, to support social distancing guidelines and remote rounding.

Objective: This study aimed to describe the unique benefits and challenges of adapting an app developed in-house to facilitate communication and remote rounding during COVID-19.

Methods: We adapted moblMD, a mobile app available on the iOS and Android platforms. In conjunction with our Hospital Incident Command System, resident advisory council, and health system innovation center, we identified critical, time-sensitive policies for app usage. A shared collaborative document was used to align app-based communication with more traditional communication channels. To minimize synchronization efforts, we particularly focused on high-yield policies, and the time of last review and the corresponding reviewer were noted for each protocol. To facilitate social distancing and remote patient rounding, the app was also populated with a searchable directory of numbers to patient bedside phones and hospital locations. We monitored anonymized user activity from February 1 to July 31, 2020.

Results: On its first release, 1104 clinicians downloaded moblMD during the observation period, of which 46% (n=508) of downloads occurred within 72 hours of initial release. COVID-19 policies in the app were reviewed most commonly during the first week (801 views). Users made sustained use of hospital phone dialing features, including weekly peaks of 2242 phone number dials, 1874 directory searches, and 277 patient room phone number searches through the last 2 weeks of the observation period. Furthermore, clinicians submitted 56 content- and phone number-related suggestions through moblMD.

Conclusions: We rapidly developed and deployed a communication-focused mobile app early during COVID-19, which has demonstrated initial and sustained value among clinicians in communicating with in-patients and each other during social distancing. Our internal innovation benefited from our team's familiarity with institutional structures, short feedback loops, limited security and privacy implications, and a path toward sustainability provided by our innovation center. Challenges in content management were overcome through synchronization efforts and timestamping review. As COVID-19 continues to alter health care delivery, user activity metrics suggest that our solution will remain important in our efforts to continue providing safe and up-to-date clinical care.
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http://dx.doi.org/10.2196/24452DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7903979PMC
February 2021

Leveling the Playing Field: Accounting for Academic Productivity During the COVID-19 Pandemic.

J Hosp Med 2021 Feb;16(2):120-123

Division of Hematology and Oncology, Department of Medicine, University of Illinois, Chicago, Illinois.

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http://dx.doi.org/10.12788/jhm.3558DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7850598PMC
February 2021

An Electronic Health Record Intervention to Increase Utilization of Limited Transthoracic Echocardiography.

J Am Soc Echocardiogr 2021 May 4;34(5):551-552. Epub 2021 Jan 4.

Department of Medicine University of Chicago Medicine, Chicago, Illinois.

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http://dx.doi.org/10.1016/j.echo.2020.12.023DOI Listing
May 2021

March On - Diversity in the Face of Adversity.

N Engl J Med 2020 12 16;383(27):e145. Epub 2020 Dec 16.

Emory University, Atlanta, GA.

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http://dx.doi.org/10.1056/NEJMpv2026445DOI Listing
December 2020

Addressing Medical Misinformation in the Patient-Clinician Relationship.

JAMA 2020 Dec;324(23):2367-2368

Academy Health, Washington, DC.

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http://dx.doi.org/10.1001/jama.2020.4263DOI Listing
December 2020

Rethinking Hospital-Associated Disability for Patients With COVID-19.

J Hosp Med 2020 12;15(12):757-759

Section of Hospital Medicine, University of Chicago Medical Center Department of Medicine, Chicago, Illinois.

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http://dx.doi.org/10.12788/jhm.3504DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8034676PMC
December 2020

Measuring eHealth Literacy in Urban Hospitalized Patients: Implications for the Post-COVID World.

J Gen Intern Med 2021 01 19;36(1):251-253. Epub 2020 Oct 19.

General Internal Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA.

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http://dx.doi.org/10.1007/s11606-020-06309-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7571520PMC
January 2021

Direct-Acting Oral Anticoagulants: A Resident-Based Workshop to Improve Knowledge and Confidence.

MedEdPORTAL 2020 09 30;16:10981. Epub 2020 Sep 30.

Professor, Department of Medicine, University of Chicago Pritzker School of Medicine.

Introduction: Direct-acting oral anticoagulant (DOAC) prescriptions have increased steadily since the first, dabigatran, was Food and Drug Administration-approved in 2010. They have multiple advantages over vitamin K antagonists including fixed dosing without coagulation lab monitoring, rapid onset and offset of action, and fewer drug and food interactions. Patient-specific dosing, administration education, adherence, and monitoring are critically important. Many providers are unfamiliar with these concepts and too often use DOACs for off-label indications or at off-label dosing. A DOAC workshop was created to address knowledge gaps and improve internal medicine resident prescribing confidence.

Methods: One author (Irsk Anderson) conducted four 1-hour DOAC workshops with 49 total internal medicine residents rotating on their outpatient clinical rotation between October 2018 and November 2019. Residents performed small-group learning around four DOAC-specific cases, followed by a large-group report-out session. The residents completed pre- and postworkshop multiple-choice questions (MCQs) to assess knowledge as well as a postworkshop DOAC confidence self-assessment.

Results: Resident knowledge, assessed by percentage of residents answering correctly, improved significantly for all four MCQs after completing the workshop (all <.003). Resident confidence, assessed on a 5-point Likert scale, improved significantly for all five themes ( <.001). Overall resident satisfaction was high ( = 4.2 on a 5-point Likert scale) and 85% desired further DOAC training.

Discussion: A 1-hour DOAC workshop was feasible and improved internal medicine resident knowledge and self-confidence. Future work should assess behavior change and patient clinical outcomes.
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http://dx.doi.org/10.15766/mep_2374-8265.10981DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7526504PMC
September 2020

COVID-19 Threatens Progress Toward Gender Equity Within Academic Medicine.

Acad Med 2021 06;96(6):813-816

H. Joffe is Paula A. Johnson associate professor of psychiatry, Mary Horrigan Connors Center for Women's Health and Gender Biology and Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.

Women remain underrepresented within academic medicine despite past and present efforts to promote gender equity. The authors discuss how the COVID-19 pandemic could stymie progress toward gender parity within the biomedical workforce and limit the retention and advancement of women in science and medicine. Women faculty face distinct challenges as they navigate the impact of shelter-in-place and social distancing on work and home life. An unequal division of household labor and family care between men and women means women faculty are vulnerable to inequities that may develop in the workplace as they strive to maintain academic productivity and professional development without adequate assistance with domestic tasks and family care. Emerging data suggest that gender differences in academic productivity may be forthcoming as a direct result of the pandemic. Existing gender inequities in professional visibility, networking, and collaboration may be exacerbated as activities transition from in-person to virtual environments and create new barriers to advancement. Meanwhile, initiatives designed to promote gender equity within academic medicine may lose key funding due to the economic impact of COVID-19 on higher education. To ensure that the gender gap within academic medicine does not widen, the authors call upon academic leaders and the broader biomedical community to support women faculty through deliberate actions that promote gender equity, diversity, and inclusion. The authors provide several recommendations, including faculty needs assessments; review of gender bias within tenure-clock-extension offers; more opportunities for mentorship, sponsorship, and professional recognition; and financial commitments to support equity initiatives. Leadership for these efforts should be at the institutional and departmental levels, and leaders should ensure a gender balance on task forces and committees to avoid overburdening women faculty with additional service work. Together, these strategies will contribute to the development of a more equitable workforce capable of transformative medical discovery and care.
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http://dx.doi.org/10.1097/ACM.0000000000003782DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7543905PMC
June 2021

Differences in Milestone Evaluations of Men and Women: The Devil Is in the Details.

Acad Med 2020 10;95(10):1465

Herbert T. Abelson Professor of medicine, assistant dean for scholarship and discovery, and associate chief medical officer-clinical learning environment, University of Chicago, Chicago, Illinois; Twitter: @FutureDocs; ORCID: https://orcid.org/0000-0002-4745-7599.

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http://dx.doi.org/10.1097/ACM.0000000000003600DOI Listing
October 2020
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