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OneCare Vermont ACO Quality Metric Evaluation
Alexander Braun
This project explores OneCare Vermont ACO quality metrics and how they can be used to improve patient care and reimbursement in a Vermont family medicine practice. Perspectives of physicians within the practice and others familiar with OneCare Vermont operations are shared. Several metrics were identified as areas for improvement within the practice by comparing ACO metrics with patient data.
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PHQ-9, but in Spanish
Jose Calderon
Spanish speaking patients are often missed for depression. A common issue is lack of awareness of the Spanish version of the PHQ-9
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Updating Concussion Protocol Information Pamphlet
Susan K. Campbell
Creating a concussion protocol pamphlet that helps guide patients through recovery with evidence based advice.
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Pap Smears in the Somali Immigrant Population
Garrett Chan
Lewiston, Maine is home to a population of Somali refugees. Women within this community have faced cultural and language barriers that have prevented them from obtaining Pap smears. We have collaborated with a local health clinic, where a cultural broker and member of the Somali community who is familiar with this population, to understand challenges Somali immigrant women face in cervical cancer screening. Together, we developed a pamphlet and health resource card, both in Somali, to lower barriers to care.
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The use of mindful breathing as part of the healthcare intake process
Deena Chanowitz and Lauren Struck
Most Americans visit the doctor’s office for an acute or chronic condition or for preventative care. No matter what the reason, a visit to the doctor’s office can be stressful for a patient. Our study was designed to determine whether a patient’s experience of the visit can be improved using a mindful breathing exercise. We developed a system for teaching a two minute breathing exercise, with a brief questionnaire to evaluate how the patient feels before and after the intervention. We presented our study design to practitioners in primary care offices in VT and CT who were receptive to the idea of including a form of mindfulness in their primary care office visits.
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Zoom Support: Virtual Health in the times of COVID
Patrick Clarke
Assessing the feasibility of implementing a "how-to" video for elderly or disabled persons utilizing Zoom to access telehealth.
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Medical Students and home-based Primary Care : Education Outside of the Clinic
Sally Clark
Home-based primary care has tremendous utility for homebound patients and those who have serious functional limitations. Patients who utilize home-based primary care have significantly lower rates of hospital admission and 30-day readmissions. Incorporating a home-health visit into the Family Medicine Clerkship rotation for MS3s will help medical students understand the importance of primary care while also learning about a patient's unique environment.
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Food Security during Remote Schooling
Julia Lane Clemens
This project examined how remote schooling during the coronavirus pandemic affected patients' food security. Patients were surveyed about their access to food and how this had changed during the pandemic. Recommendations were made to the clinic following data collection.
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Increasing Public Perceptions of Stroke
Juan A. Conde and Juan Conde Fabela
Analysis of publicly available data for the selected county of Rutland Vermont was performed to understand the underlying health problems affecting the county. Although VT overall has better health status indicators, including better access to care, and lower rates of chronic diseases than the nation, pockets of the state have higher rates of chronic diseases including obesity, DM, and cerebrovascular accidents.
Increasing awareness of stroke risk factors and symptoms is a cost-effective method to reduced stroke burden and provide successful treatment.
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Evaluating knowledge and educating patients about diabetic retinopathy screening in Washington County, VT
Delaney Curran
Diabetic retinopathy (DR) is a leading cause of blindness in adults. Early detection and subsequent treatment of DR has been shown to be effective at saving vision and medical costs. However, adherence to annual dilated eye exams is relatively poor among people with diabetes. This project in Waterbury, VT aimed to identify patients' potential knowledge gaps about the connection between diabetes and eye disease, educate patients about DR with a 2 min educational video in the primary care office, and then assess their level of interest in getting an eye exam after watching the video.
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Narrative Medicine: Perspectives on Opioid Maintenance
Noorin Damji
People who experience opioid addiction often feel marginalized by healthcare workers, or stigmatized by the medical system. Additionally, there are not enough medical providers to meet the needs of people who struggle with opioid addiction. These factors create barriers that prevent the medical establishment from effectively meeting the needs of people who experience addiction. This project compiles rich perspectives of patients on opioid maintenance treatment to share with medical students and providers to foster greater empathy for these patients, and positive attitudes toward managing substance use disorder among future medical providers.
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Creating a standardized workflow for providers at South Burlington Family Practice, South Burlington VT for documenting and diagnosing attention-deficit/hyperactivity disorder in pediatric patients aged 0-17
Racquel Sales De Castro
An initiative of the Vermont Child Health Improvement Program (VCHIP) is to improve the attention-deficit/hyperactivity disorder (ADD/ADHD) pediatric diagnostic process in both family medicine and pediatric practices in the state of Vermont. This project specifically on improving this process at South Burlington Family Practice in South Burlington Vermont but is generalizable to all practices caring for pediatric and adolescent patients. For this project emphasis was placed on creating a standardized workflow that is followed by all providers in the practice, creating educational material for caregivers who present with a behavioral concern for their child or adolescent, and establishing an efficient way to deliver screening tools to caregivers as well as teachers/guidance councilors in a fashion that will promote completion and return to the practice in a timely manner.
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Educating Patients on Flu Shot Importance in the Covid-19 Era
Nicole Delgado and Shayan McGee
As fall approaches in 2020, it is even more important than previous years for patients to receive the influenza vaccine. The CDC believes that influenza and Covid-19 will both be spreading in the fall and winter of 2020. For this project, educational pages were designed for display in patient exam rooms at Milton Family Practice in Milton, Vermont. Information included the symptom overlap of Covid-19 and influenza, the distinct features of Covid-19, an epidemiological comparison of 2019 influenza statistics vs. Covid-19 statistics, and an emphasis on the importance of getting a flu shot to prevent a dangerous co-infection with both viruses.
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Addressing Exercise Accessibility in Winter Conditions in Milton, Vermont
Liam du Preez
Exercise is a critical aspect of health maintenance, especially in the context of chronic medical problems such as diabetes, heart disease, and obesity. Weather and climate conditions in Vermont directly impact Vermonters' ability to exercise, and this results in negative impacts in their health maintenance and healthcare costs nationally and locally. This project explores the direct and indirect impact of decreased exercise and explore a modality for informing patients on how to stay active safely in the winter.
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Addressing Common Concerns About HPV Vaccination
Gia R. Eapen
The HPV vaccine is the only vaccine that can prevent the formation of cancer, and yet it is sometimes refused by parents due to misconceptions and misinformation. This project addresses some of the common barriers to HPV vaccination and provides information about why the HPV vaccination is an essential part of adolescent preventative medicine.
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Improving HPV Vaccination Rates
Emily Eichner
HPV is a very common infection and can cause multiple types of cancers. The HPV vaccination is effective at preventing these infections and subsequent cancers. The HPV vaccine is most effective when given to adolescents; however, the vaccination rates for girls and especially boys remain low. Many reasons exist for parent's choice not to have their kids' vaccinated against HPV. Identifying and addressing these barriers through educational materials for parents will hopefully help improve HPV vaccination rates and reduce rates of these preventable cancers.
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Hepatitis C Education and Screening in a Rural Northern Vermont MAT Clinic
Jack Fitzsimons
Increases in hepatitis C infection rates have mirrored increases in opioid use disorder. This project attempted to determine screening rates of HCV in a medication assisted treatment clinic for opioid use disorder. Additionally it attempted to provide education to patients that had not been screened for HCV.
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Raising Awareness About the Vermont Donor Milk Center
Rosie Friedman and Emi Eakin
The Vermont Donor Milk Center (VDMC) is an emerging community resource that provides donated, pasteurized breast milk to new parents for their infants. Upon questioning, we identified that many providers did not know about the VDMC or how to prescribe milk. In addition, VDMC expressed that they have not been able to complete the community outreach they had initially hoped for. We chose to dedicate our project to disseminating information about VDMC to perinatal care providers in Vermont.
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Promoting Healthy and Active lifestyles with Home Exercises in South Burlington, VT
Jonathan Gau
The barriers to exercise that patients face are often multi-factorial. Whether its due to weather, financial costs, lack of time, or if the individual simply isn't a gym person, we see a number of patients everyday who are not regularly exercising. This brochure is meant to provide patients during office visits with a tangible source of information that provides examples of in-home exercises, categorized by difficulty, that they can perform without any additional equipment.
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Blood Pressure Management Education
Lauren G. Gernon and Cara Rathmell
The expansion of telehealth with COVID-19 and recent recommendations to use at-home blood pressure monitoring to diagnose and monitor hypertension have increased the need for materials and education for clinicians and patients. A pilot project in Primary Care Internal Medicine UVM in Essex, VT, produced an electronic medical record dot phrase and compiled educational materials to initiate nurse visits for at-home BP measurements. Materials and experience with this pilot was researched for initiation of a similar program at UVM Family Medicine Hinesburg.
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Assessing the Need and Desire for Nutritional Education
Marc Robert Hammond
Many people suffer from health conditions that may be affected directly by diet and nutrition including diabetes, hypertension, hyperlipidemia, iron deficiency anemia, obesity, coronary artery disease, and cerebrovascular disease. Education of providers and patients alike may help decrease the prevalence of these health issues and their sequalae. The St. Albans Community has slightly poorer health and nutrition when compared to the entire state of Vermont. Patients in an outpatient primary care clinic in St. Albans, VT were provided with a survey that would assess:
The patient’s confidence in their nutritional skills and knowledge
Their willingness to go to a nutrition appointment Their preference in who would provide the nutritional education to them Results from the survey were used to attempt to understand some of the driving forces for poor nutrition.
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Integrating Oral Health in Primary Care to Reduce Early Childhood Caries (ECC): Evidence-Based Guidelines and Recommendations
Alyssa Heiser
Early childhood caries (ECC) is the most common chronic disease affecting children, despite being almost 100% preventable. ECC has become associated with a multi-factorial etiology including poor feeding practices, enamel hypoplasia, oral colonization by cariogenic bacteria, and demineralized tooth structure due to metabolism of sugars by tooth-adherent bacteria. ECC can lead to school absences, poor school performance, difficulty sleeping, attention problems, slower social development, and poor overall health. According to U.S. Preventative Services Task Force (USPSTF) guidelines, all children are at potential risk for developing ECC beginning at the time of first tooth eruption. While there are no validated multivariate screening tools to determine which children are at higher risk for ECC, there are a number of individual factors that elevate risk, including lack of preventative oral health care and screening before the age of 3 years old. The American Academy of Pediatrics (AAP) recommends fluoride varnish in the primary care setting every 3-6 months starting at tooth emergence. Thus, primary care providers can play a major role in screening for and preventing ECC by initiating fluoride varnish and providing parents and/or caregivers with information on proper oral hygiene for their children at routine well-child visits.
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