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Telemedicine Quality Improvement
Isidora R. Beach
Telemedicine use has increased dramatically since the advent of the COVID-19 pandemic in the spring of 2020. However, not all patients and physicians were prepared for this rapid change, and little evaluation of these new mechanisms for delivery of healthcare has occurred thus far. This community project explores patient and physician perspectives on the use of telemedicine in place of in-person visits and makes recommendations for future improvements. Ultimately, telemedicine use will not likely diminish any time soon, making it increasingly important to triage patient visits to determine which would lend themselves well to the telemedicine format. As this project shows, not all visits do, which has lead to both physician and patient dissatisfaction since the change.
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Promoting Physical Activity in School-Aged Children During the COVID-19 Pandemic
Abigail H. Belser
Due to the COVID-19 pandemic, children and adolescents are engaging in less physical activity and are increasing their sedentary behavior. These changes can lead to long-lasting negative lifestyle behaviors, which increases risk of health complications.
To ensure safety during the pandemic, guidelines have created restrictions on physical education and sports, which are both primary physical activity outlets for children and adolescents. Children and adolescents have to find alternate ways and resources to meet the recommended 60 minutes of physical activity daily.
An informational pamphlet was created to educate parents and children of current physical activity recommendations, with resources and ideas on how to incorporate 60 minutes of physical activity into their daily life. These were distributed to patients at the Milton Family Medicine Practice in hopes of increasing physical activity during the COVID-19 pandemic.
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Sun-Safety: Assessing Barriers and Promoting Sun-Safe Practices for Vermonters.
Joy A. Benner
Skin cancer continues to be the most common cancer in Vermont and the United States. About one in five Americans will develop skin cancer in their lifetime. Vermont currently ranks second highest in the country for melanoma skin cancer rates. Rates continue to rise and skin cancer is impacting patients at younger and younger ages. Although several factors play into development of melanoma, a large risk factor for developing skin-cancer in one's lifetime is UV exposure. One way to combat this is to encourage regular sun-safe practices, such as daily sunscreen use, seeking shade, and wearing sun-protective clothing. The aim of this project was to assess barriers to sunscreen use and evaluate current skin cancer statistics and sun-safe practices to create a SmartPhrase. Because providers only mention sunscreen in 0.9% of visits, the hope is that this SmartPhrase will be an easy and efficient way for providers at Colchester Family Practice to encourage sun-safe practices for their patients.
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Distribution of Resuscitative Measures in Lamoille County, Vermont Schools
Jared J. Bomba
This study evaluates the availability of resuscitative measures within the public schools of Lamoille County, Vermont. This includes primarily access to Automated External Defibrillators (AEDs), naloxone (Narcan), and epinephrine auto injectors (Epi-pens) subsequent to recent introduction of naloxone into schools in response to widespread opioid addiction in the region.
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Utilizing Social Media to Improve Health Education: Should We Hit Like?
Audrea Bose and Naira Goukasian
Social media presence in day to day lives is expanding, especially among younger generations. Preventative medicine is becoming the forefront of patient care. Where do the two meet? Healthcare preferences have been shown to vary by age. The younger generation is essentially ready for virtual healthcare access. In our clinical sites, we noticed a common theme of patients being unaware of preventative health practices, risk factors for diseases, or about diseases they already have. Many patients rely on their doctors for this information, but when they don’t have immediate access to their doctor, don’t regularly see their PCP, or maybe just forget what they were told, it can be difficult for people to find easily accessible and accurate health education. We also noticed that ‘accessibility’ is different for everyone and with the rapidly developing technological age, we wanted to analyze how this difference is stratified, based on age in these communities, and if using social media would be an acceptable method in this community to increase health education in all ages. The question is, can we target the masses virtually and effectively with minimal cost? And is this something patients want?
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Increasing Awareness of Added Sugar in the Outpatient Setting
Lauren Bougioukas
An estimated 80% of Americans consume more than the recommended daily amount of added sugar. Added sugar consumption significantly increases risk for cardiovascular disease mortality, and is associated with body weight, type 2 diabetes, and metabolic syndrome. In the United States, added sugar consumption contributes to public health costs related to cardiovascular disease ($555 billion spent in 2016) and diabetes ($245 billion spent in 2012). Particularly in New York, nearly 40% of all New York deaths in 2014 could be attributed to cardiovascular disease and 10.5% of New York adults had diabetes in 2017. In addition to added sugar overconsumption, many Americans have difficulty reading a Nutrition Facts Panel and nutrition education can be difficult to achieve in an outpatient primary care setting due to many competing demands.
The purpose of this project was to develop easy-to-read, educational office literature about added sugar for patient waiting and exam rooms at Champlain Valley Physicians Hospital Family Medicine Center in Plattsburgh, New York. Office literature included information about the recommended daily amount of added sugar, potential health consequences, information about reading a Nutrition Facts Panel, and common foods and drinks containing added sugar with suggested alternatives. Preliminary results suggest the office literature has effectively motivated patients to try healthier alternatives and has served as a springboard for discussion with the provider.
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Addressing Adolescent and Young Adult Mental Health During the COVID-19 Pandemic
Megan Boyer
This quality improvement project at South Burlington Family Medicine aimed to investigate the mental health of individuals ages 13-25 in our practice during the COVID-19 pandemic. Eligible patients received a PHQ-9 questionnaire with two additional questions related to COVID-19. Recommendations for future interventions to serve this population were made based on these preliminary findings, with the goal of doing a full PDSA cycle in the near future.
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Oral Health Screening for at-risk Adults
Karla I. Brandao
Oral health screening and prevention is common during well-child checks. However, this screening in adults is not as consistent. In addition, oral health has been implicated in a variety of medical conditions, making it a very important factor in systemic disease. The goal of this project is to create an oral health screening tool which can be distributed to adults, especially adults who are at high risk due to diabetes, substance use disorder, pregnancy, etc. Those with positive screening should receive a handout with some resources and information.
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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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