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Quality Improvement: Cervical Cancer Screening Rates within Hudson Headwaters Health Network
Dylon K. Gookin
Short-term ProjectNearly 8 out of every 100,000 people are diagnosed with cervical cancer each year. However, powerful screening tools exist that enable us to detect and manage cervical changes before they develop into cervical cancer. In spite of this, cervical cancer screening rates remain low for many providers. This public health project sought to identify and address a cause for low cervical cancer screening rates within the Hudson Headwaters Health Network. A literature review determined that education and mailed invitation letters were proven methods for improving cervical cancer screening rates. Following a review of the local population demographics, West Mountain Health Center within the Hudson Headwaters Health Network was targeted for a mailing campaign. The letter provided education about cervical cancer and an invitation for screening. This letter was mailed to 1075 eligible patients, with intent to compare the screening rates among patients who received this letter with screening rates among patients from previous years.
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Promoting Medical Education at Cabot School
Dore E. Grier
Short-term ProjectAs a Cabot School alumni, I returned to Cabot School to talk to the students about opportunities in medicine. Cabot School is considered environmentally disadvantaged by the Agency of Education. By definition, "the individual comes from an environment that has inhibited him/her from obtaining the knowledge, skill and abilities required to enroll in and graduate from an undergraduate or graduate school." The percentage of students achieving proficiency in math and reading/language arts is lower than the Vermont state average for the 2016-17 school year. The goal of this project was to share my journey to medical school with the Cabot students and introduce them to careers in medicine.
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Addressing Geriatric Falls in the Outpatient Setting: A Prevention Initiative
Brian W. Gross
Short-term ProjectWith approximately 25% of older aged 65 or greater falling each year, and 20% of these incidents resulting in serious injury, falls are of significant concern for both the geriatric community and the healthcare system at large. In 2017, Vermont ranked 41st in the nation with respect to the percent of older adults with self-reported falls in the past 12 months, according to the United Health Foundation’s “America’s Health Rankings" report. Many patients at risk for falling remain uneducated regarding environmental, pharmacological, and/or behavioral risk factors that may be contributing to their fall risk. In addition, providers often have limited time during office visits to counsel patients regarding strategies to combat these risk factors. The purpose of this work was to develop discharge instruction strategies for geriatric patients at Hinesburg Family Medicine to combat environmental (home hazards), behavioral, and pharmacological factors that may be increasing their risk for falls.
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Patient Education on the Association of Hormonal Contraception with Depression
Julia E. Hannigan
Short-term ProjectHormonal contraceptive agents are widely used by women during their reproductive years. In recent years, research has been released linking hormonal contraception with the initiation of antidepressant medication and a first diagnosis of depression. More research is still warranted in order to further elucidate the relationship between hormonal contraception and depression, but current evidence prompts the necessity for shared decision making between clinicians and women considering treatment with hormonal contraceptive agents. The goal of this project is to give providers easily accessible patient educational materials in the form of epic smart phrases to aid in informed decision making.
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CBD: A Resource for Patients
Ryan G. Harned
Short-term ProjectAn educational resource for patients describing the current body of research on cannabidiol (CBD), the current legal landscape, regulatory and manufacturing considerations, drug interactions, and potential risks.
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It's Not TMI: Causes and Risks of Vaginal Discomfort
Olivia Harrison
Short-term ProjectMany people with vaginas feel uncomfortable discussing vaginal discomfort with their health care providers. Not disclosing symptoms such as pain, itching, dyspareunia, etc can lead to long term complications such as PID and significantly impact quality of life. I designed a pamphlet to help normalize talking about one's vagina to one's health care provider. This pamphlet outlines common causes and risks of vaginitis.
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Beyond Acute Lyme
Nicholas Haslett
Short-term ProjectVermont has one of the highest rates of Lyme disease infection in the country. There is growing disagreement not only between the medical community and a growing patient population, but also within the medical community itself, around the issue of persistent syndromes that may or may not be related to a Lyme diagnosis. Many patients seek treatment for persistent symptoms outside of physician guidelines for either Post Treatment Lyme Disease or the contentious "Chronic Lyme Disease" via prolonged courses of IV antibiotics, colloidal silver infusions, electromagnetic frequency treatments, and more. Regardless of the debatable extent of spirochete carnage in vivo, there is a need for effective and compassionate communication between providers and concerned patients. The aim of this project is to nudge this inevitably ongoing conversation in a productive direction, and to create a broader shared awareness between populations at growing odds.
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Promoting Healthy Habits and Active Living for Children and Families at the Well-Child Visit
Jennifer E. Holland
Short-term ProjectThe 2019 Rutland Regional Medical Center Community Health Needs Assessment reported that 16% of adolescents and 30% of adults in Rutland County, Vermont are obese. This exceeds the average numbers for the state. Primary care practitioners in Rutland have struggled to find evidence-based, efficient programs to help address this issue. The 5-2-1-0 Program is an evidence-driven, low cost, and easy to remember intervention that assesses, prevents, and manages childhood obesity by promoting healthy habits and active living for children and their families. Using Brandon Medical Center, a Community Health Center of the Rutland Region, as the pilot site, this project aimed to implement the 5-2-1-0 Healthy Habits Questionnaire at all well-child visits and to propose a strategy for further integration of the 5-2-1-0 message into surrounding community health centers.
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Accessing Opioid Use Disorder Resources in Vermont
Wendy Hou
Short-term ProjectA handout listing contact information for opioid use disorder resources in Vermont.
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Domestic Violence (DV) Screening
Wilson Huang
Short-term ProjectDomestic Violence (DV) is an understated yet significant source of morbidity and mortality for victims. Healthcare providers have a unique opportunity and responsibility to identify patients who may be victims of DV. A formal screening method for DV should be developed and routinely employed in local practices to address this issue.
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Availability of Shingrix Vaccine in St. Albans and its Benefits vs Zostavax
Ibrahim Sobhi-Luther Hussein
Short-term ProjectAcross the United States, including St. Albans, Vermont, a shortage of Shingrix Vaccine has left many patients without effective protection from shingles. The purpose of this project was to identify how patients could obtain the vaccine within a reasonable amount of time, and avoid being placed on long wait-lists at pharmacies. Four different pharmacies in St. Albans were contacted. Pharmacists and pharmacy technicians explained what patients can do to receive the vaccine with less hassle. These tips will be given to patients in handouts at NOTCH along with information about the significant benefits of Shingrix vs the previous Zostravax.
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Educating Patients on Screening Guidelines and Expectations for Well-Woman Examinations
Cyrus Maxim Jalai
Short-term ProjectFemale patients seeing primary care in rural settings often do not seek out specialized care from a practicing OB/GYN, favoring instead to utilize their family practitioner to respond to their complaints. As such, it would be effective to work to educate these patients at their well-women examinations on routine screenings, immunizations, and health maintenance methods they should expect based on their presenting age. A handout simplifying and synthesizing the main screening and general health guidelines for annual well-women examinations may be helpful for female patients using primary care practitioners as their source for obstetric and gynecologic care.
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Conjunctivitis: Patient Information
Nicole Jedrzynski
Short-term ProjectConjunctivitis or “pink eye” is a common affliction encountered frequently in family medicine. Most cases are viral and do not require antibiotics, and more accurate information for patients and their caregivers is needed to minimize unnecessary visits to urgent care and the emergency room. This will facilitate better patient care and fewer healthcare costs.
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X-Ray Referrals for Uncomplicated Fractures
Gregory P. Johnston
Short-term ProjectEmergency departments (EDs) in the United States are frequently overutilized for patients in need of an X-ray imaging despite outpatient clinics, ski hills, and express care facilities having the capacity to perform X-Rays and have them read and interpreted by local Radiologists. ED visits are associated with significantly increased wait times and auxiliary costs compared to express care and outpatient facilities. Particularly within the State of Vermont, ski hills provide a reliable population of injured patients with uncomplicated fractures in need of an X-ray examination. Here, we assess potential causes and explanations for ED overuse and lack of express care utilization for uncomplicated fractures that do not require a higher level of care, as well as publish currently available X-ray sites within the State of Vermont as a means of educating local providers and promoting lower healthcare expenditure and decreased wait times for injured patients.
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A Community-Focused Approach to Reduce School Bullying in Northeastern Vermont
Istvan F. Kanyo
Short-term ProjectSchool bullying affects one in three children in the United States and represents a public health burden as students’ absentee rates increase. It also increases the risk of psychiatric disorders later in life. Public schools often place a major focus on minimizing bullying through educational programs and punishments. However, more work has to be done to educate caregivers within the school system on how they can reduce the effects of bullying. The goal of this work is to provide an educational resource for parents that details a community-oriented approach to intervene with school bullying. Caregivers can find statistics on bullying, what behaviors might be present in a bullied child, and what avenues they can pursue to support their child.
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Perceived Barriers and Trends in HPV Vaccination Among Young Men in Newtown, CT
Alexander D. Karabachev
Short-term ProjectHuman Papillomavirus (HPV) is the most prevalent sexually transmitted infection in the United States. Although the HPV vaccine has been proven to be effective and safe, the vaccination rates are significantly less compared to other vaccines. In males, HPV infection may lead to the development of numerous forms of cancer including oropharyngeal, anal and penile cancer, however, the HPV vaccination rate for males is significantly less than it is for females. This project aims to highlight various medical providers' opinions on the barriers to HPV vaccination for young men in Newtown, Connecticut, as well as, address methods for improvement including a brochure that was made and distributed to patients and medical providers in the clinic.
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Common Childhood Illnesses: Improving Parent/Guardian Education
Mary Ann Kelly
Short-term ProjectProviders at UVMMC-Milton Family Medicine have recognized that parent/guardian education around common childhood illnesses may be lacking. The goal of this project was to improve parent/guardian education surrounding common childhood illnesses by distributing educational information in the form of an Epic smart phrase to parents/guardians during both acute and well-child visits at the UVMMC-Milton Family Medicine clinic.
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Meditation for Depression and Anxiety
Max Knapp
Short-term ProjectMental health is a major burden on residents of Vermont. Access to care is the most commonly cited cause. An evidence-based pamphlet was designed to empower providers to quickly and easily help patients start a meditation practice to help address such concerns.
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Low Back Pain in Family Practice
Marc R. Kostrubiak
Short-term ProjectLow Back Pain (LBP) is the worlds leading cause of disability and the second most common reason for visiting a physician in the US. LBP is the second only to heart disease in healthcare costs. In most cases a definitive cause is never found, however most cases are also self-limited. Patient education in this area is currently insufficient and many people expect to receive advanced imaging and treatments. Most of the time these are not indicated and may be harmful to patients. To address the gap in patient knowledge and improve health literacy a patient focused educational trifold pamphlet was created for use in the primary care setting. The pamphlet addresses common causes, evaluation and treatment of LBP and stresses the importance of physical therapy and physical activity to prevent recurrence.
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What's in your Cup? Increasing Transparency and Confidence in Alcohol Use Screening and Brief Intervention
Dylan C. Koundakjian
Short-term Project19% of Vermonters report drinking alcohol at levels which puts their health at risk, but many healthcare providers do not feel confident in addressing their patients' usage. This can stem from lack of experience with alcohol use, worries about stigma, and time constraints. However, data has shown that even 5-15 minute interventional conversations can significantly reduce a patient's risky drinking. This project aims to provide real-world, practical advice for having conversations around alcohol, and provides a conversion chart converting popular alcoholic beverages into standard drink equivalents.
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Colorectal Cancer Screening Quality Improvement: A FITKit Mailing Initiative
Isabella Kratzer
Short-term ProjectAccording to the American Cancer Society, colorectal cancers are diagnosed in 1 in 22 men and 1 in 24 women in their lifetime. Despite the wide range of effective CRC screening options available in the US, the Hudson Headwaters Health Network (HHHN) has seen little improvement in its CRC screening rates of approximately 60-63% in recent years. This places HHHN, an FQHC in Upstate New York, well below the National Colorectal Cancer Round Table 2018 goal of 80% screening in eligible, average-risk adults. This quality improvement project sought to improve HHHN’s CRC screening rates through a new FITKit direct-mailing initiative. A literature search was conducted, informing the design of a pilot mailing initiative based on recent studies of direct-mailing FITKit outreach in comparable FQHC’s and safety net institutions. In mid-January, 2019, FITKits with return address labels and postage were mailed to 362 HHHN patients’ homes. The cohort represented a population that was age 50-75, currently failing the CRC screening measure, had not seen a PCP in the last calendar year, had BMI ≥ 30, and had 0-5 comorbidities per a network-wide EMR data search in December, 2018. These mailings were preceded by an introductory email and included a second introductory letter along with the network’s usual ‘FITKit Facts and FAQ’s’ sheet. Mailings were followed by two or more automated phone reminders to complete the screening. Only one month after mailings were released, the network received 26 completed FITKits for processing, representing a 7.14% early return rate for the initiative.
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Treatment Referrals for Substance Use Disorders at BFA Fairfax (Vermont)
Adam Lacayo MPH
Short-term ProjectNearly 4 of every 100 adolescents age 12-17 in our region had a substance use disorder in 2017, yet only 39% of these individuals received treatment for misuse of alcohol or illicit drugs that year. In many schools, only those students who find themselves in legal or school disciplinary trouble for substance misuse, or who request help, receive treatment referrals. The need to establish contact with students struggling with substance use problems, but who have remained “below the radar,” remains largely unmet, particularly in BFA Fairfax (Vermont), where the Substance Abuse Professional (SAP) position was vacated in early 2019 when grant funding expired.
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Caring for an Aging Loved One
meredith ann lackie
Short-term ProjectCaregivers serve as a critical extension of US health care system. Approximately 80% of adults requiring long-term care currently live at home in the community, and unpaid family caregivers provide 90% of their care. Among caregivers, 81 % feel inadequately trained for the skills they perform and those who report the highest burden are more likely to be less educated, to live with the care recipient, and to perceive they had no choice in assuming the caregiver role. The goal of this project was to identify local resources available for caregivers and to understand the barriers to accessing these supports. An educational booklet was created to increase awareness of these resources, to address frequently asked questions from caregivers of elderly individuals, and to connect them with local organizations.
These projects were completed by students in the University of Vermont Family Medicine Clerkship. Block Clerkship Projects were completed during a five-week period, while Longitudinal Clerkship Projects were completed over the course of a 12-month longitudinal clerkship.
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