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Using narrative medicine to address healthcare stigma in Washington County, Vermont
Finlay Pilcher
Stigma is a barrier to good health for people with certain medical conditions and non-medical circumstances. The purpose of this project is to use stories from members of the Washington County Community to advocate for the use of narrative medicine to mitigate healthcare stigma. A 10-minute recording was shared of an interview with someone with opioid use disorder during the presentation. Afterwards, healthcare professionals were asked whether the presentation, including the recording, impacted their percetion of narrative medicine and its clinical utility.
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ROAD Program Educational Case Series
Clifford A. Reilly
This project was done in conjunction with the Refocus on Alcohol Dependence (ROAD) program, which has been working to create low barrier treatment options for alcohol use disorder (AUD) in the Central Vermont community. This project was a series of educational cases designed to help primary care providers feel more comfortable with the medications and associated dosages used in the treatment of AUD, raise awareness about community resources in treating AUD, and provide the most current overall treatment recommendations.
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Advance Care Planning Documentation at Mad River Family Practice
Nicole A. Walch
Advance care planning is a powerful tool that helps to guide clinicians and family members to make care decisions that align with a patients values when that patient is unable to speak for themselves. Advance care planning documents such as advance directives are the primary tool used to put these patient preferences in writing, but there is little information about the true rates of document completion in Vermont. This project was focused on determining how many patients at the Mad River Family Practice had advance care planning documents, developing a tracking tool in the electronic medical record to see trends in document completion among panel patients over time, and identify strategies to increase engagement in advance care planning at the practice.
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ADHD Evaluation and Diagnosis in the Primary Care Setting
Sean R. Fox
Our goal was to develop a comprehensive Epic template for the initial evaluation of ADHD in the primary care setting.
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Primary Care and The Housing Insecure in Central Vermont
Hunter Goldsmith
In this project, I performed a literature review of the research regarding the benefits of primary care on population health. I also looked at healthcare utilization and interviewed community members. I then surveyed individuals suffering from housing insecurity to determine if they were connected to primary care homes and if not the reasons they have not been able to be connected. Finally, I attempted to link interested individuals with local primary care offices to establish care.
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Increasing Access to Advanced Care Planning Documentation
Amy B. Golinker
The purpose of this project was to determine the percent of the adult patient population at one family practice in Vermont with completed advanced care planning documentation available to health care providers and work to increase that percentage. The majority of this project was spent completing a chart review to find the advanced care planning documentation present in the current electronic health record, Epic, the previous electronic health record, ECW, or registered with the Vermont Advance Directive Registry. Efforts were also made to increase the percent of adult patients with advanced care planning documentation through conversations with patients during wellness and chronic care visits. Overall, in this practice approximately 14% of adult patients were found to have completed advanced care planning documentation which is less than the national average of approximately 33% of all adults. Discussion of further research on how to increase this percentage is ongoing.
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Learning Empowerment & Advocacy Together: A School-Based Youth Empowerment Program
Sheridan Finnie
LEAT is a virtual skills building leadership group for female identifying high school age students grades 9-12. Program objectives are to empower youth to develop their sense of self esteem, identity and to develop leadership skills to be active leaders in their community. Due to the impact of COVID-19 on youth, opportunities to build community and engage in skill building activities are lacking and this group aims to fill that gap.
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The Design and Impact of a Rural Community Supported Doula Program
Kalin Jean Gregory-Davis
The purpose of this study is to describe the design and impact of a rural community supported doula program. The Washington County Mental Health Doula Project is a unique collaboration between the Central Vermont Medical Center and Washington County Mental Health Services, whereby doula support services are offered for at risk patients during their pregnancy, through the birth process and the post partum period, and up to one year post delivery. Many more typical doula programs are of significant cost to the patient, making this support inaccessible to those that may need it the most. This program is unique in that not only are the doula services free for patients in need, but also the program is funded by a collaboration between a hospital and a community organization. What further sets this program apart is the case management background of the doulas and the significant logistical support offered to these clients who have a host of needs that go beyond just birth support. The WCMHS Doula Project has been a crucial element of women’s healthcare services in this rural community over the years, but no formal research has been conducted to evaluate the impact of the program. Through a qualitative analysis, this project seeks to give voice to the clients receiving the services in order to demonstrate the unique design and impact that such services have in the lives of patients facing numerous hardships during their pregnancy and early parenting period in rural Vermont.
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Improving the Therapeutic Environment in the Crisis Stabilization Unit at Glens Falls Hospital
Emma Hall
The Crisis Stabilization Unit (CSU) at Glens Falls Hospital provides a separate, safe space within the Emergency Department for adults and children struggling with mental health crises to stabilize before discharge or admission to an inpatient psychiatric unit. An increase in mental health crises over the past 10+ years plus a shortage of nearby inpatient beds, especially for adolescents and children, has led to longer stays in the CSU. Longer stays in a place not built for therapeutic intervention but rather for crisis stabilization may lead to increased agitation, prolonged stays or prolonged time to stabilize a patient, and potentially increased need for de-escalation or restraint. This project aimed to improve the therapeutic environment to help counter those effects of longer stays in this space, utilizing evidence-based methods and community involvement.
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Perceptions of Rural Primary Care Providers in Caring for Infants Exposed to Opioids in Utero: A Qualitative Study
Adessa M. Morano
Vermont has one of the highest rates of substance use throughout pregnancy in the country, however there is limited research on the pediatric primary care of infants under one year of age who were exposed to opioids in utero. This project used qualitative interviewing and thematic coding to identify core themes in pediatric primary care for these infants. Core themes and their corresponding targeted areas of improvement and future directions were identifies.
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Improving Primary Care Access for the Housing Insecure in Washington County
Kristina J. Valentine
For this project I went to two local hotels in Washington Co that were providing shelter for people experiencing homelessness during the COVID-19 pandemic. I would survey them on their barriers to primary care and tried to connect them to local providers. I then tracked how many individuals were able to have an appointment with a provider.
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Medication-Assisted Withdrawal and Alcohol Use Disorder Treatment in the Ambulatory Setting
Jacob Okie Weiss, Javad Mashkuri MD, and Marissa Patrick APRN
Alcohol use disorder (AUD) represents a significant burden of disease in central Vermont, but receives little attention and resources compared to other drivers of morbidity and mortality. As part of a community health improvement project, primary care providers in central Vermont were surveyed regarding current practices and perceived barriers related to the effective treatment of AUD. 69% of respondents reported treating alcohol withdrawal syndrome (AWS) and 83% reported treating AUD. Respondents indicated concern about the safety and efficacy of the medications they currently prescribe and expressed interest in learning about other evidence-based treatments for AWS and AUD. The most frequently cited barriers to the treatment of AUD were lack of time and resources for adequate follow-up; patient’s unwillingness to decrease use; and provider lack of knowledge and comfort in treating AWS and AUD. The authors make several recommendations to improve care for patients struggling with AUD, including incorporating peer recovery coaches into primary care settings; providing CME opportunities for clinician training in evidence-based treatments for AWS and AUD; and implementing a decision-making protocol to determine the appropriate setting for patients experiencing AWS.
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Easily Digestible: Addressing Food Literacy with Short Educational Videos
Kalle J. Fjeld
Food literacy is the knowledge and skills needed to select and prepare food as well as determine food intake. These skills are necessary for a healthy diet, which is a major contributing factor to chronic disease prevention and management. People with diseases such as diabetes and cardiovascular disease can have great benefit from improving diet quality through increasing at-home food preparation and consumption of fruits and vegetables. In partnership with a Food Farmacy pilot program at Hudson Headwaters Health Network in Glens Falls, NY this project sought to use web-based food literacy education for a population of 40 patients with diabetes. Short, simple videos on basic fruit and vegetable preparation were created and published on YouTube. Follow-up interviews with patients were conducted to assess the reach and efficacy of this intervention.
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Harm Reduction in the Emergency Department
Alexa J. Golden
The number of overdose deaths in Vermont has been trending up over the past several years. A majority of these fatalities involved synthetic opioid fentanyl. The Emergency Department (ED) at Central Vermont Medical Center delivers medication assisted treatment (MAT) through the Rapid Access to MAT (RAM) program. This program has connected many people in the region to treatment for opiate use disorder. However it was identified that we lacked connection to harm reduction services for those not interested in MAT. Harm reduction education was provided for recovery coaches and ED nursing staff. Harm reduction kits containing life-saving supplies such as naloxone and fentanyl test strips, safer use information, and local harm reduction services were developed for distribution through the ED.
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Identifying Food Insecurity in a Rural Vermont Primary Care Setting
Jessica Lyon
Recent years have shown an emergence of interest in social determinants of health by healthcare providers, community leaders, and social service organizations alike. Among the social determinants of health, food insecurity has been associated with higher incidences of chronic disease and poor health outcomes as compared to rates among individuals not screening positive for food insecurity. This project aims to compare the effectiveness of screening patients for food insecurity via formal paper questionnaires versus the traditional approach of an open patient-provider dialog guided by provider intuition in identifying food insecure individuals in a primary care setting.
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Medication-Assisted Treatment in the Hudson Headwaters Health Network
Jordan Munger
Background: Opioid use results in over 45,000 overdose deaths annually in the US, with rural areas disproportionately affected. While medication-assisted treatment (MAT) for opioid use disorder (OUD) is an effective intervention available through outpatient primary care, less than 25% of patients with OUD are currently in treatment. This study explored factors associated with patient retention in an MAT program offered by Hudson Headwaters, a Federally Qualified Health Center that serves a vast and mostly rural region of Northeastern New York.
Methods: We included a total of 354 patients diagnosed with OUD who had at least two appointments for MAT between December 2016 and November 2019 in this analysis. We ran univariate and multivariate regression analyses to examine factors associated with overall retention.
Results: The median age at the first MAT visit was 35.2 years (IQR=12.0), and 50% of patients self-identified as female. Overall, the one-year retention rate was 74.7% (95%CI=68.6-81.4). Increased risk for lower retention was seen among men (HR=1.7, 95%CI=1.0-2.8) and those not commercially insured (HR=3.2, 95%CI=1.1-8.7). Receiving MAT directly from a primary care provider greatly reduced the risk of lower retention (HR=0.4 ,95% CI=0.2-1.0). Roundtrip, median travel time to access care was 27.2 minutes (IQR=33.1). Although 12% of patients drove over 60 minutes to get to their MAT clinic, travel time and distance was not associated with retention.
Conclusions: While some surveys have suggested that patient access to MAT clinics is a significant barrier to treatment, for this chiefly rural population, ease of access as measured by travel time and distance was less influential on outcomes than other patient- and provider-level factors. Potential recommendations to improve retention include engaging primary care providers in MAT provision and the use of case management services to address other socioeconomic barriers to treatment.
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HHHN Clinicians' Beliefs, Barriers, and Motivations Surrounding MAT
Casandra Nowicki
Medication-assisted treatment (MAT) consists of using medications that act on the same receptors as opioids to treat opioid use disorder (OUD). MAT providers require formal training and a DEA waiver in order to prescribe certain medications. Providers were asked to complete a survey about the beliefs, barriers, and motivations surrounding MAT to provide valuable insight into what the future of MAT might look like at a specific nonprofit network of community health centers in upstate New York.
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Improving Hepatitis C Screening in Vulnerable Populations
Connor Scagnelli
A one-time HCV test has been recommended for all individuals in the Baby Boomer generation. National data shows an increase in HCV rates among younger generations, especially those with substance use disorder. In this quality improvement project, HCV screening rates were collected and analyzed from Hudson Headwaters Health Network (HHHN) and The Ryan White Program in Glens Falls, NY. A survey was disseminated to all HHHN providers to assess current screening practices and to identify barriers to screening and strategies to increase screening. From this analysis, it was determined that HHHN would benefit from and be able to increase screening rates in at risk populations by adopting a universal HCV screening policy. Weeks after this presentation was delivered, the AMA announced it was supporting the USPSTF's draft recommendation for universal HCV screening in all adults over the age of 18, in accordance with this projects conclusion.
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The "Best Snacks EVER" Series
Catherine M. Westbom
Vermont rates of obesity jump from 15.1% 10-17 year-old children to 27.5% in adults. In addition, studies show that keeping weight off is incredibly difficult with low success rates. Of the many factors that contribute to obesity, nutrition is among those that can be altered with great results. Taken in combination, this information speaks to the great change that can be made in targeting healthy eating habits in the youth population prior to the jump in obesity rates. This project aims to provide education to the child population in Montpelier, Vermont through the local Step 2 after-school program. A class series was started to provide nutrition education through reading, craft projects, and healthy snacks for a fun-filled and educational experience in hopes of encouraging healthy habits at a young age.
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Quality Improvement: Cervical Cancer Screening Rates within Hudson Headwaters Health Network
Dylon K. Gookin
Nearly 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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Colorectal Cancer Screening Quality Improvement: A FITKit Mailing Initiative
Isabella Kratzer
According 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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To Juul or Not To Juul: What We Know About The Health Effects of Vaping
Chad Serels
E-cigarette use, also known as Vaping, has garnered national attention over recent years due to its rapidly rising popularity. While some claim it is the healthier alternative to cigarette smoking we need to reduce the 480,000 deaths in the US from smoking-related diseases each year, others warn that its popularity among teens has the potential to undo years of progress combating nicotine addiction and is just another attempt by the tobacco industry to lure a new generation of customers. Given this ongoing public conversation, it is up to health care providers to stay informed on the health effects of vaping and to educate their patients appropriately. This project aimed to synthesize what we currently know about the effects of e-cigarette use for health care providers and to equip them with ways to minimize the harms, while maximizing any potential benefits, of vaping. This presentation demonstrates the effectiveness of that intervention.
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