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The Regenstrief Center is soliciting research proposals from Purdue faculty in all disciplines with healthcare delivery research interests. More
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People
> RCHE researcher explores the impact of human interaction styles on healthcare delivery. More
Projects
> WellPoint partners with RCHE researchers to help accelerate adoption rates and value realization of electronic medical records. More
> Regenstrief Center funds new projects. More
> RCHE researcher receives significant grant from Alzheimer’s Association to advance dementia studies. More
Partners
> New engagement program focuses on medication practices and system design. More
> Regenstrief Center collects toys for St. Vincent toy drive. More
Progress
> Regenstrief Center announces Request for Proposals. More
> Spring conference to focus on successes and challenges of research implementation. More
Publicity
> Purdue researchers involved in study to help reduce drug-resistant hospital infections. More
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Researcher explores the impact of human interaction styles on healthcare delivery
Patients’ ability (or inability) to communicate clearly with healthcare providers can have a significant impact on patients’ satisfaction and health outcomes, according to Cleveland Shields, Ph.D., associate professor of family therapy in Purdue’s School of Child Development and Family Studies and a Regenstrief Center affiliated faculty member. “People often use clues and hints when interacting with doctors and nurses, rather than coming out and saying what they need,” said Shields. “Busy healthcare professionals can have a difficult time picking up these subtle hints, leaving the patient dissatisfied with the interaction and the physician under-informed about the patient’s actual condition.”
Shield’s research focuses on understanding how patients and families interact with the healthcare system and finding ways to improve the interaction. After earning his Ph.D. in marriage and family therapy at Purdue, Shields spent 19 years in the Departments of Family Medicine and Psychiatry at the University of Rochester Medical Center doing research and clinical work. There, he developed an interest in patient-centered healthcare. He joined the faculty at Purdue in 2006, where he saw the opportunity to bring together research in health and family therapy.
Currently, Shields has three projects underway that examine the impact of human emotion, interaction styles, and gender on health and healthcare delivery. In one pilot study funded by the Regenstrief Center and Purdue’s Oncological Sciences Center, Shields and Vickie Champion, distinguished professor of nursing at Indiana University, are examining the potential for telephone coaching to help breast cancer patients communicate with their physicians about symptoms, fears about recurrence and anxiety. Each patient in the experimental group receives a one-time phone call from a nurse to develop communication strategies for the patient’s next healthcare visit. The researchers hope to determine whether such coaching can help patients speak more directly, improve satisfaction and outcomes, and reduce uncertainty. The American Cancer Society has expressed interest in expanding the pilot study, said Shields.
In another study, Shields is selecting participants with cross-sex cancers (i.e., cancers that occur almost equally in men and women) to examine how couples cope with cancer and the effects of gender on coping strategies. Shields is more guarded with details about his third project on physician-patient communication, to avoid tainting the results. He is currently recruiting physician specialists (in cooperation with the Indiana University School of Medicine) to be secretly audio-recorded during an appointment with a trained standardized patient. The physicians voluntarily enroll to participate, but they remain unaware of which patient(s) is a part of the study. The pilot phase in Indiana is funded by the National Institutes of Health, and could be replicated nationwide.
Shields recently spearheaded the creation of the Relationships in Healthcare Research Lab within the School of Child Development and Family Studies with colleagues Melissa Franks, Ph.D., and Dan Mroczek, Ph.D. In addition to research, the lab provides mentoring for students involved in research projects and education for collaborating faculty in relevant family theories and research methods essential to investigating individual and family processes in a health context.
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WellPoint partners with RCHE researchers to help accelerate adoption rates and value realization of electronic medical records
In 2004, President Bush mandated that the majority of Americans have electronic health records by 2014 to improve healthcare quality, reduce medical errors, advance delivery of evidence-based care, and improve coordination among hospitals, laboratories, physician offices and other ambulatory care providers (http://www.whitehouse.gov/infocus/technology/). The need for broader adoption of electronic medical records has been widely noted (e.g., Institute of Medicine, 1991, 2000, 2001), but slow adoption rates across many healthcare systems has thwarted significant nationwide progress.
“The implementation of electronic medical records is a significant financial and human resource investment for many healthcare systems, but little value is gained if healthcare professionals within the system do not adopt the new technology,” said Vince Duffy, Purdue associate professor of industrial engineering and Regenstrief Center faculty. “Lessons learned in other technology implementations may be appropriate for healthcare applications, such as the finding that usability measures alone may be insufficient to improve development and adoption. We also need to consider non-technical factors, such as staff perception, to promote widespread adoption and sustained use.”
Duffy and his research team have partnered with WellPoint, a Regenstrief Center strategic partner, to develop a framework by which physician adoption of Computer Physician Order Entry (CPOE) systems can be predicted and evaluated. In the project’s first phase, the team will use human performance engineering to determine categories of critical technology, human factors and organizational characteristics that influence physicians’ willingness to adopt a CPOE system.
The second phase involves the development, modification and testing of a lab version of the CPOE system using first-phase findings. Purdue has established a consulting relationship with Doug Bell, a UCLA Medical Center researcher who previously completed product and system evaluations for WellPoint. During the final project phase, the Regenstrief Center research team aims to gain cooperation from software contractors to embed critical characteristics and software functionality in a reviewed CPOE system. According to Duffy, there is potential for this project’s findings to apply to other IT-related health system development efforts.
"Health information technology can simultaneously improve patient safety, care quality, and the efficiency of care delivery," said Dr. Charles Kennedy, Vice President of Health Information Technology for WellPoint, Inc. "E-prescribing is a compelling first step toward all electronic physician offices. However, physicians continue to embrace these solutions very slowly. Research into the optimization of e-prescribing is critical for greater adoption, utilization, and value realization of this technology."
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Regenstrief Center funds new projects
Four project proposals were recently funded by the Regenstrief Center to advance health literacy research and the use of technology to improve self-care and hospital design.
According to Bart Collins, the Regenstrief Center director of health communications, the first three projects share a common goal of developing insight into how individuals manage their own care, which has a strong relationship with health outcomes and healthcare expenses. "One project looks specifically at self-care motivation and ability related to patient management of chronic disease in their daily lives. Another is associated with new ways of measuring health literacy, which is key component of self-care," said Collins. "The third project is looking at ways healthcare providers can use web-based learning technologies to track patient self-care activities and improve their ability to manage their care."
The fourth project extends work completed with strategic partner Ascension Health to develop a patient-centered design room in a virtual environment. "The code developed for this initial project was just the beginning," said Laura Arns, research scientist for Purdue's Envision Center and the project's principal investigator. "We want to develop a hub environment where Purdue and other virtual-reality research insitutions can share code to maximize the potential of virtual reality in hospital design."
Self-Care and Health Literacy in Telehealth and Traditional Home Health Patients with Heart Failure
- Principal Investigator: Karen Yehle, Ph.D., Nursing
- Collaborating Faculty: Kimberly Plake, Pharm.D., Pharmacy Practice
- Healthcare Partners: St. Vincent Health
- The goals of this project include determining the impact of health literacy on self-care ability and health outcomes among heart failure patients with telehealth or traditional home health care.
Health Literacy in Underserved, Pre-diabetic Populations
- Principal Investigator: Jakob Jensen, Ph.D., Communication
- Healthcare Partners: Purdue Extension, Community Health Network
- Patient-centered healthcare delivery is increasingly common, but many patients have insufficient skills to manage their own health. The study seeks to create and validate instruments that measure health skills (e.g., health literacy) necessary for patient-centered healthcare.
RCHE Healthcare E-Learning Hub
- Principal Investigator: Scott Schaffer, Ph.D., Curriculum and Instruction
- Collaborating Faculty: Bart Collins, Ph.D., Communication
- Healthcare Partners: St. Vincent Health, Community Health Network, Purdue Homeland Security Institute, Midwest Alliance for Telehealth and Technology Resources
- The primary goal of this project is to develop an e-learning framework for researching web-based education strategies for chronic disease patients (e.g., diabetes self-care), healthcare professionals (e.g., pandemic preparedness for hospital staff) and the public (e.g., gynecologic cancer awareness).
Creation of a Virtual Reality Healthcare Facility Design Hub
- Principal Investigator: Laura Arns, Envision Center
- Collaborating Faculty: James McGlothlin, Ph.D., School of Health Sciences
- Phillip Dunston, Ph.D., Construction Engineering and Management
- The primary goal of this research is to create an online community for researchers to share models to be used in virtual reality hospital design mock-ups.
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Researcher receives significant grant from Alzheimer's Association to advance dementia studies
Alzheimer’s disease and related dementias present important challenges for healthcare providers in managing medication use. Physiological changes that accompany aging alter individual response to some drugs so that use by the elderly carries increased risk. Persons with dementia can be particularly sensitive to side effects of such medications.
Researchers have developed lists of medications that are potentially inappropriate for use by the elderly and high-use rates for such medications have been found in both ambulatory and nursing home settings. Very few studies, however, have examined associations between use of such medications and changes in individuals’ health status, nor have the studies focused on persons with dementia.
Joseph Thomas, Purdue professor of pharmacy practice, co-director of the Center for Health Outcomes Research and Policy, and RCHE researcher, has received more than $230,000 from the Alzheimer's Association to examine whether medications deemed inappropriate for use by the elderly are associated with changes in health status or healthcare expenditures among dementia patients in nursing homes. The project will combine Medicaid enrollment data, Medicaid claims data, data on individuals’ ability to complete routine daily activities and data on individuals’ cognitive functioning.
“This study will provide information on associations between the use of specific medications and changes in physical status or cognitive status, which may affect both quality of life and healthcare expenditures,” said Thomas. “Findings from this project can inform the development of dementia-specific prescribing guidelines to optimize medication effects, minimize side effects, and promote healthcare expenditure efficiency.”
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New Purdue engagement program focuses on medication practices and systems design
PharmaTAP, a new engagement program of the School of Pharmacy and Pharmaceutical Sciences and the Technical Assistance Program, was established in August 2007 at Purdue University as part of a $25 million award from Lilly Endowment Inc. to promote pharmacy education, outreach and research. The program will integrate Purdue expertise in pharmacy practice, biomedical and industrial engineering, communication, nursing and technology to assess medication safety and efficiency in Indiana healthcare delivery settings and engage healthcare providers to develop and implement on-site system solutions.
“Our mission is to catalyze improvement in patient safety, clinical quality and efficiency in any setting where medications are used,” said Carol Birk, M.S., the founding director of PharmaTAP. “Through PharmaTAP, practitioners have access to Purdue’s expertise in medication safety, pharmacy practice, biomedical and industrial engineering, nursing and technology."
According to Birk, multidisciplinary teams are tailored to the specific interest of PharmaTAP clients, which include healthcare providers seeking pragmatic, quantitative, evidence-based, and customized solutions to improve medication practices and systems design. Projects may include the assessment of medication safety practices (inpatient and outpatient), investigation and evaluation of medication-related events, and application of Lean Healthcare and other tools to facilitate team-based improvements. Birk also plans to develop networks among medication-related healthcare entities to disseminate leading practices.
Birk holds a bachelor's degree in pharmacy from Purdue and a master's degree in pharmacy from the University of Wisconsin. Her professional experience includes her most recent role as director of performance improvement for VHA Central and prior senior pharmacy positions with Clarian Health Partners and the Indiana University Medical Center.
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Regenstrief Center collects toys for St. Vincent toy drive
During the month of December, the Regenstrief Center collected footballs, board games, coloring books, dolls and other toys for the St. Vincent’s Peyton Manning Children’s Hospital toy drive. A huge box covered in Christmas paper was filled by faculty and staff in Purdue’s Discovery Park and presented to St. Vincent Health, a Regenstrief Center strategic partner.
The collected toys will remain at the Children’s Hospital to be enjoyed by children during their hospital stay. According to St. Vincent Health, more than 50% of the children who use the toys are under 2 years of age, and toys that light up and make noise bring the biggest smiles.
“We were very excited to support the work of St. Vincent Health in this fun and unique way," said Mary Schultz of the Regenstrief Center and toy drive coordinator at Purdue. “It was a big success, and we’ve already set November 1 as the first day of our 2008 toy drive.”
Those interested in donating can contact Lisa Meyer of St. Vincent Health at 317-338-2661 or lmmeyer@stvincent.org.
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Regenstrief Center announces Request for Proposals
The Regenstrief Center is soliciting research proposals from Purdue faculty in all disciplines with research interests that relate to healthcare delivery. Any investigative work that might result in significant improvement in the healthcare delivery system is eligible for consideration. Project principal investigators must be Purdue faculty. Approximately $240,000 has been set aside for this year’s research-funding cycle, and it is anticipated that up to six projects will receive funding starting July 1.
Faculty intending to submit proposals should send an e-mail to rche@purdue.edu by Feb. 15, indicating a tentative title and the names of team participants. Proposals are due no later than 5 p.m., March 3, and should be delivered (only) electronically to rche@purdue.edu. Proposal awards will be announced by email no later than April 2. Projects will be funded starting anytime on or after July 1, and projects are expected to be completed by June 30, 2009.
For more information, visit www.purdue.edu/rche and click on the link for “RCHE Request for Proposal.”
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Spring conference to focus on successes and challenges of research implementation
The Regenstrief Center is dedicated not only to catalyzing innovation in healthcare delivery research, but also to implementing findings in “living laboratories” to transform the delivery system. The Regenstrief Center’s fourth annual spring conference, titled Research Solutions in Healthcare: Challenges and Lessons Learned will explore the process of implementing research innovation in the healthcare setting, highlighting select RCHE research projects and including discussion from practitioners in the field.
All healthcare researchers, graduate and undergraduate students, RCHE partners, practitioners and policymakers are invited to attend on Tuesday, April 22 in the Burton Morgan Center, Discovery Park. A conference agenda and registration page will be posted on www.purdue.edu/rche by the end of February.
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Purdue researchers involved in study to help reduce drug-resistant hospital infections
According to an article published this month in the Journal of the American Medical Association, drug-resistant staph infections result in more than 18,000 deaths a year in the United States, and about a quarter of those people become infected while in the hospital.
Heather Woodward-Hagg, an assistant professor of industrial technology and a researcher at Purdue's Regenstrief Center for Healthcare Engineering, is the implementation director of a study that is looking at whether a prevention model can help reduce the transmission of Methicillin-Resistant Staphylococcus Aureus, known commonly as MRSA, in hospital settings.
Brad Doebbeling, director of the Indiana University Center for Health Services and Outcomes Research and the Veterans Affairs Center for Implementing Evidence-Based Practice, and Paul Dexter, Regenstrief Institute scientist and Indiana University physician, are leading the study.
The team is meeting with healthcare professionals, including physicians, nurses, pharmacists and environmental services specialists, in two critical care units in each of the six hospital systems in Indianapolis (i.e., Clarian Health, St. Francis Hospitals, Community Health Network, St. Vincent Health, Wishard Health Services and the Roudebush Veterans Affairs Medical Center) to apply methods of systems engineering and systems redesign to facilitate implementation of these practices into their daily routines.
"Our faculty is working closely with front-line staff teams from each healthcare facility in the study to examine implementation issues, obstacles and solutions," Hagg said. "Through staff engagement, application of systems engineering methodologies, and ongoing measurement and feedback, we are assisting these facilities in creating sustained organizational change that we hope will result in a reduction of the spread of the antibiotic-resistant bacteria."
Hagg said that while results won't be available until after the study is complete in March, adherence to clinical practice guidelines in participating study units has been strong. Issues addressed by project teams include visibility of isolation signs, availability of contact isolation supplies and equipment, and redesign of clinical processes to ensure timely completion of admission and discharge active culture surveillance.
The 18-month study is funded by the Agency for Healthcare Research and Quality, a division of the U.S. Department of Health and Human Services.
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