Claudine T. Jurkovitz, MD, MPH

Director Clinical Research, Lead BERD Core with DE ACCEL-CTR, and Director of CRSN with DE-INBRE

Publications

Feasibility of a Novel COVID-19 Telehealth Care Management Program Among Individuals Receiving Treatment for Opioid Use Disorder: Analysis of a Pilot Program
Feasibility of a Novel COVID-19 Telehealth Care Management Program Among Individuals Receiving Treatment for Opioid Use Disorder: Analysis of a Pilot Program
Williams KD, Jurkovitz CT, Papas MA, Muther AK, Anderson SL, Anderson TL

JMIR Form Res 2022 Aug;6(8):e39772

PMID: 35973033

Abstract

BACKGROUND: The emergence of COVID-19 exacerbated the existing epidemic of opioid use disorder (OUD) across the United States due to the disruption of in-person treatment and support services. Increased use of technology including telehealth and the development of new partnerships may facilitate coordinated treatment interventions that comprehensively address the health and well-being of individuals with OUD.

OBJECTIVE: The analysis of this pilot program aimed to determine the feasibility of delivering a COVID-19 telehealth care management program using SMS text messages for patients receiving OUD treatment.

METHODS: Eligible individuals were identified from a statewide opioid treatment program (OTP) network. Those who screened positive for COVID-19 symptoms were invited to connect to care management through a secure SMS text message that was compliant with Health Insurance Portability and Accountability Act standards. Care management monitoring for COVID-19 was provided for a period of up to 14 days. Monitoring services consisted of daily SMS text messages from the care manager inquiring about the participant's physical health in relation to COVID-19 symptoms by confirming their temperature, if the participant was feeling worse since the prior day, and if the participant was experiencing symptoms such as coughing or shortness of breath. If COVID-19 symptoms worsened during this observation period, the care manager was instructed to refer participants to the hospital for acute care services. The feasibility of the telehealth care management intervention was assessed by the rates of adoption in terms of program enrollment, engagement as measured by the number of SMS text message responses per participant, and retention in terms of the number of days participants remained in the program.

RESULTS: Between January and April 2021, OTP staff members referred 21 patients with COVID-19 symptoms, and 18 (82%) agreed to be contacted by a care manager. Participants ranged in age from 27 to 65 years and primarily identified as female (n=12, 67%) and White (n=15, 83%). The majority of participants were Medicaid recipients (n=14, 78%). There were no statistically significant differences in the demographic characteristics between those enrolled and not enrolled in the program. A total of 12 (67%) patients were enrolled in the program, with 2 (11%) opting out of SMS text message communication and choosing instead to speak with a care manager verbally by telephone. The remaining 10 participants answered a median of 7 (IQR 4-10) SMS text messages and were enrolled in the program for a median of 9 (IQR 7.5-12) days. No participants were referred for acute care services or hospitalized during program enrollment.

CONCLUSIONS: These results demonstrate the feasibility of a novel telehealth intervention to monitor COVID-19 symptoms among OTP patients in treatment for OUD. Further research is needed to determine the applicability of this intervention to monitor patients with comorbid chronic conditions in addition to the acceptability among patients and providers using the SMS text messaging modality.

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Implementation of a clinical pathway to screen and treat medical inpatients for opioid withdrawal
Implementation of a clinical pathway to screen and treat medical inpatients for opioid withdrawal
Williams KD, Wilson BL, Jurkovitz CT, Melson JA, Reitz JA, Pal CK, Hausman SP, Booker E, Lang LJ, Horton TL

Implement Res Pract ;3():

PMID: 35846074

Abstract

Background: Opioid-related inpatient hospital stays are increasing at alarming rates. Unidentified and poorly treated opioid withdrawal may be associated with inpatients leaving against medical advice and increased health care utilization. To address these concerns, we developed and implemented a clinical pathway to screen and treat medical service inpatients for opioid withdrawal.

Methods: The pathway process included a two-item universal screening instrument to identify opioid withdrawal risk (Opioid Withdrawal Risk Assessment [OWRA]), use of the validated Clinical Opiate Withdrawal Scale (COWS) to monitor opioid withdrawal symptoms and severity, and a 72-h buprenorphine/naloxone-based treatment protocol. Implementation outcomes including adoption, fidelity, and sustainability of this new pathway model were measured. To assess if there were changes in nursing staff acceptability, appropriateness, and adoption of the new pathway process, a cross-sectional survey was administered to pilot four hospital medical units before and after pathway implementation.

Results: Between 2016 and 2018, 72.4% (77,483/107,071) of admitted patients received the OWRA screening tool. Of those, 3.0% (2,347/77,483) were identified at risk for opioid withdrawal. Of those 2,347 patients, 2,178 (92.8%) were assessed with the COWS and 29.6% (645/2,178) were found to be in active withdrawal. A total of 49.5% (319/645) patients were treated with buprenorphine/naloxone. Fifty-seven percent (83/145) of nurses completed both the pre- and post-pathway implementation surveys. Analysis of the pre/post survey data revealed that nurse respondents were more confident in their ability to determine which patients were at risk for withdrawal ( = .01) and identify patients currently experiencing withdrawal ( < .01). However, they cited difficulty working with the patient population and coordinating care with physicians.

Conclusions: Our study demonstrates a process for successfully implementing and sustaining a clinical pathway to screen and treat medical service inpatients for opioid withdrawal. Standardizing care delivery for patients in opioid withdrawal can also improve nursing confidence when working with this complex population.

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Alcohol Withdrawal Rates in Hospitalized Patients During the COVID-19 Pandemic
Alcohol Withdrawal Rates in Hospitalized Patients During the COVID-19 Pandemic
Sharma RA, Subedi K, Gbadebo BM, Wilson B, Jurkovitz C, Horton T

JAMA Netw Open 2021 03;4(3):e210422

PMID: 33656526

Abstract

No abstract available.
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Prediction model for COVID-19 patient visits in the ambulatory setting
Prediction model for COVID-19 patient visits in the ambulatory setting
Li RC, Harrison CK, Jurkovitz CT, Papas MA, Ndura K, Kerzner R, Teal C, Chiam T

Res Sq 2021 Mar;():

PMID: 33688638

Abstract

Array
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Alcohol Withdrawal Rates in Hospitalized Patients During the COVID-19 Pandemic
Alcohol Withdrawal Rates in Hospitalized Patients During the COVID-19 Pandemic
Sharma RA, Subedi K, Gbadebo BM, Wilson B, Jurkovitz C, Horton T

JAMA Netw Open 2021 03;4(3):e210422

PMID: 33656526

Abstract

No abstract available.
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Alcohol Withdrawal Rates in Hospitalized Patients During the COVID-19 Pandemic
Alcohol Withdrawal Rates in Hospitalized Patients During the COVID-19 Pandemic
Sharma RA, Subedi K, Gbadebo BM, Wilson B, Jurkovitz C, Horton T

JAMA Netw Open 2021 03;4(3):e210422

PMID: 33656526

Abstract

No abstract available.
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A Social Network Analysis Approach for Contact Tracing in the Hospital Setting
A Social Network Analysis Approach for Contact Tracing in the Hospital Setting
Ostovari M, Jurkovitz C, Pachter L, Chen D

Dela J Public Health 2020 Aug;6(3):22-25

PMID: 34467124

Abstract

Since the beginning of the COVID-19 pandemic, the State of Delaware has implemented various strategies including a stay-at-home order, mask-wearing requirements in public places, and community-based testing to control the spread of the disease. Health systems across the U.S. have taken actions including symptom monitoring and screening for visitors and healthcare workers, providing personal protection equipment (PPE), and contact tracing of confirmed infected individuals to provide maximum possible protection for healthcare workers. Despite such efforts, there remains a significant risk of intra-hospital transmission of COVID-19. Healthcare workers who contact patients with COVID-19 or were exposed to the disease in the community may transmit the infection to coworkers in the inpatient setting. In addition to universal and case-based precautions to prevent exposure and disease transmission, contact tracing is essential to minimizing the impact of outbreaks among healthcare workers and the community. A rapid increase in cases can quickly diminish hospital infection control and prevention program capacity to perform high-quality contact tracing. This article will describe an approach using the application of social network analysis (SNA) and Electronic Medical Records (EMR) to enhance the current efforts in COVID-19 contact tracings.
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Prediction model for COVID-19 patient visits in the ambulatory setting
Prediction model for COVID-19 patient visits in the ambulatory setting
Li RC, Harrison CK, Jurkovitz CT, Papas MA, Ndura K, Kerzner R, Teal C, Chiam T

Res Sq 2021 Mar;():

PMID: 33688638

Abstract

Array
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Evaluation of a Systems-Based Tobacco Cessation Program Using Bedside Volunteers
Evaluation of a Systems-Based Tobacco Cessation Program Using Bedside Volunteers
Taylor D, Medaglio D, Jurkovitz C, Patterson F, Zhang Z, Gbadebo A, Bradley E, Wessells R, Goldenberg E

Nicotine Tob. Res. 2018 Nov;

PMID: 30462274

Abstract

Introduction: Hospitalization and post-discharge provides an opportune time for tobacco cessation. This study tested the feasibility, uptake, and cessation outcomes of a hospital-based tobacco cessation program, delivered by volunteers to the bedside with post-discharge referral to Quitline services. Patient characteristics associated with Quitline uptake and cessation were assessed.
Methods: Between February and November 2016, trained hospital volunteers approached inpatient tobacco users on six pilot units. Volunteers shared a cessation brochure and used the ASK-ADVISE-CONNECT model to connect ready-to-quit patients to the Delaware Quitline via fax-referral. Volunteers administered a follow-up survey to all admitted tobacco users via telephone or email at 3-months post-discharge.
Results: Of the 743 admitted tobacco users, 531 (72%) were visited by a volunteer, and 97% (531/547) of those approached, accepted the visit. Over one third (201/531; 38%) were ready-to-quit and fax-referred to the Quitline, and 36% of those referred accepted Quitline services. At 3-months post discharge, 37% (135/368) reported not using tobacco in the last 30 days; intent-to-treat cessation rate was 18% (135/743). In a multivariable regression model of Quitline fax-referral completion, receiving NRT during hospitalization was the strongest predictor (OR: 1.97; 95% CI: 1.34-2.90). In a model of 3-month cessation, receiving Quitline services (OR: 3.21, 95%CI: 1.35-7.68) and having coronary artery disease (OR: 2.28; 95% CI: 1.11-4.68) were associated with tobacco cessation, but a volunteer visit was not.
Conclusions: An "opt-out" tobacco cessation service using trained volunteers is feasible for connecting patients to Quitline services.
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Patient Satisfaction with Care After Coronary Revascularization
Patient Satisfaction with Care After Coronary Revascularization
Mosby DL, Manierre MJ, Martin SS, Kolm P, Abuzaid AS, Jurkovitz CT, Elliott DJ, Weintraub WS

Patient 2018 04;11(2):217-223

PMID: 28875457

Abstract

OBJECTIVE: Bridging the Divides (Bridges), a Centers for Medicare and Medicaid Services-funded program, developed a post-hospitalization care management infrastructure integrating information technology-enabled informatics with patient care for ischemic heart disease patients. The objective of this study was to assess patient satisfaction with the Bridges program and determine the patient characteristics associated with higher satisfaction.
METHODS: All adult English-speaking patients who underwent a percutaneous coronary intervention, coronary artery bypass grafting, or catheterization plus acute myocardial infarction and agreed to participate in the Bridges program were eligible. A survey instrument was administered to address patient satisfaction of care received, aspects of care that patients appreciated, and challenges faced. Descriptive statistics were calculated, and primary analyses included comparisons of overall patient satisfaction after discharge between procedure type, and according to age, sex, race, Elixhauser comorbidity count, and length of stay.
RESULTS: Four hundred and sixty-seven (46%) had complete or partial response rates. There was a statistically significant difference in the overall satisfaction among patients undergoing percutaneous coronary intervention, coronary artery bypass grafting, or catheterization plus acute myocardial infarction (p = 0.023). There were significant procedure by sex (p = 0.052) and procedure by age (p = 0.039) interactions. There were no statistically significant differences in overall satisfaction according to age, sex, race, comorbidity count, or length of stay.
CONCLUSIONS: This study identified several important components related to patient satisfaction for patients with ischemic heart disease. Results found that patients who underwent coronary artery bypass grafting were reportedly "very satisfied" when compared with patients who underwent percutaneous coronary intervention and catheterization plus acute myocardial infarction, as well as significant age and sex interactions between procedures.
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