Christiana Care Value Institute

Who We Are

The Value Institute at Christiana Care is a diverse team of experts collaborating in the discovery and delivery of value-centered knowledge to improve health.

Who We Serve

To develop, deliver and evaluate innovative solutions impacting population health, patient experience, system performance and policy development.

How We Work

The Value Institute leads the way in conducting real-world research on today’s most pressing health care issues, helping to deliver better health, better care and better value for our neighbors.

Publications

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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Choosing Wisely in Delaware: Rationale for Evidence-Based Diagnosis & Evaluation of Low Back Pain
Choosing Wisely in Delaware: Rationale for Evidence-Based Diagnosis & Evaluation of Low Back Pain
Tanaka L, Khan OA, Jackson EV, Miller KE, Chiam TC

Del Med J 2016 Jan;88(1):14-8

PMID: 26934760

Abstract

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Patient-Centered Handovers: Ethnographic Observations of Attending and Resident Physicians: Ethnographic Observations of Attending and Resident Physicians
Patient-Centered Handovers: Ethnographic Observations of Attending and Resident Physicians: Ethnographic Observations of Attending and Resident Physicians
Mount-Campbell AF, Rayo MF, OʼBrien JJ, Allen TT, Patterson ES

Qual Manag Health Care 2016 Oct/Dec;25(4):225-230

PMID: 27749720

Abstract

Handover communication improvement initiatives typically employ a "one size fits all" approach. A human factors perspective has the potential to guide how to tailor interventions to roles, levels of experience, settings, and types of patients. We conducted ethnographic observations of sign-outs by attending and resident physicians in 2 medical intensive care units at one institution. Digitally audiotaped data were manually analyzed for content using codes and time spent using box plots for emergent categories. A total of 34 attending and 58 resident physician handovers were observed. Resident physicians spent more time for "soon to be discharged" and "higher concern" patients than attending physicians. Resident physicians spent less time discussing patients which they had provided care for within the last 3 days ("handbacks"). The study suggested differences for how handovers were conducted for attending and resident physicians for 3 categories of patients; handovers differ on the basis of role or level of expertise, patient type, and amount of prior knowledge of the patient. The findings have implications for new directions for subsequent research and for how to tailor quality improvement interventions based upon the role, level of experience, level of prior knowledge, and patient categories.
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