Utilizing Practice-Based Research Networks to Teach and Implement Quality Improvement in Academic Medicine.

BACKGROUND AND OBJECTIVES: A 2019 study found that between 2014 and 2017, family medicine residents had little improvement in self-assessed preparedness to lead quality improvement projects. This study explored the effectiveness of leveraging a practice-based research network (PBRN) across multiple family medicine residencies not only for implementing quality improvement projects, but also as a teaching tool designed to improve knowledge, attitudes, beliefs, and leadership skills in family medicine faculty and residents. METHODS: Residents in family medicine residency programs and one community internal medicine program and family medicine teaching faculty participated in a PBRN-led quality improvement project (QIP) to improve colon cancer screening in their clinic. Of 101 participants, 79 (78%) were residents and 22 (22%) were faculty or attending physicians. Questions surveying participants' knowledge and confidence related to QIP before and after the QIP were given. RESULTS: Overall, participants reported an improvement in their basic understanding of QI concepts (P=.004). They also reported having sufficient staff and ancillary support to meaningfully participate (P=.033). Participants indicated they had more confidence in their ability to participate in a QI project (P=.002), initiate, design, and lead such a project (P=.001), and teach their peers and staff basic QI concepts (P<.001). CONCLUSIONS: PBRNs appear to be a unique way to subjectively improve residents' confidence in their quality improvement skills. PBRNs should be further explored as a method for educating family medicine residents in quality improvement.

Assessing Racial Disparities in HCV Infection and Care Outcomes in a Southern Urban Population.

OBJECTIVES: This study assessed racial disparities in access to healthcare services, hepatitis C virus (HCV) exposure, and retention in a treatment cascade in two indigent populations in an urban center in the Southern US. PARTICIPANTS/METHODS: Opt-in HCV antibody screening was offered at two large homeless centers and three residential substance abuse treatment centers (SATCs) in New Orleans, LA. Five hundred ninety-four participants experiencing homelessness and 342 residents of SATCs were assessed for previous access/perceived barriers to healthcare services and high-risk behaviors associated with HCV exposure. Participants were then screened using rapid HCV antibody testing and tracked through a treatment cascade involving referral to a primary care provider (PCP), RNA confirmation, and specialist referral. RESULTS: In both the homeless and SATC populations, whites were more likely to report barriers to accessing healthcare and high-risk behaviors, especially prior intravenous drug use (IVDU). Interaction between age and race demonstrates a protective effect of white ethnicity at higher ages, at a level approaching statistical significance. Non-whites were equally likely to access follow-up care and treatment as whites. CONCLUSIONS: Despite many more risk factors reported by the white population, HCV antibody positivity was largely equal between the two racial groups. Known interactions between race and age in the African American population were demonstrated in these high-risk, urban populations. Whites were no more likely to achieve various levels of a treatment and care cascade. The results may demonstrate the impact of improved access to testing services and primary care, although access to treatment remains a significant barrier to eliminating racial disparities in HCV infection.

Help Desk: Is an intestinal biopsy necessary when the blood work suggests celiac disease?

It depends on the antibody levels in the blood work. Symptomatic patients with serologic levels of immunoglobulin A anti-tissue transglutaminase (IgA anti-tTG) or immunoglobulin G anti-deamidated gliadin peptide antibody (IgG anti-DGP) greater than 10 times the upper limits of normal--especially if they also are positive for endomysial antibodies (EMA) and human leukocyte antigen DQ2 (HLA-DQ2 or HLA-DQ8)--may not need an intestinal biopsy to confirm the diagnosis of celiac disease.

Louisiana death certificate accuracy: a concern for the public's health.

INTRODUCTION: The accuracy of death certificates is essential for public health prevention and research in the State of Louisiana. This article analyzes the accuracy of cause of death stated on Louisiana death certificates. METHODS: Discharge diagnoses from 2007 Louisiana Hospital Inpatient Discharge Diagnosis (LAHIDD) data were compared with the diagnoses in the cause of death section in the corresponding death certificates. RESULTS: Of the immediate causes of death, only 40.5% were considered an exact match and 17.4% did not have any type of match in the LAHIDD discharge diagnoses. For the preceding causes of death 54.0% of death certificates had no exact matches. There were only 55 (8.8%) of death certificates with no missing diagnosis. CONCLUSION: There are significant inconsistencies between the discharge diagnosis upon death and cause of death. This raises concern for public health and education is needed for physicians to improve accuracy of death certificates.