ABSTRACT For patients with advanced heart failure involvement as a member of the healthcare team ... more ABSTRACT For patients with advanced heart failure involvement as a member of the healthcare team is critical to safe, high-quality and goal-directed care. While recognized as an important aspect of care, patient engagement is not yet a standard practice. This presents an opportunity for professional education and development in team-based care. This short report describes the development of a Community and Patient Advisory Team (CPAT) formed to support patient involvement in interprofessional collaborative practice. The CPAT, composed of patient and family advisors, researchers, care team members, and grant operations staff, served as a core team within the structure of a project to shape a new vision of care delivery. This was accomplished through participation in quarterly leadership workshops and facilitation of team training focused on patient-provider communication strategies to improve patient safety. The advisory team led the co-development of patient materials to support patient engagement during the new implementation of structured interprofessional bedside rounds. Involving community members as partners helped shape our work to more effectively and directly address gaps in current patient care.
Background Early, regular prenatal care utilization is an important strategy for improving matern... more Background Early, regular prenatal care utilization is an important strategy for improving maternal and infant health outcomes. The purpose of this study is to better understand contributing factors to disparate prenatal care utilization outcomes among women of different racial/ethnic and social status groups before, during, and after the Great Recession (December 2007–June 2009). Methods Data from 678,235 Washington (WA) and Florida (FL) birth certificates were linked to community and state characteristic data to carry out cross-sectional pooled time series analyses with institutional review board approval for human subjects’ research. Predictors of on-time as compared to late or non-entry to prenatal care utilization (late/no prenatal care utilization) were identified and compared among pregnant women. Also explored was a simulated triadic relationship among time (within recession-related periods), social characteristics, and prenatal care utilization by clustering individual pred...
Journal of Clinical and Translational Science, 2021
IMPACT: Recognizing Interdisciplinary Collaborative Research in Promotion and Tenure Processes OB... more IMPACT: Recognizing Interdisciplinary Collaborative Research in Promotion and Tenure Processes OBJECTIVES/GOALS: Academic institutions have traditionally focused on individual achievements for promotion. We present our effort on identifying and measuring attitudes on promotion and tenure (PT) criteria that values and rewards interdisciplinary research (IR). We have developed a toolkit to facilitate the recognition of IR in PT processes. METHODS/STUDY POPULATION: Our group reviewed appointment, promotion and tenure (APT) policies from each of the six Health Science Schools and the College of Engineering at the University of Washington (UW) to assess language of objective criteria and attributes of IR to guide APT committees in the evaluation of interdisciplinary researchers. We surveyed faculty about their attitudes relating to IR within the context of promotion and tenure. Interviews of department chairs and administrators about institutional policies and infrastructure that support...
In baboons, nonreinforced (unwrapped) 60 microns internodal distance polytetrafluoroethylene graf... more In baboons, nonreinforced (unwrapped) 60 microns internodal distance polytetrafluoroethylene grafts form a complete endothelial lining within 2 weeks by capillary ingrowth through the wall. Smooth muscle cells then grow under the endothelium and proliferate to form a complete neointima. To determine if spontaneous endothelialization of these grafts can also occur in humans, 10 above-knee femoropopliteal grafts composed of equal lengths of 60 and 30 microns polytetrafluoroethylene were placed in eight patients. These grafts were reinforced (wrapped) for human use. Because biopsy of the grafts was not possible, endothelialization was assessed noninvasively by 111In-labeled platelet imaging 1 week and 3 months after surgery. There was no difference in indium uptake between 60 and 30 microns segments at either time. Histologic sections were available from 60 microns segments of two patients who underwent operation for graft thrombosis. Capillary ingrowth was seen in these grafts, but it rarely extended more than half the distance from the outside of the graft to the lumen. Smooth muscle cells were not seen on the flow surface, indicating that a neointima had not formed. These findings demonstrate that capillary ingrowth can occur in 60 microns grafts in humans but does not produce an endothelial lining. The failure to endothelialize is perhaps a result of inadequacy of angiogenesis in adult humans or retardation of capillary ingrowth by the reinforcing wrap.
Effective anticipation is a fundamental characteristic of highly reliable organizations. In Rosen... more Effective anticipation is a fundamental characteristic of highly reliable organizations. In Rosen’s anticipatory theory of complex systems, all living systems and virtually all other complex systems require anticipatory models to maintain an organized state. This paper provides an overview of Rosen’s anticipatory theory of complex systems and presents a conceptual framework for applying this framework to improve safety and quality in healthcare. Organizational interventions based on this theory could include education of clinicians, patients, and families on how anticipatory complex systems function and improve safety in clinical environments, and systems interventions to promote optimal concordance between a team’s model of a clinical situation and the actual clinical situation. Enhanced general understandings of anticipatory complex systems and of their failure modes could help reduce communications failures that are a common cause of serious adverse events.
Effective delivery of healthcare is highly interdependent within and between interprofessional (I... more Effective delivery of healthcare is highly interdependent within and between interprofessional (IP) care teams and the patients they serve. This is particularly true for complex health conditions such as advanced heart failure (AHF). Our Academic Practice Partnership received funding to carry out IP workforce development with inpatient AHF care teams. Our objectives were to (a) identify challenges in team functioning that affected communication and relationships among the AHF care teams, (b) collaboratively identify a focal work process in need of improvement, and (c) test whether facilitated implementation of team training and work process changes would lead to improvements in team communication, relationships, and process outcomes. The healthcare team identified implementation of structured IP bedside rounds (SIBR) as the preferred approach to improving collaborative care.Utilizing a cross-sectional pre/post design changes in team communication and relationships before and after a team intervention that included TeamSTEPPS training and SIBR implementation using a validated Relational Coordination (RC) survey were assessed. The study population included AHF care team members (n~100) representing seven workgroups (e.g., nurses, pharmacists) from two inpatient cardiology units at a 450-bed academic medical center in the Pacific Northwest during 2015–2016.Improvements in RC scores were demonstrated across all seven RC dimensions from baseline (Year 1) to follow-up (Year 2). Percent change on each of the seven dimensions ranged from 3.57%–9.85%. Changes were statistically significant for improvements between baseline and follow-up on all but one of the seven RC dimensions (shared knowledge).The IP team intervention was associated with improvements in RC from baseline to follow-up. Additional research is needed to assess patient perspectives and outcomes of the IP team intervention. Findings of this study are consistent with the growing body of RC and SIBR research and provide a useful model of an IP team-based intervention in clinical practice.
Personal health records(PHRs) are proposed as a strategy to make health care delivery increasingl... more Personal health records(PHRs) are proposed as a strategy to make health care delivery increasingly patient-centered. Yet little work has been done in understanding the workflows of patients in their own homes, or influence of access, cognitive, physical, or literacy barriers on workflow and outcomes of using health records. Many populations may require assistance in using PHRs to improve their health out-comes. We studied PHR use by an elderly and disabled population and describe those barriers encountered by our patients.
ABSTRACT For patients with advanced heart failure involvement as a member of the healthcare team ... more ABSTRACT For patients with advanced heart failure involvement as a member of the healthcare team is critical to safe, high-quality and goal-directed care. While recognized as an important aspect of care, patient engagement is not yet a standard practice. This presents an opportunity for professional education and development in team-based care. This short report describes the development of a Community and Patient Advisory Team (CPAT) formed to support patient involvement in interprofessional collaborative practice. The CPAT, composed of patient and family advisors, researchers, care team members, and grant operations staff, served as a core team within the structure of a project to shape a new vision of care delivery. This was accomplished through participation in quarterly leadership workshops and facilitation of team training focused on patient-provider communication strategies to improve patient safety. The advisory team led the co-development of patient materials to support patient engagement during the new implementation of structured interprofessional bedside rounds. Involving community members as partners helped shape our work to more effectively and directly address gaps in current patient care.
Background Early, regular prenatal care utilization is an important strategy for improving matern... more Background Early, regular prenatal care utilization is an important strategy for improving maternal and infant health outcomes. The purpose of this study is to better understand contributing factors to disparate prenatal care utilization outcomes among women of different racial/ethnic and social status groups before, during, and after the Great Recession (December 2007–June 2009). Methods Data from 678,235 Washington (WA) and Florida (FL) birth certificates were linked to community and state characteristic data to carry out cross-sectional pooled time series analyses with institutional review board approval for human subjects’ research. Predictors of on-time as compared to late or non-entry to prenatal care utilization (late/no prenatal care utilization) were identified and compared among pregnant women. Also explored was a simulated triadic relationship among time (within recession-related periods), social characteristics, and prenatal care utilization by clustering individual pred...
Journal of Clinical and Translational Science, 2021
IMPACT: Recognizing Interdisciplinary Collaborative Research in Promotion and Tenure Processes OB... more IMPACT: Recognizing Interdisciplinary Collaborative Research in Promotion and Tenure Processes OBJECTIVES/GOALS: Academic institutions have traditionally focused on individual achievements for promotion. We present our effort on identifying and measuring attitudes on promotion and tenure (PT) criteria that values and rewards interdisciplinary research (IR). We have developed a toolkit to facilitate the recognition of IR in PT processes. METHODS/STUDY POPULATION: Our group reviewed appointment, promotion and tenure (APT) policies from each of the six Health Science Schools and the College of Engineering at the University of Washington (UW) to assess language of objective criteria and attributes of IR to guide APT committees in the evaluation of interdisciplinary researchers. We surveyed faculty about their attitudes relating to IR within the context of promotion and tenure. Interviews of department chairs and administrators about institutional policies and infrastructure that support...
In baboons, nonreinforced (unwrapped) 60 microns internodal distance polytetrafluoroethylene graf... more In baboons, nonreinforced (unwrapped) 60 microns internodal distance polytetrafluoroethylene grafts form a complete endothelial lining within 2 weeks by capillary ingrowth through the wall. Smooth muscle cells then grow under the endothelium and proliferate to form a complete neointima. To determine if spontaneous endothelialization of these grafts can also occur in humans, 10 above-knee femoropopliteal grafts composed of equal lengths of 60 and 30 microns polytetrafluoroethylene were placed in eight patients. These grafts were reinforced (wrapped) for human use. Because biopsy of the grafts was not possible, endothelialization was assessed noninvasively by 111In-labeled platelet imaging 1 week and 3 months after surgery. There was no difference in indium uptake between 60 and 30 microns segments at either time. Histologic sections were available from 60 microns segments of two patients who underwent operation for graft thrombosis. Capillary ingrowth was seen in these grafts, but it rarely extended more than half the distance from the outside of the graft to the lumen. Smooth muscle cells were not seen on the flow surface, indicating that a neointima had not formed. These findings demonstrate that capillary ingrowth can occur in 60 microns grafts in humans but does not produce an endothelial lining. The failure to endothelialize is perhaps a result of inadequacy of angiogenesis in adult humans or retardation of capillary ingrowth by the reinforcing wrap.
Effective anticipation is a fundamental characteristic of highly reliable organizations. In Rosen... more Effective anticipation is a fundamental characteristic of highly reliable organizations. In Rosen’s anticipatory theory of complex systems, all living systems and virtually all other complex systems require anticipatory models to maintain an organized state. This paper provides an overview of Rosen’s anticipatory theory of complex systems and presents a conceptual framework for applying this framework to improve safety and quality in healthcare. Organizational interventions based on this theory could include education of clinicians, patients, and families on how anticipatory complex systems function and improve safety in clinical environments, and systems interventions to promote optimal concordance between a team’s model of a clinical situation and the actual clinical situation. Enhanced general understandings of anticipatory complex systems and of their failure modes could help reduce communications failures that are a common cause of serious adverse events.
Effective delivery of healthcare is highly interdependent within and between interprofessional (I... more Effective delivery of healthcare is highly interdependent within and between interprofessional (IP) care teams and the patients they serve. This is particularly true for complex health conditions such as advanced heart failure (AHF). Our Academic Practice Partnership received funding to carry out IP workforce development with inpatient AHF care teams. Our objectives were to (a) identify challenges in team functioning that affected communication and relationships among the AHF care teams, (b) collaboratively identify a focal work process in need of improvement, and (c) test whether facilitated implementation of team training and work process changes would lead to improvements in team communication, relationships, and process outcomes. The healthcare team identified implementation of structured IP bedside rounds (SIBR) as the preferred approach to improving collaborative care.Utilizing a cross-sectional pre/post design changes in team communication and relationships before and after a team intervention that included TeamSTEPPS training and SIBR implementation using a validated Relational Coordination (RC) survey were assessed. The study population included AHF care team members (n~100) representing seven workgroups (e.g., nurses, pharmacists) from two inpatient cardiology units at a 450-bed academic medical center in the Pacific Northwest during 2015–2016.Improvements in RC scores were demonstrated across all seven RC dimensions from baseline (Year 1) to follow-up (Year 2). Percent change on each of the seven dimensions ranged from 3.57%–9.85%. Changes were statistically significant for improvements between baseline and follow-up on all but one of the seven RC dimensions (shared knowledge).The IP team intervention was associated with improvements in RC from baseline to follow-up. Additional research is needed to assess patient perspectives and outcomes of the IP team intervention. Findings of this study are consistent with the growing body of RC and SIBR research and provide a useful model of an IP team-based intervention in clinical practice.
Personal health records(PHRs) are proposed as a strategy to make health care delivery increasingl... more Personal health records(PHRs) are proposed as a strategy to make health care delivery increasingly patient-centered. Yet little work has been done in understanding the workflows of patients in their own homes, or influence of access, cognitive, physical, or literacy barriers on workflow and outcomes of using health records. Many populations may require assistance in using PHRs to improve their health out-comes. We studied PHR use by an elderly and disabled population and describe those barriers encountered by our patients.
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Papers by Brenda Zierler