Tuesday, October 3, 2017                                                                                               Volume 4. Issue 1.

The Pulse  

The Department of Community Health and Family Medicine
Quarterly Newsletter

“Growth is never by mere chance; it is the result of forces working together"

- James Cash Penney

TOP STORIES

Chair's Message 
Achievements 
Three Missions: Patient Care, Education & Scholarship
CHFM Events
Faculty & Staff Spotlight
Link to 2015-2016 Annual Report
Past Grand Rounds Presentations
Past PCP Live Presentations

CHAIR'S MESSAGE

ACHIEVEMENTS

CHFM faculty and staff have been hard at work to advance the field of family medicine. In recognition of their accomplishments, the section below outlines some of the most notable achievements across the department this quarter.

Residency Faculty of the Year Award (2016-2017)

Dr. Charlie Michaudet was presented the 2016–2017 Residency Faculty of the Year Award. The residents vote for this award and all core faculty at the CHFM Residency Program are eligible.

STFM Leading Change Fellowship (National)

Dr. John Malaty and Mindy Halbrook have been accepted into the STFM Leading Change Fellowship. This fellowship program is designed to educate and empower faculty in clinical leadership roles to lead change at the national level. 

Medication Focused Outpatient Care for Underutilization of Secondary Prevention 

Grant: National Heart, Lung and Blood Institute (NHLBI) of the National Institutes of Health (NIH) 

Extension: 3/31/2018

• Dr. John Gums (Principal Investigator) 

• Dr. John Malaty (Co-Investigator) 

• Dr. Scott Garland (Study Coordinator) 

Competency Certification in Controlled Substance Management 

Dr. Siegfried O.F. Schmidt passed the American Board of Interventional Pain Physicians “Competency Certification in Controlled Substance Management” 

THREE MISSIONS:

PATIENT CARE, EDUCATION & SCHOLARSHIP

PATIENT CARE

Dr. Carek and Dr. Durkin preparing for the 2017-2018 Gator football season

PROGRAM  IN BIOETHICS, LAW AND MEDICAL PROFESSIONALISM: 

The BLMP program strives to promote professional development, patient safety, and awareness of interpersonal dynamics by educating present and future generations of healthcare providers. Through robust bioethics training, healthcare personnel are better prepared to handle ethical issues that may arise during patient care. BLMP faculty are committed to providing a comprehensive curriculum—including ethical frameworks and both historical and contemporary issues—to promote patient-centered healthcare decision-making.

BLMP faculty introduced the “Stigma of Illness” lecture and CLG topic for second-year medical students this August. Dr. Ray Moseley and Professor Bill Allen have expanded their offerings of the popular Financial, Business and Health Systems Aspects of Medicine elective course. Offered fully online for the first time, fourth-year medical students may contact their senior electives coordinator to enroll in this innovative course held during Period 8B in early December. Professor Allen will also be offering CM E 21: Advanced Issues in Medical Ethics and Law; CM E 23: History of Medicine; and CM E 30: Religion, Culture and Medicine, as fourth-year medical student electives at various times throughout the fall semester.

BLMP faculty are revamping the curriculum for CHFM first-year resident ethics workshops offered quarterly on Wednesdays. Faculty and residents will be covering topics including professionalism in the physician-patient relationship, capacity, informed consent, confidentiality, and end of life.

Dr. Moseley lectured over 175 talented high school students this summer participating in BIODecide and the Student Science Training Program, which are hosted by the UF Center for Precollegiate Education and Training.

Dr. Moseley and his team of researchers have been developing software to aid patients with making, storing, and transmitting their advance directives. Dr. Moseley gave a talk during the Palliative Lunch and Learn on August 8, where he explained how the technology he is developing is helping patients with making end-of-life decisions.

Professor Allen also participated in an interdisciplinary panel discussion on September 19, where panelists discussed the advantages and disadvantages of prescribing psychedelics to treat psychiatric symptoms. The panel also included Adam Strauss, whose comedic performance, “The Mushroom Cure,” served as a prominent topic in the discussion.

Spurred by an interest in the field of bioethics, first-year medical students at UF have gathered and established an ethics interest group. Dr. Moseley will serve as the group’s faculty advisor.

A journalist for The Miami Herald interviewed Professor Allen for an article about a clinical trial called the Myocardial Ischemia and Transfusion (MINT) study: http://www.miamiherald.com/news/health-care/article164845882.html

FACULTY DEVELOPMENT:

The next Faculty Development session is scheduled for Thursday, September 21st. During this session, a series on leadership development will be introduced. Just as a reminder, Faculty Development sessions are scheduled on the third Thursday of each month starting at 12:15pm. You may attend these sessions in person at UF Health Family Medicine—Main or via Jabber by dialing 75003.

SCHOLARSHIP

RESEARCH: NEW STUDIES

A PATIENT-CENTERED INTERVENTION USING VIRTUAL TECHNOLOGY TO REDUCE COLORECTAL CANCER DISPARITIES IN PRIMARY CARE

Dr. Peter Carek, in collaboration with Dr. Janice Krieger, Director of the STEM Translational Communication Research Program in the College of Journalism and Communications, are working on a study that will test the efficacy of a patient-centered, tailored message intervention. The message will be delivered via virtual technology for increasing CRC screening within guidelines among racial/ethnic minority and rural patients. Colorectal cancer (CRC) is the second leading cause of cancer death in the United States. Unfortunately, there are significant CRC screening disparities that result in higher rates of CRC-related morbidity and mortality for minority and rural patient populations, particularly in the southern United States. The development of interventions that capitalize on advances in communication, informatics, and computer science have great promise for resolving theoretical and practical problems associated with CRC screening decision-making. This study hypothesizes that exposure to a minimally tailored CRC screening intervention delivered via VHT will lead to improved cognitive processing of the intervention and increased adherence with initial and repeated annual FIT screening completion as compared to a fully tailored, text-only intervention. This hypothesis will be tested through two specific aims. In Specific Aim 1, the study will conduct focus groups and think-aloud interviews stratified by geography, gender, and racial/ethnic background to expand and pilot test an intervention that uses a virtual human as a delivery mechanism for CRC screening information. In Specific Aim 2, patients (N = 3,000) will be recruited via primary care clinics and a secure, clinical data warehouse to complete a randomized patient test of the efficacy of the intervention for promoting initial and repeat FIT testing. Dependent measures will be assessed via patient self-report and chart review. The proposed study will reduce health disparities and associated morbidity and mortality due to CRC via increasing screening among racial/ethnic minority and rural populations.

GRACE MARKETPLACE & DIGNITY VILLAGE PILOT STUDY

Dr. Shenary Cotter, in collaboration with Dr. Karla Shelnutt, an Associate Professor in the Department of Family, Youth, & Community Sciences, and Dr. LaToya O’Neal, an Assistant Professor in the Department of Family, Youth, & Community Sciences, are working on a study assessing food insecurity, poor nutrition, mental health issues, and chronic health conditions with members of the homeless population at GRACE Marketplace and Dignity Village. These are all contributing factors to the many health problems that members of the homeless population face and could further exacerbate their other present chronic health conditions. The study collected data from residents of Grace Marketplace and Dignity village in the form of a semi-structured interview-styled survey between July 14, 2017 and August 5, 2017, on-site at GRACE Marketplace. The survey contained two segments: an intake assessment segment, and a survey segment. The intake assessment involved the collection of physiological health parameters that included: blood pressure, heart rate, height, weight, Body Mass Index (BMI), BMI classification, waist circumference, and self-reported diabetes diagnosis status. The participants then completed an interview-styled survey consisting of validated scales and unique items which assess the self-reported access to healthcare services, nutritious foods, physical and mental health levels of the GM / DV, and interest in a community garden. The validated scales included: the National Cancer Institute (NCI) Fruit & Vegetable Screener (NCI_F/V), Stage of Change Measure items for nutrition and fruit & vegetable intake, the International Physical Activity Questionnaire (IPAQ), and the DASS-21 (Depression, Anxiety, Stress Scale). The proposed study will assess physiological, psychological, and nutritional health while evaluating potential solutions from the perspective of the participants including community-oriented interventions such as a community garden and or nutrition education program.

PROFESSIONAL IDENTITY, JOB SATISFACTION, AND COMMITMENT OF NONPHYSICIAN FACULTY IN ACADEMIC FAMILY MEDICINE

Dr. Arch Mainous, in collaboration with Dr. Peter Carek, are conducting a survey study through the Council of Academic Family Medicine Educational Research Alliance (CERA) which is a joint initiative of all four major U.S. academic family medicine organizations (STFM, NAPCRG, ADFM, and AFMRD). The aims of this study were to 1) investigate in a national survey of academic nonphysician faculty the feeling of identity of nonphysician faculty in family medicine and perceptions of respect by their colleagues and 2) evaluate the level of self-efficacy, job satisfaction, and organizational commitment of nonphysician faculty in relation to the feelings of family medicine identity. The overall participant pool indicated that their sense of feeling valued within family medicine, professional status with family medicine, commitment to their organization, job satisfaction, and self-efficacy were all high.

PERCEPTIONS OF BIOETHICS EDUCATION IN FAMILY MEDICINE RESIDENCY PROGRAMS (FMRPs)

Dr. Solberg in collaboration with Drs. Porter, Moseley, and Allen are conducting a survey study with Family Medicine Residency Program Directors (PDs) through the Council of Academic Family Medicine Educational Research Alliance (CERA) which is a joint initiative of all four major U.S. academic family medicine organizations (STFM, NAPCRG, ADFM, and AFMRD). The aims of this study are to 1) assess the distribution of family medicine residency programs (FMRPs) with informal and formal bioethics education and characterize and compare the methods utilized behind using each format, and 2) identify the bioethics topics that program directors (PDs) of family medicine residency programs (FMRPs) identify as important and assess whether FMRPs are teaching what they believe to be important for medical residents to receive from their FMRP education. Using ten general variables that will be measured and combined to characterize and define the FMRPs, the team will assess the implications of these variables on two separate analyses with two cohorts in each. For part a, they will compare FMRPs that have bioethics education (BE+) versus FMRPs that do not have bioethics education for their residents (BE–). For part b, they will define what a formal vs. an informal program would consist of based on particular survey answer choices for the above items- such as bioethics education provided by residents, infrequent bioethics education, or lack of bioethics topics taught, etc. Then they will compare FMRPs with informal bioethics education (formal cohort or FC) and FMRPs with informal bioethics education (informal cohort or IC).

MEDICAL STUDENT PERSPECTIVES ON ABORTION AND UNPLANNED PREGNANCY AS PART OF THE MEDICAL SCHOOL CURRICULUM DURING THIRD YEAR FAMILY MEDICINE CLERKSHIPS

Dr. Shenary Cotter is working on a study assessing the third year medical student perceptions on abortion and unplanned pregnancy education provided in their family medicine clerkship. The overall purpose of this study is to explore medical student perceptions on the overall topics of unplanned pregnancy and abortion through 1) evaluating whether third-year medical school students deemed the lectures on unplanned pregnancy and abortion as valuable in their educational curriculum, 2) determining the impacts of positive or negative both the clinical and / or didactic practice and knowledge regarding the lectures on unplanned pregnancy and abortion, and 3) assessing student perceptions on the need for further clinical and/or didactic education on the topics of unplanned pregnancy and abortion.

RESEARCH: ONGOING STUDIES

MEDICAL STUDENT WELLNESS CURRICULUM TO IMPROVE MEDICAL STUDENT WELL BEING

Dr. Kristy Smith is developing a wellness curriculum to improve medical student well-being and decrease depression and anxiety in medical students. Medical Student Well Being Index, GAD-7, and PHQ-9 scores will be taken on medical students every three months longitudinally throughout medical school. Interventions will include incorporating basic stress management, study skills, and resilience training to help students gain the tools they need to improve quality of life, decrease depression and anxiety, decrease dropout rates and time off, and ultimately improve academic performance. Data collection will commence with the incoming first year medical students this fall.

ASSESSMENT OF MEDICATION CHANGES DURING HOSPITAL DISCHARGES AND CORRELATION WITH RISK FOR HOSPITAL READMISSION

Eric Dietrich, PharmD, BCPS, a clinical assistant professor in the Department of Community Health and Family Medicine and a clinical assistant professor in the Department of Pharmacotherapy and Translational Research, is working on a study correlating number and type of medications during inpatient hospital stays with rate of readmission. According to CMS, approximately 1 in 5 patients are readmitted to the hospital within 30 days of discharge. 75% of these readmissions have been estimated to be preventable, which equates to a cost of $12 billion dollars per year. Medication changes during hospital stays between January 1, 2014, and November 1, 2014, will be characterized and analyzed for their correlation to rate of readmission. 

SICKLE CELL / HEMOGLOBINOPATHIES

Dr. Arch Mainous, in collaboration with Dr. Peter Carek, are conducting a study to develop and implement a clinical decision support system into the electronic health record for patients with sickle cell disease and other hemoglobinopathies whose primary care is delivered in the Department of Community Health and Family Medicine. The purpose of this study is to show the impact of utilizing programmed alerts to remind providers to order ferritin test on patients during routine office visits.  Due to the increased blood transfusions as part of treating pain associated with sickle cell disease, this patient population tend to have high amounts of iron in their blood.  Patients who test a ferritin level above 1,000ng/mL are recommended to undergo chelation therapy. Mid-cycle numbers show that there is a 50% rate of ordering ferritin labs on eligible patients.

HOW WELL DO GRADUATING MEDICAL STUDENTS RECOGNIZE KEY PHYSICAL EXAM ABNORMALITIES?

Dr. Jonathan Grant Harrell, in collaboration with Drs. Heather Harrell, Ashleigh Wright, and Carolyn Stalvey (all from UF Department of Internal Medicine), is conducting a study that intends to enroll 4th-year medical students to participate in a half-day Observed Structured Clinical Examination (OSCE) with the goal of evaluating the students’ physical examination performance based on identifying the correct abnormalities. This study is the first phase of a two-phase project. This phase involves the development of the curriculum and assessment of 4th-year students’ baseline performance on physical examination technique and recognition of abnormal findings. The Longitudinal Clinical Skills Task Force (LCSTF) will develop a longitudinal physical examination curriculum proposal following the methods proposed by Kern et al. 5 The LCSTF created a list of core abnormal physical examination findings based on a literature review, evidence of clinical usefulness, local expert opinion, and needs assessment. As another part of the needs assessment, 4th-year students’ physical examination skills will be assessed using an Observed Structured Clinical Examination (OSCE). The following are the specific aims of this study: (1) to assess 4th-year medical students’ physical examination technique; (2) to assess 4th-year medical students’ ability to identify common abnormal physical exam findings; (3) to assess 4th-year medical students’ recollection of the amount of direct observation of physical examinations after implementation of a new curriculum; and (4) to assess 4th-year medical students’ recollection of the types of abnormal physical examination findings they encountered after implementation of a new curriculum.

IMPROVING INFLUENZA VACCINATION RATES IN A FAMILY MEDICINE CENTER

Dr. John Malaty, in collaboration with Drs. Dickmann (PGY-3), Conroy (PGY-1), and Dideban (PGY-2), is conducting a study to determine if a quality improvement intervention implemented at a family medicine center has been effective in improving influenza vaccination rates. The influenza vaccination rate for patients seen by family medicine residents and faculty members in their family medical center will be determined, both before and after the intervention, and sub-group analysis involving vaccination rates for patients with specific demographic details and relevant chronic conditions will be analyzed. Data will be requested from UF Physicians Decision Support on patients seen at UF Health Family Medicine – Main clinic starting September 1, 2015 through August 31, 2016 for the pre-intervention analysis and from September 1, 2016 to August 31, 2017 for the post-intervention analysis. The data being analyzed is associated with patients who received primary and/or specialty care at UF Health Family Medicine - Main. Descriptive statistics will be used to determine the baseline influenza vaccination rate prior to the intervention, the rate of vaccination after the intervention and the rate of declines for vaccination after the intervention. The data will then be stratified to assess the rates across important demographic sub-groups. Further statistical analyses, using descriptive statistics and bivariate analyses, will be done to evaluate the prevalence of vaccination among patient subgroups with specific diagnoses which place them at high-risk for influenza-related complications per CDC guidelines. 

FEO PROGRAM EVALUATION

Dr. David Quillen, in collaboration with Dr. Lisa Chacko, is conducting a retrospective 9-year program evaluation of the Faculty Enhancement Opportunities (FEO) Program at the University of Florida, including a survey of grantees and review of grant documents. The purpose of the study is to assess the degree to which University of Florida’s innovative FEO program has impacted career development of individual faculty members and departmental advancement. A comprehensive program evaluation will allow the FEO program to share its model with other institutions, quantify the degree to which promotion and career growth were served by FEO funding and seek grantee feedback for areas of future growth and improvement. The specific aims of this study are to; (1) to assess FEO grantee perspectives of the impact of FEO funding on publication, promotion, academic collaboration and contribution to departmental goals; (2) to compare original goals of FEO grants with reported outcomes; and (3) to describe and compare FEO funding across the Colleges and Departments within the University of Florida. The University of Florida’s FEO program is unique, as there is currently only one other known institution-initiated faculty enhancement award nationwide.  The other existing program is at Harvard University. This faculty enhancement program targets “vulnerable” faculty at risk of falling short of promotion and tenure goals early in their careers (prior to promotion). UF’s FEO program is innovative in its availability to faculty as soon as three years into a faculty position. This proactive approach to supporting faculty outside of traditional sabbatical or continuing education funding lines places UF’s FEO program at the forefront of innovation for faculty development nationally.

PATIENT EMPOWERED STRATEGY TO REDUCE ASTHMA MORBIDITY IN HIGHLY IMPACTED POPULATIONS (PREPARE)- VANGUARD STUDY

Dr. Ku-Lang Chang, in collaboration with Harvard University, is conducting a study measuring the impact of adding PARTICS- PARTICS-patient activated rescue therapy with Inhaled Corticosterorids (ICS) for the high-risk racial and ethnic groups of African American/Black and Hispanic/Latino patients. The PREPARE study will enroll self-identified African American/Black and Hispanic/Latino patients, the racial and ethnic groups most adversely affected by asthma. The enrolled patients will be randomized equally to the intervention (PARTICS-patient activated rescue therapy with ICS) and the usual care groups. PARTICS, the addition of ICS to each puff of SABA for rescue while continuing usual daily controller therapy was effective in a smaller very tightly controlled clinical trial; decreasing asthma exacerbations that required steroids, and asthma related ED visits or hospitalizations. Despite the added use of an ICS to rescue therapy, there was no increase in rates of oral thrush or other side effects associated with ICS use. Dr. Chang and the UF CHFM department are assisting with patient recruitment, and data collection from high-risk patients.

STANDARDIZED HOME EXERCISE PRESCRIPTION: EDUCATION OF FAMILY MEDICINE RESIDENTS

Dr. Charlie Michaudet, in collaboration with Drs. Kramer (PGY-3), Eldayrie (PGY-2), Seitchik (PGY-1), Allen (PGY-1), Gonzalez (PGY-1), and Leasure (PGY-1), is conducting a study that will evaluate the educational value of having evidence based home exercise protocols available for family medicine residents in regard to the prescription of home exercise treatment for common musculoskeletal conditions. We will be evaluating resident knowledge on home exercise prescription as well as their level of comfort in educating their patients before and after a series of didactic sessions and implementation of exercise protocols. The data will be collected in two phases with didactic lectures provided between the two phases: (1) phase I: Residents will be surveyed as to their knowledge and confidence in both diagnosing specific MSK issues and prescribing the correct home rehabilitation regimen; (2) in between phase 1 and phase 2 there will be a series of didactic lectures to educate resident on home exercise prescription and get them familiarized with the handouts; and (3) phase II: Residents will be surveyed again in May 2017 with the same multiple choice questions and Likert style confidence scales from phase 1. The specific aims of this study are to: (1) to improve resident knowledge, comfort, and efficiency in prescribing home exercise programs; and (2) to implement an evidence-based database of standardized rehabilitation programs for common musculoskeletal complaints.

EVALUATION OF ADVANCE DIRECTIVES IN AN OUTPATIENT CLINIC SETTING

Dr. Lauren Solberg, in collaboration with Drs. Ray Moseley and Bill Allen, is conducting a study to evaluate Advance Directives (ADs) in the UF Department of Community Health & Family Medicine (CHFM) in order to provide an understanding of the impact and effects of the AD educational lecture provided to clinicians to improve the quantity of CHFM patients with ADs. Between June and September 2016, the faculty members of the Program in Bioethics, Law & Medical Professionalism (BLMP), part of CHFM, delivered lectures about ADs to all of the providers and staff in each of the CHFM clinics. In total, 11 lectures were delivered; providers and staff each attended 1. The purpose of this study is to analyze data about patients with ADs on file in EPIC each month beginning 1 year prior to and 4 months after the CHFM AD lectures in order to make conclusions about the potential impact of the education. Thus, BLMP faculty will analyze data about CHFM patients with ADs on file in EPIC between June 1, 2015 and January 1, 2017. This study represents a preliminary effort to make conclusions about CHFM patients with ADs in their medical records in order to facilitate the design and implementation of future interventions to increase the number of CHFM patients with ADs on file. The specific aims of the study are to: (1) compare the number of ADs on file for CHFM patients prior to and after lectures to CHFM providers and staff about ADs; and (2) analyze demographic information about patients with ADs on file in EPIC in the specified date range in order to facilitate the design and implementation of future interventions to increase the number of CHFM patients with ADs on file in EPIC.  

INFLUENCE OF SLEEP & PHYSICAL ACTIVITY ON CONCUSSION RECOVERY

Dr. Jay Clugston, in collaboration with Dr. Jaffee (UF Department of Neurology) and Dr. Bauer (UF Department of Clinical & Health Psychology), is working on a study measuring the impact of sleep and physical activity on concussion recovery. Sleep and physical activity play a crucial role in the maintenance and restoration of cognition, learning, and memory, and serves as a key factor in brain recovery. Sleep and physical activity may be factors that affect concussion recovery, including the days to symptom resolution, days to neurocognitive deficit resolution, and days to balance deficit resolution. Despite the high incidence of sleep and vigilance problems following concussion, few studies have used objective measures, such as actigraphy (e.g. wrist accelerometer unit), to describe sleep and wake disturbances. The purpose of this study is to determine the influence of sleep and physical activity on concussion recovery. The results of this study will help guide clinicians in determining the utility of sleep management programs and physical activity recommendations to aid recovery following concussion.

CHARACTERIZATION OF ED HIGH UTILIZERS

Dr. Peter Carek, in collaboration with Drs. Maribeth Porter and Lisa Chacko, is working on a study to characterize the patients who are frequently readmitted to the hospital. According to CMS, approximately 1 in 5 patients are readmitted to the hospital within 30 days of discharge. 75% of these readmissions have been estimated to be preventable, which equates to a cost of $12 billion dollars per year. This study’s characterization will be completed for patients that were readmitted to the ED within 30 days of a previous hospital admission. The characterization will include demographic variables, length of stay, readmissions, primary and secondary diagnoses, and medications. Subgroups from the high utilizers will be identified and further analyzed in order to develop patient-centered and population health interventions.

STFM FACULY DEVELOPMENT STUDY

Dr. Tanya Anim is working on a study to enhance development of the Family Medicine Residency Program faculty members through identification of current areas of weakness or need, and the development of a tailored faculty development series based on the needs identified. The UF Family Medicine Residency Program did not provide internal faculty development sessions until the start of this intervention. The existing faculty development program for the entire College of Medicine presents topics that often are not specific to the unique needs of the family medicine faculty. Relevant, targeted (i.e. based on identified needs) faculty development promises to dramatically improve resident and medical student education. The objectives of this study are to (1) develop and implement a tailored Faculty Development Series for the UF Department of Community Health and Family Medicine to improve the quality of teaching and (2) create a practical faculty development toolkit for programs across the nation, enabling them to tailor faculty development to the needs of their own faculty. The four-step protocol for enhancing faculty development: (1) a Research Electronic Data Capture (RED Cap) survey will be administered to faculty, residents, and clinic staff to identify areas of faculty teaching that could benefit from improvement; (2) development of a tailored faculty development series based on the needs identified in the surveys; (3) the delivery of the faculty development series utilizing a variety of presentation and teaching styles; and (4) evaluation of the impact of the faculty development series on the experience of teaching and learning. At the end of the academic year, a follow-up faculty, resident and staff survey will assess satisfaction and perceived impact of the tailored Faculty Development Series. This evaluation will specifically assess the degree to which the Faculty Development Series addresses the stated needs. Moreover, Dr. Anim and her team will assess the educational applicability and the experiential nature of the Faculty Development Series.

LOW LITERACY ASTHMA PLAN STUDY

Drs. Elvira Mercado and Kim Nguyen, in collaboration with Karen Theoktisto, DNP, ARNP, are working on a study to test the use of a low literacy asthma plan in order to improve compliance of pediatric patients regarding asthma management and reduce the number of asthma-related emergency room visits and hospital admission rates. Asthma is the most prominent chronic illness in childhood and affects an overall 9.6% of all children in the United States (Gold, et al., 2016). Text-based asthma self-management plans in a low-literacy population may not be well received and are difficult to understand. Asthma plans that utilize pictures may communicate the severity of asthma in a more understandable method, leading to better asthma control and reducing visits to the emergency room. In Alachua County, Florida, the number of emergency room visits for children age 0-17 years with asthma has increased from 293 in 2005 up to 488 in 2014, and hospitalizations have increased from 82 to 164 during the same period (Florida Public Health Tracking System, 2016). Improved health literacy approaches have been linked to improved patient outcomes but have not been well studied in childhood asthma outcomes (Yin et al., 2016).  Asthmatic children of parents with low health literacy are at risk for worse asthma-related outcomes, more severe asthma exacerbations and increased use of emergency rooms. The development of a low-literacy asthma plan can be used as part of counseling that can offer providers a framework with which to educate parents and families on specific asthma issues. Asthma affects all Americans, but the burden is especially high for children of low-income, lesser-educated and racial- and ethnic-minority populations.

INTERACTIVE INFORMED CONSENT STUDY

Dr. Ray Moseley and Dr. Arch G. Mainous III (CHFM and UF Department of Health Services Research, Management, and Policy), in collaboration with Dr. Christopher Harle from Indiana University (UF Department of Health Policy & Management), Dr. Janice Krieger (UF College of Journalism), and Dr. Babette Brumback (UF Department of Biostatistics), are collaborating with the goal of developing and evaluating a novel, electronic informed consent application for research involving electronic health record (EHR) data. In response to NIH RFA-OD-15-002, this study addresses research using clinical records and data, including the issues of the appropriate content and duration of informed consent and patient preferences about research use of clinical information. This study will design an electronic consent application intended to improve patients’ satisfaction with and understanding of consent for research using their EHR data. The electronic application will provide interactive functionality that creates a virtual, patient-centered discussion with patients about research that uses EHR data. Also, to correct potential misconceptions and increase informedness, the application will present trust-enhancing messages that highlight facts about research regulations, researcher training and data protections. This study will improve understanding of how to best give patients information about research that uses their health records and data. With this understanding, this study will develop a new computer application that patients can use in their doctors’ offices. This application will allow patients to learn more about clinical research and make informed choices about whether or not they want their health records and data to be used for research. This project is innovative because it will create a virtual, patient-centered discussion about research using EHR data. Moreover, this project will produce a consent application that clinicians and researchers can use as an ethically sound and practical tool for consenting patients, in a clinical setting, for research involving EHRs.

PAIN MANAGEMENT PROGRAM STUDY

Dr. Siegfried O. F. Schmidt, in collaboration with Lesa Gilbert, FNP-BC, Dr. George Samraj, Dr. David Feller and Dr. Ku-Lang Chang, are nearing the fourth year of the UF Pain Management Program at Main (PMPM) within the UF Family Medicine Residency Program. Through this study, researchers are continuing to monitor the care received by patients with chronic pain conditions who are being seen at the location with the goal to analyze patient data to better understand these patients’ experiences and understand how their treatment and diagnoses changed after being referred to this program. Alongside the patient care aspect, the research team intends to evaluate resident education and knowledge gained from their one-month rotation with PMPM.

OTIC BAROTRAUMA STUDY

Dr. Susan Millan and her research team at the UF Health Wound Care and Hyperbaric Center at Magnolia Parke have begun their project to evaluate the causes of barotrauma during hyperbaric oxygen therapy (HBOT) and what treatments can be used to prevent otic barotrauma (OB). They have begun by analyzing historical data from 2/1/2014 through 12/31/2015, and specifically otic barotrauma adverse events that have occurred at the UF Health Wound Care and Hyperbaric Center. They plan to analyze diagnoses, depth of treatments, chamber operators, number of treatments received, gender, day of week and TEED otic barotrauma scores. The aim of this project is to determine whether there are significant factors that affect otic barotrauma while patients are undergoing hyperbaric oxygen therapy. The results of this study will help aid clinicians to not only assist in decreasing the number of OB adverse events in HBOT, but it may also inform scuba divers with comorbidities of otic barotrauma. Available literature does not address comorbidities on the incidence of otic barotrauma in HBOT or of pre-hyperbaric oxygen therapy evaluation and treatment by Otolaryngology.

QUALITY:
Highlights for CHFM quality projects for the past quarter:

Readmission Trends in Family Medicine – Over the past 13 months, the inpatient readmission rate continues to move in a downward trend. The department's current readmission initiatives include weekly quality improvement rounds with the inpatient team, during which all readmissions from the preceding week are discussed. Additionally, CHFM outpatient sites are actively working to decrease emergency department (ED) utilization and improve overall access for patients. With this specific effort, CHFM hopes to further decrease the need to readmit our patients following their initial hospitalization. 

ED Utilization – The Eastside ED Utilization project wrapped up the second phase of cohorts.  The 75 patients chosen as high utilizers showed a slight reduction in ED utilization as the orange trend line shows. Interventions for usage reduction included bi-weekly team meetings that consisted of physicians, nursing staff, a social worker, a health coach and pharmacists.  Of the 75 patients in the cohort, 27 of the highest utilizers were discussed in the team meetings. Care plans were conveyed to the patients and staff.  A total of 7 patients out of the 27 patients were tracked for ED usage pre-and post-team meeting and the numbers showed a 90% reduction in ED usage (91 visits pre-team meeting vs. 9 post-team meeting). The Phase Three cohort of patients has been chosen and interventions are actively underway by Reathea Felder, and the team at Eastside. 

POSTERS: 

National

Asken BM (g), Stevens T (g), Brooke Z (g), Boone JK, Clugston JR. Rate and Magnitude of Head Impacts Sustained by Linemen during Football Practice Quantified by Drill-Specific Outcomes: Implications for Exposure Prevention. American Academy of Neurology Sports Concussion Conference. Jacksonville, FL.  July 14, 2017.

PRESENTATIONS: 

National

Buckley T, Breedlove K, Oldham J, Kontos A, DiFabio M, Kaminski T, Clugston JR, Schmidt J, Chrisman S, DeWolf R, Ortega J.  Year to year reliability of the King Devick Test in collegiate student-athletes: an NCAA/DoD Grand Alliance report.  American Academy of Neurology Sports Concussion Conference.  Jacksonville, FL. July 15, 2017. Oral Research Presentation. Invited.

PUBLICATIONS:

Agana DF, Porter M, Hatch R, Rubin D, Carek PJ. Job Satisfaction Among Academic Family Physicians. Fam Med. 2017;49(8):622-625.

Carter CS., Solberg LB, & Solberg LM (2017). Applying theories of adult learning in developing online programs in gerontology. Journal of Adult and Continuing Education, doi: 10.1177/1477971417721718.

Delcher C, Wang, Y, Young HW, Goldberger BA, Reisfield GM, Schmidt S (accepted). Trends in Florida’s Prescription Drug Monitoring Program Registration and Utilization: Implications for Increasing Voluntary Use. Journal of Opioid Management.

Houck Z (g), Asken B (g), Clugston JR, Perlstein W, Bauer R.  Socioeconomic status and race outperform concussion history and sport participation in predicting collegiate athlete baseline neurocognitive scores.  Journal of International Neuropsychology. Published online ahead of print August 9, 2017.  PMID: 28791942

Schmidt S, Przkora R. Opioid Basics. Anesthesia Toolbox. 2017. URL: https://toolboxlms.collectedmed.com.

Solberg LB, & Shniderman AB (2017). Legal Language of Health Care Consent Forms: Complexity, Comprehension, and Impact on Patient Decision Making. AJOB Neuroscience, 8(1), 47-49.

CHFM EVENTS

UPCOMING EVENTS

ANNUAL ADMINISTRATIVE RETREAT – OCTOBER 5, 2017

This year’s annual administrative retreat will focus on wellness with an emphasis on promoting personal growth. In addition to the indoor morning activities, the afternoon activities will be outdoors and will allow attendees to interact with their team members in an environment outside of an office. All participants should dress accordingly—in comfortable clothing and closed toe/sports shoes.

If you have any questions or concerns please contact Sheila Diuguid at diuguid@ufl.edu. 

Retreat Schedule: 

• 8:00 AM–8:30 AM (Breakfast) 

• 8:30 AM–8:45 AM (Chair's Welcome) 

• 8:45 AM–11:45 AM (Presentation) 

• 11:45 AM–12:15 PM (Group activity led by Dr. Carek) 

• 12:15 PM–1:15 PM (Lunch) 

• 1:15 PM–3:45 PM (Wellness Activity) 

• 3:45 PM–4:00 PM (Closing) 

UNIVERSITY OF FLORIDA CAMPAIGN FOR CHARITIES – OCTOBER 20, 2017

The University of Florida Campaign for Charities (UFCC) is the annual employee giving campaign. All UF employees can participate by making charitable donations though payroll deduction, cash, check, credit card or stock contribution. For the last 12 years, UF employees have given almost $1 million annually to charities serving our region. Please plan to make your charitable contribution because…Gators Give! Pledge Now: http://ufcc.ufl.edu/pledge-now/

The UFCC provides an opportunity for UF employees to give to their area charity of choice through payroll deduction, check, cash or stock contribution. Since 1993, our employees’ contributions have helped improve the quality of life for people in the communities of the Alachua County region. http://ufcc.ufl.edu/2017-agencies/

The UF Campaign for Charities is divided into two focus times: The Leadership Campaign and the General Campaign. Traditionally, the Leadership Campaign period is an opportunity for those who qualify at the leadership level to donate before the general campaign begins. Those who qualify for the Leadership Campaign include individuals who have either given $500 or more during the previous year’s campaign, OR whose annual salary is more than $50,000. However, due to the easier and convenient online giving system, all employees will be able to log on during either campaign period and give their donations to their favorite agency. http://ufcc.ufl.edu/pledge-now/

Some gifts to the UFCC are designated to a specific agency. Those not given to a specific agency—but given to the overall campaign—are considered “undesignated.”  The undesignated funds are divided among all agencies in proportion to the amount they received in the campaign. If an agency received 0.5% of the total designated donations, they would receive 0.5% of the total undesignated funds. The distribution of undesignated funds added 35% to the total donations for our agencies in 2016.

During the campaign, UF employees will receive e-mails from the UFCC with links to the online contribution site. UF employee donations may be made through payroll deduction or by check, cash, bankcard, or direct bill. Payroll deductions will begin in January 2018. The University of Florida Campaign for Charities (UFCC) is open for your pledges now through October 20th, and payroll deductions can be made through November. 

MIND, BODY, AND SOLE 5K – NOVEMBER 12, 2017
This is the fourth year of the Mind, Body, and Sole 5K and all profits from this race will go to the Carey R. Barber, M.D. Scholarship for Providers Depression Awareness and Suicide Prevention fund, providing funding for medical students who are interested in helping this cause. This race is sponsored by the American Medical Student Association (AMSA), and Awareness Wellness Ambassadors Reaching Everyone (AWARE). Come join this fun event and help support this great cause!

Race Date and Time
Saturday, November 12, 2017, at 8:30 a.m.

Event Information
Check In: 7 a.m.
Start Time: 8 a.m.
Awards Ceremony: 9:15 a.m.

Location
UF Commuter Lot on Gale Lemerand Drive
Gainesville, FL 32608

Early Registration Fee until November 10, 2017, at 9 a.m.

• UF Students: $15

• Non-UF Students and Faculty and General Public: $25

• Children (18 and under): $10

Late Registration Fee after 9 a.m. on November 10

• UF Students: $20

• Non-UF Students and Faculty: $30

• Children (18 and under): $15

Registration
Register online at www.ITSYourRace.com
An additional processing fee will be charged by ITSYour Race.com for online registration. Online registration closes Friday, November 10, 2017, at 9 a.m. For mail-in registrations, please make checks payable to UF Foundation or UFF and mail to 3800 Sandy Shores Drive, Jacksonville, FL 32277. Sorry, no refunds will be provided.

Course
The “Infamous UF Boot”

Post-Race Celebration
Join attendees after the race for a runner’s banquet with refreshments!
Gift certificates for food, shirts and items are up for bid.

Stacey Kirkpatrick (left) is this years recipient of the Carey R. Barber, MD Scholarship for Suicide Prevention and Depression Awareness

Pictured is Carolyn Barber (left) sharing moments with some wonderful donors of the Carey R. Barber, MD Scholarship for Suicide Prevention and Depression Awareness

ANNUAL HOLIDAY PARTY – DECEMBER 15, 2017

Save the date for the CHFM Annual Holiday Party, hosted by Dr. and Mrs. Carek at their home. The evening promises to be a great time for all!

PAST EVENT HIGHLIGHTS

YOUR SHOE SIZE X 2 FUNDRAISING CAMPAIGN – AUGUST 18, 2017

In conjunction with UF Health’s Raising Hope at Work Campaign 2017, CHFM’s fundraising focus “Your Shoe Size x 2” was created to increase donor participation within the department. An interactive aid for tracking all donors was displayed in the UF Health Shands Hospital Atrium by having each donor write their name on a blue cube to be placed in a clear box display.

The campaign ended August 18, 2017. During this year’s campaign 1,800 UF Health and UF College of Medicine Employees joined to Raise Hope at Work. In totality, Community Health and Family Medicine raised $2,155.36 for the 2017 Raising Hope at Work Campaign for 2017. Overall, the campaign raised $203,301! Thank you for your commitment to Raising Hope at Work! 

20th ANNUAL GAINESVILLE CODING FIESTA – SEPTEMBER 23, 2017

The 20th annual Coding Fiesta took place on Saturday, September 23, at the Harrell Medical Education Building. Healthcare professionals involved with medical billing, coding, and utilization management attended the event. The lineup this year consisted of workshops pertaining to wellness, anatomy, physiology, clinical documentation, coding updates, and business skills, as well as a panel discussion on physician billing compliance. Attendees enjoyed breakfast, lunch, and refreshments amidst a plethora of tables where vendors and sponsors sold their merchandise while event staff facilitated registration and raffles. The event also featured past chapter presidents and honored their contributions to their communities.

MOBILE OUTREACH CLINIC OPEN HOUSE – SEPTEMBER 27, 2017

The Mobile Outreach Clinic finally got a makeover and had its open house in front of the Harrell Medical Education Building (HMEB) on September 27th. The clinic aims to reach out to neighborhoods in our community who are suffering health disparities and offer primary care to individuals in these communities. 

Goals of the Clinic:

1. Identify neighborhoods where residents are demonstrably under-served.

2. Offer primary and preventive care to areas with known health disparities.

3. Assist under-served individuals with enrollment in health plans for which they may qualify.

4. Screen for chronic illness.

5. Provide disease prevention services with community partners.

6. Expand the reach of health and wellness education programs provided by AHEC and UF Health Eastside Community Practice.

Overall, the Mobile Outreach Clinic provides primary medical care services at no cost to the patient and will deliver services to all individuals regardless of their ability to pay or because of their race, color, sex, national origin, disability, religion, or sexual orientation. The clinic's vision is that every student leaves their learning environment believing that access to health care is a right and not a privilege. The CHFM department is excited and honored to be working with the Mobile Outreach Clinic in efforts to continue helping the Gainesville community.

Dr. Grant Harrell speaking at the Mobile Outreach Clinic Open House

Mobile Outreach Clinic Open House outside of the Harrell Medical Education Building

STATE OF THE DEPARTMENT – SEPTEMBER 29, 2017

The State of the Department meeting took place on September 29th, at the Hilton University of Florida Conference Center. Faculty, residents and staff were welcomed to attend the meeting as the department discussed updates from an administrative and clinical standpoint for the 2016-2017 fiscal year. 

FACULTY & STAFF SPOTLIGHT

LINK TO 2015-2016 ANNUAL REPORT

The 2015-2016 Annual Report has been published and added to the CHFM webpage. Here is the link to the report: 2015-16 Annual Report

GRAND ROUNDS PRESENTATIONS

In case you missed any of the latest sessions:

June 6, 2017
Jessica Gonzalez, PharmD
Working Together to Reduce e-Prescribing Errors
June 2017 Grand Rounds Presentation - Mediasite

May 2, 2017
Anzeela M. Schentrup, PharmD, PhD, BCPS
MACRA: Moving From Volume to Value 
May 2017 Grand Rounds Presentation - Mediasite

April 4, 2017
Jeannette South-Paul, MD
The Road to Leadership in Academic Family Medicine: Challenges and Rewards
April 2017 Grand Rounds Presentation - Mediasite

March 14, 2017
Shireen Madani Sims, MD
Coaching for Resilience to Foster Wellness in Faculty and Learners
March 2017 Grand Rounds Presentation - Mediasite

February 7, 2017
Brian Berryman
COM Faculty Benefits and Retirement
February 2017 Grand Rounds Presentation - Mediasite

January 2017
Cancelled

PCP LIVE PRESENTATIONS

PCP Live sessions have been cancelled. The last session was held in November 2016.

In case you missed any of the latest sessions:

PCP Live #33
November 16, 2016
Ki Park, MD
Cardiovascular Risk Stratification in Women- Where are we in 2016?
November 2016 PCP Live Presentation - Mediasite

PCP Live #32
October 19, 2016
Alice Rhoton-Vlasak, MD
Oncofertility and Infertility – What is the Difference and Why does it Matter?
October 2016 PCP Live Presentation - Mediasite

PCP Live #31
September 21, 2016
Siddhartha A. Wayangankar, MD, MPH
Demystifying the Screening and Diagnosis of Peripheral Arterial Disease
September 2016 PCP Live Presentation - Mediasite

If you would like to add something to this newsletter or have any suggestions, questions, comments or concerns, please email Maggie Martinez at magdianismartine@ufl.edu with subject “CHFM Newsletter”