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Impact of Electronic Prescription, Access, and Messaging on Health Information Exchange Utilization During Care Transition
Full text linkThis study examined the impact of electronic prescription generation and transmission, patient access, and secure electronic messaging on health information exchange (HIE) utilization during healthcare transitions. Leveraging longitudinal data from the 2018 CMS EHR Incentive Program, this research tested hypotheses concerning the influence of these variables on HIE utilization using a quantitative method. Findings from logistic regression analyses indicated that electronic prescription practices (B = 2.265, OR = 9.628, p \u3c .001) and patient electronic access capabilities (B = 1.108, OR = 3.027, p \u3c .001) significantly increased HIE usage, aligning with previous studies that underscored the importance of digital prescription systems and patient empowerment in HIE enhancement. Additionally, secure electronic messaging showed a significant association with HIE utilization (χ²(1) = 126.982, p \u3c .001), further reinforcing the role of secure communication in effective healthcare information exchange. A combined predictive model revealed that electronic prescriptions and patient electronic access drastically improved the likelihood of HIE adoption (B = 4.546, OR = 94.284, p \u3c .001), highlighting a synergistic effect. These findings underscored the need for integrated technological frameworks within healthcare systems to optimize communication and care coordination, ultimately improving patient outcomes. The study advocated continued investment in digital health tools to strengthen HIE systems and enhance healthcare delivery
Improving Depression Screening for Young Adults in Outpatient Settings
Full text linkProblem: Depression among young adults aged 25 to 35 years in the United States has been among the second highest at 19.9%. Depression underdiagnosis stems from many patient-level causes, including a lack of standardized screening, inadequate provider education, and stigma of mental illness. Untreated depression results in low quality of life, comorbidities, suicidality, and socioeconomic issues.
Aim of the Project: The aim of this project was to address the gap in practice by implementing a standardized screening process for young adults to enhance diagnoses and increase screening rates.
Review of the Evidence: A comprehensive review of the evidence demonstrated that the application of standardized screening tools, such as the Patient Health Questionnaire-9 (PHQ-9), significantly enhances depression recognition by clinicians. Evidence also supports the urgent need for targeted screening among adults aged 25 to 35, a population that often presents with underdiagnosed or untreated depressive symptoms, despite being at high risk due to transitional life stressors and reduced healthcare engagement.
Project Design: This quality improvement (QI) project focused on improving depression screening rates among young adults aged 25 to 35 in an outpatient behavioral health clinic using the PHQ-9. The project used the Institute for Healthcare Improvement (IHI) Plan-Do-Study-Act (PDSA) cycles to structure iterative improvements. The OhioHealth Change Management Model provided a framework to engage stakeholders, reduce resistance, and promote long-term adoption of the screening process. During project implementation, the PHQ-9 was integrated into the electronic medical record (EMR) system, and clinical staff were educated on the administration of the tool.
Intervention: A standardized screening process was implemented using the PHQ-9 in an outpatient behavioral health center serving 75 to 100 young adult patients per month. Administration of the PHQ-9 recorded in the EMR was used to track screening rates, depression diagnoses, and treatment plans.
Significant Findings/Outcomes: The standardized screening procedures resulted in increased early detection and timely intervention. Project outcomes revealed decreased barriers to screening protocols, effective communication, and utilization of mental health professionals on primary care teams. Screening levels increased by 30% within the 10-week project timeframe. The team recommended that enhanced screening practices at the outpatient behavioral health center be sustained after the project, to include ongoing staff education and monitoring to maintain the effectiveness of the intervention.
Implications for Nursing: Early detection, timely intervention, and continuity of care for young adults experiencing depression were effective. This QI initiative aligns with the Institute of Medicine (IOM) Six Aims: Healthcare that is safe, effective, patient-centered, timely, efficient, and equitable. In addition, the project supports the IHI Triple Aim by improving the patient experience of care, advancing population health among a high-risk age group, and potentially reducing long-term healthcare costs through earlier intervention and reduced crisis-driven care utilization
A Workplace Posture Initiative to Reduce Work-Related Musculoskeletal Disorders
Full text linkProblem: Work-related musculoskeletal disorders (WRMSDs) are a leading cause of occupational injury and discomfort in industrial workplaces. Although an ergonomic program existed at the project site, a formalized process to detect postural misalignments early had not been established. Relying on employee self-reporting, delayed intervention, and limited opportunities to prevent injuries before they progress.
Aim of the Project: A proactive posture screening program using PostureScreen® was implemented to identify postural deviations that could contribute to WRMSDs. Emphasis was placed on supporting employees through early awareness of posture-related issues and evaluation of alignment improvements following individualized intervention.
Review of the Evidence: Evidence supported the use of early posture screening and ergonomic interventions to reduce the risk of WRMSDs. Digital tools have been shown to accurately detect postural misalignments and provide timely feedback and correction. Literature supported proactive posture assessments as a means to improve employee well-being, reduce chronic injury risk, and strengthen workplace safety and efficiency.
Project Design: Structured implementation and long-term sustainability were supported by applying the Plan-Do-Study-Act cycle in conjunction with OhioHealth’s organizational change framework. Strategies included shift-based screening schedules, peer liaisons to increase participation, and consistent engagement through communication efforts and visual materials. Staff were trained using standardized vendor tutorials to ensure consistent execution of screening protocols.
Intervention: Twelve full-time employees completed PostureScreen® assessments at baseline, mid-project, and at the eight-week mark. Each employee received posture education and personalized web-based exercises generated by the PostureScreen® tool to support alignment. Consistent screening protocols were followed to ensure the accuracy and reliability of results.
Significant Findings/Outcome: Ten of the 12 participants demonstrated a reduction in effective head weight of 11 pounds or more, with the most significant improvement reaching 29 pounds. The average reduction across the group was 12.75 pounds, indicating notable improvements in posture and a reduced load on the neck and shoulders. One slight increase was attributed to clothing interference during the final assessment.
Implications for Nursing: Early posture screening was shown to be effective in supporting musculoskeletal health. A preventive workplace culture was reinforced, contributing to improved employee outcomes, sustained engagement, and increased productivity across the workforce
Effect of Standardized Phone Call Protocol on the Achievement of Target HbA1c Levels
Full text linkProblem:
Type 2 Diabetes Mellitus is a common chronic illness with far-reaching health and financial consequences. At the project’s primary care clinic, the average hemoglobin A1c among adults with Type 2 Diabetes Mellitus was 9.6%, exceeding the recommended clinical goal of less than 7% (American Diabetes Association, 2023). The absence of a standardized follow-up protocol and inconsistent use of health literacy-based communication contributed to persistent hyperglycemia and failure to reach target HbA1c levels. These factors indicated an urgent need for an evidence-based intervention.
Aim of the Project: The aim of this project was to reduce HbA1c levels among adults with Type 2 Diabetes Mellitus to the target range of 6.5%–8.5% by implementing a nurse-led, standardized follow-up phone call protocol. The intervention was designed to address medication adherence barriers, reinforce patient self-management, and enable timely response for uncontrolled blood glucose.
Review of the Evidence: Substantial evidence supports nurse-led structured follow-up and health literacy-informed communication for improving glycemic outcomes in adults with Type 2 Diabetes Mellitus. Randomized controlled trials and meta-analyses show significant reductions in hemoglobin A1c when teach-back, structured follow-up, and tailored education are used (Moreira et al., 2024; American Diabetes Association, 2023).
Project Design: A quality improvement approach, guided by the Plan-Do-Study-Act framework, allowed for iterative refinement of the protocol. The OhioHealth Change Management Model supported staff engagement, leadership commitment, and long-term sustainability.
Intervention: Eligible adults with Type 2 Diabetes Mellitus and hemoglobin A1c levels greater than 8.5% received four structured nurse-led follow-up phone calls over twelve weeks. Nurses used the Agency for Healthcare Research and Quality Health Literacy Universal Precautions Toolkit: Tool 6 – Follow-Up with Patients (Agency for Healthcare Research and Quality, n.d.) to guide each call, focusing on medication adherence, self-monitoring of blood glucose, diet, and symptom management.
Significant Findings/Outcomes: The project resulted in a mean hemoglobin A1c reduction of 1.67%, with a post-intervention average of 7.93%. Approximately 62% of participants achieved the target HbA1c range of 6.5%–8.5%. Nurse adherence to the protocol was 82.3%, and documentation compliance was 63.8%. No safety events were reported. Staff expressed increased confidence and noted improved workflow.
Implications for Nursing: This project illustrates the value of advanced practice nurses leading quality improvement initiatives using health literacy strategies. The protocol is a sustainable, evidence-based solution to reduce disparities and address care gaps for adults with Type 2 Diabetes Mellitus
Phillips Hall Groundbreaking, undated
No full textThis photo features a Benjamin Franklin impersonator posing with Dr. Bunte and others during the Phillips Hall groundbreaking.https://fuse.franklin.edu/phillipshall/1008/thumbnail.jp
Improving Patient Portal Messaging Workflow
No full textProblem: Inefficiencies in patient portal secure messaging between providers and patients in a large primary care practice led to delayed resolution times, averaging 5.6 days per message. Most messages were closed by physicians or advanced practice providers, resulting in imbalanced workload distribution, increased provider burden, and reduced communication efficiency. The lack of standardized guidelines for message use, character limits, or triage processes contributed to workflow disruptions, a diminished patient experience, and unreimbursed provider time.
Aim of the Project: The aim of the project was to reduce average portal message closure times by at least 38% through the implementation of standardized communication protocols, role-based triage, and patient education to enhance communication efficiency while promoting equitable workload distribution.
Review of the Evidence: Evidence supports that structured communication processes, role differentiation, and patient guidance improve efficiency, reduce provider burnout, and enhance patient engagement. Team-based triage workflows and standardized portal guidelines may reduce delays, promote equity in task delegation, and enhance continuity of care.
Project Design: The quality improvement (QI) initiative used Plan-Do-Study-Act (PDSA) cycles within the framework of the OhioHealth Change Management Model to guide iterative improvements. The American Medical Association (AMA) STEPS Forward® toolkit informed interventions. Weekly run and control charts monitored outcomes, process, and balancing measures to ensure safe and effective adoption.
Intervention: Interventions included reducing patient message character limits to 500, distributing patient-facing portal use guidelines, and implementing a role-based team triage system with message categorization, with staff training on message maturation.
Significant Findings/Outcomes: The project achieved an average reduction in time from baseline over 12 weeks of 45%. Workload redistribution improved, but it did not achieve full equity. There was no increase in unresolved messages, confirming interventions did not negatively affect care.
Implications for Nursing: Structured workflows and standardized protocols may reduce inefficiencies and improve the timeliness of communication. Sustaining improvements requires continued monitoring, as well as provider and patient education. The project supports the AACN DNP Essentials and aligns with the Institute for Healthcare Improvement’s Triple Aim by enhancing patient experience, advancing communication efficiency, and reducing provider burden
Implementing Pain Reassessment Workflow to Improve Timely Pain Management in Hospice Patients: A Quality Improvement Project
No full textProblem: Timely pain reassessment is a vital component of hospice care, directly influencing the quality of life for patients. Despite the high prevalence of pain, which affects 55% of hospice patients due to disease progression or adverse drug reactions, only 51% of those reporting moderate to severe pain at admission receive a documented reassessment. The gap highlights an organizational issue in pain management stemming from the absence of a clearly defined period and workflow for reassessment.
Aim of the Project: The aim of the quality improvement (QI) project was to improve compliance with pain reassessment documentation within 48 hours for hospice patients with moderate to severe pain by creating a standardized workflow to enhance symptom management and quality of care.
Review of the Evidence: Evidence-based practice confirms the necessity of ongoing pain assessment in patients receiving hospice and palliative care to optimize pain management and enhance patient outcomes. Timely pain reassessment maximizes the initiation and evaluation of pain control mechanisms, provides symptom relief, fosters clinician-patient communication, and improves patients’ overall experience.
Project Design: The Institute for Healthcare Improvement Model for Improvement guided the QI project, providing a structured framework for evaluating and refining changes through iterative Plan-Do-Study-Act (PDSA) cycles. The OhioHealth Change Management Model served as a guiding tool emphasizing the human and organizational aspects of change. The planning, connecting, and adopting phases of the model influenced activities leading to change.
Intervention: The project provided educational presentations to staff members on pain reassessment workflow, conducted change readiness surveys, and implemented EMR updates, real-time auditing, and a phased rollout of the implementation, guided by the Centers for Medicare and Medicaid Services (CMS) requirements.
Significant Findings/Outcomes: Data analysis revealed a 31% increase in documented pain reassessments within 48 hours. Staff confidence in using the workflow improved, and compliance with CMS pain-related measures increased by 78.6%.
Implications for Nursing: Establishing a structured workflow for pain reassessment in hospice care has significant implications for nursing practice. Reduced variation in clinical decisions and symptom management empowers nurses to be more accountable in providing patient-centered care and fosters a stronger nurse-patient relationship
An Assessment of Access to Care: Telehealth Utilization at FQHCs in Alabama During and After the COVID-19 Pandemic
No full textDuring and after the COVID-19 pandemic, telehealth emerged as a primary modality for delivering healthcare services. Its potential for expanding access to care has become a significant area of interest, particularly for Federally Qualified Health Centers (FQHCs). This exploratory qualitative study examined the perceptions of administrators and medical leaders at FQHCs in Alabama to determine how telehealth utilization during and after the pandemic could enhance access to care for the vulnerable populations served by these health centers.
Using purposive sampling, this study incorporated semi-structured interviews and open-ended survey responses of ten administrators and medical leaders representing eight of the 20 FQHCs and FQHC look-alikes in the state. Data were analyzed through the theoretical lens of the integrated BMHSU-UTAUT.
The findings gleaned from the participant responses revealed that while there was enhanced utilization of telehealth services at the height of the pandemic, much of this use declined as the COVID-19 vaccine was introduced and the public health emergency ended. Participants identified several barriers contributing to this decline, including limited access to technology, inadequate broadband access, and poor payer reimbursement. However, despite the obstacles, participants noted the potential for integrating telehealth in a hybrid model to improve chronic care management and continuity of care
Practical Strategies for ERP Success: Analyzing Lived Experiences of Leaders at Two-Year Community and Technical Colleges in the Upper Midwest
No full textThe enterprise resource planning (ERP) industry is a billion-dollar software industry with two prominent higher education ERP companies bringing in a combined $14.27 billion the third quarter of their 2024 fiscal years (Oracle, 2023; Workday, 2023). ERP systems stemmed from materials resource planning (MRP) systems in the manufacturing industry (Jacobs & Weston, 2006; Lowson, 2002; Nowak, 2021) and were designed to mitigate risk, centralize data, and create consistency (Albarghouthi et al., 2020; Alhazmi et al., 2022; Kumar et al., 2022; Liu et al., 2023; Rubel et al., 2023). Multiple sources indicate that the failure rate of ERP systems within higher education institutions (HEIs) surpasses that of other sectors, which is why it is essential to examine critical success factors of ERP implementations (Albarghouthi et al., 2020; Alhazmi et al., 2022; Kajbaje & Kamatchi, 2022; Skoumpopolou et al., 2022; Soliman & Noorliza, 2020). This study aimed to explore the practical strategies for ERP success by analyzing lived experiences of leaders at two-year community and technical colleges in the upper Midwest. The exploration was achieved by conducting a qualitative phenomenological study that consisted of semi-structured interviews with 12 leaders at three sites. There were eight interview questions; two were introductory demographic questions. There were six detailed interview questions, with two specifically addressing the research question, and four designed to lead participants into a more in-depth analysis of factors related to leadership approaches and ERP project success factors. Interviews were conducted via Zoom and in-person, based on the participants’ preferences. The interview transcriptions were analyzed via Atlas.ti using a thematic coding approach resulting in four themes: (1) project and change management, (2) strategic guidance, (3) resource alignment and allocation, (4) vendor and software. Theme one is comprised of eight sub-themes covering specifics about change management processes and systems to support informed decision making, governance, and standardization, accountability, communication, stakeholder involvement, a third-party project manager/consultant, business process re-engineering, focusing on the student experience, and training. Theme two outlines that executive involvement and support is needed to prioritize the project, coach and empower employees, remove barriers and break down silos, and acknowledge challenges. Theme three is focused on ensuring a strategic project team with the necessary skills and experience are involved in the project, and that workload is managed for these resources. Theme four is centered around the vendor and software, which demonstrates that leaders need to ensure their organizations select software that is mature, integrates well with other systems, and is from a collaborative and supportive vendor. There are six practical recommendations derived from the study findings to guide leaders in future ERP implementations, which are centered around specific actions for executive involvement, accountability, governance, a third-party project manager, communication, and ERP selection. Recommendations for future research include a larger sample size to address generalizability, conducting a similar study using grounded theory to delve further into the meaning of the data, and to study failure rates based on shared definition of failure
Let’s Get Digital: Retrospective Digitization of ETDs for an Institutional Repository
Full text linkFranklin University Library conducted a retrospective digitization project to make a collection of education master’s theses available in its institutional repository. Digitizing bound theses and dissertations to make them available in an institutional repository benefits the institutional repository, the university, the student authors of the works, and external researchers. When conducting a retrospective digitization project for theses or dissertations that are protected by copyright, a university library must consider how the students’ copyright in their work affects the library’s ability to digitize the theses or dissertations and make them available in an institutional repository. University libraries should also consider making the scanned theses and dissertations digitally accessible to reach the widest possible audience. For this project, the Franklin University Library decided to contact the student authors of the theses to request permission, gave the students the opportunity to select a Creative Commons license for their work, and then digitized the theses of those students who granted permission. As part of the digitization process, library staff remediated the scanned theses to meet Franklin University’s digital accessibility standards