Medical College of Wisconsin MPH Program - Capstone Project Abstracts and Presentations
Abstracts and Presentations
cball84@gmail.com
Advisor: Julie Willems Van Dijk, PhD
Abstract:
Background
Childhood obesity continues to be of great concern for today’s school children. School-based physical activity and nutrition programming have been implemented in schools across the nation in an attempt to curb the growing problem and enhance the health and wellbeing of youth. An evaluation of Parkview Health’s school-based physical activity and nutrition program, Planting Healthy Seeds (PHS), was conducted to evaluate the effectiveness of the program in increasing children’s knowledge in the areas of physical activity, nutrition, and behavior change.
Methods
A retrospective, one-group, pre-post-test design was conducted to evaluate the impact PHS had on third and fourth grade students in the areas of physical activity and nutrition knowledge and behavior change. Pre-and post-test questionnaire results for third and fourth grade students who completed PHS during the 2015/2016 and 2016/2017 school year were analyzed for changes in knowledge and behavior from the beginning of the program to completion. Success was determined as any percentage of positive change noted from pre-to post-test questionnaire results.
Results
A major limitation of the evaluation was that while the program was delivered in 11 schools in 2015/2016 and 14 schools in 2016/2017, numerous students were missing full sets of pre- and post-test results, so many students were excluded from the evaluation. Results for those students who met inclusion criteria revealed that 60% to 88% of students demonstrated positive knowledge gains in nutrition, 58% to 87% of students demonstrated positive knowledge gains in physical activity, and 45% to 57% of students demonstrated positive behavior changes when post-test results were compared to pre-test results.
Conclusion
Results are consistent with previous study findings from programs with similar duration, curriculum, and incorporation into the classroom setting. Further study is needed to determine the long-term effectiveness of the program in reducing childhood obesity rates locally, regionally, and nationally.
Advisor: Eric Gass, PhD
Abstract
In 2014, over 29 million people in the United States carried a diagnosis of diabetes. Many employers are looking to improve the health of employees for production and cost reasons. The aim of this project was to evaluate the effect of a program featuring health education and co-pay reduction on health care utilization and disease control. In a pre/post study, diabetic employees and spouses (members) covered under the company health plan received reduced out of pocket co-pays for insulin, in exchange for attending two sessions with a diabetic educator. De-identified electronic health record data were assessed quarterly. The diabetics who participated were compared to those who did not participate. There were 1717 diabetic members. 343 members met the requirements to receive the incentive benefit and 273 members were included for analysis. From 2015 to 2016 there was a 75% increase in the number of members who attended diabetic education. Mean HbA1C in the recipient group decreased by 0.15. Compared to the diabetics who did not participate, this was a significant change (p=0.025). The effect was seen in males, ages 50-60, and in members with an endocrinology encounter (p=0.01). There were no significant changes to the number of ER or hospital visits and related costs in the groups. After one year, this diabetic incentive program had the desired effect of increasing utilization of health education and outpatient services with a modest reduction in mean HbA1C. Efforts to determine if the trend will continue and any impact on total health care costs related to diabetes are underway. A value-based benefit design combined with health education may be an effective strategy for population health management of diabetes in the workplace.
Translating Trauma-Informed Care from The Community to The Clinician: A Community-Informed, Strengths-Based Approach to Asking About Trauma
kceelee@yahoo.com
Advisor: Hillary Petska, MD, MPH
Abstract
Background/Hypothesis/Objective(s)
Exposure to adverse childhood experiences (ACEs) is a major public health problem. ACEs can lead to childhood toxic stress and negatively impact health and well-being. National organizations have advised that providers discuss childhood adversity and its impact with children and families. However, little is known regarding patients’ perspectives on ACEs, or their preferences on discussing these topics in the medical setting. This study addresses these gaps by adding the voices of adults from a community with a heavy burden of ACEs.
Methods
Design: Descriptive qualitative study.
Setting: Three Federally Qualified Health Centers (FQHC) in Milwaukee, WI.
Recruitment: English- or Spanish-speaking adults were recruited from health center waiting rooms and interviewed. Participants: 37.5% African-American, 50% Hispanic, 12.5% Caucasian, 55% female, ages 18-35 (mean 43), 70% parents, and 75% from poorest zip codes.
Data Collection: Interview elicited responses about the impact of stress on individuals and families; preferences and recommendations for discussing adults and their children’s ACEs; and barriers and facilitators of disclosing ACEs. 31 interviews were audio-recorded and transcribed. 9 interviewees declined recording; those interview notes were transcribed after the interview.
Data Analysis: Transcriptions were analyzed with an iterative coding process and thematic analysis.
Results
Five themes emerged.
- Stress adversely affects parenting and children.
- Benefits include getting help for themselves and their children, receipt of resources and feeling less alone.
- Barriers to disclosure include judgment and mistrust.
- Providers should ask patients about ACEs and strengths and can overcome barriers by establishing rapport and building trust.
- Providers should frame discussions of ACEs, utilize a variety of approaches for starting conversations, and be transparent about reporting responsibilities.
Discussion
Providers whose practices reflect patients’ preferences may facilitate disclosure of adversity, identify strengths, and prevent negative health consequences and promote resilience.
The Importance and Challenges Associated with Recruiting African American Donors for Blood Donation in the United States
Advisor: Kim Gearin, PhD
Abstract
Objective
The purpose of this paper is to enhance understanding of the importance, challenges, and strategies associated with recruiting African American donors for blood donation in the United States.
Methods
This literature review analyzed 14 studies related to African American blood donation conducted within the last 30 years.
Results: From these studies, it was determined that several barriers prevent African Americans from donating blood. Notable barriers include lower donation eligibility rates and increased rate of deferrals, different motivators and deterrents to donating, and lower hemoglobin levels as compared to Caucasian donors. This paper also discusses strategies to increase African American blood donation, such as new marketing strategies, and hemoglobin education programs aimed specifically at African American donors.
Conclusions
These findings demonstrate the need to further explore what prevents African Americans from donating blood and explore various strategies that may increase donation rates.
PowerPoint Presentation (PDF)
Multi-domain Evaluation of Concussion Management, Practice Patterns, and Resource Utilization Among Wisconsin Athletic Trainers
dhuber@mcw.edu
Advisor: Michael McCrea, PhD
Abstract
Background
Sport-related concussion (SRC) is a significant public health concern which effects as many as 1.6–3.8 million people each year. Athletic trainers (ATs) are uniquely suited to address the challenges associated with SRC and may help reduce or prevent its impact. Current guidelines recommend a multifaceted (i.e., more than two) approach to assessment at baseline, acute assessment, and return-to-play (RTP). Previous national and state-level investigations do not adequately reflect regional differences in practice patterns due to variations in legislation and policy.
Purpose
The purpose of this project is to evaluate the current awareness and utilization of resources and practice patterns related to SRC management and education among Wisconsin ATs.
Methods
A 55-item questionnaire was disseminated through email and social media to over 900 Wisconsin ATs in early 2018. Survey questions were intended to assess respondent clinical and educational practice patterns, and demographics and professional experience.
Results
A total of fifty-two (n = 52) survey responses were collected from Wisconsin Athletic Trainers’ Association (WATA) members for an estimated response rate of 7.6% (52/680 certified members). Respondents were typically between the ages of 35 to 44 with 11 to 15 years of experience. ATs in Wisconsin indicated using multiple guidelines (84%) for SRC management and generally employed a multifaceted approach to concussion assessment (94%) and RTP (82%), but not at baseline (22%). A minority (12%) of ATs indicated that they conducted no baseline assessments. Computerized neuropsychological testing was the most common assessment at baseline (86%) with a symptom checklist most frequently used acutely (96%) and at RTP (92%). Resource access was considered adequate by most ATs (92%), but a significant minority reported by feeling overwhelmed by number available (34%). A sizeable proportion of ATs also felt that improvements could be made to athlete (46%), coach (51%), and parent (51%) education. Although the sample size was relatively limited, practice patterns were not found to significantly vary based on gender, practice setting, or years of experience.
Conclusion
Wisconsin ATs have largely complied with current SRC guidelines for injury assessment and management but may not have the necessary resources (i.e., time, personnel, or funding) to provide multifaceted assessment at baseline. Additionally, ATs generally feel well informed but indicate that there may be significant gaps in athlete, parent, and coach education.
Infant and Early Childhood Risks and Services Assessment of Wisconsin Counties
t.kohlman@gmail.com
Advisor: Kaija Zusevics, PhD
Abstract
This report is a statewide, county-level needs assessment of select risks to healthy development facing children under the age of five across Wisconsin. This assessment identifies the counties whose children are at the greatest and lowest risk of negative developmental outcomes based on eleven health, safety, and economic indicators. An overall risk score is calculated by combining the results from these risk indicators. Eight counties are identified as being at the highest risk level, and eleven counties are found to be at the lowest risk, but vulnerabilities and strengths exist within each county. Additionally, the current availability and utilization of five programs aimed at improving outcomes for this age group are examined in relation to the overall level of risk faced by children in each county. This information is meant to inform conversations regarding how to best meet the developmental needs of Wisconsin’s youngest and most vulnerable population.
Social Stigma and Substance Use Patterns Among Women: A Review
skrechel3@gmail.com
Advisor: Kim Gearin, PhD
Abstract
Objective
Stigma is a product of social interaction and identity management. It is found to have profound effects on health outcomes, particularly for women who use illegal drugs. This paper will draw on Goffman’s theory of stigma to examine how stigmatization frames social perceptions of substance abuse, addiction and treatment in scientific literature and mainstream media.
Methods
Sixteen journal articles and 30 magazine articles were selected and examined to identify and analyze references to women, stigma and opioids. A summary of findings from the literature review is organized into three categories: stigma and addiction, stigma and treatment and stigma, and the criminal justice system.
Results
This qualitative review found differing attitudes toward women who use opioids. The mainstream media tends to have a more understanding perspective, acknowledging opioid addiction as a mental health condition deserving of fair treatment. Whereas the most common protocols in the criminal justice system bar women from receiving referrals to appropriate treatment programs, thereby perpetuating stigma.
Conclusion
Despite recent changes to how opioid use and addiction are understood, the history of opioid use as inherently criminal continues within the criminal justice system. The differing opinions of how opioid use should be addressed in the United States creates inconsistency in treatment approach and continues to perpetuate stigma. To reduce the burden of stigma on women who use, the United States’ criminal justice system and drug treatment courts should adopt policies that promote best-practice treatment standards and recognize opioid use/addiction as a mental health concern.
Quality Improvement Project Using Assessment Feedback Incentives Exchange to Increase Human Papillomavirus Immunization Rates
kailynn.mitchell@dhs.wisconsin.gov
Advisor: Kim Gearin, PhD
Abstract
Background
The Assessment, Feedback, Incentives, and eXchange (AFIX) Program applies quality improvement (QI) to increase vaccination rates in the Vaccines for Children (VFC) program. To improve adolescent human papillomavirus (HPV) vaccination rates, AFIX site visits were conducted at VFC clinics in Wisconsin in 2015.
Objective
To assess effectiveness of an HPV AFIX project by examining whether 1) participating clinics implemented their QI strategies, 2) providers strengthened their HPV vaccine recommendations, 3) clinic immunization staff engaged in QI, 4) participating clinics wanted additional support, and 5) HPV vaccination rates and missed opportunities changed more at participating clinics compared to control clinics.
Methods
HPV AFIX site visits (187) were conducted at self-selected VFC clinics during 2015 and 2016. At these visits immunization rates, practices and strategies to improve HPV immunization rates were evaluated. The Wisconsin Immunization Registry (WIR) was used to provide data for 11-18 years olds, for one dose of tetanus, diphtheria, acellular pertussis vaccine (Tdap), one dose of meningococcal vaccine (MCV4), and one (HPV1) and three doses (HPV3) vaccines. Missed opportunities (any contact a patient has with a health service that did not result in an eligible child receiving recommended vaccines) were also assessed. Control clinics were chosen based on population size and geographical proximity to participating clinics.
Results
For both age groups, HPV1 and HPV3 rates increased at control clinics and AFIX clinics. Compared to control clinics, the increase at participating clinics was not statistically significant. Compared to control clinics, there was a statistically significant reduction in missed opportunities at AFIX for both age groups at six months. Findings suggest that many clinics engaged staff and completed QI projects, and some clinics wanted additional support.
Conclusion
AFIX should be used by all clinics to increase uptake and awareness of the HPV vaccine in adolescents.
Assisted Living in Wisconsin: An Analysis of the Relationship Between Enforcement Data and Client Groups Served
spica@mcw.edu
Advisor: Kim Gearin, PhD
Abstract
Background
Wisconsin leaders have described assisted living homes in Wisconsin as operating as “mini-nursing homes” but with far less resources. This is not surprising, given the substantial increase in the number of assisted living facilities and equal decrease in skilled nursing facilities. The Wisconsin Department of Health Services reports an increase in serious regulatory concerns, especially within Community Based Residential Facilities. These facilities may serve residents from one to ten client groups. Given the rapid growth, increased needs of residents, and serious quality issues, the relationship between client groups served and regulatory measures recorded should be examined.
Methods
A literature review for existing data on serving different client groups in one facility and regulatory best practices in assisted living. Then, enforcement data provided by the Wisconsin Department of Health Services on Community Based Residential Facilities to examine the relationship between client groups served and enforcements.
Results
Facilities that serve residents with irreversible dementia/Alzheimer’s and advanced age accounted for a disproportionate share of enforcements. They also had the highest percentage of facilities with key code enforcements. An unexpected finding of this study was the lack of data collected and reported by the state, as well we the significant backlog of surveys not conducted by the departments target.
Conclusion
These findings raise important issues and point to an alarming pattern of increased enforcement citations at CBRFs that serve specific client groups, especially irreversible dementia/Alzheimer’s. Urgent action and additional research is needed, which would be best initiated through an external legislative audit.
Cancer Disparities Among Asian-Americans
alramoski@me.com
Advisor: Kaija Zusevics, PhD
Abstract
Background
Cancer is the leading cause of death among Asian Americans compared to heart disease for other racial groups. Several barriers exist that preclude this racial group to cancer screening and early detection. This study aimed to describe the cancer disparities among the different subgroups of Asian Americans and the evidence-based and culturally-tailored interventions to reduce their cancer burden.
Methods
Literature review was performed to analyze the trend of cancer among Asian Americans. Physicians in the Inland Empire region of Southern California were recruited to participate in individual interviews (n=8) to assess their opinions about cancer in this racial group. The medical providers from various specialties belong to medical groups, public, and private practice.
Results
Literature review: Four articles described cancer trends among Asian Americans. The data revealed the extent of heterogeneity and variation of cancer morbidity and mortality among the U.S. Asian subgroups. The most common malignancies include prostate, breast, colorectal, and lung. There is also a higher incidence of infection-related cancers including liver, nasopharyngeal, and stomach malignancies compared to other racial groups.
Physician interviews: Lifestyle patterns including poor diet, obesity, and smoking were the most commonly identified risk factors for the heavier cancer burden in this group. Several barriers to care including lack of access to health insurance and language and cultural barriers were reported. Physicians’ time limitation during clinic visits was an unexpected response. Most physicians agreed that collaboration between health care and public health must occur to improve cancer awareness and screening.
Conclusion
Promotion of cancer awareness, screening, and early detection among Asian Americans is of utmost priority to decrease disease cancer rates. Addressing the multiple barriers will reduce cancer disparities in this racial group. Further research is needed to investigate the impact of cancer on underrepresented subgroups and the cultural determinants of cancer among young Asian Americans.
Reducing Childhood Asthma Exacerbations
Advisor: Kristen Volkman, MD
Abstract
Background
Childhood asthma is the most common chronic illness in the pediatric population, affecting thousands of children across the nation. Asthma triggers found in a variety of locations increase asthma exacerbations, hospitalizations, and mortality and morbidity. Prevention techniques should be utilized to reduce and/or eliminate asthma triggers and improve the quality of children’s lives.
Objective
To describe common asthma triggers found in a variety of environments and prevention techniques to reduce and/or eliminate their presence.
Methods
Five scientific articles were reviewed to determine the most common asthma triggers found in homes, child care centers, and schools. Prevention techniques were also identified from these articles as well as other sources.
Results
Asthma triggers that can be found in homes, child care centers, and schools include tobacco smoke, dust mites, outdoor air pollution, pests, pets, mold, and strong odors. Many prevention methods were identified, such as removal of carpeting, smoking cessation, effective cleaning methods, and repairing water incursion.
Conclusion
If prevention techniques of common asthma triggers were utilized, positive outcomes, such as decreased asthma exacerbations, decreased missed school days, decreased hospitalizations, and decreased mortality and morbidity of children can be achieved.
The Opiate Impact on Southeastern Wisconsin Communities
awiess1987@yahoo.com
Advisor: Eric Gass, PhD
Abstract
Background
Opioid related deaths have become a growing epidemic in Wisconsin. A steady increase has been documented throughout the state from 2000 to 2016, increasing from 111 deaths in 2000 to 827 deaths in 2016. While the entire state has seen an overall increase, no county has been hit harder than Milwaukee County. Between the years of 2003 and 2013, opioid overdose increased in Milwaukee by 600%. Between the years of 2012 and 2016, Milwaukee County had a documented total of 967 opioid related deaths. One of the biggest contributors to the increase of opioid related overdoses and deaths is the drastic increase in prescriptions for pain killers that are being written and dispensed to patients. In 2013, nearly 207 million prescriptions were written for opioids, and in 2016, prescribing rates were so high that in a quarter of U.S. counties, there were enough prescription opioids prescribed for each person to have one.
Objective
To establish the best evidence-based practices of lessening the burden of opioid related overdoses and death.
Methods
A literature review and analysis was conducted through an online search of databases and government websites including: Google Scholar, PubMed, National Institute of Health and Centers for Disease Control and Prevention. The database searches were completed using the following search terms: prescription drug monitoring, PDMP success, naloxone, opioid prevention, medication-assisted therapies, drug take back, opioid epidemic state success and opioid policies.
Results
Studies suggest that the most successful programs included improving and requiring the use of prescription drug monitoring programs, development of medication assisted therapies, creating new state policies, and establishing drug take back programs are proven ways to create the highest level of success. In addition, states with success have also begun requiring opioid prevention programs into school curriculum to promote awareness.