Pamela Reeves - Academia.edu (original) (raw)

Papers by Pamela Reeves

The Diabetes Educator

Purpose The purpose of the study was to examine whether a peer coaching intervention is more effe... more Purpose The purpose of the study was to examine whether a peer coaching intervention is more effective in improving clinical outcomes in diabetes when enhanced with e-health educational tools than peer coaching alone. Methods The effectiveness of peer coaches who used an individually tailored, interactive, web-based tool (iDecide) was compared with peer coaches with no access to the tool. Two hundred and ninety Veterans Affairs patients with A1C ≥8.0% received a 6-month intervention with an initial session with a fellow patient trained to be a peer coach, followed by weekly phone calls to discuss behavioral goals. Participants were randomized to coaches who used iDecide or coaches who used nontailored educational materials at the initial session. Outcomes were A1C (primary), blood pressure, and diabetes social support (secondary) at 6 and 12 months. Results Two hundred and fifty-five participants (88%) completed 6-month and 237 (82%) 12-month follow-up. Ninety-eight percent were men...

ABSTRACT PURPOSE: The puporse of this implementation project examines the effectiveness of an int... more ABSTRACT PURPOSE: The puporse of this implementation project examines the effectiveness of an intervention to decrease prescribing of high risk (HR) medications. METHODS: This quality improvement project was a single group, pre/post intervention design within a regional network of eight VA medical centers and 21 VA outpatient clinics. Eligibility included all outpatient veterans >65 years receiving 1 or more HR medications (amitriptyline, imipramine, doxepin, chlordiazepoxide, and diazepam) and the clinicians who prescribed them. A two-stage intervention was implemented. First, a real-time warning message to prescribers appeared whenever one of the HR drugs was ordered; and second, a personally addressed letter from the Chief Medical Officer asking prescribers to consider discontinuing the HR medication along with a copy of the Beers criteria article, a list of suggested alternatives to HR medications, and a list of older patients, receiving the HR medications, who had upcoming appointments with these prescribers. The primary outcome was the absence of prescribed HR medication for all patients in the cohort during the post-intervention period. A secondary outcome was the absence of prescribed HR medication for each patient within a subgroup of the cohort whose prescribers received the second-stage intervention. RESULTS: There were 2,753 unique patients in the cohort. More than fifty percent (n=1,396, 50.7%) of the patients had the HR medications discontinued, resulting in a significant decrease in the number of patients prescribed HR medication from the pre-intervention period to the post-intervention period (p<0.001). Of the 801 patients in the subgroup whose prescribers received the second-stage intervention, 72.0% (n=577) of patients had HR medications discontinued (p<0.001). CONCLUSIONS: This multi-method quality improvement intervention significantly decreased prescribing of high risk medications in elderly veterans. Further studies are needed to confirm the findings from this single group intervention.

Appropriate cleaning, disinfection and sterilization of reusable medical equipments (RMEs) in the... more Appropriate cleaning, disinfection and sterilization of reusable medical equipments (RMEs) in the Sterile Processing Department (SPD) are important to reduce healthcare acquired infections (HAIs) and person-to-person transmission. Currently, healthcare facilities utilize Standard Operating Procedures (SOP"s) following manufacturer"s instructions to guide staffs in SPD to complete the reprocessing procedure thoroughly and consistently each time. However, it is hard to ensure that operation steps are in proper manners by physical observations since there are no effective solutions to automatically monitor, trace, and verify the performance of SPD dynamic workflows. Through an enhanced, interdisciplinary understanding of business process management in healthcare enterprises, we design and develop an innovative framework of real-time healthcare workflow management in SPD. RFID-enabled intelligent objects are assigned to automatically capture the real-time data from multiple resources and RMEs. SOA-based workflow system is used to define and execute a flexible reprocessing and supply procedure from soiled RMEs collection to ready-to-use RMEs distribution. Via supervising the instant messages about the performance status of SPD operation processes, compliance check and smart rerun scheme are achieved by an intelligent rule engine to prevent and remedy delinquent operations.

IIE Transactions on Healthcare Systems Engineering, 2015

A no-show occurs when a scheduled patient neither keeps nor cancels the appointment. A cancellati... more A no-show occurs when a scheduled patient neither keeps nor cancels the appointment. A cancellation happens when individuals contact the clinic and cancel their scheduled appointments. Such disruptions not only cause inconvenience to hospital management, they also have a significant impact on the revenue, cost and resource utilization for almost all of the healthcare systems. In this paper, we develop a hybrid probabilistic model based on multinomial logistic regression and Bayesian inference to predict accurately the probability of no-show and cancellation in real-time. First, a multinomial logistic regression model is built based on the entire population's general social and demographic information to provide initial estimates of no-show and cancellation probabilities. Next, the estimated probabilities from the logistic model are transformed into a bivariate Dirichlet distribution, which is used as the prior distribution of a Bayesian updating mechanism to personalize the initial estimates for each patient based on his/her attendance record. In addition, to further improve the estimates, prior to applying the Bayesian updating mechanism, each appointment in the database is weighted based on its recency, weekday of occurrence, and clinic type. The effectiveness of the proposed approach is demonstrated using healthcare data collected at a medical center. We also discuss the advantages of the proposed hybrid model and describe possible real-world applications.

Annals of Behavioral Medicine, 2014

Military Medicine, 2011

mandated the establishment and implementation of a national enrollment system for health care ser... more mandated the establishment and implementation of a national enrollment system for health care services to veterans. The result was a signifi cant increase in VA patients, precipitating serious problems with access to ambulatory care services across the country. 5-7 Hence, a 200% increase over 2 years in the use of nonphysician providers of primary care (both NPs and physician assistants ) was mandated. 8 In 1996, 75% (98/131) of VA primary care practices reported using NPs; by 1999, 90% were doing so resulting in a mean increase of 3.2 vs. 2 NPs per practice. However, Huang et al found the use of NPs was not equal across the VA ranging from 7.4 to 57 NPs/100,000 population. They determined that increased rates of NPs to VA patients were related to urban settings, facility complexity, and association with an academic medical center. 9 The purpose of this study was to assess NPs' and physicians' perceptions about NPs to further determine possible reasons for variation in the use of NPs within the VA.

Journal of Nursing Scholarship, 2007

Purpose: To describe NPs' and MDs' perceptions of the role of NPs, the degree of collegiality bet... more Purpose: To describe NPs' and MDs' perceptions of the role of NPs, the degree of collegiality between professions, and NPs' feeling of acceptance, three relationship components that may affect the acceptance of NPs as providers of primary care. Design and Methods: A descriptive study including both closed-and open-ended questions plus several Likert-type questions conducted June-August 2004. Our sample included all primary care NPs (87) and MDs (162) within a Midwestern Veterans Health Administration (VHA) region. Data were collected from 153 providers. Findings: NPs saw their role as one of autonomous practice with physician back-up as needed, while MD respondents envisioned a role akin to a physician extender. Most of the physician respondents did not think NPs could provide adequate primary care to veterans who tend to have many comorbid conditions. Yet both groups considered their relationships to be collegial and most NPs felt accepted by physicians. MDs particularly valued NPs' teaching and interpersonal skills leading to greater patient satisfaction. Conclusions: To facilitate the teamwork of NPs and MDs while improving utilization of NPs as primary care providers, VHA officials should routinely clarify roles, monitor quality of care of both MDs and NPs, and provide feedback to all concerned.

Applied Nursing Research, 2008

In preparation for delivering an inpatient smoking cessation intervention, surveys and interviews... more In preparation for delivering an inpatient smoking cessation intervention, surveys and interviews of general inpatients and staff were conducted in two Veterans Affairs (VA) hospitals to determine the motivation of veterans to quit smoking and to identify facilitators and barriers to inpatient staff delivery of inpatient cessation services. Seventy percent of inpatients were bmotivated smokersQ (thinking of quitting in the next 30 days), yet only 17% stated that they received cessation services during their hospitalization. Most staff said that VA should do more to assist patients to quit, yet less than half said that they personally provided cessation services due to lack of confidence/training and hesitancy to upset patients. Given the high motivation to quit among hospitalized veterans and the lack of knowledge about providing cessation services among nurses, training health professionals may facilitate and overcome barriers to the provision of these services. As frontline providers, nurses are ideally positioned to deliver inpatient smoking cessation services to hospitalized veterans. D

The American Journal of Medicine, 2004

To evaluate the effects of a collaborative case management intervention for patients with poorly ... more To evaluate the effects of a collaborative case management intervention for patients with poorly controlled type 2 diabetes on glycemic control, intermediate cardiovascular outcomes, satisfaction with care, and resource utilization. METHODS: We conducted a randomized controlled trial at two Department of Veterans Affairs Medical Centers involving 246 veterans with diabetes and baseline hemoglobin A 1C (HbA 1C ) levels Ն7.5%. Two nurse practitioner case managers worked with patients and their primary care providers, monitoring and coordinating care for the intervention group for 18 months through the use of telephone contacts, collaborative goal setting, and treatment algorithms. Control patients received educational materials and usual care from their primary care providers. RESULTS: At the conclusion of the study, both case management and control patients remained under poor glycemic control and there was little difference between groups in mean exit HbA 1C level (9.3% vs. 9.2%; difference ϭ 0.1%; 95% confidence interval: Ϫ0.4% to 0.7%; P ϭ 0.65). There was also no evidence that the intervention resulted in improvements in low-density lipoprotein cholesterol level or blood pressure control or greater intensification in medication therapy. However, intervention patients were substantially more satisfied with their diabetes care, with 82% rating their providers as better than average compared with 64% of patients in the control group (P ϭ 0.04). CONCLUSION: An intervention of collaborative case management did not improve key physiologic outcomes for highrisk patients with type 2 diabetes. The type of patients targeted for intervention, organizational factors, and program structure are likely critical determinants of the effectiveness of case management. Health systems must understand the potential limitations before expending substantial resources on case management, as the expected improvements in outcomes and downstream cost savings may not always be realized.

Journal of the American Geriatrics Society, 2000

OBJECTIVES: To examine the effectiveness of a quality improvement program to decrease prescribing... more OBJECTIVES: To examine the effectiveness of a quality improvement program to decrease prescribing of high-risk medications. DESIGN: Single cohort, pre-and postintervention. SETTING: Regional network of Department of Veterans Affairs medical facilities. PARTICIPANTS: Outpatient veterans aged 65 and older who received one or more high-risk medications and the prescribing clinicians. INTERVENTION: A two-stage intervention was implemented. First, a real-time warning message to prescribers appeared whenever one of the high-risk drugs was ordered; second, a personally addressed letter from the Chief Medical Officer asking prescribers to consider discontinuing the high-risk medication along with a copy of the Beers criteria article, a list of suggested alternatives to high-risk medications, and a list of older patients receiving the high-risk medications who had upcoming appointments with these prescribers. MEASUREMENTS: The primary outcome was the absence of prescribed high-risk medications for all patients in the cohort during the postintervention period. For a subgroup of the cohort whose prescribers received the second-stage intervention, an additional outcome was the absence of prescribed high-risk medications within the subgroup. RESULTS: Two thousand seven hundred fifty-three unique patients were identified in the cohort; 1,396 (50.7%) had high-risk medications discontinued, resulting in a significant decrease in the number of patients prescribed high-risk medications from the preintervention period to the postintervention period (Po.001). Of the 801 patients in the subgroup, 72.0% (n 5 577) had high-risk medications discontinued (Po.001). CONCLUSION: This multimethod intervention significantly decreased prescribing of high-risk medications to older patients. Further studies are needed to confirm the findings.