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2010 LEADS Scholarly Projects

Our LEADS Scholars


 

 2010 Summer Projects

 

 The Bell Policy Ceter

Looking Forward ProjectLooking Forward Project"-
Maggie Tillquist, Kathan Amin
LEADS Faculty Mentor: Dr. Daniel Matlock                                       Organization Mentor:   Rich Jones
 
8-week Project Goals: 
Our 8-week project goal is to conduct over twenty interviews across the state to better understand peoples’ attitudes toward fiscal issues.  This information will allow the Bell to more effectively communicate with these various communities.  Each interview session will be debriefed and analyzed in a qualitative manner to bring out major themes.
 
Very Brief Background or Rationale of Project:  
It is often the case that communities that could be most positively impacted by raised taxes refuse to support any legislation to raise taxes.  The rationale for looking forward is to understand why some communities that historically vote for progressive measures fail to do so when it comes to raising taxes.  It is crucial to understand why voters tend to vote one way on some issues and another way on other issues.  It is important to understand what is important to people in terms of community and legislative goals.  This information is necessary if a legislative body is to effectively target a population group to pass legislation. 
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 Rocky Mountain Youth Clinic

"Health Outcomes in a Pediatric Population with Insurance Churn at a Safety Net Provider"
Kate Grimsrud, Courtenay Holscher, Michelle Rappaport
LEADS Faculty Mentor: Cathy Battaglia                       Organization Mentor:  Joe Craig, MD
 
8-week Project Goals: 
·        Compare the quality of health care (as measured by proxy health care outcomes) provided to patients who have and have not experienced insurance churn.
·        Determine if patients who experience better health care outcomes have common demographic or other traits.
·        Determine if patients who experience better health outcomes have different patterns of health care utilization, and if those patterns correspond to insurance status and/or churn.
·        Determine if patients who stay in the safety longer experience better health outcomes and compare patient populations who did and did not experience churn.
 
Very Brief Background or Rationale of Project: 
This is important because children have many well-child visits where vaccines are given and developmental milestones are checked. Currently, children on Medicaid are eligible on a month-to-month basis. If we find there is a significant difference in the care that uninsured children are receiving even when they have a provider they know they can see with or without insurance, this may be worth studying in different populations around Colorado. If this is a state-wide trend, children ought to be enrolled in Medicaid for years at a time, rather than on a month-to-month basis.
 
If there are certain groups within the uninsured cohort that have better outcomes, we could use that information to shape the way RMYC targets its patients to make them aware of the services available at RMYC regardless of insurance status.
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 Colorado Physicians Insurance Company (COPIC)

​"Diagnostic Errors Resulting in Patient Harm: Identification, Assessment, and Prevention"
 
Brandon Morris
LEADS Faculty Mentor: Mark Earnest, MD       Organization Mentor: Michael Victoroff, MD
 
8-week Project Goals
Extract data necessary to complete qualitative descriptive analysis of missed or delayed diagnosis events recorded in the COPIC database.
 
Very Brief Background or Rationale of Project: 
Current Understanding of Diagnostic Error: Based on the limited findings previously published, there exists much need for further research on the subject. Current estimates place the rate of diagnostic error in clinical practice between 10-15%.2-5 Research on diagnostic error has lagged behind other areas such as treatment or medication error research. Diagnostic errors often are unrecognized and/or unreported, and the science of measuring these errors and their effects is underdeveloped.1 Research also has not focused on diagnostic error due to lack of public or scientific attention. In the To Err is Human report, there were only two mentions of diagnostic error, compared to 70 mentions of medication error.7 Out of 20 evidenced-based Patient Safety Indicators established by the Agency for Healthcare Research and Quality (AHRQ) or the 30 safe practices recommended by the National Quality Forum, none of these specifically measure a failure to diagnose.8,9  Identifying and preventing treatment error has been emphasized over diagnostic error by the Joint Commission, the National Quality Forum, and the Leapfrog Group.8
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 Colorado Coalition for the Medically Underserved

Aurora Health Access Taskforce" 
 
Liz Corey-Pacheco
LEADS Faculty Mentor:  Dr. Jamal Moloo         Organization Mentor: Gretchen Hammer
 
8-week Project Goals:
1.      Understand the community health profile of Aurora
a.      General demographics
b.      Health status of residents
c.      Capacity of the community health system
d.      of residents to community health system
2.      various models of care
3.      Provide recommendations on best practices/successful model elements

Very Brief Background or Rationale of Project: 
Aurora faces significant challenges in meeting the healthcare needs of its residents.  Through community discussion and preliminary health statistic research it has been determined that Aurora faces problems with high numbers of uninsured or underinsured individuals, inadequate primary care capacity, limited access to specialty care, and inequitable distribution of health care resources.  The current system also lacks integration and coordination of care models.  Various community members and organizations have gathered in the form of the Aurora Health Access Taskforce in an effort to address the problems that challenge Aurora’s health care system.  The goals of this project aim to provide the background information necessary for the community to create and implement solutions to improve the health of its residents.
 
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 Denver Public School Based Clinics Pregnancy Prevention Program

"Texting Programs in Pregnancy Prevention Education"
 
Molly Ainsman, Kate Arata, Katy Lewis
LEADS Faculty Mentor: Steve Federico         Organization Mentor: Kari Kuka
 
8 week project goals: 
We are creating a text messaging program for teens to anonymously text in questions pertaining to sexual health. We will be targeting teens that are at the three middle and high schools associated with the Denver Teen Pregnancy Prevention Partnership (DTPPP). We have three major goals by the end of the summer, so that the program can launch in the fall.
·        Manual: write a complete manual with possible questions and answers so that an employee of Planned Parenthood can answer any texts that come into the line. All texts will go through Ezuku.com, a website that will track questions being answered and store the data.
·        Website: create a website associated with the texting line so that teens can access more detailed information.
·        Marketing: create a marketing scheme to spread the word about the program.
 
Very Brief Background or Rationale of Project: 
Teen pregnancy is a continuing problem, particularly in Denver county:
  • There is a strong need for sexual health education in Colorado and Denver:
o   The CDC predicts that 1 out of 4 women aged 14-19 has an STD
o   In 2007 in Colorado 6,396 teens were diagnosed with Chlamydia or gonorrhea
o   In 2008 9 new cases of HIV were reported for 15-19 year olds
o   In 2004-2006 Denver had almost twice the average teen birth rate than the average in Colorado and the highest of all urban counties in the state
o    According to the CDC, in 2006, the national average for birth rates for teens between the ages of 15-19 was 42 per 1,000 live births. In Colorado, the teen birth rate was 44 live births per 1,000.
o   Additionally, there was a disproportionate number of Latina girls who were getting pregnant. In Colorado, 107 per 1,000 live births was to Latina women between the ages of 15-19, which accounts for over half of the births to teenage girls.  (CDC)
  • DTPPP is a powerful way to reach teens in Denver
o   DTPPP reached 1,139 students in 2007-2008 and an additional 1,200 in 2008-2009
o   The DTPPP goals are in line with the goals of this program 
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 Colorado Coalition for the Medically Underserved

"Barriers to Primary Care Access and Emergency Department Utilization: Implications for Healthcare Reform on a National and Community Level"

Paul Cheung
LEADS Faculty Mentor:                             Organization Mentor: Gretchen Hammer

            
Project Goal
Data collection and analysis of NHIS data
 
Brief Background or Rationale of Project
Previous data on the association between health insurance, primary care access, and ED visit rates are limited, often with conflicting results. The argument1 that the uninsured and those without primary care access contribute to ED visits and crowding has been challenged in recent studies.2-6 Factors associated with frequent ED visits include low socioeconomic status, chronic illness7, and having been refused care in an office or clinic in the past.8 Even for individuals with a regular source of primary care, numerous barriers to outpatient access may result in ED visits for episodic acute care.9 These prior studies are limited to samples from single institutions, limited geographic distribution, or cross-sectional with short time frames. Thus, the findings lack generalizability to the overall population and do not provide information on changes in annual trends. Better characterization of the relationship between limited access to primary care and ED utilization is important to address this potential cause of ED crowding and to evaluate ED implications of increased health insurance coverage and changes to primary care access.
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 Metro Community Provider Network (MCPN)

“Documenting Best Practices of Clinical Workflow in the Management of Chronic Diabetes: What Variables Affect HbA1c as a Measure of Clinical Outcomes in a Community Clinic”
 
Chloe Hughes
CU LEADS Faculty Mentor: Daniel Matlock                                           Organization Mentor: Luci Lyon
 
8-week Project Goals:
The overarching aim is to attempt to identify “best practices” within Metro Community Provider’s Network (MCPN) in order to optimize clinical effectiveness for their patients.  
·        To verify the initial data set the organization has for HbA1c values in its diabetic patients.
·        Use surveys and observation to look for variations between clinical sites to explain the variation in HbA1c values.
 
Very Brief Background or Rationale of Project:
The Metro Community Provider’s Network (MCPN) performs clinical audits quarterly in order to track various clinical quality metrics across the seven clinical sites it operates. In a recent study of diabetic patients in this system, HbA1c was used as an indicator of clinical effectiveness of care. The analysis of HbA1c data looking at a random 10% sample of patients who have been receiving care at MCPN for eighteen months or longer showed that overall, HbA1c values improved. When this data was looked at according to each clinical site, an unexpected variation in outcomes was found.
 
This project aims to explain the unexpected variation in HbA1c values. Ideally, this will lead to identification of “best practices” within the organization. If variation in care is found, it will allow providers and clinical teams to be more aware of what factors lead to this variation and allow MCPN to standardize care within the organization. This will also help me to understand how different factors impact on clinical care and recognize them more readily in the future. 
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 LEADS Harm Reduction Action Center (HRAC)

"​Factors Related to Quality Healthcare Services Among Active Injection Drug Users in Denver, CO"

 

Jessica Kohring
LEADS Faculty Mentor:  Dr. Jeremy Long                                Organization Mentor:  Stephanie Wood
 
8-week Project Goals:
·        Measure and describe attitudes/beliefs of injection drug users (IDUs) on healthcare provision that affect the utilization of preventive and urgent healthcare services in Denver.
·        Identify and describe factors that impact medical provider satisfaction in working with IDUs within the Metro-Denver area.
 
Very Brief Background or Rationale of Project
IDUs often face complex problems of homelessness, unemployment, history of incarceration, poor mental and physical health, discrimination, and violence among other challenges. In Colorado, there are an estimated 11,500 IDUs; approximately 4,900 reside in Denver County4. IDUs experience physical, social and cultural barriers to quality healthcare not altogether dissimilar from racial/ethnic minority populations. These include inability to pay, poor health literacy, and lack of adequate, timely, patient-centered care. As a result, IDUs are more inclined to forego primary or secondary health services, thereby increasing the likelihood of morbidity and mortality associated with normally manageable or preventable overdose or infections9.Due to barriers to health insurance enrollment, backed-up health service lines, and perceived judgmental care for injection-related or chronic diseases, IDUs are less likely to establish a medical home.

 

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 Autism Society of Colorado (ASC)

“Identify and Disseminate Best Practices for the Interaction Between First Responders and People with Autism”

 

Chris Rogers, Spencer Tomberg
LEADS Faculty Mentor: Dr. Jeremy Long                                            Organization Mentor:  Lorrie Park
 
8-week Project Goals:
  I.          to identify the “best practices” for interactions between autistic people and professionals in education, healthcare and social services (primarily within EMS, police, fire dept.’s, health care).
II.          work with the EMS, fire department and police communities to incorporate the identified best practices into their training programs.
III.          present resources to ASC and member families that will facilitate positive interactions with the EMS community.
 
IV.          encourage communication and shared responsibility between the EMS community and the autistic community and their families.
V.          explore avenues for promotion and sustainability of the recommendations that we provide (ie, funding, training personnel, legislation).
VI.          Explore expanding the program to personnel in emergency rooms.
  
Very Brief Background or Rationale of Project:
To investigate the resources that exist for assisting the autistic population, compile that information, and ascertain which practices are most effective.  Disseminate information on the practices that work best.
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 Lowry Family Health Center and Colorado Asian Health Education and Promotion (CAHEP)

“Student/Refugee Health Education Collaborative”
Helenka Rowe, Ray Choi
LEADS Faculty Mentor: Dr. Michelle Nikels                                         Organization Mentor: Sue Franta
 
 8-week Project Goals: 
 This elective incorporating the goals of the LEADS program, the Urban Scholars track, and the Global Health track, and the Office of Diversity, will be open to students of all professions. The goals for student participants are to provide clinical experience and the importance of culture in medicine, while providing the refugees much needed health services. We hope to offer the elective in the Fall of 2011 and adjust the curriculum as needed.
 
Very Brief Background or Rationale of Project: 
The refugee population in Colorado contains a large range of nationalities (implying a variety of customs, cultural norms) and medical needs that vary from common to extremely rare to this area, and a position of forced resettlement in a culture often vastly different from their own.  The healthcare community faces many challenges in handling this volume, especially with obstacles such as language and cultural differences.   While providing some of the help that is needed in the clinics, they can learn about the needs of refugees and gain an understanding of how to handle situations that they may not otherwise face until much later in their careers.
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 The Center

"GLBT Provider DatabaseGLBT Provider Database"
 
 
Nathan Reich
LEADS Faculty Mentor: Dr. Michelle Nikels                               Organization Mentor:   Hope Wisneski
 
8-week Project Goals: 
  • Update contact information for providers currently on the database.
  • Perform quality control by verifying all licenses of providers on the database and limiting number of listed specialties to three.
  • Perform an informal survey of each contacted provider to determine if there is a desire for additional training in GLBT specific healthcare competencies.
  • Update the database by re-entering the n information in a way where we have control over the listings by setting a standard password for administrators rather than individual providers.
  • Look for gaps in the database regarding specialties.
  • Investigate new ways to both advertise the database to the GLBT community and to providers so that the database may grow and become more useful for the GLBT community.
 
Very Brief Background or Rationale of Project: 
 This project is important because it helps to provide a list of healthcare providers for the GLBT community who are sensitive and knowledgeable on GLBT healthcare needs. This is important because everyone deserves to feel comfortable and receive the best care possible for their medical issues.
Although the current list is a good start, it is rather unregulated and has remained stagnant for almost three years. Not only does it need to be updated so patients can have access to the correct information, but there are specialties which currently have no medical providers listed. Without having a broad spectrum of specialties and multiple choices in each specialty, if one of the providers is not as competent in GLBT healthcare issues as they claim, there are very few other options, and the database becomes much less useful.
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