Karen Homa

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Kansas State University

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Universidade de Lisboa

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Lahore University of Management Sciences

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University of North Carolina at Chapel Hill

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Utrecht University

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UNL - New University of Lisbon

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University of North Carolina at Greensboro

Gabriel Gutierrez-Alonso

University of Salamanca

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Papers by Karen Homa

Supplemental Material, sj-pdf-5-jpx-10.1177_23743735211034032 - Assessing Shared Decision-Making in Cystic Fibrosis Care Using collaboRATE: A Cross-Sectional Study of 159 Programs

Supplemental Material, sj-pdf-5-jpx-10.1177_23743735211034032 for Assessing Shared Decision-Makin... more Supplemental Material, sj-pdf-5-jpx-10.1177_23743735211034032 for Assessing Shared Decision-Making in Cystic Fibrosis Care Using collaboRATE: A Cross-Sectional Study of 159 Programs by Karen Homa, Gabrielle Stevens, Rachel Forcino, Peter Scalia, Pamela Mertz and Glyn Elwyn in Journal of Patient Experience

Team och mikrosystem : Deras roll och funktion i kvalitetsförbättringsarbetet

A New Performance Improvement Model: Adding Benchmarking to the Analysis of Performance Indicator Data

The Joint Commission Journal on Quality and Patient Safety, 2016

I n measuring health care performance in the improvement of quality and patient safety, clinician... more I n measuring health care performance in the improvement of quality and patient safety, clinicians can review their performance and make adjustments, as necessary, in the existing care process, monitor progress, and share success with various stakeholders. Performance measures-to which we refer as performance indicators (PIs) here-then, can help clinicians and other staff to not only track the progress of improvement initiatives but to identify and implement best care practices. As Benneyan et al. have stated, the major components of health care performance measures are as follows: (1) identifying the PI, (2) collecting an appropriate and required quantity of data, (3) analyzing and interpreting the data, and (4) driving an action plan for improvement. 1 We developed a model that focuses on the third component-the analysis and interpretation of the data using statistical process control (SPC). SPC is a branch of statistics that combines rigorous time series analysis methods with graphical presentation of data to make the data more understandable to lay decision makers. 1 The basic theory of SPC was developed in the late 1920s by Walter Shewhart, 2 and, starting in the 1950s. W. Edwards Deming expanded its application in the industrialized world. 3,4 Our model also incorporates benchmarking, which is an important tool that health care administrators can use to help engage clinicians in improvement work and, in particular, to help the process owner of a specific care practice to understand how his or her performance compares with that of others. Benchmarking theory is built on performance comparison, gap identification, and changes in the management process. 5 In this way, benchmarking can stimulate healthy competition, as well as help clinicians reflect on their own performance, and, at the very least, understand that better results are possible. 6 Some PIs may not suitable for the comparison with benchmarks, so the essential first step is to verify that the data fall within the statistically accepted limit-that is, show only random variation. Specifically, if there is no significant special-cause variation over a period of time, then the data are ready to be benchmarked. Thus, if the data from a process are stable, their variation Methods, Tools, and Strategies

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Norris Cotton Cancer Center (NCCC) neuro-oncology glioma tumor quality improvement project

Journal of Clinical Oncology, 2012

137 Background: Glioma patients represent 30% of the primary brain tumor population at NCCC, and ... more 137 Background: Glioma patients represent 30% of the primary brain tumor population at NCCC, and often require surgical intervention prior to medical management. In order to ensure coordinated, comprehensive and timely care, reliable referral to the neuro-oncology program is needed. Earlier quality improvement efforts identified 10 best practices designed to facilitate referral into the neuro-oncology program, though over the years these practices lapsed. A manual record review of 2010 cases revealed 43 glioma patients, of which compliance with best practices ranged from 29% to 93%, and none of the patients had all best practices when indicated. Additionally, the percentage of 9 out of the 10 best practices (excluding post-operative order sets) completed for all consecutive patients from January 2010 to May 2011 was 63%. Methods: A project was chartered by leadership and a multidisciplinary team was convened twice a month from May to October 2011. The team was organized into three g...

Normative Data for Interpreting the BREAST-Q: Augmentation

Plastic and reconstructive surgery, 2017

The BREAST-Q is a rigorously developed, well-validated, patient-reported outcome instrument with ... more The BREAST-Q is a rigorously developed, well-validated, patient-reported outcome instrument with a module designed for evaluating breast augmentation outcomes. However, there are no published normative BREAST-Q scores, limiting interpretation. Normative data were generated for the BREAST-Q Augmentation module by means of the Army of Women, an online community of women (with and without breast cancer) engaged in breast-cancer related research. Members were recruited by means of e-mail; women aged 18 years or older without a history of breast cancer or breast surgery were invited to participate. Descriptive statistics and a linear multivariate regression were performed. A separate analysis compared normative scores to findings from previously published BREAST-Q augmentation studies. The preoperative BREAST-Q Augmentation module was completed by 1211 women. Mean age was 54 ± 24 years, the mean body mass index was 27 ± 6 kg/m, and 39 percent (n = 467) had a bra cup size of D or greater....

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Potential Impact of a Validated Screening Tool for Pediatric Abusive Head Trauma

The Journal of pediatrics, Jan 15, 2015

To conduct a retrospective, theoretical comparison of actual pediatric intensive care unit (PICU)... more To conduct a retrospective, theoretical comparison of actual pediatric intensive care unit (PICU) screening for abusive head trauma (AHT) vs AHT screening guided by a previously validated 4-variable clinical prediction rule (CPR) in datasets used by the Pediatric Brain Injury Research Network to derive and validate the CPR. We calculated CPR-based estimates of abuse probability for all 500 patients in the datasets. Next, we demonstrated a positive and very strong correlation between these estimates of abuse probability and the overall diagnostic yields of our patients' completed skeletal surveys and retinal examinations. Having demonstrated this correlation, we applied mean estimates of abuse probability to predict additional, positive abuse evaluations among patients lacking skeletal survey and/or retinal examination. Finally, we used these predictions of additional, positive abuse evaluations to extrapolate and compare AHT detection (and 2 other measures of AHT screening accur...

Parenting Children with Cystic Fibrosis: Developmental Acquisition of Expertise

Journal of Developmental & Behavioral Pediatrics

Patients and families experience with pharmacist care at cystic fibrosis foundation accredited clinics

Pediatric Pulmonology, 2019

Cystic fibrosis (CF) is a complex genetic, multiorgan disease. The CF Foundation (CFF) recommends... more Cystic fibrosis (CF) is a complex genetic, multiorgan disease. The CF Foundation (CFF) recommends a multidisciplinary team (physician, nurse, respiratory therapist, dietitian, physical therapist, social worker, mental health coordinator, clinic coordinator, and pharmacist) to work with patients and families. The objective of our study was to describe the impact of a pharmacist involved in the care of patients and families from their perspective. The CF Patient and Family Experience of Care (PFEC) is a voluntary, 50-question telephonic or internet-based survey designed to continuously collect information from patients and their families regarding their care experience. From August of 2017 through February of 2018, five questions were added to the internet survey to assess the impact of the pharmacist on the care experience. From the 666 respondents, 54% reported that a pharmacist was involved in their CF care. At two CF clinics designated as "full access" to a pharmacist, respondents reported a higher percentage of the CF-team discussed medications compared to those from three clinics designated as "limited access" to the pharmacist (95% vs 67%). Respondents in clinics with "full access" to a pharmacist were significantly more likely to get their medications refilled on time (78% vs 63%) and reported using fewer pharmacies to fill their medications. Pharmacist involvement in CF care may improve patient's access to medication and the ability to sustain use. K E Y W O R D S chronic care, cystic fibrosis, experience of care survey, multidisciplinary care, pharmacist, pharmacy care 1 | INTRODUCTION Cystic fibrosis (CF) is a genetic disease, which affects multiple organs 1-3 and is characterized by persistent lung infections and reduced capacity to breathe. Medications and respiratory therapies are utilized to help alleviate symptoms and treat the underlying cause of the disease. 4,5 People with CF can take an average of 10 (±5) medications per day, such as oral antibiotics, aerosolized mucolytic agents, and pancreatic enzymes. 6 Other daily interventions may be nutritional supplements, including CF-specific vitamins, high-calorie foods, and enteral feedings. The amount of time to do these treatments can be between 1 and 4 hours per day and additionally people living with CF may have extended hospital stays or frequent emergency department visits. 7-9 Given the complexity of the medication regimen, the CF Foundation (CFF) recommends a multidisciplinary approach to care. 10

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Impact of early versus late administration of bamlanivimab on readmissions in patients with high-risk COVID-19

The American Journal of Emergency Medicine, 2021

Background: Recombinant monoclonal antibody therapies have been utilized under emergency use auth... more Background: Recombinant monoclonal antibody therapies have been utilized under emergency use authorization (EUA) for the prevention of clinical decompensation in high-risk COVID-19 positive patients for up to 10 days from symptom onset. The purpose of this study was to determine the impact of the timing of the monoclonal antibody, bamlanivimab, on clinical outcomes in high-risk COVID-19 positive patients. Methods: This was an IRB-approved, retrospective evaluation of adult patients who received bamlanivimab per EUA criteria in the emergency department (ED). Patients were dichotomized into two groups-3 days of symptoms or less (early) versus 4 to 10 days (late). The primary outcome was hospitalization for COVID-related illness at 28 days (or treatment failure). Secondary outcomes were COVID-related ED visits at 28 days, hospital and intensive care unit (ICU) length of stay (LOS), and in-hospital mortality at 28 days. Results: A total of 839 patients were included in the analysis. There was no difference observed in COVID-related hospitalization rates within 28 days between the early and late bamlanivimab administration groups (7.5% vs. 8.2%, p = 0.71). There was no difference in COVID-related ED visits within 28 days with 13% of patients returning to the ED. Conclusions: In conclusion, there were no differences in the rates of hospitalization at 28 days when bamlanivimab was administered in the first 3 days of illness versus days 4 to 10. Future prospective studies are warranted to expand upon the characteristics of patients that may or may not benefit from monoclonal antibody therapy.

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Assessing Shared Decision-Making in Cystic Fibrosis Care Using collaboRATE: A Cross-Sectional Study of 159 Programs

There are numerous opportunities for shared decision-making (SDM) in cystic fibrosis (CF) care, y... more There are numerous opportunities for shared decision-making (SDM) in cystic fibrosis (CF) care, yet little is known about patients’ SDM experiences. This study evaluated SDM across 159 CF care programs (4024 participants) in the United States. Shared decision-making was assessed using the patient-reported collaboRATE measure, which was included in the CF Foundation’s Patient and Family Experience of Care Survey over 18 months. Overall, 69% of respondents reported experiencing SDM. Respondents at pediatric programs were more likely to experience SDM than those at adult programs (72% vs 67%, P < .001). Multivariable logistic regression analyses showed a relationship between SDM and patient age, whereby SDM was less likely to occur with patients aged 18 to 24 years, compared to some younger and older age groups (P = .02-<.001). Shared decision-making was more likely to occur at pediatric programs when patients had better general health (P = .02-<.01), and at pediatric and adul...

Who Needs a Jackhammer When a Hammer Is All That May Be Needed?

American Journal of Medical Quality

Addressing distress in head and neck cancer patients: A quality improvement project

Journal of Clinical Oncology

43 Background: To better address the emotional needs of cancer patients by improving mental healt... more 43 Background: To better address the emotional needs of cancer patients by improving mental health care in Head and Neck Cancer (HNC) Medical oncology at Norris Cotton Cancer Center, Lebanon, NH, through implementing an evidence-based process for identifying and managing psychological distress. Methods: Using quality improvement methods, mental health care in HNC Medical Oncology was evaluated and revised November 2010 through April 2012. In January 2011, a two-component intervention was put into routine care including 1) the validated National Comprehensive Cancer Network (NCCN) distress thermometer (DT) and 2) a treatment decision algorithm. A licensed nursing assistant administered the DT and providers reviewed results as part of the clinical exam. Heightened distress was defined as a score of ≥ 4. Screening processes were improved through Plan-Do-Study-Act (PDSA) cycles. Results: Prior to January 2011, identification of distress was based on provider’s clinical assessment. Of 10...

End-of-life practice patterns at U.S. adult cystic fibrosis care centers: A national retrospective chart review

Journal of Cystic Fibrosis

There are many challenges to providing end-of-life care (EOLC) to people with cystic fibrosis (CF... more There are many challenges to providing end-of-life care (EOLC) to people with cystic fibrosis (CF). Chart abstraction was used to examine EOLC in adults with CF who died between 2011 and 2013. We reviewed 248 deaths from 71 CF care centers. Median age at death was 29years (range 18-73). While median FEV1 was in the severe lung disease category (FEV1&amp;amp;amp;amp;amp;amp;amp;amp;lt;40%), 38% had mild or moderate lung disease in the year preceding death. The most common location of death was the intensive care unit (ICU, 39%), and 12% of decedents were listed for lung transplant. Fewer of those dying in the ICU personally participated in advance care planning or utilized hospice or Palliative Care Services (p&amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05). Adults dying with CF in the United States most commonly die in an ICU, with limited and variable use of hospice and Palliative Care Services. Palliative care and advance care planning are recommended as a routine part of CF care.

Understanding the Health Burden of Macromastia: Normative Data for the BREAST-Q Reduction Module

Plastic and reconstructive surgery, 2017

The BREAST-Q Reduction module evaluates outcomes in reduction mammaplasty. However, there are cur... more The BREAST-Q Reduction module evaluates outcomes in reduction mammaplasty. However, there are currently no published normative scores, limiting the interpretation of BREAST-Q data. The BREAST-Q Reduction module was administered via the Army of Women, an online community of women (with and without breast cancer) engaged in breast-cancer related research. Normative data were generated from women aged 18 years and older, without a history of breast cancer or breast surgery. Data analysis was performed using descriptive statistics and a linear multivariate regression. Generated normative data were compared to published BREAST-Q Reduction findings. The preoperative version of the BREAST-Q Reduction module was completed by 1206 women. Participant mean age was 55 ± 13 years, mean body mass index was 27 ± 6 kg/m, and 40 percent (n = 481) had a bra cup size ≥ D. Mean normative scores were as follows: Satisfaction with Breasts, 57 ± 16; Psychosocial Well-being, 68 ± 19; Sexual Well-being, 55 ...

Cultures Pending at Discharge: Systematically Closing the Loop to Improve Patient Safety

Open Forum Infectious Diseases, 2016

Patient focused registries can improve health, care, and science

BMJ (Clinical research ed.), 2016

Large scale collection and analysis of data on patients' experiences and outcomes have become sta... more Large scale collection and analysis of data on patients' experiences and outcomes have become staples of successful health systems worldwide. The systems go by various names-including registries, quality registries, clinical databases, clinical audits, and quality improvement programmes 1 2-but all collect standardised information on patients' diagnoses, care processes, and outcomes, enabling systematic comparison and analysis across multiple sites. Hundreds of what we will term, for simplicity, "registries," now exist around the world. The United Kingdom is home to over 50 clinical audit programmes, 3 the United States has over 110 federally qualified registries certified to report quality metrics, 4 and Sweden, perhaps the registry epicentre, has over 100, covering conditions from birth to frail old age. 5 These registries have had far reaching effects. They facilitate public reporting, retrospective and prospective research, professional development, and service improvement. They reveal variations in practices, processes, and outcomes, and identify targets for improvement. In the UK, they have been associated with many notable successes, including improvements in management of cardiovascular disease and stroke, 6 7 cancer, 8 and joint replacement. 9

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17. Depression screening in spine patients using the SF-36 health survey

Spine J, 2003

All patients who showed significant (Ͼ60%) or complete unilateral or bilateral TceMEP and/or SSEP... more All patients who showed significant (Ͼ60%) or complete unilateral or bilateral TceMEP and/or SSEP amplitude loss for at least 10 minutes were identified. RESULTS: Twelve of 427 patients demonstrated significant tceMEP amplitude loss. Ten showed complete reversal with propitious intervention, whereas two awoke with new motor deficit. SSEP monitoring failed to identify one of these and lagged behind tceMEPs changes by 33 minutes in the other. There were no patients who experienced SSEP loss in the absence of tceMEP change. tceMEP monitoring was 100 % sensitive and 100 % specific, whereas SSEP sensitivity was only 25%, although specificity was 100%. Several diagnostic and surgical factors were identified that appear to heighten the risk for neurophysiological change. DISCUSSION: tceMEP monitoring is superior to conventional SSEPs for identifying evolving motor tract injury during cervical spine surgery. Care in maintaining a moderately high mean arterial blood pressure (Y ´75 mm Hg), especially in the setting of cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament, as well as when using a multi-level strut graft is recommended. CONCLUSIONS: Evolving spinal cord dysfunction during cervical spine surgery can be rapidly identified and treated by following tceMEP modalities. DISCLOSURES: Device or drug: transcranial motor evoked potential monitoring. Status: approved. CONFLICT OF INTEREST: No conflicts.

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Discharge Delays for Patients Requiring In-Hospital Guardianship: A Cohort Analysis

Journal for healthcare quality : official publication of the National Association for Healthcare Quality, Jan 13, 2015

To assess nonclinical factors delaying hospital discharge of guardianship patients. Utilization r... more To assess nonclinical factors delaying hospital discharge of guardianship patients. Utilization review data over 3 years. Retrospective cohort study. Mann-Whitney test was used to compare patients' medically unnecessary days (MUD) of hospitalization with additional subcategories of delays-defined as beyond clinicians' control. Overall median number of MUD was 19.5; 14 of 48 patients were additionally delayed while awaiting long-term care Medicaid approval (N = 7, 50%), pending insurance (N = 3, 21%), social or transportation difficulties (N = 3, 21%), or preadmission review (N = 1, 7%). The median number of MUD for the 14 delayed patients was 63, a difference of 53 days compared with the routine guardianship cohort (P < .0001) and $5.5M in net revenue opportunity. Nonclinical discharge delays for guardianship patients are costly and potentially unavoidable. Further exploration into policy change is therefore recommended.

Improving Cystic Fibrosis Care: Understanding Advance Care Planning

Pediatric Pulmonology

Care Processes for Adults Dying from Complications of Cystic Fibrosis: Results of a Nationwide Survey

Pediatric Pulmonology

Supplemental Material, sj-pdf-5-jpx-10.1177_23743735211034032 - Assessing Shared Decision-Making in Cystic Fibrosis Care Using collaboRATE: A Cross-Sectional Study of 159 Programs

Team och mikrosystem : Deras roll och funktion i kvalitetsförbättringsarbetet

A New Performance Improvement Model: Adding Benchmarking to the Analysis of Performance Indicator Data

The Joint Commission Journal on Quality and Patient Safety, 2016

Download

Norris Cotton Cancer Center (NCCC) neuro-oncology glioma tumor quality improvement project

Journal of Clinical Oncology, 2012

Normative Data for Interpreting the BREAST-Q: Augmentation

Plastic and reconstructive surgery, 2017

Download

Potential Impact of a Validated Screening Tool for Pediatric Abusive Head Trauma

The Journal of pediatrics, Jan 15, 2015

Parenting Children with Cystic Fibrosis: Developmental Acquisition of Expertise

Journal of Developmental & Behavioral Pediatrics

Patients and families experience with pharmacist care at cystic fibrosis foundation accredited clinics

Pediatric Pulmonology, 2019

Download

Impact of early versus late administration of bamlanivimab on readmissions in patients with high-risk COVID-19

The American Journal of Emergency Medicine, 2021

Download

Assessing Shared Decision-Making in Cystic Fibrosis Care Using collaboRATE: A Cross-Sectional Study of 159 Programs

Who Needs a Jackhammer When a Hammer Is All That May Be Needed?

American Journal of Medical Quality

Addressing distress in head and neck cancer patients: A quality improvement project

Journal of Clinical Oncology

End-of-life practice patterns at U.S. adult cystic fibrosis care centers: A national retrospective chart review

Journal of Cystic Fibrosis

Understanding the Health Burden of Macromastia: Normative Data for the BREAST-Q Reduction Module

Plastic and reconstructive surgery, 2017

Cultures Pending at Discharge: Systematically Closing the Loop to Improve Patient Safety

Open Forum Infectious Diseases, 2016

Patient focused registries can improve health, care, and science

BMJ (Clinical research ed.), 2016

Download

17. Depression screening in spine patients using the SF-36 health survey

Spine J, 2003

Download

Discharge Delays for Patients Requiring In-Hospital Guardianship: A Cohort Analysis

Journal for healthcare quality : official publication of the National Association for Healthcare Quality, Jan 13, 2015

Improving Cystic Fibrosis Care: Understanding Advance Care Planning

Pediatric Pulmonology

Care Processes for Adults Dying from Complications of Cystic Fibrosis: Results of a Nationwide Survey

Pediatric Pulmonology

Karen Homa

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