Mammah, Kyndall

Timely identification of palliative care needs in primary care is pivotal in improving patient outcomes and quality of life for individuals with chronic or life-limiting illnesses. Conversely, delayed recognition of these needs frequently results in missed opportunities for early intervention and comprehensive care planning. This quality improvement (QI) project focused on implementing the Supportive and Palliative Care Indicators Tool (SPICT) to enhance early identification and referral to palliative care within a primary care setting. The initiative sought to bridge care gaps by providing structured educational sessions to three medical doctors and five nurse practitioners. Participants received training on the SPICT framework and subsequently incorporated the tool into routine patient assessments. A pre- and post-intervention study design was employed to evaluate the intervention's efficacy. Data collection encompassed retrospective chart reviews to assess changes in referral patterns and provider feedback to evaluate the tool's practicality and usability. The analysis revealed a significant increase in early palliative care referrals and improved provider confidence in recognizing patients with palliative care needs. These findings underscore the value of integrating evidence-based tools like SPICT into routine primary care practice to enhance care delivery and patient outcomes. The project highlights the critical role of provider education in adopting standardized tools, emphasizing the broader implications for system-wide improvements in palliative care referrals.

The purpose of this quality improvement initiative was to improve sleep quality and reduce insomnia severity in individuals diagnosed with insomnia. This project was completed with 11 total participants, in which smartphone-delivered cognitive behavioral therapy for insomnia (i.e., CBT-I Coach) was utilized four or more days out of the week. The project spanned the course of six weeks. Insomnia severity was measured using the Insomnia Severity Index (ISI) and sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI). The General Self- Efficacy Scale (GSE) was also utilized to evaluate participants general self-efficacy. Questionnaires were administered pre and post intervention. Additionally, a self-developed CBT-I utilization questionnaire was administered at weekly check-ins. The results yielded a mean decrease of 57% for PSQI scores and 50% for ISI scores, as well as a mean increase of 17% on GSE scores. The results confirm that smartphone delivered CBT-I is a beneficial tool in improving sleep outcomes for individuals suffering from insomnia. Mobile CBT-I has significant implications for enhancing patient care and evolving current healthcare practices, particularly for the treatment of insomnia.

Substance abuse, specifically opioid abuse, continues to be one of the largest epidemics in the United States. Death caused by overdose has seen a steady increase over the past few decades, and despite public health initiatives such as clean needle exchange programs, methadone clinics, and Narcan, there continues to be a concerning rise in the number of drug usage and death secondary to drug overdose in the young adult. Recently, Narcan became approved for over-the-counter usage to combat the increased incidents of overdose. Scholarly evidence shows that opioid use disorder is most effectively treated with a combination of medication and psychotherapy, particularly Cognitive Behavioral Therapy (CBT). Although Medication-Assisted Therapy (MAT) remains the gold standard in the treatment of opioid use disorder, the evidence and literature presented throughout this project will document how much more effective treatment is when patients are engaging in psychotherapy. The evidence shows that patients have a reduction in cravings, there is a reduction in relapse, and in many cases the patients can maintain long-term sobriety utilizing the tools learned in psychotherapy sessions. This project is a quality improvement project, in which I assessed the current processes in place to assess current treatment of patients seeking initial psychiatric evaluation, as well as of those engaging in follow up visits for the treatment of OUD. From there, I realized that my project site did not have a current process in place unique to patients being seen for OUD. I developed a questionnaire, based on similarities between our patients seen for OUD, that would be used with patients to establish a baseline and used to gauge effectiveness of treatment at increments. Ten patients were followed from May to October to generate these findings that will be presented. In the end, this project has provided a promising conclusion: combined therapy with MAT and psychotherapy for treatment of OUD is effective in optimizing sobriety.

In the United States over 37 million people have diabetes. The condition damages blood vessels and tissues leading to peripheral neuropathy and impaired wound healing. The loss of protective sensation associated with diabetes can prevent patients from recognizing when they have a wound or some other kind of skin damage present. Delayed identification of wounds in a diabetic patient can have dangerous consequences, most notable amputation of the affected body part. In fact, diabetes is the strongest influence in non-traumatic lower extremity amputations. The purpose of this project was to increase patient knowledge of proper foot-care as well as improve foot self-care behaviors at home. The project team members sought to achieve this by implementing a standardized patient education program for diabetic patients in addition to performing a diabetic foot exam (DFE) with the patient in the primary care setting. The education sessions included verbal and written instruction that were developed using the American Diabetes Association (ADA) proper foot care guidelines. After the implementation of the project, scores on both the basic diabetes foot-care questionnaire and the diabetes foot self-care behavior scale (DFSBS) increased.