Health Systems Research
This section includes Class of 2023 Embark Projects within the Health Systems research areas. This is a wide range of projects including Quality Improvement, Patient Safety and Health Systems studies.
Women representation in dermatology residency program leadership: A cross-sectional study
Yasmine Abushukur, B.S.1, Sandra Oska, M.D.2, Nathan Nartker, M.D.3, Fatima Fahs, M.D.3, Geoffrey Potts, M.D.3
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Dermatology, Henry Ford Health System
3Department of Dermatology, Wayne State University
INTRODUCTION
Women in dermatology training programs now outnumber men. Despite making up the majority of trainees, a gender gap persists within dermatology faculty and leadership positions. For instance, in 2016, women were underrepresented as academic dermatology chairs, dermatology program directors (PDs), dermatologic surgery PDs, and dermatopathology PDs. The goal of our study was to reevaluate the state of the disparity within academic dermatology leadership to determine if any increases have been made given the increased scrutiny to expand gender diversity in medicine and dermatology.
METHODS
To evaluate representation of women in leadership positions, we conducted a cross-sectional observational study in August 2021 of dermatology departments accredited by the Accreditation Council for Graduate Medical Education (ACGME). The ACGME and official department websites were used to identify accredited dermatology residency programs (n = 142), dermatopathology fellowships (n = 58), and micrographic surgery and dermatologic oncology fellowships (n = 74). Data were obtained from the American Board of Dermatology website to identify pediatric dermatology fellowship leadership (n = 38). The gender expression of dermatologic leaders was obtained through official department websites and department coordinators.
RESULTS
Our results demonstrate that women make up 53.5% (76/142) of dermatology residency PDs, 62.6% (42/67) of associate PDs, and 58.3% (14/24) of assistant PDs. Notably, women are least represented as program chairs, making up 39.0% (48/123) of chairs. Within fellowship program leadership, women make up 41.4% (24/58), 26.0% (19/73), and 76.3% (29/38) of PDs in dermatopathology, micrographic surgery, and pediatric dermatology, respectively.
CONCLUSIONS
Our study demonstrates an overall increase in women’s representation within academic dermatology leadership, while identifying a persisting disparity within dermatologic pathology, surgery, and chairman positions. Overall, this study highlights the advancements made in gender diversity within academic dermatology from 2016 to 2021.
What Exactly is a Patient's Best Interest
Saketh Akula, B.S.1, Joshua Jones, B.S.1, Jason Adam Wasserman, Ph.D., HEC-C2,3, Mark C. Navin, Ph.D., HEC-C4, Abram Brummett, Ph.D., HEC-C2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan
3Department of Pediatrics, Oakland University William Beaumont School of Medicine, Rochester, Michigan
4Department of Philosophy, Oakland University, Rochester, Michigan
INTRODUCTION
In any clinical setting, the patient’s preferences are respected and valued by the medical team. As clear as that may seem, that can be tough when considering all the perspectives of what makes up a patient’s best interest (BI), especially for a minor. In the literature, there is wide disagreement about the interpretation of BI. The primary goal of this project is to unearth the perspectives that play into a pediatric patient’s best interest and delineate how and whether family interests should be considered.
METHODS
A critical scoping analysis of 4523 search results in normative clinical bioethics literature was conducted. An inclusion/exclusion criterion was used with a two-person systematic screening process in COVIDENCE, followed by a review of the abstracts, and full text articles. A final 72 publications were analyzed using the criterion.
RESULTS
There is near consensus that children’s interests are entangled with the interests of family, but there is disagreement about how they are entangled and how much expertise family have about their children’s interests. The entanglements included metaphysical interests (overlapping interests between patient and family) and instrumental interests (family’s interest matter due to the better care provided to the child). Additionally, the expertise of the family is in question where ‘specific’ interests are the focus, while the clinicians have a larger role to play on the side of ‘general’ interests.
CONCLUSIONS
The idea that family interests are entangled with the child does not follow that they have special knowledge about that entanglement or that they have special moral authority to make decisions for their children. It’s clear that there is dissensus on the role of family in the care of the child-patient. A more focused study will need to be done to provide a standardized practice in today’s era.
Review of Salvage Therapy for MRSA Bacteremia at Beaumont Health System
Hazem Alakhras, B.S.1, Matthew D. Sims, M.D./Ph.D.2, Tracey A.H. Taylor, Ph.D.3
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Infectious Disease, Beaumont Health System
3Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan
INTRODUCTION
Treating methicillin-resistant Staphylococcus aureus (MRSA) effectively is imperative to reduce mortality rates, as it contributes to a large amount of healthcare-associated bacteremia in the U.S. However, due to the insufficient and sometimes contradicting studies to guide salvage therapy, there is a lack of clear consensus on treatment of MRSA bacteremia after vancomycin failure. The goal of this study is to showcase the salvage therapies of choice for patients with MRSA bacteremia at Beaumont Health System.
METHODS
This project was a retrospective chart review with data collected from the Beaumont Health System from January 2017 through January 2020. Participants were included only if they had MRSA-positive blood cultures and if they were above 18 years of age. Participants were excluded if they were treated with only vancomycin; from 675 potential patients, 62 were enrolled based on the criteria. Variables of interest included therapy of choice and vancomycin’s minimum inhibitory concentration (MichiganC) to MRSA.
RESULTS
From the 62 patients, there were 19 unique variations of MRSA bacteremia therapy after vancomycin failure. Daptomycin was the most commonly used drug at 13 times, while ceftaroline and daptomycin were used as a combination 10 times. Other medications such as linezolid, vancomycin, gentamicin, and clindamycin were used in a variety of single, double, and triple combination therapies anywhere from 1 to 6 times.
CONCLUSIONS
With 19 different therapeutic regimens utilized for 62 patients, it is clear that there is no consensus on salvage therapy for MRSA bacteremia at Beaumont Health System. Further research on patient outcomes associated with each drug could help unify and guide physicians to effectively treat MRSA bacteremia.
The Impact of Hospital Volume on Immediate In-Hospital Outcomes Following Total Joint Arthroplasties
Tarek Almsaddi, B.S.1, Mouhanad El-Othmani, M.D.2, Abdul Zalikha, Ph.D.2, Inaya Hajj Hussein, Ph.D.3
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Detroit Medical Center Department of Orthopedics and Sports Medicine, Detroit, Michigan
3Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan
INTRODUCTION
A previous study from 1997 using the National Inpatient Sample (NIS) database has determined an association between volume of total joint arthroplasty procedures and better patient outcomes. Since then, additional less-powered studies have shown similar trends. These studies have determined that patients treated by providers with lower caseload volumes of total joint arthroplasty (TJA) were more likely to experience post-operative complications, longer length of stay (LOS) at the hospital, and higher mortality rates. Additionally, most studies available in the literature include data that date up to 2011. Given the continued advances in healthcare delivery, especially in joints replacement, the aim of this project is to assess the correlation between hospital volume of procedures performed and direct inpatient clinical and economic outcomes using the NIS database over a more recent time period from 2006 to 2016.
METHODS
The study was a retrospective cohort utilizing data from the National Inpatient Sample database from 2006-2016 and include patients age 40 or older receiving a primary or revision THA and TKA. This database was used to determine the frequency of TJA performed at each hospital registered within the NIS between 2006 and 2016, and the postoperative outcomes were comparatively analyzed.
RESULTS
Procedures performed at lower volume centers have an increased incidence of cardiac, respiratory, GI, GU complications as well as an increased incidence of postoperative infection and death during hospitalization compared to higher volume centers. Additionally, length of stay and total cost of hospitalization were higher at low volume centers compared to those at high volume centers.
CONCLUSIONS
The results support the hypothesis that procedures performed at lower volume hospitals will be at increased incidence of adverse perioperative event, and that there will be an increased length of stay and cost of hospitalization compared to those at high volume institutions.
Conceptualization of Effective Surrogate Decision Making
Zachary Armstrong, B.S.1, Michael Bourgoin, B.S.1, Abram Brummett, Ph.D.2, Jason Wasserman, Ph.D.2,3, Mark Navin, Ph.D.4, Stephanie Swanberg, MSI2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan
3Department of Pediatrics, Oakland University William Beaumont School of Medicine, Rochester, Michigan
4Department of Philosophy, Oakland University, Rochester, Michigan
INTRODUCTION
Surrogate decision making is a key component in the hierarchy of medical decisions, whereby an assigned individual makes choices on behalf of a patient incapable of making the decision themselves. Although this is common in healthcare, there are still many questions about best surrogate practices and ethical credibility. This capstone project aspires to map these concepts and discuss issues related to the current landscape of surrogate decision making with regards to medical ethics through the use of a systematic literature review.
METHODS
This capstone project is a systematic review of the normative terrain of surrogate decision making. Articles for review were compiled from major bioethics research databases using specific search terms. These articles were then screened for inclusion according to abstract followed by full text review. Full texts were coded to highlight prevalent topics related to surrogate decision making in healthcare and what motivates their difference in approach to clinical ethics issues.
RESULTS
The full text coding revealed a current hierarchy of standards a surrogate should act on which is as follows: advance directive, substituted judgment standard, and best interest standard. Ethical dilemmas surrounding this current process, including surrogate disputes, surrogate credibility, and surrogate removal/replacement among others highlight the need for refinement and potential legal standardization. Additionally, further evaluation into judging a surrogate’s decision-making capacity is warranted due to the limitations of the current schema.
CONCLUSIONS
With this systematic review, we hope to address issues associated with surrogate decision making and provide an integrated ethical framework which promotes further discussion into improving decision making in health care.
Differences in Rational and Relational Autonomy during End-of-Life Care
Michael Balce, B.S.1, Mark Navin, Ph.D.2, Abram Brummett, Ph.D.3, Jason Wasserman, Ph.D.3,4
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Philosophy, Oakland University, Rochester, Michigan
3Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan
4Department of Pediatrics, Oakland University William Beaumont School of Medicine, Rochester, Michigan
INTRODUCTION
Within biomedical ethics, the principle of autonomy focuses on a patient’s right to make choices about his or her medical decisions and care. Along these lines, patients can then make decisions based on their own beliefs, attitudes, and customs, which is referred to as rational autonomy. However, shared-decision making is often more complicated than this, and patients often desire input from their spouse, family, and other trusted individuals, which is termed relational autonomy. These two concepts of autonomy drive different approaches to an individual’s perceptions and choices regarding medical-decision making during the end of one’s life.
METHODS
The project utilized the software, Covidence, a systematic management review program. Using this application, search parameters were in place to screen 10,614 articles to select them for inclusion or exclusion. A full-text review resolved discrepancies in choices to include or exclude 126 articles, and 81 inclusions were extracted for the final systematic review.
RESULTS
During end-of-life decisions, utilizing rational autonomy tended to promote more privacy, self-sufficiency, personal values, and confidentiality. Rational autonomy is ideal when the patient is facing end-of-life care in an “ideal” mental and physical state. A major drawback to rational autonomy is that during serious illnesses, the circumstance is usually very physically and emotionally demanding, which affects one’s ability to choose. On the other hand, utilizing relational autonomy increases flexibility during unknown circumstances and relieves the patient of feeling as though they are making decisions alone. A disadvantage to relational autonomy is that it does not protect the patient against abuses and unwarranted interventions from family members.
CONCLUSIONS
Rational and relational autonomy have their places in making choices at the end of a patient’s life. It is critical to realize and support patients’ preferences for how they want the process of shared-decision making to occur.
Rapid Response Team Codes Following Transition-of-Care from the Emergency Department to an Inpatient Medicine Unit
Kerrin Bersani, B.S.1, Brett Todd, M.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Corewell Health, Royal Oak, Michigan
INTRODUCTION
Transitions-of-care from the emergency department (ED) to an inpatient unit have been identified as a high-risk period for medical error due to multiple causes, such as communication mishaps, excessive workload, variability in patient flow, and unclear assignment of responsibility. Patients who experience a diagnostic error are also at increased risk for poor outcomes, including increased length-of-stay and mortality. Rapid Response Teams (RRTs) are frequently utilized by hospitals to address a sudden deterioration in clinical status, often after a transition-of-care. We investigated the occurrence of RRT in patients shortly after a transition-of-care from the ED to a medicine unit. Further, we analyzed the rates of RRT across various demographic groups.
METHODS
Using the electronic health record, we generated a list of patients who had an RRT called with 24-hours after transition-of-care from the ED to an inpatient medicine unit in 2019. Data was additionally analyzed using a Chi-Square test to determine if certain demographic groups (race, ethnicity, sex, sexual orientation, age, insurance, and income) are at higher risk of experiencing an RRT after transfer.
RESULTS
During 2019, there were approximately 18,719 transfers from the emergency department to an inpatient medicine unit. Of these patients, 3840 had an RRT code called within 24 hours of transfer. Out of these, 55% were female patients. As age increased, the number of admitted patients increased, as well as the percentage of patients experiencing an RRT. Rates of RRT also varied across racial groups, the highest being 23% of Black or African American patients experiencing an RRT. This patient population had 30% of all RRT codes, but only made up 26% of all patients included during this one-year period.
CONCLUSIONS
Providers need to be aware of risks patient populations experience in hospital transfers to ensure patient safety and mitigate clinical deterioration.
Conceptualization of Evidence Used by Surrogate Decision-Makers to Determine a Patient’s Wishes
Michael Bourgoin, B.S.1, Zach Armstrong , B.A.1, Abram Brummett, Ph.D.2, Mark Navin, Ph.D.3, Jason Wasserman, Ph.D.2, Stephanie Swanberg, MSI2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan
3Department of Philosophy, Oakland University, Rochester, Michigan
INTRODUCTION
Many modern concepts within clinical bioethics can be conceptualized in various ways. This subjectivity is demonstrated when analyzing ideas in the literature about the types of evidence that can or should be used by surrogate decision-makers to determine a patient’s wishes. This project aims to explore normative claims on this topic in order to map out the current landscape of the various understandings of this concept.
METHODS
Covidence, a web-based software program, was the main tool used to carry out the systematic review. Search terms were generated to yield articles that would then be filtered to determine which would be included in the final review. These articles were first screened based on title and abstract, and then through a full article review. Inclusion and exclusion criteria were used to decide if articles were to be included. Finally, normative claims about what evidence can or should be used to determine a patient’s wishes were extracted to map the current landscape of this concept in the literature.
RESULTS
There are varying opinions about sources used to determine an incapacitated patient’s wishes. These sources include stated wishes, advance directives, social media, cultural and religious beliefs. Many believe that qualities such as specificity, thoughtfulness and consistency of the evidence should be used to determine validity. Along with source and quality of information, many authors are concerned with the timing of the evidence as wishes can evolve over time.
CONCLUSIONS
This project maps the myriad of opinions on what evidence can and should be used by surrogate decision-makers in medical decision-making. Further exploration into this complex topic is required to provide recommendations that can ultimately lead to improved accuracy in determining patient wishes.
Attitudes and self-assessment of physical medicine and rehabilitation clinicians in addressing reproductive health care needs for women with physical disabilities
Kaylie A Bullock, B.S.1, Edward J Rohn, Ph.D.2,3, Claire Z Kalpakjian, Ph.D.3, Nancy Chiaravalloti, Ph.D.4, Tamara Bushnick, Ph.D.5
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Interdisciplinary Health Studies, Oakland University, Rochester, Michiganchigan
3Dept of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, Michigan
4Kessler Foundation, Department of Neurophysiology and Neuroscience, East Hanover, New Jersey
5Rusk Rehabilitation, New York University Langone Health, New York, New York
INTRODUCTION
Women with physical disabilities frequently have inadequate access to reproductive health care due to environmental barriers, social stigma, and lack of medical knowledge among clinicians for overlapping reproductive and disability-specific needs. Further, people with disabilities often rely on physical medicine and rehabilitation (PM&R) clinicians for primary care, creating a need for these specialists to be knowledgeable of reproductive health issues in order to address patient concerns. However, little is known about the perspectives and experiences of PM&R clinicians regarding these topics.
METHODS
Using qualitative analytic software (Dedoose ver8.3.35) and an inductive coding schema, this study explored transcripts from three semi-structured focus group interviews with PM&R clinicians (N=15) from large, metropolitan rehabilitation centers. Coded data were analyzed for themes on clinicians’ attitudes, approaches to and perceived barriers in addressing reproductive health needs of women with physical disabilities.
RESULTS
Analysis revealed three themes related to PM&R clinicians’ perspectives on addressing reproductive health topics. These themes were: 1) varying levels of comfort discussing reproductive health topics; 2), a desire for increased collaboration between gynecology and PM&R; and 3) the importance of promoting informed reproductive health decisions.
CONCLUSIONS
Reproductive care for women with physical disabilities sits at the intersection of PM&R and gynecology, with no overlap in training. Given the frequency with which PM&R clinicians provide primary care for women with physical disabilities, the results of this study support increased education and collaboration with gynecologists for PM&R clinicians. Ideally, such efforts could help to reduce reproductive care disparities for this population of women.
Telemedicine Success - A Rapid Review
Anna Carman, B.S.1, Victoria Lucia, Ph.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan
INTRODUCTION
Telemedicine involves utilizing telecommunications and technology to deliver healthcare - including diagnosis, consultation, education, care management, and patient self-management - to populations with otherwise limited access to care. It offers a broad-range of benefits, including increased care accessibility, improved continuity of care, and decreased costs, without sacrificing patient satisfaction. However, telemedicine requires unique skills and approaches, unfamiliar to many physicians. We conducted a rapid review of research-validated techniques, across multiple subspecialties, to identify research-validated techniques for maximizing telemedicine appointments, synthesized in a comprehensive list, in order to support clinicians in modern healthcare settings.
METHODS
The methodology for this rapid review project involved a comprehensive search of PubMed (via MeSH searching) and Google Scholar to identify existing research. Articles were selected that address telehealth strategies in various settings by a single-reviewer, initially by title and abstract screening and secondarily by full-text screening. In summary, 149 studies were screened with 97 reports excluded. Then, 112 papers were retrieved with a final 52 included in the qualitative synthesis. Article selection is visualized in Figure 1. Findings were organized into an appendix with key findings from each article, then synthesized into a concise list of practical and realistic strategies.
RESULTS
Ultimately, 52 articles were included across several subspecialties, with three major themes emerging, including good practices for any telehealth appointment (Table 1), strategies for a successful telemedicine implementation (Table 2), and telemedicine strategies for clinicians (Table 3). For all telehealth appointments, physicians should be prepared and proficient at utilizing the required technology. On a systemic level, engaging stakeholders and future users, with regular, systematic re-evaluation can increase program adoption success. Individually, clinicians should consider appropriate telehealth candidates and opportunities to augment the virtual experience.
CONCLUSIONS
In conclusion, a broad scope of practical techniques were identified which could improve adoption, implementation, and use of telemedicine in numerous settings.
The Ethics of Medical Interventions Against Parental Consent
Corey R. Carney, M.S.1, Mark Navin, Ph.D.2, Jason Wasserman, Ph.D.3,4, Abram Brummett, Ph.D.3, Kaitlyn Hanson, B.S.1
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Philosophy, Oakland University Rochester, Michigan
3Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan
4Department of Pediatrics, Oakland University William Beaumont School of Medicine, Rochester, Michigan
INTRODUCTION
Between an adult patient and physician they are the only two people that have a say in the patient’s medical treatment with the patient having the final say. In pediatrics, there is a patient, parent, and physician which adds a third party that is a proxy decision maker for the child but lacks absolute authority over the child’s treatment. The goal of this study is to give a sense of the diversity of the pediatric ethics literature regarding parent/physician disagreements and to address ambiguities about pediatric interventions.
METHODS
This critical scoping review used a search strategy generated by an information sciences researcher and experts in pediatric ethics, conducted on 11 databases. Search results were screened by two authors independently on COVIDENCE first by title and abstract, then full text to ensure each article met inclusion criteria. A final content analysis was then performed.
RESULTS
Of 6,961 search results 72 publications were included in a final content analysis. Although over ten different frameworks for intervention were mentioned only three (Harm Threshold (34.7%), Best Interest Standard (31.9%), Constrained Parental Autonomy (12.5%)) were endorsed by more than 10% of authors. Although the vast majority (81%) of authors mentioned government intervention as the predominant method to resolve disputes, 22% of authors identified non-governmental forms of interventions.
CONCLUSIONS
Our paper demonstrates that pediatric ethical literature names a vast amount of distinct frameworks to intervene against parental consent. Yet, despite the diversity of the literature it seems the true debate is between the Harms Threshold and Best Interest Standard. It appears each independently named framework may not be conceptually distinct from one another( ie rational parent vs responsible mode of thinking). Furthermore, these two paramount frameworks likely do not differ vastly when applied clinically as the harm generated from intervention may be greater than benefit of proposed treatment.
Analysis of the Efficacy of the Modified Finnegan Scoring System
Benjamin Collaer, B.S.1, Victoria Lucia, Ph.D2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan
INTRODUCTION
Neonatal Abstinence Syndrome (NAS) is a constellation of opiate withdrawal symptoms including irritability, inadequate feeding/ growth, and seizures in neonates This condition occurs shortly after birth if the fetus had significant exposure to opiates in-utero. Since 2014, each NAS case at Beaumont Royal Oak and Troy Hospitals has had their treatment dictated by their score on the Modified Finnegan Scoring System (MFSS). This scoring system was created to minimize unnecessary opiate-based treatments for neonates with NAS. The main objective of this study is to analyze the efficacy of the MFSS and observe the change in patient outcomes since its implementation in 2014.
METHODS
This is a retrospective chart review of all neonates born at Beaumont Royal Oak and Troy Hospitals with a diagnosis of NAS from 2009-2019. The majority of data was already collected from patient charts as part of a quality improvement study and required no additional in-person recruitment. Additional data points were collected from patient charts. De-identified data was analyzed to compare the difference in the length of stay in the Neonatal Intensive Care Unit (NICU) and hospital as well as the rates and duration of opiate-specific intervention before and after the implementation of the MFSS.
RESULTS
Neonates with Neonatal Abstinence Syndrome that were treated after the implementation of the MFSS had statistically significant shorter lengths of stay in the NICU and hospital and also had lower rates and duration of pharmacological intervention compared to those treated before the implementation.
CONCLUSIONS
The results support the use of the MFSS within the NICU for neonates diagnosed with NAS. While it should be noted that this was not an isolated change that was made over this period to improve the care for these neonates, the improvements in treating NAS were statistically associated with the MFSS at the Beaumont Royal Oak and Troy NICUs.
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Concern for Authenticity in Rational and Relational Autonomy
Joshua J. Daniel, M.S.1, Abram L. Brummett, Ph.D.2, Mark C. Navin, Ph.D.2,3, Jason A. Wasserman, Ph.D.2,4
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan
3Department of Philosophy, Oakland University, Rochester, Michigan
4Department of Pediatrics, Oakland University William Beaumont School of Medicine, Rochester, Michigan
INTRODUCTION
The four principles of bioethics described by Beauchamp and Childress are beneficence, nonmaleficence, justice, and autonomy. Two definitions of autonomy are very commonly used: rational autonomy, which refers to a patient making decisions based on their own beliefs and customs, and relational autonomy, which refers to shared decision making with the input of a patient’s close trusted individuals. Beauchamp and Childress described autonomous actions as those with intention, understanding, and lack of controlling factors. A fourth component that is sometimes included is authenticity, or making decisions true to one’s self. The primary goal of this study is to determine whether a trend exists for the inclusion of authenticity in rational or relational autonomy. A secondary goal is to determine whether a trend exists with the use of autonomy and the highest degree of the authors.
METHODS
Covidence, an online platform for systematic review management, was utilized for this study. Search parameters were used to identify publications from medical and philosophical journals related to the discussion of autonomy. These publications underwent title and abstract screening, full text review, and data extraction using Covidence. The results were used for data interpretation.
RESULTS
Out of 81 studies included for data extraction, 6 studies (7.41%) included discussion of authenticity within the context of defining autonomy. Authenticity was used in reference to relational autonomy in 2 publications written by first-authors with M.D.’s. It was used in reference to rational autonomy in 4 publications, of which 3 were written by first-authors with Ph.D.’s and 1 with M.D.
CONCLUSIONS
Our findings indicate that M.D. first-authors are more likely to include authenticity in reference to relational autonomy, while Ph.D. first-authors are more likely to include it with rational autonomy. These results will be organized within a systematic review to analyze varying meanings of autonomy in bioethics.
Behavioral Response to Narrative vs. Non-narrative Pictorial Alcohol Warning Labels
Susan Duong, B.S.1, Joshua Haworth, Ph.D.2, Zexin Marsha Ma, Ph.D.3
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Oakland University Department of Human Movement, Rochester, Michigan
3Oakland University Department of Communications & Journalism, Rochester, Michigan
INTRODUCTION
In the effort to curb nicotine use, public campaigns have often resorted to graphic imagery to raise awareness of the harmful effects to encourage cessation or abstinence. In a similar vein, this project aimed to examine the effect of warning labels on alcohol bottles on alcohol consumers’ visual attention, reactance, risk perceptions, and behavioral intentions to reduce drinking. Labels were split into narrative types, emphasizing the toll use has on the person versus non-narrative types that visualized the pathology itself. It was hypothesized that the narrative labels will evoke greater visual attention, higher risk perceptions, and more intention to reduce drinking through increased visual attention and decreased reactance.
METHODS
26 participants over the age of 18 who had consumed >1 drink over the past 12 months were recruited via word of mouth for a 30-minute session at the BEAR Lab at Oakland University to view the labels on a computer outfitted with eye-tracking software and administered a survey before, during, and after to gauge their perceptions about the harmful effects of alcohol. Participants were divided into two groups. One group was shown the narrative labels and the other, the non-narrative images.
RESULTS
Participants averaged 28.96 years old (σ 11.19). A subset of eye-tracking data revealed increased minimum fixation time in narrative labels and increased number of fixations in non-narrative labels. However, participants did not consciously acknowledge increased visual attention on survey questions. Risk perceptions averaged in the disagree category in both groups with (p 0.48). Participants in both groups endorsed no plans to change their drinking habits in the next 30 days with non-narrative groups on average expressing less desire (p 0.11-0.20).
CONCLUSIONS
Although not conclusive, data suggests that narrative warning labels are experienced differently than non-narrative labels and may lead to different behavioral outcomes. Further research is warranted.
Does Practicing Iyengar Yoga Improve Posture and Reduce Musculoskeletal Pain in Ophthalmologists? A Pilot Study
Kevin Eid, M.S.1, Amanda Herrera, B.S.1, Michelle Akler2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Akler Eye Center, Dearborn, Michigan
INTRODUCTION
Poor ergonomics is increasingly being found to be a significant occupational hazard for ophthalmologists, and as a result, musculoskeletal (MSK) discomfort is widespread. Iyengar yoga is distinguished from other styles of yoga by its emphasis on precise structural alignment. Previous studies have shown Iyengar yoga practice to be effective in alleviating low back pain. We hypothesize that participation in an online instructional Iyengar yoga video will reduce MSK discomfort and increase awareness of proper ergonomics in the clinic and operating room.
METHODS
Fifty ophthalmologists were recruited from online professional forums and the authors’ personal contacts. A pre-intervention online survey will be completed by the participants. The survey will collect data on demographics, work volumes, wellness activities, baseline MSK pain scores, and a baseline quality of life questionnaire. A 15-minute instructional video focusing on simple yoga poses for the neck, shoulder and low back will then be provided to the participants to complete three times weekly for 4 weeks. A post-intervention survey will collect MSK pain scores, quality of life questionnaire, information about ergonomics and compliance with the intervention, and be compared with the pre-intervention survey.
RESULTS
The post-intervention group showed a statistically significant reduction in cervical, shoulder, upper and lower back, elbow, and wrist/hand pain. were all statistically significant in the study group. Post-intervention improvements in quality of sleep and stress level also achieved statistical significance. 91% of respondents reported improved awareness of their posture in the clinic and operating room after the intervention, and 90% of respondents felt this awareness would decrease their MSK symptoms.
CONCLUSIONS
The results support the hypothesis that a simple Iyengar yoga video program specifically designed for ophthalmologists could be a convenient and effective tool for reducing MSK pain and improving awareness of proper ergonomics for practicing ophthalmologists.
Factors Attributed to Beliefs of Conscientious Objection Towards LGBTQPIA+ Individuals in Healthcare Settings
Benjamin Galen, B.S.1, Travis Ray, Ph.D.2, Michele Parkhill-Purdie, Ph.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Oakland University Department of Psychology, Rochester, Michigan
INTRODUCTION
The LGBTQPIA+ community faces many disparities in healthcare, and there are higher levels of suicide, anxiety, and depression. Transgender individuals encounter discrimination in healthcare at significantly higher levels. The current study examines associations between background characteristics and beliefs concerning whether conscientious objection (CO) is permissible towards transgender individuals and at what level of healthcare. This information was intended to inform individuals of characteristics to seek or avoid when searching for physicians.
METHODS
An online survey was dispersed to US adults via Prolific. The survey collected information pertaining to subject background characteristics, beliefs, and thoughts of CO. Subjects were randomly assigned to read one of six vignettes that depicted either a cisgender or transgender woman (i.e., patient condition) seeking treatment pertaining to blood pressure, psychiatric care, or hormone replacement therapy (HRT) (i.e., treatment condition). Data were analyzed using two-way and three-way analyses of variance (ANOVA).
RESULTS
ANOVA results indicated a significant main effect of vignette treatment (F[2] = 4.58, p = .009, partial η2 = .03) and a marginally significant main effect of vignette patient (F[1] = 3.83, p = .051, partial η2 = .01) on acceptance of CO. The interaction between the vignette treatment and vignette patient conditions also was significant (F[2] = 9.97, p < .001, partial η2 = .06). No three-way interaction was significant.
CONCLUSIONS
Subjects were significantly more permissive with physician CO towards transgender women receiving HRT across all background characteristics and demographics. There were no statistically significant differences between cisgender and transgender patients in need of blood pressure or psychiatric treatment. This data provides evidence to suggest that people primarily permit CO toward transgender patients within the context of HRT. There were no substantial differences in the pattern of results across demographic constructs, indicating no additional benefit of searching for a physician of a specific background.
Trends & Outcomes in Shoulder Arthroplasty: Comparing Anatomic, Reverse, & Hemiarthroplasty
James Gannon, B.S.1, Anthony Arveschoug, M.D.2, Leonardo M. Cavinatto, M.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Orthopaedic Surgery, William Beaumont University Hospital, Royal Oak, Michigan
INTRODUCTION
The field of shoulder replacement has evolved greatly since the inception of the reverse shoulder arthroplasty (RTSA) in 2004. With yearly gains of 32%, the RTSA now encompasses the largest portion of shoulder arthroplasty procedures. In contrast, the anatomic total shoulder arthroplasty (ATSA) and hemiarthroplasty (HA) have steadied or decreased. Surgical outcomes between these three procedures are mixed however. The purpose of this study was to characterize trends and outcomes between the RTSA, ATSA, and HA at a large-volume, single-institution center.
METHODS
Trends in RTSA, ATSA, and HA were tracked over five years. Duration of surgery (DOS), length of postoperative hospital stay (LOS), total patient charges, and revision surgery within twelve months postoperatively were recorded and compared between the three procedures.
RESULTS
This study analyzed 2296 patients who underwent primary arthroplasty with ATSA, RTSA, or HA from 2016 – 2020. Trends in arthroplasty usage changed significantly over the study timeline, p<0.0001. The RTSA grew nearly 12% to represent 78.7% of total volume in 2020, while the ATSA and HA saw proportional decreases. Patients 65 years and younger increased in RTSA usage (57.3% to 76.14%) compared to older patients (72% to 79%). Overall outcomes between the three procedures were mixed. The RTSA carried a shorter DOS compared to ATSA, however RTSA was not superior in regards to LOS, charges, or risk of revision surgery in the overall cohort, p<0.0001.
CONCLUSIONS
The trends at our institution mirror those seen elsewhere, with the RTSA comprising a larger proportion of arthroplasty usage over time. While our results demonstrate a decreased DOS for RTSA patients, no single procedure shows superior outcomes in all areas of LOS, DOS, charges, and revision. This study indicates that forces outside of these critical outcome variables may be driving the current changes in arthroplasty procedures nationwide.
Conceptualization of Intervention in Pediatrics Systematic Review
Kaitlyn Hansen, B.S.1, Mark Navin, Ph.D.2, Jason Wasserman, Ph.D.3,4, Stephanie Swanberg, MSI5
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Philosophy, Oakland University, Rochester, Michigan
3Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan
4Department of Pediatrics, Oakland University William Beaumont School of Medicine, Rochester, Michigan
5Michigan School of Psychology
INTRODUCTION
Navigating when to intervene against parents’ wishes is a difficult task in pediatrics. Different frameworks have been proposed, but disagreements remain. One problem debated about in pediatric intervention principles often refer to different kinds of interventions (e.g. calling Child Protective Services, consulting the Ethics Committee). This project reports results of a critical scoping review of recent bioethics literature about the concept of pediatric intervention principles.
METHODS
A search strategy was conducted on 11 databases to capture publications that were about (1) pediatrics, (2) intervention, (3) clinical contexts, and (4) ethics. The 6,961 studies were imported to Covidence, duplicates removed, and titles & abstracts screened based on inclusion criteria. After screening full texts, 72 studies were reviewed for content that included 6 different aspects of pediatric intervention. These were coded and used to form the themes that give the results of this study.
RESULTS
Intervention styles described are the ‘state’, Child Protective Services, courts, internal hospital mechanisms, noncoercive measures, Ethics Committee, and manipulation/nudges. These were grouped into government interventions and non-government interventions. For these categories, 58/72 identified at least one government intervention, 16/72 identified at least one non-governmental intervention, 58/72 identified at least one of both kinds of intervention, while 42/72 identified only a form of government intervention. All study authors who identified non-governmental intervention forms also identified government intervention forms. None of the study authors who did not identify any government interventions identified any non-government interventions.
CONCLUSIONS
Government interventions were more commonly used when intervening in pediatric clinical settings. In contrast, few studies referred to non-governmental interventions even though these are common in clinic and more common than state interventions. Although using coercive state power comes with a higher risk and burden, the intervention may be justified in cases when there are risks of serious harm on child patients.
Chief Complaint and Geriatric Depression: Assessing Risk for 30- and 90-Day Readmission
Eric James, B.S.1, Joan Michelle Moccia, DNP2, Victoria Lucia, Ph.D.3
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Emergency Department, St. Mary Mercy Hospital, Livonia, Michigan
3Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan
INTRODUCTION
Readmission to the hospital has significant monetary costs and represents a care gap for older adults. This investigation examines how a positive geriatric depression screen and chief complaint contribute to 30- and 90-day readmission risk. Depression recognition with follow-up care is a critical first step to prevent adverse outcomes such as readmission.
METHODS
A retrospective review of the electronic medical record of 329 older adults aged 65 and older from February 1, 2020, to January 31, 2021, who screened positive for possible depression during an emergency department visit at an American College of Emergency Physician Level 1 Geriatric Emergency Department was conducted. Admission and final ICD-10 diagnosis coding groups (used as a surrogate to standardize chief complaint), and social factors were analyzed and considered as potential contributory factors.
RESULTS
This population was found to have readmission rates reaching 42.6% within 30-days, 61.7% within 90-days, and 22.2% with a readmission within both 30- and 90-days. Two diagnosis groups were associated with an increased risk: (1) endocrine, nutritional, and metabolic diseases for 90-day readmission (OR: 1.72, p=0.03), and (2) circulatory system diseases for dual readmission at 30- and 90-days (OR: 2.45, p=0.02). Two diagnosis groups had a decreased risk: (1) mental, behavioral, or neurocognitive disorders on 30-day readmission (OR: 0.43, p=0.01) and 90-day readmission (OR: 0.49, p=0.02) and (2) factors influencing health status or contact with health services on 90-day readmission (OR: 0.12, p=0.02).
CONCLUSIONS
Our results suggest an interplay between a positive depression screening and specific concurrent diagnosis groups on the risk for 30- and 90-day readmission. These findings support the importance of depression identification followed by action that could lower the odds of readmission, as well as consideration for additional characteristics of the patient’s health.
'Best Interest' in Clinical Medicine: A Critical Scoping Review
Joshua R Jones, B.S.1, Saketh Akula, B.S.1, Jason Wasserman, Ph.D.2,3, Mark Navin, Ph.D.4
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan
3Department of Pediatrics, Oakland University William Beaumont School of Medicine, Rochester, Michigan
4Department of Philosophy, Oakland University, Rochester, Michigan
INTRODUCTION
The Best Interest Standard (BIS) has been a much-debated guidance principle in clinical ethics with ambiguous definition and application. In this study we focus on the conceptions of best interests that differ according to which kinds of interests are included. While there is wide agreement that ‘best interests’ include the physiological welfare of a patient, there is still substantial disagreement about which other interests are included in wider accounts of welfare, the balancing of those other interests, and whether interests are objective or subjective.
METHODS
This study followed a systematic, scoping review framework. Searches were conducted on 11 databases that generated an initial 4,523 publications. Abstracts were included if they; (1) used the term "best interest," "beneficence" or "benefits" in the title or abstract, (2) focused on the best interests of patients, (3) focus on clinical care, and (4) contain significant discussion of normative claims. 72 publications were included for full article review and stratified by normative themes based on objective and subjective definitions of best interests and definitions that accepted more than the physiologic well-being of the patient.
RESULTS
Almost all authors of the studied articles assert that ‘best interests’ is about the wider welfare of the patient in that it includes more than mere physiological goods, but also interests that are psychological/emotional, relational, familial, or cultural, among others. Indeed, there is a consensus among authors of study articles that ‘best interests’ involves a balancing of different considerations and that these ‘best interests’ are often thought to include both objective and subjective elements.
CONCLUSIONS
This paper’s findings suggest there is significant consensus and dissensus in the bioethics literature about the meaning of ‘best interests.’ Further conceptual development of ‘best interests’ is especially needed in the subjective balancing of other interests beyond those pertaining physiologically to the patient.
The Meaning of Pediatric Assent: A Critical Scoping Review
Natalie Liogas, B.S.1, Amelia Najor, B.S.1, Jason Adam Wasserman, Ph.D.2,3, Stephanie Swanberg4, Abram Brummett, Ph.D.2, Naomi T. Levanthal, M.D.5,6
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan
3Department of Pediatrics, Oakland University William Beaumont School of Medicine, Rochester, Michigan
4Michigan School of Psychology, Farmington Hills, MI, USA
5Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
6Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA
INTRODUCTION
The moral obligation to include children and adolescents in medical decisions has been long recognized. Soliciting pediatric assent is a component essential to this effort. Despite the AAP characterization of assent (AAP 1995; AAP 2016), there appears to be a lack of consensus regarding the operational and conceptual meanings of pediatric assent. This this critical scoping review provides an analysis of the varied meanings of pediatric assent in the clinical context.
METHODS
Relevant MESH terms were first identified. Inclusion and exclusion criteria centered on the use of pediatric assent as a normative construct and in the context of clinical care (as opposed to research). Article screening at both the title/abstract and full text review stages was conducted by two independent reviewers, with conflicts resolved by a third expert reviewer.
RESULTS
The search yielded 7446 results with 1054 duplicates removed, leaving 6392 references for title/abstract screening. 6292 were excluded during title/abstract review. Based on a full text review of the 100 remaining articles, 29 studies were extracted for coding and included in the final paper.
A central theme identified was the meaning of assent is context dependent. In particular, it is influenced by the proposed treatment, the population, and the geographic/cultural context in which it is used.
CONCLUSIONS
The meaning of pediatric assent depends on the specific treatment context, the qualities population in question, and the geographic/cultural context. The results of the systematic review highlight the divergent nature of the concept of assent as a moral consideration in the care of children. Greater clarity about this construct and its ethical contours will be able would contribute to greater clarity and consistency of practice and likely amplify protections for children in the context of clinical care.
Pediatric Assent in Clinical Practice: A Critical Scoping Review on the Ethical Justifications for Assent
Amelia N. Najor, B.S.1, Natalie Liogas, B.S.1, Jason Adam Wasserman, Ph.D., HEC-C2,3,5, Stephanie Swanberg, MSI4, Abram Brummett, Ph.D., HEC-C2,5, Naomi Laventhal, M.D.6, Mark Christopher Navin, Ph.D.5,7
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan
3Department of Pediatrics, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
4Michigan School of Psychology, Farmington Hills, Michigan
5Clinical Ethics, Beaumont Hospital – Royal Oak, Royal Oak, Michigan
6Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan
7Department of Philosophy, Oakland University, Rochester, Michigan
INTRODUCTION
Pediatric assent is an important ethical construct, yet there is little agreement on what precisely it means, including the ethical justifications for assent. The term is used to indicate everything from acquiescence to an analogue of informed consent itself. The primary goal of this study is to assess the range of ways that pediatric assent is specified in the clinical ethics literature, as well as what different conceptions intimate about its moral value. This systematic review will summarize the normative claims about pediatric assent in recent literature. Analysis will map divergent constructs and various moral and ethical justifications for pediatric assent.
METHODS
Relevant MESH terms were defined and nine databases identified in consultation with an information sciences expert. Inclusion and exclusion criteria centered on the use of pediatric assent as a normative construct and in the context of clinical care (as opposed to research). Article screening at both the title/abstract and full text review stages was conducted by two independent reviewers using the COVIDENCE software, with conflicts resolved by a third expert reviewer. Included research-based studies will be assessed using a modified version of the Joanna Briggs Critical Appraisal Tools for bias and quality.
RESULTS
The search yielded 7446 results with 1054 duplicates removed, leaving 6392 references for title/abstract screening. 6292 were excluded during title/abstract review. Based on a full text review of the 100 remaining articles, 29 studies were extracted for coding and included in the final paper.
CONCLUSIONS
This study will help clarify the normative parameters of pediatric assent and the moral obligations of clinicians to include children in treatment decisions. The variability in the meaning of, and moral justification for, pediatric assent currently contributes to wide variation in the practice of including children in their own care. This research will contribute to clarifying a confusing discourse on this subject.
Family/Decision maker Perception of Patient Care and Withdrawal of Life Sustaining Treatment
Joshua Paul, B.S.1,2, Revelle Gappy, B.S.1,2, Tracy Wunderlich-Barillas, Ph.D.1, Robert A. Swor, D.O.1,2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Emergency Medicine, Beaumont Hospital , Royal Oak, Michigan
INTRODUCTION
Withdrawal of life sustaining treatment (WLST) is the process by which a patient has life supporting measures removed when a decision is reached that further care if futile. This process is a complex interplay of medical science, the healthcare teams’ past experiences, and communication with the patient’s family/decision maker Family members are commonly called upon to make critical decisions regarding the provision or withdrawal of patient care. Our objective was to describe the perceptions and experiences of the family members of patients who were admitted to an intensive care unit after resuscitation from an Out of Hospital Cardiac Arrest (OHCA).
METHODS
We conducted a mail in survey study to evaluate this topic. Our target population was family/decision makers of patients who survive to admission after OHCA during 2020 and 2021 at one of four Beaumont hospitals: Royal Oak, Troy, Farmington Hills, and Grosse Pointe. This population was identified through the Cardiac Arrest Registry to Enhance Survival (CARES) database. Our survey included yes/no questions, open ended questions, and Likert scale ratings of participant’s experiences.
RESULTS
During the study period, 243 Surveys were sent by mail, of these 35 were undelivered, 183 surveys received no response , five declined participation, and 20 surveys were completed and returned,. Respondents were family members or life partners, average age 62.2, and more commonly female (60%).
CONCLUSIONS
This preliminary data showed that most respondents felt they were well informed regarding the patient’s status, they were given consistent information regarding the patient’s clinical status, and the respondent had adequate time and support to make critical decisions on behalf of the patient. Most respondents identified caregivers as competent and compassionate. This preliminary data provides new insights into family members experiences and how they are engaged in the decision making process for a critically ill patient.
Designing a Surgical Scorecard to Inform and Evaluate Appropriate Perioperative Antibiotic Prophylaxis
Rehan Tariq, B.S.1, Paul Chittick, M.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Corewell Health, Royal Oak, Michigan
INTRODUCTION
Perioperative antibiotic prophylaxis (PAP) implementation is a widespread strategy used to ensure the minimization of surgical site infections (SSIs) during various surgical procedures including hip and knee replacements and organ transplants. Despite the widespread implementation of PAP, there exists a gap in understanding what is considered appropriate PAP. This may be due in part to the absence of a feedback mechanism that educates physicians on which antibiotics are truly appropriate for preventing the SSIs arising from certain surgical procedures. The goal of this project is to design an informative surgical prophylaxis scorecard that physicians can use to determine which antibiotic is appropriate for PAP. We are interested in the impact our quality improvement tool will have on appropriate perioperative prophylaxis services at Beaumont Royal Oak.
METHODS
We conducted a retrospective study that reviewed multiple surgical procedures at Beaumont Royal Oak for a selected 1-week period with no exclusion criteria. Patient charts were accessed using the Epic EMR system to collect data regarding drug, dosage, duration, and timing of drug administration. The data was organized by surgical type on SharePoint and data analysis as well as the scorecard creation was completed in Excel.
RESULTS
The implementation of antibiotic prophylaxis was appropriate greater than 90% of the time in terms of drug selection, dosing, and duration. However, the timing of correct antibiotic administration was only approximately 27% across all surgical procedures, with most antibiotics being administered within 30 minutes of incision.
CONCLUSIONS
The results indicate that although antibiotics were correctly chosen, dosed, and infused according to the recommended duration, antibiotics were often administered outside the recommended time intervals and too close to incision time. This highlights an area of improvement that should be investigated with a larger sample size to optimize perioperative antibiotic prophylaxis and prevent surgical site infections.
Evaluation of online patient information regarding emergency center utilization
Rachel Truland, B.S.1, Steven Joseph, M.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Emergency Medicine, William Beaumont University Hospital, Royal Oak, Michigan
INTRODUCTION
The decision a patient makes when seeking emergency medical care comes with risks and ambiguity if the right decision is not made. The internet is increasingly accessible to patients, and they often consult an internet search prior to seeking healthcare. The aim of this study is to assess the readability and reliability of online information regarding a patient’s decision to seek emergency care.
METHODS
The phrase ‘should I go to the ER?’ was put in 3 search engines. The first 10 websites from each were identified and screened. A source category was assigned for each. For each website, the quality was assessed using the DISCERN instrument. The readability was assessed using the Flesch Reading Ease Score (FRE), the Flesch-Kincaid grade level (FKGL) and the Gunning Fog Index (GFI). Each website was also surveyed using the WAVE web accessibility evaluation tool to identify potential accessibility errors.
RESULTS
Following screening, twenty websites were included, fourteen healthcare and two each of insurance, news, and government. Fourteen of the websites had a date of publication posted. The median DISCERN score was 53 corresponding to ‘good’ quality. The quality of the website was not dependent on category or whether a publication date was displayed. The median FRE (59.8) corresponded to ‘fairly difficult’ to read. The median FKGL (8.2) and GFI (11.9) corresponded to 8th grade and high school reading levels respectively. The median number of web accessibility errors was 14. The highest quality information was from the National Institutes of Health. The most readable website was from University of Utah Health.
CONCLUSIONS
The readability and reliability of online information for patients about emergency medical care usage is inadequate. Health information websites should guide patients to information that is readable and reliable as well as personalized to their symptoms.
