Highlights from some of MAHEC's recently published and ongoing research projects.
Preliminary Study Finds Differences in Fetal Growth Indices with Medication-Assisted Treatment Options
Researchers and clinicians in MAHEC's Ob/Gyn Division studied more than 170 women with opioid use disorders who received either methadone or buprenorphine therapy during pregnancy.
Babies born to mothers receiving buprenorphine, which is prescribed in MAHEC’s Project CARA Clinic, tended to have larger head circumferences (one measure of healthy development) and fewer instances of neonatal abstinence syndrome requiring treatment than babies born to mothers receiving high doses (>90 mg/day) of methadone in an abstract published in the American Journal of Obstetrics and Gynecology.
A larger sample size is needed to confirm this trend since NAS has not been associated previously with methadone dose. Further analysis is recommended and should include coincident exposures to prescribed psychotropic medications.
MAHEC, UNC Chapel Hill Demonstrate Validity of Surgical Skills Assessment Tool
MAHEC was one of 12 ob/gyn residency programs across the U.S. that helped test the construct validity of the myTIPreport, a web-based program that provides real-time, interactive feedback on skills performed by residents during surgical procedures to improve performance for subsequent learning experiences.
Comparisons of teacher assessments and learner self-assessments from more than 5,000 surgical procedures demonstrated significant differences in skills performance between first and fourth-year residents, supporting the emerging construct validity of this web-based tool that was developed in 2014. myTIPreport incorporates assessments from surgical evaluation cards that were developed by MAHEC’s Dr. Andrea Currens and Shelley Galvin.
“This effort is one example of how MAHEC Ob/Gyn continues to pursue excellence in patient care and education beyond the narrower definition of quality that focuses only on checking the right boxes,” explains Jeff Heck, MD, MAHEC president and CEO.
Dr. Beth Buys, Director of MAHEC’s Ob/Gyn Division, and ob/gyn faculty collaborated on this research under the direction of AnnaMarie Connolly, MD, from the Division of Female Pelvic Medicine and Reconstructive Surgery at UNC School of Medicine at Chapel Hill with support from the Foundation for Exxcellence In Women’s Health.
This research partnership between MAHEC and UNC SOM Chapel Hill has expanded to include ob/gyn residency and FPMRS fellowship programs from across the country. Results from the myTIPreport study were published in the October 2017 journal of Obstetrics & Gynecology.
“The development and study of myTIPreport has been the result of an ongoing collaboration between MAHEC and Dr. AnnaMarie Connolly at UNC Chapel Hill,” Dr. Buys explains. “This partnership has been a powerful combination for bringing new technologies to resident education.”
Team-Based Approach Encourages Preventive Healthcare for Older Adults
Research conducted by MAHEC faculty and staff shows that a team-based approach to Annual Wellness Visits tripled patient participation and led to significant increases in the use of preventive services including vaccinations, mammography, bone density scans, colorectal cancer screening and recommended laboratory tests like cholesterol testing.
The study, published online in September by the North Carolina Medical Journal, included 500 patients from three MAHEC community-based clinics and two retirement community outpatient clinics who received Annual Wellness Visits over a 20-month period coordinated by a team that included clinical pharmacists, a licensed practical nurse, a scheduler and a supervising physician.
This project was funded by a grant from The Duke Endowment and was conducted by an interdisciplinary team at MAHEC that included researchers, pharmacists, public health professionals, and physicians.
Benefits of Longitudinal Integrated Clerkships
This article, published in the September 2017 Journal of Academic Medicine, shares graduates’ perceived benefits of participating in a longitudinal integrated clerkship (LIC) model during their third year at Harvard Medical School and UNC School of Medicine Asheville Campus.
Reported benefits include continuity and relationships with preceptors, patients, place, and peers (known as the “4 Ps”). Graduates also appreciated the integration and flexibility within the curriculum.
The LIC model is the foundation of the Asheville Campus’ innovative patient-centered curriculum that has guided the program since its inception in 2009. Third-year students in the program have consistently demonstrated high Step 2 exam scores, a breadth of clinical experience including rural medicine, and preservation of empathy for patients, which contrasts with the national trend toward burnout in the third year of medical school.
Read the abstract and full text.
The Road to Rural Primary Care: A Narrative Review of the Factors That Help Develop, Recruit, and Retain Rural Primary Care Physicians
An interdisciplinary team of MAHEC researchers, public health professionals and physicians conducted a literature review of hundreds of articles exploring the factors that help cultivate, recruit and retain rural primary care physicians. This narrative review led to the development of a theoretical model that was published online in August 2017 in advance of the print journal of Academic Medicine.
The authors found that the development of a rural identity is crucial for attracting and retaining physicians in rural practice. Many factors were found to influence the development of a rural identity including a rural upbringing, positive rural exposure, preparation for rural life and medicine, financial incentives, support with integrating into rural communities, and a good work-life balance.
The review found that attending medical schools and/or residencies with a rural emphasis may reflect, rather than produce, a rural identity. This finding validates MAHEC’s emphasis on providing rural students with hands-on clinical learning opportunities before and during college to encourage interest in pursuing a healthcare profession and in a rural practice.
Near-Miss Reporting in Primary Care May Improve Patient Safety
The Agency for Healthcare Research and Quality (AHRQ) published research conducted by MAHEC’s Dr. Steven Crane and colleagues on implementing a near-miss reporting system in primary care practices.
Near-miss errors are mistakes that occur during the care process but are caught in time before the patient experiences any significant harm. These near-miss events represent an important but underutilized approach to improve safety in ambulatory care settings.
The one-year pilot project involved seven practices including two residency practices, two safety net providers, and three private practices in both rural and urban settings in Western North Carolina. Together, the practices reported 632 near-miss events over a 6-month period, representing a nearly one-percent error rate for visits to these practices. Every practice initiated practice improvement activities based on the information contained in the anonymous reports.
“These results seem to indicate that near-miss reporting can spur process and safety improvements,” shares Dr. Crane. “And this quality improvement tool is adaptable to a wide variety of clinical practices.”
The next step is to determine whether these results can be duplicated over a longer period of time and to what extent near-miss reporting and remediation can reduce adverse events (where harm actually occurs to patients), reduce malpractice claims, lower overall healthcare costs, and improve the patient care experience across a larger care network.