2023
Permanent URI for this communityhttps://hdl.handle.net/20.500.12503/32070
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Browsing 2023 by Author "Aguiniga, Ashlyn"
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Item Diabetes-Related Outcomes of an Interprofessional Chronic Care Management (CCM) Service in Medicare Beneficiaries(2023) Rodriguez, Emmanuel; Wesling, Megan; Nguyenly, Angel; Ebert-Blackburn, Didi; Aguiniga, AshlynPurpose: Patients with type 2 diabetes (T2D) often have coexisting conditions requiring consistent monitoring and preventative measures. Chronic Care Management (CCM) is a Medicare program that aims to improve chronic disease state management, however literature on clinical outcomes is lacking. The purpose of this study is to evaluate the diabetes-related outcomes of an interprofessionally-delivered CCM program in patients where Medicare is the singular payer and secondarily, its financial impact. Methods: Adult Medicare patients with T2D enrolled in CCM between February 2020 and August 2021 were included in this retrospective chart review. Participants were evaluated pre- and post-CCM enrollment using non-parametric tests on 1) clinical measures such as A1C; 2) preventative measures; and 3) involvement of clinical staff such as pharmacists and social workers. Descriptive statistics were used to describe financials. Results: Thirty-three patients were included in the study. Changes in clinical measures included a significant reduction in mean A1C from 8.4% to 7.4% (p=0.012), and a nonsignificant reduction in blood pressure and body mass index. There was also a significant increase in pharmacist and social worker involvement, but no significant changes to preventative measures. A total of $26,673.00 was billed to Medicare, with a reimbursement rate of 44%. Conclusion: The CCM service demonstrated a significant reduction in A1C and a significant increase in pharmacist and social worker access. There were no significant changes in preventative measures, likely due to the overlapping study period and COVID-19 pandemic. Future studies outside of pandemic conditions are needed to further assess these nonsignificant outcomes.Item Evaluation of Create-Your-Own-Adventure Activities on Student Knowledge and Critical Thinking Skills in Second-Year Student Pharmacists(2023) Phillips, Heather; Aguiniga, Ashlyn; Howard, MeredithPurpose: Create-your-own-adventure (CYOA) activities are educational innovations where students choose the "best pathway” of treatment. Current literature suggests increased student perception of knowledge and critical thinking skills with use of CYOA activities; however, evidence that such skills ultimately improve is lacking. The primary objective of this study is to assess changes in knowledge and critical thinking after completing a CYOA activity. Methods: Seventy-five second-year pharmacy students completed a CYOA activity on venous thromboembolism, with a six-question quiz immediately before and after. Questions were mapped to pre-set learning objectives with slight alterations to questions on each assessment. Four questions were then mapped to the final exam which occurred approximately three weeks after the activity. Friedman’s two-way analysis and Cochran’s Q test were used to evaluate differences in scores. Descriptive statistics were used to describe student perceptions and scores on a modified Need for Cognition scale. Results: There was a significant decrease in mean scores for each assessment (68.1% vs. 64.9%, vs. 40.0%; p<0.001). Similar results were found when stratifying scores by question. Of the 48 survey responses, 94% preferred the CYOA activity and perceived increased critical thinking skills. All Need for Cognition items scored >3.5, indicating satisfaction in critical thinking. Conclusions: Although we hypothesized an increase in scores with use of CYOA activities, there was a negative association between the activity and scores. Possible limitations include mapped questions that were too dissimilar, VTE management being too multivariate, and lower student retention of cumulative material on finals. These limitations will be addressed in future CYOA activities.Item Outcomes of a Team-Based Chronic Care Management Service in a Dual-Eligible Medicare and Medicaid Population with Diabetes Mellitus(2023) Nguyenly, Angel; Aguiniga, Ashlyn; Rodriguez, Emmanuel; Ebert-Blackburn, Didi; Wesling, MeganTitle: Outcomes of a Team-Based Chronic Care Management Service in a Dual-Eligible Medicare and Medicaid Population with Diabetes Mellitus Purpose: Patients receiving Medicare and Medicaid benefits (dual-eligible) have a higher prevalence of multiple comorbidities, including diabetes mellitus. This same population is less likely to have routine preventative measures completed and a higher incidence of disease-related complications. The purpose of this study is to evaluate the effectiveness of a team-based Chronic Care Management (CCM) program in achieving health outcomes in dual-eligible patients with type 2 diabetes (T2D) and the financial sustainability of a CCM program. Methods: Dual-eligible patients with T2D meeting CCM enrollment criteria were evaluated in a retrospective, pre-/post- intervention, observational chart review study from March 2019 to August 2021. Statistical analyses using non-parametric tests evaluated clinical outcomes (e.g., hemoglobin A1c), preventative measures and clinical staff encounters. Preliminary financials are reported descriptively. Results: Twenty-six patients were included in the analysis. There was a significant reduction in mean A1c levels (8.15% to 7.34%, p = 0.035). Changes in preventative metrics included a statically significant increase in statin prescriptions (p=0.039) while a non-significant increase in pneumococcal and influenza vaccine rates and depression screenings is noted. $14,721.00 was billed to insurers for the service with a reimbursement rate of 39.6%. Conclusion: This study shows that team-based patient care in a CCM program improves A1c levels and supports achievement of preventative measures. Full realization of intervention impact limited by the lack of in-person access to healthcare services due to shutdowns in response to the global pandemic.