Faculty Development in Improvement Science: Building Capacity and Expanding Curricula Across an Academic Health Center.

BACKGROUND: The ability of health professions faculty to design, teach, evaluate, and improve relevant curricula is vital for teaching improvement science (IS) skills to trainees. OBJECTIVE: We launched a Foundational Improvement Science Curriculum (FISC) to build faculty competence in IS teaching and scholarship, and to develop, expand, and standardize IS curricula across one institution. METHODS: FISC consisted of 9 full or half-day sessions over 10 months in 2015-2016 and 2016-2017 academic years. Each session required pre-work, including readings, Institute for Healthcare Improvement Open School modules, and personal improvement projects. Sessions included brief didactics, group activities, planning, and feedback on curriculum development. An evaluation strategy was employed, including pre- and post-program self-assessment, competency mapping, evaluations of didactics and overall program, and participant satisfaction. RESULTS: Forty individuals from 23 academic programs voluntarily completed FISC, representing 20% of graduate medical education (GME) programs and 50% of primary GME programs in addition to undergraduate medical education (UME) and nursing programs. Median self-assessed competency scores (mid versus final score; scale 1-9, 9 high; P < .05 for all comparisons) improved over the course for all competencies for knowledge (3 versus 7), application (2 versus 7), curriculum design (2 versus 7), and scholarship (2 versus 5). Eighteen new or revised IS curricula were developed across GME, UME, and nursing programs. CONCLUSIONS: FISC offers a feasible model to enhance and support faculty development in IS and IS curriculum design.

Patient and provider comfort discussing substance use.

BACKGROUND AND OBJECTIVES: Substance use is a prevalent issue in primary care with wide-reaching implications, particularly for the care of HIV-infected patients. This analysis identified patient and provider characteristics associated with high comfort discussing substance use in HIV primary care clinics using multivariable logistic regression. METHODS: A total of 413 patients and 44 providers completed surveys on their comfort discussing substance use. Additional independent variables from surveys included demographics, drug and alcohol use, self-efficacy, and activation for patients. Provider-level data included demographics, training, practice descriptors, and stress levels. RESULTS: The majority of patients (76%) and providers (73%) reported high comfort. In multivariable analysis, patients with current problematic alcohol use or current drug use were half as likely to report high comfort compared to their non-substance-using peers. Higher patient self-efficacy and high levels of patient activation were independently associated with increased odds of high patient comfort. While provider-level characteristics were not associated with provider comfort, the types of patients a provider saw were. Namely, the proportion of patients on antiretroviral therapy was inversely associated with the odds of high provider comfort, whereas the proportion of patients with high patient activation was positively associated. CONCLUSIONS: Patients likely to benefit from a discussion of substance use, those with current use, are the least likely to report comfort discussing that use. Interventions that increase patient activation or self-efficacy may also increase their comfort. This research guides future interventions to increase the prevalence of discussions on substance use.

Feasibility of gaining access to women in jail for health interventions.

UNLABELLED: Female jail populations are comprised of women at high-risk for an array of psychological and physical health problems. Jails offer an opportune site to deliver clinical health interventions to women who often quickly cycle back into the community. In contrast with prison population studies, many investigators have encountered recruitment problems when attempting to engage the jailed population in clinical research. This study addressed the feasibility of recruiting detained women for eligibility for clinical research. METHODS: Commitments to the Women's Facility at the Rhode Island Department of Corrections were chronicled for 40 months, from February 2004 to June 2007. Research staff, working 8 a.m. to 5 p.m., Monday through Friday, attempted to screen all detained women for a randomized clinical trial. RESULTS: During the 40-month study period, 4,131 individual women had 8,010 commitments to the facility. Staff was able to gain access to nearly 50% of women. Of the inaccessible women, 65% were released in less than 24 hours. In total, 88% of accessed women agreed to be screened for study participation. No significant differences were observed by race/ethnicity or age between women who were screened and those who were not. CONCLUSIONS: Clinical research with the female jail population is feasible. The jail setting requires researchers to plan for short-commitment lengths and high rates of recidivism to optimize screening and recruitment in this population.

Educational attainment but not literacy is associated with HIV risk behavior among incarcerated women.

PURPOSE: To identify the educational factors associated with HIV risk behaviors among incarcerated women. METHODS: We evaluated a cohort of female detainees at The Rhode Island Adult Correctional Institute between July and September 2004. Among the 423 women who participated in the study, 55% did not have a high school diploma, 29% had < or = 8th grade reading capacity, 32% had a learning disability, 37% had problem drinking, and 61% (257/423) reported HIV risk behavior. RESULTS: In multiple logistic regression, participants who had completed high school had the lowest likelihood of HIV risk behavior (adjusted odds ratio [OR] 0.35, 95% confidence interval [CI] 0.12-1.00). There was no association between participants? literacy level and HIV risk behavior (adjusted OR 2.02, 95% CI 0.83-4.92). CONCLUSIONS: Correctional education programs to reduce HIV risk behavior should focus on those with low educational attainment irrespective of literacy skills.