Feasibility of Mobile Technology to Identify and Address Patients' Unmet Social Needs in a Primary Care Clinic.

Mobile health tools may overcome barriers to social needs screening; however, there are limited data on the feasibility of using these tools in clinical settings. The objective was to determine the feasibility of using a mobile health system to screen for patients' social needs. In one large primary care clinic, the authors tested a tablet-based system that screens patients for social needs, transmits results to the electronic health record, and alerts providers. All adult patients presenting for a nonurgent visit were eligible. The authors evaluated the feasibility of the system and conducted follow-up surveys to determine acceptability and if patients accessed resources through the process. All providers were surveyed. Of the 252 patients approached, 219 (86.9%) completed the screen. Forty-three (19.6%) required assistance with the tablet, and 150 (68.5%) screened positive for at least 1 unmet need (food, housing, or transportation). Of the 150, 103 (68.7%) completed a follow-up survey. The majority agreed that people would learn to use the tablet quickly. Forty-eight patients (46.6%) reported contacting at least 1 community organization through the process. Of the 27 providers, 23 (85.2%) completed a survey and >70% agreed the system would result in patients having better access to resources. It was feasible to use a tablet-based system to screen for social needs. Clinics considering using mobile tools will need to determine how to screen patients who may need assistance with the tool and how to connect patients to resources through the system based on the burden of unmet needs.

Sustained Improvement in Inflammatory Bowel Disease Quality Measures Using an Electronic Health Record Intervention.

BACKGROUND: Inflammatory bowel disease (IBD) is a chronic condition with wide variation in treatment and resource utilization because of many different disease presentations and treatment options. In an effort to standardize care and improve health outcomes, several organizations have created performance measures to monitor various aspects of IBD care. OBJECTIVES: We aimed to assess longitudinal documentation adherence with physician quality reporting system's (PQRS) IBD performance measures before, immediately after, and 1 year following the implementation of a comprehensive electronic health record (EHR) IBD clinical documentation support tool intervention. METHODS: We reviewed 50 patient charts that were randomly selected from consecutive outpatient IBD visits at our tertiary care center from September 1, 2015 to June 30, 2016, prior to implementation of an IBD-specific note template, order set, and patient education handout on September 1, 2016. Two additional cohorts of 50 patient charts were randomly selected from September 1, 2016 to June 30, 2017 and September 1, 2017 to June 30, 2018. These charts were reviewed to assess adherence of pertinent PQRS performance measures for outpatient IBD care. The project was deemed not human subjects research and received exempt approval by the Institutional Review Board (IRB#: IRB00040399). RESULTS: The cohort immediately after the intervention showed significant increases in documentation rates of influenza immunization (19-59%, p < 0.001), pneumococcal immunizations (2-38%, p < 0.001), tobacco cessation (28.6-77.8%, p = 0.049), and proportion of all eligible measures (40.6-62.2%, p < 0.001) when compared with the preintervention group. Moreover, documentation rates were sustained in the 1-year follow-up group when compared with the postintervention group. CONCLUSION: A multifaceted, EHR focused approach can significantly and sustainably improve documentation of outpatient IBD quality measures.

Phenotype of transgenic mice carrying a very low copy number of the mutant human G93A superoxide dismutase-1 gene associated with amyotrophic lateral sclerosis.

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease of the motor neuron. While most cases of ALS are sporadic, 10% are familial (FALS) with 20% of FALS caused by a mutation in the gene that codes for the enzyme Cu/Zn superoxide dismutase (SOD1). There is variability in sporadic ALS as well as FALS where even within the same family some siblings with the same mutation do not manifest disease. A transgenic (Tg) mouse model of FALS containing 25 copies of the mutant human SOD1 gene demonstrates motor neuron pathology and progressive weakness similar to ALS patients, leading to death at approximately 130 days. The onset of symptoms and survival of these transgenic mice are directly related to the number of copies of the mutant gene. We report the phenotype of a very low expressing (VLE) G93A SOD1 Tg carrying only 4 copies of the mutant G93ASOD1 gene. While weakness can start at 9 months, only 74% of mice 18 months or older demonstrate disease. The VLE mice show decreased motor neurons compared to wild-type mice as well as increased cytoplasmic translocation of TDP-43. In contrast to the standard G93A SOD1 Tg mouse which always develops motor weakness leading to death, not all VLE animals manifested clinical disease or shortened life span. In fact, approximately 20% of mice older than 24 months had no motor symptoms and only 18% of VLE mice older than 22 months reached end stage. Given the variable penetrance of clinical phenotype, prolonged survival, and protracted loss of motor neurons the VLE mouse provides a new tool that closely mimics human ALS. This tool will allow the study of pathologic events over time as well as the study of genetic and environmental modifiers that may not be causative, but can exacerbate or accelerate motor neuron disease.