The James Jackson Society White Coat Fund 2014 Winners

The Jackson Society’s White Coat Fund helps to support resident-led initiatives in the Department of Medicine at Massachusetts General Hospital.

Housestaff Hacking Healthcare (HHH) at Mass General

Benjamin Bearnot, MD – Intern Class of 2013

The Massachusetts General Hospital Internal Medicine house staff are highly motivated and creative problem solvers.  By virtue of our front line roles throughout the hospital, we quickly become expert process innovators, working in formal and informal ways to improve workflow and delivery of care.

House Staff Hacking Health (HHH) at Mass General provides a logical extension of this work, providing training and support for our residents to participate in local, national and international health care hackathons and process improvement projects. In this way, we hope to elevate the influence of Mass General internal medicine residents on health care innovation and implementation at Mass General and beyond.  To date we have founded a group working to redesign the intranasal delivery of naloxone for opioid overdose and participated in the Department of Medicine Global Primary Care/Consortium for Affordable Medical Technology co-creation session, with many more opportunities on the horizon. We are extraordinarily appreciative of the continued support of the Jackson Society and the Internal Medicine Residency Program.

The Spatial Epidemiology of Malaria in Western Uganda

Ross Boyce, MD – Intern Class of 2012

The overall objective of this project was to explore the basis of variations in malaria transmission in the Bugoye sub-county of rural Western Uganda. The intent of this epidemiological work is to identify high transmission micro-environments as sites for targeted interventions. As the first step in this process, we worked with community health workers to define village boundaries and major terrain features using geographic information systems (GIS). This data was used to create the first village-level map of the sub-county.

We then applied the information gained from our mapping efforts to routine data collected from the health center over the last four years. The resulting analysis has identified important associations between elevation, seasonal flooding and common indicators of malaria transmission. We currently have three manuscripts under review at various journals describing these findings. This information will form the basis the basis for future studies and interventions seeking to reduce malaria transmission in the region.

Peer Mentorship in Diabetes: Implementation in a Hispanic Population

Utibe Essien, MD – Intern Class of 2013; Jacqueline Seiglie, MD – Intern Class of 2014

Diabetes is one of the top-ten chronic diseases in the United States and a leading cause of mortality. Notably, there is a significant disparity in the epidemiology of the disease, as Hispanics are nearly two times more likely than whites to be diagnosed with diabetes, and 1.5 times more likely to die from its complications. Peer mentorship, or the provision of support from people who have experiential knowledge of a condition, has been shown to affect outcomes in diabetes. Thus we are studying the hypothesis that an outpatient peer mentorship program will improve clinical outcomes compared to usual care, specifically in Hispanic patients with diabetes.

Design and pilot testing of a social mobile app to improve graduate medical education

Akl Fahed, MD – Intern Class of 2013

Development of a mobile app that:
  1. Collects and tracks data on everyday learning experienced by residents within pre-defined core topics and key learning environments
  2. Provides ongoing personalized interactive data allowing a learner to compare their experiences to those of their peers and also against objective measures of clinical competence.
  3. Serves as an educational companion by using adaptive, tailored algorithms for education from question banks
  4. Creates a social mobile platform that allows for virtual interaction among resident learning and interest groups
The app will allow residents to continuously self-evaluate, identify gaps and prioritize their learning. The residency program will have massive time and rotation stamped data on learning which will inform data-driven educational improvements in the program, and allow quantitative measurements of any educational intervention.

Improving the data collection methods for adults in hospital cardiopulmonary arrests to be able to track survival and benchmark on national quality measures

Laura Myers, MD – Intern Class of 2012

Massachusetts General Hospital currently maintains a database of patients who experience hospital cardiac arrests but does not track outcomes or process improvement measures in our emergency response system. The American Heart Association has identified four priority quality measures that they recommend hospitals follow.  These include percentage of events monitored, confirmation of endotracheal tube and time until chest compressions and epinephrine bolus for Pulseless Electrical Activity arrest. We have started to track these measures and benchmark with national standards of care. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is also interested in making sure that we have a system in place for following these measures.

The current system involves a resident from the Step Down Unit recording data on paper. A hired medical student then manually uploads the data into a national database.  However, much of the data is inaccurate because it is done without a centralized, lapsable timer; and the upload process is certainly prone to human error and recall bias. This app will upload data to an intermediate server and then to the national database automatically.

Improving completion of therapy for latent tuberculosis infection (LTBI) in the Massachusetts General Hospital outpatient clinic system

Scott Nabity, MD – Intern Class of 2013

As domestic transmission of tuberculosis continues to decline in the United States, effective treatment of latent tuberculosis infection (LTBI) assumes increasing importance in the prevention of morbidity and achievement of TB elimination. While no target rate for treatment completion in the general population has been universally adopted, the Centers for Disease Control and Prevention (CDC) goal among contacts to confirmed TB cases is 80%.

Currently, there is no simple means for Mass General outpatient general medicine clinics to systematically measure adherence, and the effectiveness of current clinical practices is unknown. We hypothesize that adherence to a full six-to-nine month treatment regimen is low and that certain patient characteristics may identify those at highest risk for non-adherence. We further hypothesize that clinical practices for monitoring adherence vary between clinicians and among general medicine outpatient clinics. Patient-clinician shared decision making (SDM) models for outpatient care offer a proven avenue for engaging patients in the commitment to long-term preventive treatment of chronic diseases. A similar model may be an effective adjunct to preventive treatment strategies for TB. This is a staged investigational approach within the Mass General outpatient clinic system to optimize the completion of LTBI among patients initiated within the Mass General general medicine outpatient clinics.

Specific aims are: to define the rate of treatment completion for LTBI; to identify patient characteristics associated with non-adherence; and to evaluate the effectiveness of a comprehensive outpatient tool kit that includes a SDM model at improving adherence.