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Open Access Publications from the University of California

Scholarly Works (24 results)

  • Thesis
  • Peer Reviewed
UC Irvine Electronic Theses and Dissertations (2014)

Quality improvement (QI) projects and clinical research projects both contribute to the body of evidence that furthers clinical practice. With a recent shift in making research more pragmatic, the lines between QI and research can be blurred. The purpose of this study was to develop a survey aimed at understanding the patient's perspective on being part of QI and research projects in a hospital or health care system (HCS). The goal is to identify if a common ethical framework exists for the implementation of minimal risk projects. Additionally, we wanted to understand the drivers of patient's decisions pertaining to projects aimed at improving patient care. In order to assess this, we developed constructs, or subjects of measurement, of sequential examples that assess these concepts. Patients were asked to select a response ranging from definitely yes to definitely not (Likert scale) on a number of questions related to their comfort level of providing their permission for hospitals to implement these projects. The surveys will allow us to better understand the patient perspective when it comes to improving patient care in a minimal risk setting. Their responses will enable us to establish when permission would be needed to carry out certain activities intended to improve patient care. Additionally, the surveys may allow us to assess potential linkages between attitudes and actions and the strength of that association across various scenarios. Further data collection is needed to obtain a more concrete understanding of patient's comfort level in participating in patient care improvement projects.

    Cover page: Understanding the Patient Perspective in the Ethical Gray Space between Research and Quality Improvement
    • Article
    • Peer Reviewed
    UC Irvine Previously Published Works (2021)
    Recruitment registries are novel tools to accelerate Alzheimer disease research accrual. Optimal methods to populate such registries remain largely unstudied. We sent postcards with 3 unique taglines (Alzheimer's Prevention Research, brain health research, general research) to 100,000 local residents aged 50 years and older to assess the effectiveness of recruiting to an online recruitment registry by mail. The postcard campaign recruited 273 new registry enrollees (0.27% overall response rate). Neither the response rate nor the demographic characteristics of recruited participants differed by the postcard tagline. These results suggest that direct mail may not be the most cost-effective approach to recruit participants to online registries.
      Cover page: Direct Mail Recruitment to a Potential Participant Registry
      • Multimedia
      • Peer Reviewed
      ICTS Publications (2017)

      C-2-C, UCI MIND, and ICTS Translational Science Research Day 2017, University of California Irvine

       

      Introduction: The most consistent barrier to improved medical care is slow recruitment to clinical research. To help clinical investigators at UCI overcome this barrier, we developed a potential participant registry. The UCI Consent-to-Contact Registry (C2C, c2c.uci.edu) is an online repository of individuals who have given permission to be contacted about studies for which they may be eligible. The objective of the registry is to enhance clinical research recruitment at UCI. Investigators from all departments and schools have the opportunity to recruit through the registry, provided that they have IRB approval to do so and complete the necessary components to access the registry with the organizers. The C2C is supported by HCP, Inc; NIA AG106573; and UL1 TR000153.

      • 1 supplemental PDF
      Creative Commons 'BY' version 4.0 license
      • Article
      • Peer Reviewed
      UC Irvine Previously Published Works (2017)

      Background

      The east-to-west spread of carbapenem-resistant Enterobacteriaceae (CRE) represents an opportunity to explore strategies to limit spread in nonendemic areas. We evaluated CRE emergence and regional support for containment strategies.

      Methods

      A 17-question cross-sectional survey was administered to infection prevention programs in Orange County, CA (31 hospitals serving 3 million residents), between January and September 2014. Questions addressed newly detected hospital- and community-onset CRE cultures (2008-2013), current CRE control strategies, and support for prevention strategies for a hypothetical regional intervention.

      Results

      Among 31 hospitals, 21 (68%, representing 17 infection prevention programs) completed the survey. CRE was scarcely detected between 2009-2010; within 4 years, 90% of hospitals reported CRE, with 2.5-fold higher community-onset than hospital-onset CRE. Between 2011 and 2013, annual CRE incidence increased 4.7-fold (1.4-6.3 cases/10,000 admissions). Support for a regional CRE prevention bundle was unanimous. Although 22% bathed patients positive for CRE with chlorhexidine gluconate and 11% actively screened for CRE, 86% and 57%, respectively, would consider these strategies in a regional intervention.

      Conclusions

      CRE epidemiology in Orange County parallels early progression previously seen in now-endemic areas, representing an opportunity to consider interventions to prevent endemic spread. Many facilities would consider proactive strategies, such as chlorhexidine bathing, in the setting of a regional collaborative.
        Cover page: Emergence of carbapenem-resistant Enterobacteriaceae in Orange County, California, and support for early regional strategies to limit spread
        • Article
        • Peer Reviewed
        UC Irvine Previously Published Works (2013)
        There is a need for a regional assessment of the frequency and diversity of MRSA to determine major circulating clones and the extent to which community and healthcare MRSA reservoirs have mixed. We conducted a prospective cohort study of inpatients in Orange County, California, systematically collecting clinical MRSA isolates from 30 hospitals, to assess MRSA diversity and distribution. All isolates were characterized by spa typing, with selective PFGE and MLST to relate spa types with major MRSA clones. We collected 2,246 MRSA isolates from hospital inpatients. This translated to 91/10,000 inpatients with MRSA and an Orange County population estimate of MRSA inpatient clinical cultures of 86/100,000 people. spa type genetic diversity was heterogeneous between hospitals, and relatively high overall (72%). USA300 (t008/ST8), USA100 (t002/ST5) and a previously reported USA100 variant (t242/ST5) were the dominant clones across all Orange County hospitals, representing 83% of isolates. Fifteen hospitals isolated more t008 (USA300) isolates than t002/242 (USA100) isolates, and 12 hospitals isolated more t242 isolates than t002 isolates. The majority of isolates were imported into hospitals. Community-based infection control strategies may still be helpful in stemming the influx of traditionally community-associated strains, particularly USA300, into the healthcare setting. © 2013 Hudson et al.
          Cover page: Diversity of Methicillin-Resistant Staphylococcus aureus (MRSA) Strains Isolated from Inpatients of 30 Hospitals in Orange County, CaliforniaCreative Commons 'BY' version 4.0 license
          • Article
          • Peer Reviewed
          UC Irvine Previously Published Works (2013)

          Background

          A range of strategies and approaches have been developed for preventing health care-associated infections. Understanding the variation in practices among facilities is necessary to improve compliance with existing programs and aid the implementation of new interventions.

          Methods

          In 2009, HCA Inc administered an electronic survey to measure compliance with evidence-based infection prevention practices as well as identify variation in products or methods, such as use of special approach technology for central vascular catheters and ventilator care. Responding adult intensive care units (ICUs) were those considering participation in a clinical trial to reduce health care-associated infections.

          Results

          Responses from 99 ICUs in 55 hospitals indicated that many evidenced-based practices were used consistently, including methicillin-resistant Staphylococcus aureus (MRSA) screening and use of contact precautions for MRSA-positive patients. Other practices exhibited wide variability including discontinuation of precautions and use of antimicrobial technology or chlorhexidine patches for central vascular catheters. MRSA decolonization was not a predominant practice in ICUs.

          Conclusion

          In this large, community-based health care system, there was substantial variation in the products and methods to reduce health care-associated infections. Despite system-wide emphasis on basic practices as a precursor to adding special approach technologies, this survey showed that these technologies were commonplace, including in facilities where improvement in basic practices was needed.
            Cover page: Infection prevention practices in adult intensive care units in a large community hospital system after implementing strategies to reduce health care-associated, methicillin-resistant Staphylococcus aureus infectionsCreative Commons 'BY' version 4.0 license
            • Article
            • Peer Reviewed
            UC Irvine Previously Published Works (2016)
            Background: Recent efforts to study quality improvement (QI) efforts to improve the effectiveness and efficiency of healthcare have raised important questions about ethical boundaries for waiving informed consent. Confusion exists because similar projects can be undertaken for research or QI purposes, a distinction currently used to define Institutional Review Board oversight. However, patients are not aware of such distinctions. We sought to evaluate patients' views of waiving consent for non-invasive projects to improve healthcare quality and delivery. Methods: We developed a 32-item measure of patient thresholds for waiving consent for different types of QI interventions, including those involving changes to: 1) the hospital environment; 2) hospital policies or procedures; 3) objects used by patients; 4) medications or devices; and 5) use of patient information. In a sample of 200 hospitalized patients, we tested and confirmed the reliability and validity of subscales representing each of the 5 intervention types. Results: For each of the five consent threshold scales, all items in each scale had substantial item-to-total correlations with the other items in that scale taken together. All five internal consistency reliability coefficients exceeded.70 for the total sample. Means for all 5 scales indicated general patient support for waiving consent across all categories of interventions studied. However, patients were significantly less comfortable foregoing consent for interventions involving medications or devices, or sharing of patient information. Conclusion: We developed and tested a survey instrument to contribute to the understanding of patient preferences for consent in QI assessment activities. Measures were found to be reliable and valid. Findings indicated general patient support for waiving consent across all minimal risk categories studied. However, more work is needed to reassure and protect patients during minimal risk studies involving medications or devices, or the sharing of patient information.
              Cover page: The patient's perspective on the need for informed consent for minimal risk studies: Development of a survey-based measureCreative Commons 'BY' version 4.0 license
              • Article
              • Peer Reviewed
              UC Irvine Previously Published Works (2013)

              Objective

              We sought to identify hospital characteristics associated with community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) carriage among inpatients.

              Design

               Prospective cohort study.

              Setting

               Orange County, California.

              Participants

               Thirty hospitals in a single county.

              Methods

               We collected clinical MRSA isolates from inpatients in 30 of 31 hospitals in Orange County, California, from October 2008 through April 2010. We characterized isolates by spa typing to identify CA-MRSA strains. Using California's mandatory hospitalization data set, we identified hospital-level predictors of CA-MRSA isolation.

              Results

               CA-MRSA strains represented 1,033 (46%) of 2,246 of MRSA isolates. By hospital, the median percentage of CA-MRSA isolates was 46% (range, 14%-81%). In multivariate models, CA-MRSA isolation was associated with smaller hospitals (odds ratio [OR], 0.97, or 3% decreased odds of CA-MRSA isolation per 1,000 annual admissions; P < .001, hospitals with more Medicaid-insured patients (OR, 1.2; P = .002), and hospitals with more patients with low comorbidity scores (OR, 1.3; P < .001). Results were similar when restricted to isolates from patients with hospital-onset infection.

              Conclusions

               Among 30 hospitals, CA-MRSA comprised nearly half of MRSA isolates. There was substantial variability in CA-MRSA penetration across hospitals, with more CA-MRSA in smaller hospitals with healthier but socially disadvantaged patient populations. Additional research is needed to determine whether infection control strategies can be successful in targeting CA-MRSA influx.
                Cover page: Predictors of Hospitals with Endemic Community-Associated Methicillin-Resistant Staphylococcus aureusCreative Commons 'BY' version 4.0 license
                • Article
                • Peer Reviewed
                UC Irvine Previously Published Works (2022)
                Adolescent COVID-19 vaccination has stalled at 53% in the United States. Vaccinating adolescents remains critical to preventing the continued transmission of COVID-19, the emergence of variants, and rare but serious disease in children, and it is the best preventive measure available to return to in-person schooling. We investigated parent-adolescent COVID-19 vaccine decision-making. Between 24 February and 15 March 2021, we conducted surveys and 12 focus groups with 46 parent-adolescent dyads in Southern California. Parents and adolescents completed a survey prior to participation in a focus group discussion, which focused on exploring COVID-19 vaccine acceptance or uncertainty and was guided by the 5C vaccine hesitancy model. Parents uncertain about vaccinating adolescents expressed low vaccine confidence and high COVID-19 disease risk complacency. Parents who accepted COVID-19 vaccination for adolescents expressed high confidence in health authority vaccine recommendations, high perceived COVID-19 risk, and collective responsibility to vaccinate children. Additionally, unique pandemic-related factors of vaccine acceptance included vaccinating for emotional health, resuming social activities, and vaccine mandates. Among parents, 46% were willing to vaccinate their adolescent, 11% were not, and 43% were unsure. Among adolescents, 63% were willing to vaccinate. Despite vaccine availability, 47% of adolescents remain unvaccinated against COVID-19. Factors associated with vaccine uncertainty and acceptability inform health care practitioner, school, community, and public health messaging to reach parents and adolescents.
                  Cover page: Adolescent COVID-19 Vaccine Decision-Making among Parents in Southern California.Creative Commons 'BY' version 4.0 license
                  • Article
                  • Peer Reviewed
                  UC Irvine Previously Published Works (2012)
                  We calculated hospital-onset methicillin-resistant Staphylococcus aureus (HO-MRSA) rates for Orange County, California, hospitals using survey and state data. Numerators were variably defined as HO-MRSA occurring more than 48 hours (37%), more than 2 days (30%), and more than 3 days (33%) postadmission. Survey-reported denominators differed from state-reported patient-days. Numerator and denominator choices substantially impacted HO-MRSA rates.
                    Cover page: What Is Nosocomial? Large Variation in Hospital Choice of Numerators and Denominators Affects Rates of Hospital-Onset Methicillin-Resistant Staphylococcus aureusCreative Commons 'BY' version 4.0 license
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