Rapid Prospective Evaluation (RapidEval) Program
The RapidEval Program features the unique opportunity for investigators to be supported in generating high-quality new evidence on healthcare practices. The program focuses on and fosters rapid, iterative learning that builds upon the natural innovation taking place within the healthcare system. The activities of the RapidEval Program are aimed at and designed to increase adoption of best practices. The unit features a “Call for Proposals” for new research projects. RapidEval is led by Joe Koopmeiners, PhD and Debbie Pestka, PharmD, PhD and receives project management support from Chloe Botsford.
The RapidEval Call for Proposals (CFP) is an opportunity for health care professionals and investigators to submit their idea for improving healthcare practice. If accepted into the research program, the RapidEval unit provides investigators with:
- Mentorship & research design expertise
- Project management, implementation & dissemination support
- Statistical analysis
- M Health Fairview projects include data and technology support
The RapidEval CFP typically takes place once or twice a year. Research proposals that are best suited for the RapidEval program have the following qualities:
- Feasible implementation of intervention within 4 months
- Significant frequency for research to be completed in ~6 months
- Potential for positive impact on healthcare delivery or health equity
- Alignment with health system priorities
- Low risk/likely cost-effective intervention
- Encourage established best practices
- Improve outcomes already captured in routine care
The RapidEval CFP process occurs over a period of 3 months. The steps in the process are outlined below:
- Submission of an application
- Selected proposals will be notified and invited to a final round of interviews
- Final selection of proposals for acceptance into the RapidEval research program
- Project kickoff
Does the RapidEval research program provide funding?
The RapidEval Program does not provide investigator funding, but does offer the following services if accepted into the research program:
- Mentorship & research design expertise
- Project management, implementation & dissemination support
- Statistical analysis
- M Health Fairview projects include data and technology support
Is previous research experience required?
No previous research background is required. The RapidEval Program aims to help guide new investigators in study design, statistical analysis, and implementation and dissemination strategies.
What is the timeline for a RapidEval project?
The timeline from application to completion of an accepted RapidEval research project varies, but a rough estimate is:
- Application phase: 2 months
- Planning phase: 3 months
- Implementation phase: 6 months
- Dissemination phase: 3 months
- Total: 14 months
Can the RapidEval team review my project idea when the call for proposals is not open?
Yes! At any time you can request a RapidEval consult by completing the applicable CLHSS Intake Form.
RapidEval People
Leadership
Joe Koopmeiners, PhD
Debbie Pestka, PharmD, PhD
Core Member
Project Manager, Chloe Botsford
Current Rapid Eval Research Projects
Using decision aids to improve utilization of cardiac monitoring (January 2022)
Investigator:
Brian Hilliard, MD
- Assistant Professor of Medicine, Division of General Internal Medicine, University of Minnesota
- Co-chair, Quality Committee, Hospital Medicine Domain, M Health Fairview
The problem:
Within M Health Fairview hospitals, patient flow is critical for exceptional patient experience, clinical safety and cost efficiencies. We have observed that the cardiac monitoring (or telemetry) bed capacity is a bottleneck for patient flow in our system. Wide variation still exists among sites, units and physicians on what is considered appropriate use for telemetry. This inappropriate use leads to suboptimal uses of our staff time, skill sets, equipment and facilities, and limits access to telemetry for patients who need it.
The intervention:
The intervention will use a multi-faceted approach that incorporates decision aids into the electronic health record. First, clearer indications for use of telemetry, with links to evidence based literature, will be provided within the cardiac monitoring order. Second, best practice alerts (BPAs) will be displayed at the end of the guideline-supported duration for use.
Outcomes:
This intervention aims to improve quality and safety by removing patients who don’t need telemetry, thus improving capacity and access for patients who need it. It can also improve the total cost of care by reducing patients’ length of hospital stay, financially benefiting both the health system and the patients.
Status:
In Progress
Reducing chemotherapy toxicity in older adults with cancer (January 2022)
Investigator:
Arjun Gupta, MD
- Assistant Professor of Medicine, Division of Hematology, Oncology and Transplantation, University of Minnesota
The problem:
Every year, over 30,000 Minnesotans are diagnosed with cancer, and cancer is the leading cause of death in Minnesota. Older adults with cancer have vulnerabilities (e.g., issues with function, comorbidity, cognition, and nutrition) that place them at high risk of chemotherapy toxicity. Unfortunately, busy oncologists do not have the time, resources, or infrastructure in clinic to assess or address these vulnerabilities in a systematic manner. This leads to higher rates of chemotherapy toxicity in older adults with cancer.
The intervention:
The intervention will involve an on-screen electronic alert which will pop-up during the first clinic visit of eligible patients with their oncologist. The alert will inform the oncologist that the patient is at a high-risk of chemotherapy toxicity due to their age and comorbidities, and link to a free, online tool which calculates the risk of chemotherapy for individual patients (https://www.mycarg.org/?page_id=2405).
Outcomes:
Incorporating chemotherapy toxicity tools into the electronic health record can inform patient-oncologist decision-making about whether and what chemotherapy to pursue, and decrease toxicity, primarily unplanned hospitalization. The intervention aims to improve patient outcomes, decrease burden on the healthcare system, and result in cost savings.
Status:
In progress
Improving management of septic patients with a micro educational tool (February 2022)
Investigator:
Ben Webber, MD
- Assistant Professor of Medicine, Division of General Internal Medicine
The problem:
Sepsis remains the leading cause of in-hospital mortality at MHealth Fairview despite a push for more standardized care. Process measures aimed at improving care involve early identification of patients at risk for sepsis and subsequent evaluation and treatment. Despite these processes being in place for over 5 years at MHealth Fairview, provider compliance remains poor. It is well established in the literature that antibiotic timing is associated with inpatient mortality, length of stay, and complication rates following diagnosis. Developing strategies to improve efficiency in recognition of sepsis and delivery of disease altering treatment is a priority across the country and the target of a national public health campaign.
The intervention:
This study will involve micro-educational interventions delivered to physicians, advanced practice providers, residents, students, and nurses who can impact clinical outcomes through increased awareness, knowledge, and clinical information that the intervention targets, i.e. sepsis recognition, treatment, and outcomes. As the education pieces disseminate, the interventions themselves will change and adapt to better cater to the new clinical reality and scenario that the previous intervention helped create. In the process, creating a replicable framework for iterative education to impact future clinical outcomes or targets.
Status:
In progress
Communication tool designed to tailor post op pain control to reduce opiate overuse/dependency (May 2022)
Investigator:
Sagar Deshpande, MD
- Surgical Resident, University of Minnesota Medical School
The problem:
It is no secret that post-surgical opiate counseling is often suboptimal. But even with ideal counseling, the deck can be stacked against patients. Patients must remember instructions weeks-to-months later, despite being in great pain or already on opiate medications at the time of counseling. At baseline, patients have poor and inaccurate memories for medical advice, especially with regard to treatment, and the very pain that necessitates opiate medication only exacerbates that issue. The confluence of these factors potentiates patients towards addiction. To overcome these barriers, a partnership is necessary between the care team and patient in a co-productive initiative to use and discontinue opiate medication usage.
The intervention:
Behavioral economics offers a novel perspective to the problems of opiate overutilization and diversion rather than the existing medical approach. By harnessing the natural tendencies of populations, changes in behavior and decision-making can be induced. We are developing a “chatbot”- type artificial intelligence (AI) application (“OPY”) which counsels patients on appropriate opiate usage and delivers timely information to patients who are prescribed new opiate medications. Using insights from behavioral economics, we have designed and tested various “nudges,” or informational framing schemes, regarding information on opiate weaning and disposal. These nudges will instruct patients on how to optimize their pain control, maximize their ability to wean off their opiates, and dispose of their medications safely and legally.
Status:
In progress
Improving utilization of medication therapy management services for patients with economic instability (June 2022)
Investigator:
Shana Steinbeck, PharmD, BCPS
- Clinical Pharmacy Manager, Residency Program Director, M Health Fairview, Woodwinds Health Campus
The problem:
The inpatient pharmacist assesses all patient admission medication histories, inpatient medications, and discharge medications for indication, effectiveness, safety, and convenience.
Currently, a medication therapy management (MTM) referral is placed for M Health Fairview patients with certain high-risk disease states and/or polypharmacy based on an Epic formula.
Research has shown the benefit of MTM pharmacist inclusion on care teams through alleviating chronic disease risk factors and monitoring patients for clinical care needs.
Unfortunately, there are currently no pharmacist assessment questions nor an Epic formula that can identify patients with potential economic instability who would benefit from MTM care. The inclusion of social determinants of health, such as economic stability, can directly impact a patient's ability to afford their medications, and, therefore, maintain adherence and reduce disease progression.
The intervention:
This proposal aims to identify patients with potential economic instability and refer them to MTM services. The hypothesis is that the inclusion of patients who may not be able to afford their medications in the MTM referral process will ultimately reduce medication non-adherence, which will impact patient morbidity and health care utilization in the long-term.
Status:
In Progress
Expanding specialist telestroke care for all hospitalized MHFV stroke patients (June 2022)
Investigator:
Christopher Streib, MD
- Associate Professor, Department of Neurology; Vascular Neurology Fellowship Director, University of Minnesota; Cerebrovascular Director, M Health Fairview
The problem:
Stroke is the fifth leading cause of death and number one cause of long-term disability in the United States. For patients presenting to the hospital with acute ischemic stroke, urgent diagnostic stroke evaluation and immediate initiation of targeted secondary stroke prevention is essential.
However, due to a severe shortage of stroke neurologists, timely specialist stroke care is often unavailable. This is problematic because fragmented and inconsistent stroke care reinforces known racial and geographic healthcare disparities.
The intervention:
It is our intent to utilize telemedicine ("telestroke") to facilitate urgent stroke specialist care for all hospitalized M Health Fairview stroke patients regardless of geographic location.
We aim to test the impact of this care model on multiple relevant stroke care outcomes, including the percent of acute ischemic stroke patients who receive an urgent telemedicine stroke, recurrent stroke rate, and readmission rate among other outcomes.
Status:
In progress
Improving Access to HIV Preexposure Prophylaxis Through a Targeted EHR Intervention (December 2022)
Investigator:
Zachary Kaltenborn, MD
- Assistant Professor of Medicine and Pediatrics, University of Minnesota Medical School
The problem:
Pre-exposure prophylaxis (PrEP) is effective at stopping adolescents and adults from contracting HIV when combined with emtricitabine-tenofovir DF or emtricitabine-tenofovir alfenamide. However, there is a large gap between patients eligible for PrEP and patients who actually receive it.
One major barrier to providing PrEP is that the guidelines for prescribing it are confusing, which makes it difficult for providers to determine if a patient should be prescribed it. The purpose of this project is to make PrEP easier to provide so that disparities between who qualifies for PrEP and who actually receives it are reduced.
The intervention:
The project seeks to address the barriers for prescribing PrEP by creating a smart set in Epic for prescribing PrEP. The team also proposed creating an alert that notifies healthcare providers when a patient’s electronic health record indicates they have a high risk of contracting HIV.
Finally, the team is also looking to create an After Visit Summary that includes information about PrEP and links to a social media campaign designed to raise awareness about PrEP.
Status:
In progress
Optimizing Clostridioides difficile testing in the EHR to improve diagnostic practices (February 2024)
Investigator:
Alison Galdys, MD
- Assistant Professor, Department of Medicine
The problem:
Clostridioides difficile infection (CDI) is a frequent hospital-associated infection that can cause significant harm to patients. More common than CDI is Clostridioides difficile (CD) colonization, where patients have CD but do not have disease caused by it or any clinical symptoms of infection. CD colonized patients test positive for CD, which can cause them to be mistaken for having CDI.
At M Health Fairview, a best practice alert (BPA) has been in place since 2018 that provides education on published guidance for CD testing and attempts to nudge clinicians toward appropriate use of CD tests. Currently, a large proportion of patients who test positive for CD do not meet standard testing criteria for CDI, meaning they may be CD colonized instead. This is potentially because the BPA is too late in the diagnostic evaluation process to effectively promote appropriate use of CD testing, and/or that providers do not have sufficient clinical decision support.
The intervention:
To reduce the number of false positive tests, this team proposed a diarrhea order set to assist providers in the clinical evaluation of patients with diarrhea. This order set will complement or replace the current BPA for the CD testing.
Status:
In progress
Phase 1: Optimizing Appointment Reminders to Improve Clinic Show Rates (June 2023)
Investigator:
Rebecca Markowitz, MD
- Assistant Professor of Internal Medicine and Associate Chief Medical Informatics Officer for Hospital Medicine
The problem:
Optimizing ambulatory access is a highly important priority for M Health Fairview (MHFV) operations in order to best utilize resources and improve patient care. Access optimizations include optimizing appointment lengths, referral queues, and provider block scheduling, as well as concierge scheduling (ensure that patients end up with the right provider).
Despite a number of interventions for no shows, including historical telephony for appointment reminders, no show rates continue to be relatively high.
Ambulatory 2-way text appointment reminders were recently implemented in February 2023 aiming to decrease no show rates. This functionality allows for 3 reminders, one of which is a 2-way text allowing for cancellation or confirmation of the appointment via text.
We plan to optimize ambulatory messaging strategies to maximize access/fill rates and minimize no show appointments.
The intervention:
This is a pragmatic randomized trial to evaluate a two-way text messaging approach to appointment reminders within MHFV. The goal of the intervention is to limit no-shows and improve resource allocation.
We plan to begin by testing out different content within the text messages sent to patients, to see which approach results in the best outcomes.
Status:
In progress
Phase 2: Optimizing Appointment Reminders to Improve Clinic Show Rates (September 2024)
Investigator:
Rebecca Markowitz, MD
- Assistant Professor of Internal Medicine and Associate Chief Medical Informatics Officer for Hospital Medicine
The problem:
Optimizing ambulatory access is a highly important priority for M Health Fairview (MHFV) operations in order to best utilize resources and improve patient care. Access optimizations include optimizing appointment lengths, referral queues, and provider block scheduling, as well as concierge scheduling (ensure that patients end up with the right provider).
Despite a number of interventions for no shows, including historical telephony for appointment reminders, no show rates continue to be relatively high. Ambulatory 2-way text appointment reminders were recently implemented in February 2023 aiming to decrease no show rates. This functionality allows for 3 reminders, one of which is a 2-way text allowing for cancellation or confirmation of the appointment via text.
A/B testing has been completed in Phase 1 of this project to compare the organizational standard appointment reminder text against three other message options. Early analysis of A/B testing show promising results of decreasing no show rates in the ambulatory appointment setting aligned to a “call to action” in the message content, where patients are asked to take action to confirm their appointments rather than receive a passive reminder.
Additional A/B testing that directly compares the standard message content to the “call to action” message content can provide additional clarity and analysis to demonstrate impacts of messaging content on no show appointment rates. Additionally, the current standard appointment reminder message contains a considerable amount of COVID specific content that may be out of date as the organization continues to integrate COVID care workflows into standard practice.
The intervention:
The “call to action” message content that was identified in Phase 1 of the project will now be evaluated in comparison to the current messaging. Additional high-fidelity tracking will be utilized to track how patient groups are assigned and receive text messages over a three-month time period. Messages will be optimized to remove COVID pandemic language, aligning to endemic public health status.
Status:
In progress
Identifying Targets to Mitigate Provider attributable Variation in Critical Care (October 2024)
Investigator:
Nick Ingraham, MD, MS
- Assistant Professor of Pulmonary, Allergy, Critical Care, and Sleep Medicine (PACCS) and Co-Director of C-QODE
The problem:
Over 1 million Americans require mechanical ventilation each year and mortality estimates range from 30-35% with significant variability at the patient, hospital, and regional level. More recently, physicians were found to be associated with mortality in mechanically ventilated patients, adding yet another level of variation. There is little research as to what individual physicians do to cause this variation in outcomes and whether provider practice patterns can be modified to improve outcomes.
To date, morbidity and mortality reduction interventions in this population involve ventilation strategies and harm reduction therapies. Despite these interventions being evidence-based and guideline-supported, their use remains highly variable. The potential link between provider-level variability in mortality and population-level variation in evidence-based practice represents a critical knowledge gap. Specifically, there is a need to understand how physicians’ adherence to evidence-based practices vary, the degree to which this results in harm, and what barriers are modifying practice patterns.
The intervention:
The objective of this project is to develop a pilot intervention and evaluate its acceptability and feasibility at addressing barriers to evidence-based care. The intervention will aim to minimize barriers or leverage underutilized facilitators to low tidal volume ventilation.
Upon completion of this project, it is our expectation that we will have developed and piloted an intervention that the PI can use in a subsequent R01-funded randomized controlled trial and obtained preliminary data to justify funding that trial.
Status:
In progress
Funded Projects
I CAN DO Surgical ACP
We are conducting a multi-center clinical trial to help test different delivery strategies to increase advance care planning in older surgical patients and surgical patients with serious illness receive care that matches their goals and values.