The RapidEval Unit features the unique opportunity for investigators to be supported in generating high-quality new evidence on healthcare practices. The unit focuses on and fosters rapid, iterative learning that builds upon the natural innovation taking place within the healthcare system. The activities of the RapidEval Unit are aimed at and designed to increase adoption of best practices. The unit features a semi-annual “Call for Proposals” for new research projects. RapidEval is led by Mike Usher, MD, PhD and Nathan Shippee, PhD and receives project management support from Maya Peters, MPH.
Call for Proposals Process
The RapidEval Call for Proposals is currently closed. The next cycle will open in Fall 2022. Email firstname.lastname@example.org to be notified when the next cycle opens.
The Call for Proposals Process consists of the following steps:
- Submission of a brief Letter of Intent form (see draft template)
- Initial submissions will be reviewed for the following key considerations:
- Significant frequency for research to be completed in ~6 months
- Feasible implementation of intervention within 2-3 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
- Selected proposals will be notified and then invited to complete a full application
- Proposal selection and project kickoff. Initial objectives will focus on research design, data availability, and regulatory requirements.
Current Rapid Eval Research Projects
- Improving utilization of cardiac monitoring
- Reducing chemotherapy toxicity
- Improving management of septic patients
- Communication tool for post op pain control
Improving utilization of cardiac monitoring
Using decision aids to improve utilization of cardiac monitoring
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
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 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.
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.
Reducing chemotherapy toxicity
Reducing chemotherapy toxicity in older adults with cancer
Arjun Gupta, MD
Assistant Professor of Medicine, Division of Hematology, Oncology and Transplantation, University of Minnesota
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 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).
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.
Improving management of septic patients
Improving management of septic patients with a micro educational tool
Ben Webber, MD
Assistant Professor of Medicine, Division of General Internal Medicine
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.
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.
Communication tool for post op pain control
Communication tool designed to tailor post op pain control to reduce opiate overuse/dependency
Sagar Deshpande, MD
Surgical Resident, University of Minnesota Medical School
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.
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.