RapidEval Portfolio

Investigator:

Bethany Sabol, MD, MAS

• Associate Professor, Division of Maternal Fetal Medicine; Physician, Fairview Women & Childrens Service Line, University of Minnesota Medical Center Department of Obstetrics, Gynecology, and Women’s Health

The Problem:

Hypertensive disorders of pregnancy (HDP) affect about 20% of our patients, around 2,800 births each year. These conditions are a major cause of complications and deaths after childbirth, especially because blood pressure usually peaks 3–6 days postpartum, once most patients are already home. Severe spikes can lead to stroke and organ damage, making hypertension the top reason for postpartum readmissions.

To address this, the Home Observation of Postpartum Elevated Blood Pressures (HOPE-BP) program was launched in November 2023 in a subset of Fairview patients. HOPE-BP is a 6-week home monitoring program using MyChart Care Companion. Patients log their blood pressure twice daily and get immediate feedback. The Maternal Fetal Medicine nursing team reviews data and adjusts medication as needed through a remote patient monitoring program. The team is interested in testing HOPE-BP to determine if a full 6-week program is necessary to observe positive patient outcomes, or if a shorter 2-week program would be sufficient for many patients, while also saving resources.

The Intervention:

We are optimizing the HOPE-BP program to better support patients with hypertensive disorders of pregnancy while minimizing resource requirements. This study will evaluate whether a shorter 2-week program is just as effective as the full 6-week program for low-risk patients. Findings from this study will help inform the full health system roll out of the HOPE-BP program.

Status:

Implementation Phase

Investigator:

Nick Ingraham, MD, MS

• Assistant Professor of Pulmonary, Allergy, Critical Care, and Sleep Medicine (PACCS), University of Minnesota

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 was to develop a pilot intervention and evaluate its acceptability and feasibility at addressing barriers to evidence-based care through a pragmatic trial. The intervention aimed to minimize barriers or leverage underutilized facilitators to low tidal volume ventilation.

Outcomes:

Between July 2025 and July 2026, the trial enrolled approximately 1,500 mechanically ventilated patients and leveraged fully automated data collection to support efficient evaluation and implementation. Results are forthcoming and will assess the intervention’s impact on adherence to lung-protective ventilation practices and patient outcomes.

Status:

Analysis and Dissemination Phase

Investigator:

Zachary Kaltenborn, MD

• Assistant Professor of Medicine and Pediatrics, University of Minnesota Medical School

The Problem:

PrEP is highly effective at preventing HIV infection, yet many patients who could benefit from PrEP never receive it. Significant disparities in PrEP access and prescribing continue to contribute to inequities in HIV prevention. Although primary care is increasingly recognized as an important setting for PrEP delivery, providers often face challenges related to workflow integration, medication familiarity, time constraints, and implementation of evolving clinical guidelines. New approaches are needed to help primary care clinicians efficiently identify patients who may benefit from PrEP and expand access to evidence-based HIV prevention services.

The Intervention:

The project implemented an electronic health record (EHR)-based clinical decision support tool designed to simplify PrEP prescribing in primary care. A guideline-based PrEP SmartSet was embedded within a Sexually Transmitted Infection (STI) testing SmartSet, allowing providers to access streamlined recommendations for laboratory testing, medication selection, and prescribing during routine clinical workflows. The intervention also included provider education on updated CDC PrEP guidelines to support broader adoption of HIV prevention services in primary care.

Outcomes:

The project demonstrated that an EHR-based PrEP clinical decision support tool could be successfully implemented across a large primary care network and was associated with increased HIV testing. While PrEP prescribing rates did not significantly increase, the study identified substantial variation in prescribing patterns across clinics and providers, highlighting key opportunities for future interventions. The findings provide important insights into the challenges of expanding PrEP access through primary care and inform future strategies to improve equitable delivery of HIV prevention services.

Status:

Dissemination Phase

Publications:

In Preparation: PrEP in Primary Care: A Pragmatic Cluster Randomized Trial Assessing the Impact of Linking PrEP and STI testing

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 Fairview Health Services 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 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.

Publications:

Osegueda ER, Webber B, Koopmeiners JS, Melton GB, Beebe TJ, Usher MG, Pestka DL. Optimizing sepsis care within a learning health system: qualitatively examining the perspectives of those involved in sepsis care. J Crit Care. 2026 Apr;92:155367. doi: 10.1016/j.jcrc.2025.155367. Epub 2025 Dec 6. PMID: 41354009.

Osegueda ER, Webber B, Mehta T, Pestka DL, Koopmeiners JS, Ninkovic I, Melton GB, Beebe TJ, Usher MG. Lessons Learned from Sepsis Microlearning Intervention. Appl Clin Inform. 2025 Aug;16(4):1165-1171. doi: 10.1055/a-2677-6012. Epub 2025 Sep 26. PMID: 41005753; PMCID: PMC12473517.

Investigator:

Christopher Streib, MD

• Associate Professor, Department of Neurology; Vascular Neurology Fellowship Director, University of Minnesota; Cerebrovascular Director, Fairview Health Services

The Problem:

Stroke is the fifth leading cause of death and number one cause of long-term disability in the United States. Timely diagnostic evaluation and initiation of evidence-based secondary stroke prevention are critical following an acute ischemic stroke, as early intervention can improve outcomes including morbidity and mortality. However, severe shortages of stroke neurologists and limited access to specialty stroke services, particularly in rural and community hospitals, create significant geographic disparities in care. Patients without specialist involvement are less likely to receive comprehensive stroke evaluations and may experience worse outcomes. Frequent transfers to tertiary stroke centers also increase costs and disrupt care for patients and families. These challenges create a critical need for new approaches to deliver expert stroke care regardless of hospital location.

The Intervention:

We implemented an inpatient telestroke program across Fairview hospitals to provide timely access to stroke specialists for hospitalized patients regardless of geographic location. Using a hub-and-spoke telemedicine model, neurologists and stroke advanced practice providers at comprehensive stroke centers performed remote consultations, guided diagnostic evaluations, initiated evidence-based secondary stroke prevention, and collaborated with local hospital teams to optimize stroke care. The program was designed to expand access to specialist expertise, standardize stroke care across hospitals, reduce unnecessary patient transfers, and enable patients to receive high-quality stroke care within their own communities.

Outcomes:

The inpatient telestroke program successfully expanded access to vascular neurology expertise for hospitalized stroke patients across multiple community hospitals. Providers reported improved access to specialist stroke care, greater standardization of evidence-based stroke evaluation and prevention, fewer unnecessary patient transfers, and the ability for patients to receive high-quality care closer to home. The program also reduced burden on local clinicians and identified implementation strategies that can support broader adoption of telemedicine-based specialty care services.

Status:

Dissemination Phase

Publications:

Pestka DL, Boes S, Ramezani S, Peters M, Usher MG, Koopmeiners JS, Beebe TJ, Melton GB, Streib CD. Implementing Telestroke in the Inpatient Setting: Identifying Factors for Success. Stroke. 2024 Jun;55(6):1517-1524. doi: 10.1161/STROKEAHA.123.046024. Epub 2024 Apr 19. PMID: 38639090. 

In Preparation: Evaluating quality of stroke care after implementation of a telestroke program