RapidEval Portfolio

Investigator:

Zach Lauer, MD

• Medical School, University of Minnesota; Fairview Health Services

The problem:

Point-of-care (POC) blood glucose testing (fingersticks) causes patient discomfort, disrupts sleep, and consumes significant nursing time. Many hospitalized patients placed on sliding scale insulin orders achieve stable blood sugar levels over time but remain on these orders, leading to continued, unnecessary fingerstick monitoring.

The intervention:

To design an effective quality improvement intervention for de-implementing unnecessary POC blood glucose testing, this project conducted 30-minute semi-structured qualitative interviews with care team members across Fairview (including hospitalists, endocrinologists, nurses, and nurse managers). The interviews evaluated current testing perceptions, barriers and facilitators to reducing unnecessary testing, and gathered feedback on interventions to streamline care, improve patient experience, and reduce healthcare costs. These qualitative data will be used to inform and develop a quality improvement intervention.

Status:

Phase 1 - Qualitative: Dissemination phase
Phase 2 - Intervention: Design phase

Investigator:

Diana Langworthy, PharmD

• BCPS Department of Pharmaceutical Care and Health Systems, University of Minnesota College of Pharmacy; Fairview Health Services

The problem:

Historically, serum creatinine (SCr) and the Cockroft-Gault equation have been the standard for estimating renal function in clinical practice, particularly for medication dosing adjustments. However, SCr is prone to inaccuracies in specific patient populations, such as older adults, as well as those who are frail, cachectic, cirrhotic, or have low body weight, muscle wasting, or limb amputations. Cystatin C (CysC) is an evidence-based serum biomarker that provides a more accurate assessment, and recent clinical guidelines from the National Kidney Foundation and KDIGO recommend transitioning toward equations incorporating both SCr and CysC. Despite this emerging evidence, CysC estimates have not been routinely integrated into clinical practice at Fairview Health Services.

The intervention:

To assess and encourage the implementation of evidence-based kidney function equations, qualitative focus groups and one-on-one interviews were conducted with Fairview clinicians and pharmacists. These discussions evaluated current perceptions of CysC use,  foreseeable barriers and facilitators to using CysC estimates, and  provider feedback to inform future interventions and practice guideline updates.

Status:

Data analysis

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:

Alison Galdys, MD

• Assistant Professor, Department of Medicine, University of Minnesota

The Problem:

Clostridium difficile infection (CDI) is a common and potentially serious healthcare-associated infection. However, most hospital-onset diarrhea is not caused by Clostridium difficile (CD), and diagnostic testing cannot distinguish active infection from asymptomatic colonization. Consequently, inappropriate testing can lead to overdiagnosis, unnecessary treatment, increased costs, and delays in identifying the true cause of diarrhea. Although Fairview previously implemented an electronic clinical decision support (CDS) alert to encourage appropriate testing, many patients continued to be tested outside guideline recommendations, suggesting a need for earlier and more effective decision support during the diagnostic evaluation process.

The Intervention:

The team developed an EHR-based diarrhea order set to improve the evaluation of hospitalized patients with diarrhea and promote appropriate CD testing. The order set replaced the previous standalone alert with earlier CDS that incorporated patient-specific data, evidence-based testing criteria, educational content, and management options for diarrhea. The goal was to help clinicians distinguish patients who were appropriate candidates for CD testing from those whose symptoms were likely due to other causes, thereby improving diagnostic stewardship and reducing unnecessary testing.

Outcomes:

The new diarrhea order set did not significantly improve appropriate CD testing or reduce testing rates compared with the existing CDS alert. However, providers reported that the order set improved awareness of testing guidelines, promoted more deliberate clinical evaluation of diarrhea, and served as a valuable educational tool. The project also identified important system, workflow, and cultural barriers that contribute to unnecessary CDI testing, providing critical insights for future diagnostic stewardship efforts aimed at reducing overtesting and improving the accuracy of CDI diagnosis.

Status:

Dissemination phase

Publications:

In preparation: Enhancements to clinical decision support for optimized Clostridioides difficile testing: A pragmatic randomized trial

In preparation: Optimizing Clostridium Difficile testing through an electronic health record order set: A qualitative study of clinician perspectives

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 developed 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 designed and tested various “nudges,” or informational framing schemes, regarding information on opiate weaning and disposal. These nudges instructed patients on how to optimize their pain control, maximize their ability to wean off their opiates, and dispose of their medications safely and legally.

Outcomes:

The OPY program successfully implemented a scalable EHR-integrated digital opioid stewardship intervention across a large health system. Although the randomized trial did not reduce postoperative opioid use, patients reported high levels of satisfaction and found the tool valuable for education, opioid tapering guidance, safe disposal practices, and postoperative support. The project generated important insights regarding the need for clinician engagement, personalized content, and interactive communication to maximize adoption and effectiveness of digital health interventions. These findings are informing the next generation of patient-centered tools designed to improve opioid stewardship and postoperative recovery.

Status:

Dissemination Phase

Publications:

Deshpande S, Gunderson M, Rajamani G, Park S, Diethelm M, Marquard J, Melton G, Rizvi R. Development and Usability Evaluation of an Opioid Management App. Stud Health Technol Inform. 2024 Jan 25;310:976-980. doi: 10.3233/SHTI231110. PMID: 38269954.

Rizvi RF, Schoephoerster JA, Desphande SS, Usher M, Oien AE, Peters MM, Loth MS, Bahr MW, Ventz S, Koopmeiners JS, Melton GB. Decreasing Opioid Addiction and Diversion Using Behavioral Economics Applied Through a Digital Engagement Solution: Protocol for a Randomized Controlled Trial. JMIR Res Protoc. 2024 Mar 8;13:e52882. doi: 10.2196/52882. PMID: 38457203; PMCID: PMC10960208.

In Preparation: An Electronic Health Record Embedded Patient-Facing Behavioral Tool for Postoperative Opioid Stewardship (OPY): A Pragmatic Randomized Controlled Trial

In Preparation: Evaluation of an Opioid Management Tool: A Mixed-Methods Study in a Post-Surgical Outpatient Population

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: 

Shana Steinbeck, PharmD, BCPS

• Clinical Pharmacy Manager, Residency Program Director, Fairview Health Services, Woodwinds Health Campus

The Problem: 

Inpatient pharmacists assess 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 Fairview patients with certain high-risk disease states and/or polypharmacy based on a healthcare system 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, pharmacists cannot routinely assess and successfully 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:

The project integrated two validated screening questions for cost-related medication nonadherence into the electronic health record (EHR) medication reconciliation process used during hospital admissions. Pharmacy staff routinely assessed whether patients had skipped medications because of cost within the past year and documented responses. By embedding medication affordability screening into standard admission workflows, the intervention enabled systematic identification of patients experiencing financial barriers to medication adherence and created an opportunity for targeted support and follow-up services.

Outcomes

Embedding cost-related medication nonadherence screening into routine hospital care successfully identified patients facing medication affordability barriers, many of whom had greater medical complexity, racial disparities, and longer hospital stays. The study highlighted opportunities to improve health equity by standardizing screening, increasing referrals to medication management services, and addressing financial barriers to medication adherence. These findings provide a foundation for integrating medication affordability assessments into routine care as a strategy to improve outcomes and reduce avoidable healthcare utilization.

Status:

Complete

Publications:

Pestka DL, Steinbeck S, Alemayehu N, Koopmeiners JS, Melton GB, Beebe TJ, Usher MG. Assessment of cost-related medication nonadherence during routine hospital-based care: Association with racial disparities and hospital utilization. Am J Health Syst Pharm. 2026 Feb 10;83(4):183-189. doi: 10.1093/ajhp/zxaf191. PMID: 40685655.

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.

View the online tool here.

Outcomes:

A chemotherapy toxicity tool was implemented into the electronic health record to inform patient-oncologist decision-making about whether and what chemotherapy to pursue, and decrease toxicity, primarily unplanned hospitalization. While we did not observe any improvement in outcomes (clinical toxicity, healthcare system burden and cost savings), we gained significant insights into benefits and service challenges that providers experienced with a new clinical decision support tool.

Status:

Complete

Publications:

Johnson WV, Gupta A, Blaes AH, Botsford C, Koopmeiners JS, Beebe TJ, Melton GB, Pestka DL. Oncologist perspectives on the acceptability, appropriateness, and feasibility of the Cancer and Aging Research Group (CARG) chemotherapy toxicity prediction tool for older adults. J Geriatr Oncol. 2025 Sep;16(7):102303. doi: 10.1016/j.jgo.2025.102303. PMID: 40580678.

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

Investigator: 

Brian Hilliard, MD

• Assistant Professor of Medicine, Division of General Internal Medicine, University of Minnesota
• Co-chair, Quality Committee, Hospital Medicine Domain, Fairview Health Services

The Problem: 

Within many hospitals, patient flow is a critical issue which affects patient experience, clinical safety and cost. We observed at Fairview sites that the cardiac monitoring (or telemetry) bed capacity is a bottleneck for patient flow in our system and was being used at high rates beyond that recommended by clinical guidelines. 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 used a multi-faceted approach leveraging clinical decision support aids in the electronic health record (EHR). The decision support provided clearer indications for use of telemetry, with links to evidence based literature within the cardiac monitoring order and an alert which was displayed at the end of the guideline-supported duration for use. 

Outcomes:

The intervention demonstrated that embedding guideline-based decision support within the EHR can meaningfully improve telemetry stewardship. Across multiple hospitals, telemetry utilization decreased, duration of monitoring became more consistent with American Heart Association recommendations, and unnecessary monitoring was reduced. These changes improved telemetry bed availability and patient flow while maintaining patient safety, with no evidence of worsening clinical outcomes. The work established a scalable approach for reducing low-value monitoring, promoting evidence-based practice, and optimizing use of limited hospital resources.

Status:

Complete

Publications:

Bergstedt A, Hilliard B, Alabsi S, Usher MG, Peters M, Grace J, Melton GB, Beebe TJ, Pestka DL. Evaluation of a Clinical Decision Support Tool to Guide Adoption of the American Heart Association Telemetry Monitoring Practice Standards. J Am Heart Assoc. 2024 May 7;13(9):e031523. doi: 10.1161/JAHA.123.031523. PMID: 38686881; PMCID: PMC11179861.

Hilliard B, Mehta T, Grace J, Pestka DL, Ingraham NE, Beebe T, Tignanelli C, Melton GB, Shippee N, Koopmeiners JS, Usher M. Aligning cardiac monitoring with American Heart Association Guidelines: Impact on utilization, hemodynamic monitoring, and outcomes. PLoS One. 2026 Jan 30;21(1):e0338943. doi: 10.1371/journal.pone.0338943. PMID: 41616031; PMCID: PMC12858011.