Academic literature on the topic 'Baystate Medical Center'

Abstract Baystate is the largest health system in Western Massachusetts with 4 hospitals, 3 Community Health Centers (CHCs) and a large primary care network. Baystate Medical Center (BMC) is in Springfield, Massachusetts. BMC and the CHCs were the first health care sites nationally to be recognized by the Institute for Healthcare Improvement as “Committed to Care Excellence” in the age friendly movement. Collaboration with a city-wide coalition of community-based organizations led to simultaneous recognition of Baystate as “age friendly” and recognition of the city as both dementia and age friendly. The 3 awards were presented at a Springfield senior center with media coverage and the participation of the mayor and other political leaders. This collaboration persists and the GWEP and coalition partners continue to participate in multiple joint educational and community outreach projects. As a result, the city coalition has added health care to its initial focus on housing and transportation.

Abstract Objectives: With the publication of updated guidelines for care of transgender and gender non-conforming individuals, there has been an increase in the presence of gender diversity in both mainstream media and medical literature. Several gaps currently exist in medical knowledge regarding long term effects of gender-affirming therapies. There is a lack of standardization in study design, patient sampling, and outcome measures, and most studies are retrospective. Here we describe the creation of both a retrospective and prospective repository of patients who presented to the Massachusetts Medical School-Baystate Medical Center (UMass-Baystate) pediatric gender program. Methods: Baystate Medical Center is located in western MA and is a tertiary referral center. A pediatric gender clinic was created in 2014. A repository containing both retrospective and prospective data was approved by the UMass-Baystate IRB to include patients ages 2 to 24 years of age who presented to our gender clinic. Retrospective data was obtained using the McKesson billing database. Sociodemographic, clinical and behavioral health data were collected. We are consenting individuals as they present to the clinic for the prospective component. Those that have consented fill out a survey at each visit. The repository has been approved to follow outcome data for 25 years. Results: To date, we have 218 individuals in the repository, 75 of which are in the prospective component. Age of presentation ranged from 6 yrs to 24 yrs with an average age of 15 yrs. 62% identified as transmale, 31% as transfemale and the remainder as gender fluid or other. 75% have been prescribed gender affirming hormone therapy (56% GnRH agonist therapy, 20% estrogen, 58% testosterone). Of those being followed prospectively, 76% identified as white, 19% Hispanic. 79% were satisfied or very satisfied with their care. Conclusions: Here we describe the demographic and clinical characteristics of patients that have presented to our gender clinic since 2014. The creation of our gender repository will allow us to assess sociodemographic, clinical and behavioral health outcomes of treatment, including metabolic parameters, bone health, and mental health outcomes in our pediatric population. Future projects include assessment of the change in cardiovascular risk in individuals on gender-affirming hormone therapy.

Abstract Objectives: Several recent publications have described the lack of education in transgender health care among providers across all levels of medical training. Here we describe a QI project that developed and implemented a transgender health care curriculum for the University of Massachusetts Medical School-Baystate Medical Center (UMass-Baystate) pediatric and combined internal medicine-pediatrics residency programs. Methods: We designed a curriculum for the UMass-Baystate pediatric (9 residents/yr) and med-peds (8 residents/yr) residency programs. The curriculum included grand rounds presentations on transgender health care, didactic sessions integrated into the residents’ protected educational time throughout the academic year, and a panel discussion with non-binary and transgender individuals from the community. The didactic sessions included a mixture of lectures, role- playing, and case-based discussion. The curriculum development was guided by a curriculum design specialist and adapted each year based on feedback. Residents’ self- reported comfort and competency level were assessed through a survey at baseline and at the end of each year. Results: Ninety-eight percent (42/43) completed the baseline survey. Forty percent (17/42) had received no formal training in medical school, and 21% (9/42) had never taken care of a transgender patient. At baseline, 62% felt a little less comfortable and 50% felt somewhat competent, 2.4% very competent caring for transgender individuals compared to cisgender individuals. After three years, 25% felt a little less comfortable and 44% felt somewhat competent, 19% felt very competent caring for transgender individuals compared ot cisgender individuals. The community panel was very well received. Free text comments regarding the curriculum included “very helpful,” “loved the panel,” “clinically relevant.” Conclusions: This QI initiative served as the groundwork for the development of a formal curriculum to enhance medical education among residents in caring for transgender individuals. After three years, residents felt more comfortable and competent in caring for transgender individuals as compared to the baseline survey. We will continue to adapt the curriculum as it continues. The curriculum has expanded to include the pediatric nurses and the UMass medical students.

In October of 2005, a two-day conference, “Controversies in End-of-Life Care: Terri Schiavo's Lessons,” was jointly sponsored by Baystate Medical Center and the Smith College School for Social Work. Both the conference and this special issue of the journal are prompted by recognition that the Schiavo case has clearly generated considerable national attention, and it consequently offers palliative medicine, social work, psychiatry, neurology, and allied disciplines a singular opportunity to reflect on our clinical practices and assumptions about the management of catastrophically ill individuals. At the core of the Schiavo case was a bitter family feud, but before it ended, it became a legal battle, a political fight, a disability rights issue, and a macabre media circus. It is heartbreaking that Congress held a midnight session about the health care of one irreparably brain-damaged woman, Terri Schiavo, while ignoring the health crisis of 40 million uninsured Americans (Friedman, 2005).

This past fall (October 2005), my good friend and colleague Lewis Cohen, M.D., of Baystate Medical Center, helped organize a unique conference (cosponsored by the Smith College of Social Work) that represented an early attempt by psychosocial palliative care clinicians, ethicists, and legal experts to grapple with the issues raised by the Terri Schiavo case, which had so captured the attention of the nation and raised tremendous disagreement and debate. As editor-in-chief of Palliative & Supportive Care, I was, of course, quite thrilled when Dr. Cohen proposed the possibility of our journal publishing the main papers from this unique and timely conference. As the readers of Palliative & Supportive Care will recall, this journal has expressed the opinion that the case of Terri Schiavo represented a watershed event in palliative care practice and research (Breitbart, 2005), and we called for more research into the experience of patients who die of dehydration. Of course, the issues raised by the Schiavo case are so much broader and do, in fact, range from palliative care practice and research to ethics and spiritual issues to legal issues regarding decision making at the end of life.

Abstract Introduction Uncontrolled sleep-disordered breathing (SDB) and hypoventilation, which are common in COPD, CHF and obesity hypoventilation patients can lead to death and readmissions. It is unknown whether inpatient sleep studies to diagnose and optimize treatment improve care and prevent readmissions. Methods All patients > 18 years old with sleep studies while inpatient at Baystate Medical Center between October 2015 and September 2017 were included. Patient characteristics, comorbidities, sleep study diagnoses, and treatment recommendations were evaluated. Admission (inpatient or observation) and death rates were determined for 1-year before admit date and 1-year after discharge date of index admission. Results 326 adult inpatients had 120 portable and 304 in-laboratory tests performed. Average age was 62.9±14.4, mean BMI was 37.2±12.3 and 56% were male. Principal diagnoses were CHF (50%), COPD (39%), both COPD and CHF (20%) and obesity hypoventilation (27%). 31 used PAP and 71 used oxygen prior to admission. Sleep diagnoses included OSA (73%), central sleep apnea (CSA) (29%), treatment emergent CSA (8%), hypoxia (48%), hypoventilation (41%), and normal or non-diagnostic (6%). Treatment recommendations included CPAP (25%), BiPAP (18%), BiPAP ST (3%), ASV (4%), iVAPS (22%), oxygen only (5%) and further titration (20%). The average length of stay was 11.6 ± 9.6 days. There was no difference in the percentage of patients who had an admission before or after their sleep study (53% vs 56%, respectively). In addition, no difference was seen in the median number of admissions before and after the sleep study (median=1.0, IQI=0-2, p=0.77). 90-day readmission rate was 19%. 14% died. Conclusion SDB, hypoxia and hypoventilation were common in inpatients evaluated with sleep studies with PAP therapy recommended in most patients. Further research is needed to determine whether inpatient testing and subsequent treatment can result in decreased readmissions and death. Support None

Objective. The objective of this project was to demonstrate the feasibility and value of collecting harmonized depression outcome measures in the patient registry and health system settings, displaying the outcome measures to clinicians to support individual patient care and population health management, and using the resulting measures data to support patient-centered outcomes research (PCOR). Methods. The harmonized depression outcome measures selected for this project were response, remission, recurrence, suicide ideation and behavior, adverse effects of treatment, and death from suicide. The measures were calculated in the PRIME Registry, sponsored by the American Board of Family Medicine, and PsychPRO, sponsored by the American Psychiatric Association, and displayed on the registry dashboards for the participating pilot sites. At the conclusion of the data collection period (March 2020-March 2021), registry data were analyzed to describe implementation of measurement-based care and outcomes in the primary care and behavioral health care settings. To calculate and display the measures in the health system setting, a Substitutable Medical Apps, Reusable Technology (SMART) on Fast Healthcare Interoperability Resource (FHIR) application was developed and deployed at Baystate Health. Finally a stakeholder panel was convened to develop a prioritized research agenda for PCOR in depression and to provide feedback on the development of a data use and governance toolkit. Results. Calculation of the harmonized outcome measures within the PRIME Registry and PsychPRO was feasible, but technical and operational barriers needed to be overcome to ensure that relevant data were available and that the measures were meaningful to clinicians. Analysis of the registry data demonstrated that the harmonized outcome measures can be used to support PCOR across care settings and data sources. In the health system setting, this project demonstrated that it is technically and operationally feasible to use an open-source app to calculate and display the outcome measures in the clinician’s workflow. Finally, this project produced tools and resources to support future implementations of harmonized measures and use of the resulting data for research, including a prioritized research agenda and data use and governance toolkit. Conclusion. Standardization of outcome measures across patient registries and routine clinical care is an important step toward creating robust, national-level data infrastructure that could serve as the foundation for learning health systems, quality improvement initiatives, and research. This project demonstrated that it is feasible to calculate the harmonized outcome measures for depression in two patient registries and a health system setting, display the results to clinicians to support individual patient management and population health, and use the outcome measures data to support research. This project also assessed the value and burden of capturing the measures in different care settings and created standards-based tools and other resources to support future implementations of harmonized outcome measures in depression and other clinical areas. The findings and lessons learned from this project should serve as a roadmap to guide future implementations of harmonized outcome measures in depression and other clinical areas.