4 results
RocHealthData.org: Development and usage of a publicly available, geographic source of social determinants of health data
- Kathleen D. Holt, Gretchen Roman, Laura McIntosh, Jamie Kleinsorge, Jeanne Holden-Wiltse, Nancy M. Bennett
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- Journal:
- Journal of Clinical and Translational Science / Volume 8 / Issue 1 / 2024
- Published online by Cambridge University Press:
- 15 February 2024, e41
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Access to local, population specific, and timely data is vital in understanding factors that impact population health. The impact of place (neighborhood, census tract, and city) is particularly important in understanding the Social Determinants of Health. The University of Rochester Medical Center’s Clinical and Translational Science Institute created the web-based tool RocHealthData.org to provide access to thousands of geographically displayed publicly available health-related datasets. The site has also hosted a variety of locally curated datasets (eg., COVID-19 vaccination rates and community-derived health indicators), helping set community priorities and impacting outcomes. Usage statistics (available through Google Analytics) show returning visitors with a lower bounce rate (leaving a site after a single page access) and spent longer at the site than new visitors. Of the currently registered 1033 users, 51.7% were from within our host university, 20.1% were from another educational institution, and 28.2% identified as community members. Our assessments indicate that these data are useful and valued across a variety of domains. Continuing site improvement depends on new sources of locally relevant data, as well as increased usage of data beyond our local region.
Evaluating variation in pre-operative evaluation and planning for children undergoing atrial or ventricular septal defect repair
- Catherine C. Dawson-Gore, Andrew Well, Scott Wallace, Elizabeth Teisberg, Christopher Born, Kathleen Carberry, Erin Gottlieb, Dudley Byron Holt, Charles D. Fraser, Jr., Carlos M. Mery
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- Journal:
- Cardiology in the Young / Volume 34 / Issue 1 / January 2024
- Published online by Cambridge University Press:
- 13 June 2023, pp. 164-170
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Background:
CHD care is resource-intensive. Unwarranted variation in care may increase cost and result in poorer health outcomes. We hypothesise that process variation exists within the pre-operative evaluation and planning process for children undergoing repair of atrial septal defect or ventricular septal defect and that substantial variation occurs in a small number of care points.
Methods:From interviews with staff of an integrated congenital heart centre, an initial process map was constructed. A retrospective chart review of patients with isolated surgical atrial septal defect and ventricular septal defect repair from 7/1/2018 through 11/1/2020 informed revisions of the process map. The map was assessed for points of consistency and variability.
Results:Thirty-two surgical atrial septal defect/ventricular septal defect repair patients were identified. Ten (31%) were reviewed by interventional cardiology before surgical review. Of these, 6(60%) had a failed catheter-based closure and 4 (40%) were deemed inappropriate for catheter-based closure. Thirty (94%) were reviewed in case conference, all attended surgical clinic, and none were admitted prior to surgery. The process map from interviews alone identified surgery rescheduling as a point of major variability; however, chart review revealed this was not as prominent a source of variability as pre-operative interventional cardiology review.
Conclusions:Significant variation in the pre-operative evaluation and planning process for surgical atrial septal defect/ventricular septal defect patients was identified. If such process variation is widespread through CHD care, it may contribute to variations in outcome and cost previously documented within CHD surgery. Future research will focus on determining whether the variation is warranted or unwarranted, associated health outcomes and cost variation attributed to these variations in care processes.
2514: Governance for a decentralized informatics academic environment
- Thomas Fogg, Margaret Demment, Jack Chang, Kathleen Holt, Dongmei Li, Helene McMurray, David Pinto, Timothy De Ver Dye
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- Journal:
- Journal of Clinical and Translational Science / Volume 1 / Issue S1 / September 2017
- Published online by Cambridge University Press:
- 10 May 2018, p. 21
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OBJECTIVES/SPECIFIC AIMS: Due to scope and breadth of research activity and infrastructure capacities at academic medical centers, the discipline of Biomedical Informatics is often deployed in a decentralized manner through geographically dispersed and unrelated organizational units. As a result, without a conscious strategy, an academic medical center risks redundant effort and gaps in resources, and perhaps poor coordination. A mechanism to bring together disparate organizational entities to identify, discuss, and negotiate Informatics-related concerns may produce a better institutional research environment. The University of Rochester (UR) has implemented such a strategy of Informatics governance, adapting tactics from team science, diplomacy, and deliberative engagement. METHODS/STUDY POPULATION: Based on current needs and institutional Informatics priorities, the UR’s Clinical and Translational Science Institute (CTSI) established 6 Informatics “clusters” in distinct but deliberately overlapping focal areas: (1) Data—capture, management, and analysis of all types of data for research. (2) Analytics—quantitative research across the spectrum of translational research. (3) Infrastructure—technical and computing infrastructure to support informatics. (4) Electronic health records (EHR)—(i) features within the EHR explicitly designed to address the needs of research; (ii) accessing and procuring EHR data for research. (5) Population health—Informatics design and systems expertise relevant to population health research (a key CTSI focus area). (6) Education—development, deployment, and assessment of Informatics learning opportunities for learners at all levels. Each cluster facilitates access to expertise and resources around the institution, promotes collaboration, identifies redundancy, and serves as a forum to strategize regarding institutional needs related to Biomedical Informatics. A CTSI faculty or staff member leads each cluster. To maximize effectiveness of the cluster, other members are decision-makers in the organizations they represent, or serve in a critical staff function. Clusters meet in person on a quarterly basis with more frequent electronic interaction. The clusters share documents via Box, a secure online file sharing app. The cluster coordinators meet as a group on a biweekly basis to monitor progress and make plans. RESULTS/ANTICIPATED RESULTS: There were 45 different people representing 46 distinct centers, departments or offices, and 2 outside agencies agreed to participate in the clusters. In total, 20 people represented a single organizational unit; 15 represented 2 units; 8 represented 3 units, and 2 represented 4 units. The richness and complexity of these organizational linkages illustrates the decentralized nature of Informatics at the institution and the promise of the cluster approach. DISCUSSION/SIGNIFICANCE OF IMPACT: Adapting to a decentralized Informatics environment, the CTSI established clusters that recognize and respect autonomy and capacity of a wide range of units throughout the university, creating a collaborative atmosphere for steering and implementing an overall Informatics vision. As Informatics capacity rapidly expands throughout growing biomedical research institutions without a centralized Informatics hub, this distributed, deliberative approach could offer an effective governance solution that promotes cooperation. In this model, the CTSI provides the leadership and staffing necessary to ensure progress at the institutional level around Informatics and creates a venue for communication and coordination on Informatics-related topics.
Resilience in maltreated children: Processes leading to adaptive outcome
- Dante Cicchetti, Fred A. Rogosch, Michael Lynch, Kathleen D. Holt
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- Journal:
- Development and Psychopathology / Volume 5 / Issue 4 / Fall 1993
- Published online by Cambridge University Press:
- 09 September 2009, pp. 629-647
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Evidence for resilience, competent functioning despite severe adversity, was investigated in school-age, disadvantaged maltreated (N = 127) and nonmaltreated (N = 79) children attending a summer camp program. Multiple areas of adaptation (social adjustment, risk for school difficulty, psychopathology) were assessed from self, peer, and camp counselor perspectives and school records. A composite index of adaptive functioning was developed, and levels of competence were delineated. Personality dimensions and personal resources, including cognitive maturity, self-esteem, ego-resiliency, and ego-control, were evaluated as mechanisms promoting individual differences in successful adaptation. Maltreated children as a group evidenced lower overall competence when compared to nonmaltreated children. An equal proportion of maltreated and nonmaltreated children, however, demonstrated high levels of competence, whereas more maltreated children than nonmaltreated children evidenced low levels of competence. Ego-resiliency, ego-control, and self-esteem were each found to predict individual differences in competent functioning. Evidence for the differential role of ego-control in promoting competence for maltreated versus nonmaltreated children was found. The results are discussed in terms of mechanisms contributing to resilient outcomes in maltreated children and the implications of the study of resilience for the field of developmental psychopathology.