Recent Publications by CFE Educators

OBJECTIVE

Immunocompromised patients with chronic inflammatory disease (CID) may have experienced additional psychosocial burden during the COVID-19 pandemic due to their immunocompromised status. This study was undertaken to determine if vaccination would result in improved patient-reported outcomes longitudinally among individuals with CID undergoing SARS-CoV-2 vaccination regardless of baseline anxiety.

METHODS

Data are from a cohort of individuals with CID from 2 sites who underwent SARS-CoV-2 vaccination. Participants completed 3 study visits before and after 2 messenger RNA vaccine doses in the initial vaccination series when clinical data were collected. Patient-reported outcomes were measured using the Patient-Reported Outcomes Measurement Information System 29-item Health Profile and expressed as T scores, with 2 groups stratified by high and low baseline anxiety. Mixed-effects models were used to examine longitudinal changes, adjusting for age, sex, and study site.

RESULTS

A total of 72% of the cohort was female with a mean ± SD age of 48.1 ± 15.5 years. Overall, sleep disturbance improved following both doses of SARS-CoV-2 vaccinations, and anxiety decreased after the second dose. Physical function scores worsened but did not meet the minimally important difference threshold. When stratifying by baseline anxiety, improvement in anxiety, fatigue, and social participation were greater in the high anxiety group. Physical function worsened slightly in both groups, and sleep disturbance improved significantly in the high anxiety group.

CONCLUSION

Sleep disturbance decreased in a significant and meaningful way in patients with CID upon vaccination. In patients with higher baseline anxiety, social participation increased, and anxiety, fatigue, and sleep disturbance decreased. Overall, results suggest that SARS-CoV-2 vaccination may improve mental health and well-being, particularly among those with greater anxiety.

Background Quality measures help identify gaps and disparities in care delivery and prioritize opportunities to improve health. Calls to enhance Systems-Based Practice and Practice-Based Learning and Improvement competencies for residency training cite the need for quality measures for trainees as central to this effort. The authors sought to demonstrate the feasibility of creating a residency program data visualization dashboard to examine individual and program quality measures for an internal medicine residency program within Kaiser Permanente Northern California. Methods An interactive display was developed to allow for easy visualization of quality and operational measures through an iterative design process. The dashboard displays data for individual residents, residency classes (PGY1-3), and the entire program, including quality measures, systems measures, and patient diagnoses. An iterative process continues to improve the functionality and usefulness of the dashboard. Results It is feasible to create a dashboard to visualize individual and program quality measures and health equity measures for a residency program using a learner-centered approach and alignment with institutional goals through collaboration between education and operational teams. Future studies will examine the audit and feedback process, resident perceptions, and changes to patient outcomes. Conclusion Use of dashboards in graduate medical education is feasible and can be used to help residents and residency programs identify gaps in quality of care.