Health Services Research & Development

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RCS 11-222 – HSR&D Study

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RCS 11-222
Research Career Scientist Award
Sarah L. Krein PhD RN
VA Ann Arbor Healthcare System, Ann Arbor, MI
Ann Arbor, MI
Funding Period: April 2016 - March 2021

BACKGROUND/RATIONALE:
HSR&D Career Scientist awards are intended to support accomplished VA investigators who make exemplary contributions to the VA health services research enterprise, including exercising leadership and mentoring the next generation of VA HSR&D investigators. As such, it is a privilege to have the opportunity to use the skills and expertise I have acquired as a VA health services researcher to not only continue my own research related to patient safety and management of complex, chronic conditions but also support the work of junior investigators and collaborators across VHA to improve the health and health care of Veterans.

OBJECTIVE(S):
The objectives of this award are to use my clinical, content and methodological expertise to: 1) obtain funding, conduct, publish and disseminate high quality research (with two primary areas of focus, patient safety and management of complex chronic conditions); 2) train/mentor early career investigators (particularly in the use of qualitative and mixed-methods and implementation research); 3) work with colleagues and collaborators across the VA; and 4) serve on VA committees and panels (local and national) to support VA research and care delivery.

METHODS:
My research career and focus builds on my clinical background as a nurse, my multidisciplinary health services research training (with concentrations in health economics, research methods and epidemiology) and the interest and expertise I have acquired in the use of qualitative methods and implementation research. Indeed, applying mixed-methods and implementation research techniques to better understand and ultimately improve care delivery with respect to safety, quality and effectiveness has been and continues to be a consistent theme of my research. This includes research designed to reduce risk of harm related to commonly used devices among hospitalized patients, improving infection prevention practices and reducing disease transmission, and improving health care personnel communication. Likewise, I am actively involved in a number of projects focusing on better management of chronic back pain including large-scale implementation work as part of the Improving Pain-Related Outcomes for Veterans (IMPROVE) QUERI program. My mentorship activities similarly focus largely on providing guidance on qualitative, implementation and mixed-methods research across a variety of clinical domains and involve working with both clinician and non-clinician early investigators. I am currently a member of on various VA work groups and committees, locally and nationally, including serving on the leadership council for the VA Ann Arbor Center for Clinical Management Research (CCMR) and as co-director of the CCMR research core, and the VA Ann Arbor Clinical Research Mentorship Program.

FINDINGS/RESULTS:
Not yet available.

IMPACT:
My continuing focus on developing, evaluating and implementing strategies to ensure the safety of hospitalized Veterans has led to tangible improvements in patient care, such as a reduction in rates of catheter-associated urinary tract infection. Moreover, my work related to improving management of Veterans with complex health conditions, such as chronic musculoskeletal pain, continues to play an important role in improving care delivery and health outcomes for Veterans. Finally, my commitment to ensuring the rigorous application of qualitative and mixed-methods and implementation research approaches both in my own work as well as those for whom I serve as a mentor is important in developing and ensuring the application of high-quality evidence to optimize care delivery and outcomes across the VA health care system.

PUBLICATIONS:

Journal Articles

  1. Quinn M, Forman J, Harrod M, Winter S, Fowler KE, Krein SL, Gupta A, Saint S, Singh H, Chopra V. Electronic health records, communication, and data sharing: challenges and opportunities for improving the diagnostic process. Diagnosis (Berlin, Germany). 2019 Aug 27; 6(3):241-248.
  2. Trautner BW, Saint S, Fowler KE, Van J, Rosen T, Colozzi J, Chopra V, Lescinskas E, Krein SL. What do patients say about their experience with urinary catheters and peripherally inserted central catheters? American journal of infection control. 2019 Sep 1; 47(9):1130-1134.
  3. Gregory L, Weston LE, Harrod M, Meddings J, Krein SL. Understanding nurses' workflow: Batching care and potential opportunities for transmission of infectious organisms, a pilot study. American journal of infection control. 2019 May 6.
  4. Saint S, Greene MT, Fowler KE, Ratz D, Patel PK, Meddings J, Krein SL. What US hospitals are currently doing to prevent common device-associated infections: results from a national survey. BMJ quality & safety. 2019 Sep 1; 28(9):741-749.
  5. Umberfield E, Ghaferi AA, Krein SL, Manojlovich M. Using Incident Reports to Assess Communication Failures and Patient Outcomes. Joint Commission Journal on Quality and Patient Safety. 2019 Jun 1; 45(6):406-413.
  6. Forman JH, Robinson CH, Krein SL. Striving toward team-based continuity: provision of same-day access and continuity in academic primary care clinics. BMC health services research. 2019 Mar 4; 19(1):145.
  7. Likosky DS, Harrington SD, Cabrera L, DeLucia A, Chenoweth CE, Krein SL, Thibault D, Zhang M, Matsouaka RA, Strobel RJ, Prager RL. Collaborative Quality Improvement Reduces Postoperative Pneumonia After Isolated Coronary Artery Bypass Grafting Surgery. Circulation. Cardiovascular quality and outcomes. 2018 Nov 1; 11(11):e004756.
  8. Smith ME, Wells EE, Friese CR, Krein SL, Ghaferi AA. Interpersonal And Organizational Dynamics Are Key Drivers Of Failure To Rescue. Health affairs (Project Hope). 2018 Nov 1; 37(11):1870-1876.
  9. Manojlovich M, Hofer TP, Krein SL. Advancing Patient Safety Through the Clinical Application of a Framework Focused on Communication. Journal of Patient Safety. 2018 Oct 31.
  10. Krein SL, Mayer J, Harrod M, Weston LE, Gregory L, Petersen L, Samore MH, Drews FA. Identification and Characterization of Failures in Infectious Agent Transmission Precaution Practices in Hospitals: A Qualitative Study. JAMA internal medicine. 2018 Aug 1; 178(8):1016-1057.
  11. Saint S, Trautner BW, Fowler KE, Colozzi J, Ratz D, Lescinskas E, Hollingsworth JM, Krein SL. A Multicenter Study of Patient-Reported Infectious and Noninfectious Complications Associated With Indwelling Urethral Catheters. JAMA internal medicine. 2018 Aug 1; 178(8):1078-1085.
  12. Vaughn VM, Saint S, Krein SL, Forman JH, Meddings J, Ameling J, Winter S, Townsend W, Chopra V. Characteristics of healthcare organisations struggling to improve quality: results from a systematic review of qualitative studies. BMJ quality & safety. 2019 Jan 1; 28(1):74-84.
  13. Manojlovich M, Frankel RM, Harrod M, Heshmati A, Hofer T, Umberfield E, Krein S. Formative evaluation of the video reflexive ethnography method, as applied to the physician-nurse dyad. BMJ quality & safety. 2019 Feb 1; 28(2):160-166.
  14. Nallamothu BK, Guetterman TC, Harrod M, Kellenberg JE, Lehrich JL, Kronick SL, Krein SL, Iwashyna TJ, Saint S, Chan PS. How Do Resuscitation Teams at Top-Performing Hospitals for In-Hospital Cardiac Arrest Succeed? A Qualitative Study. Circulation. 2018 Jul 10; 138(2):154-163.
  15. Annis AM, Harris M, Kim HM, Rosland AM, Krein SL. Trends in primary care encounters across professional roles in PCMH. The American journal of managed care. 2018 Jul 1; 24(7):e222-e229.
  16. Clack L, Zingg W, Saint S, Casillas A, Touveneau S, da Liberdade Jantarada F, Willi U, van der Kooi T, Damschroder LJ, Forman JH, Harrod M, Krein S, Pittet D, Sax H, PROHIBIT Consortium. Implementing infection prevention practices across European hospitals: an in-depth qualitative assessment. BMJ quality & safety. 2018 Oct 1; 27(10):771-780.
  17. Greene MT, Fowler KE, Ratz D, Krein SL, Bradley SF, Saint S. Changes in Influenza Vaccination Requirements for Health Care Personnel in US Hospitals. JAMA Network Open. 2018 Jun 1; 1(2):e180143.
  18. Krein SL, Greene MT, King B, Welsh D, Fowler KE, Trautner BW, Ratz D, Saint S, Roselle G, Clifton M, Kralovic SM, Martin T, Mody L. Assessing a National Collaborative Program To Prevent Catheter-Associated Urinary Tract Infection in a Veterans Health Administration Nursing Home Cohort. Infection control and hospital epidemiology. 2018 Jul 1; 39(7):820-825.
  19. Becker WC, DeBar LL, Heapy AA, Higgins D, Krein SL, Lisi A, Makris UE, Allen KD. A Research Agenda for Advancing Non-pharmacological Management of Chronic Musculoskeletal Pain: Findings from a VHA State-of-the-art Conference. Journal of general internal medicine. 2018 May 1; 33(Suppl 1):11-15.
  20. Chopra V, Harrod M, Winter S, Forman J, Quinn M, Krein S, Fowler KE, Singh H, Saint S. Focused Ethnography of Diagnosis in Academic Medical Centers. Journal of hospital medicine. 2018 Oct 1; 13(10):668-672.
  21. Kurlander JE, Barnes GD, Anderson MA, Haymart B, Kline-Rogers E, Kaatz S, Saini SD, Krein SL, Richardson CR, Froehlich JB. Mind the gap: results of a multispecialty survey on coordination of care for peri-procedural anticoagulation. Journal of Thrombosis and Thrombolysis. 2018 Apr 1; 45(3):403-409.
  22. Hutton DW, Krein SL, Saint S, Graves N, Kolli A, Lynem R, Mody L. Economic Evaluation of a Catheter-Associated Urinary Tract Infection Prevention Program in Nursing Homes. Journal of the American Geriatrics Society. 2018 Apr 1; 66(4):742-747.
  23. Trautner BW, Prasad P, Grigoryan L, Hysong SJ, Kramer JR, Rajan S, Petersen NJ, Rosen T, Drekonja DM, Graber C, Patel P, Lichtenberger P, Gauthier TP, Wiseman S, Jones M, Sales A, Krein S, Naik AD, Less is More Study Group. Protocol to disseminate a hospital-site controlled intervention using audit and feedback to implement guidelines concerning inappropriate treatment of asymptomatic bacteriuria. Implementation science : IS. 2018 Jan 19; 13(1):16.
  24. Annis AM, Robinson CH, Yankey N, Krein SL, Duffy SA, Taylor B, Sales A. Factors Associated With the Implementation of a Nurse Staffing Directive. The Journal of nursing administration. 2017 Dec 1; 47(12):636-644.
  25. Adams MA, Prenovost KM, Dominitz JA, Holleman RG, Kerr EA, Krein SL, Saini SD, Rubenstein JH. Predictors of Use of Monitored Anesthesia Care for Outpatient Gastrointestinal Endoscopy in a Capitated Payment System. Gastroenterology. 2017 Dec 1; 153(6):1496-1503.e1.
  26. Krein SL, Harrod M, Collier S, Davis KK, Rolle AJ, Fowler KE, Mody L. A national collaborative approach to reduce catheter-associated urinary tract infections in nursing homes: A qualitative assessment. American journal of infection control. 2017 Dec 1; 45(12):1342-1348.
  27. Mody L, Greene MT, Meddings J, Krein SL, McNamara SE, Trautner BW, Ratz D, Stone ND, Min L, Schweon SJ, Rolle AJ, Olmsted RN, Burwen DR, Battles J, Edson B, Saint S. A National Implementation Project to Prevent Catheter-Associated Urinary Tract Infection in Nursing Home Residents. JAMA internal medicine. 2017 Aug 1; 177(8):1154-1162.
  28. Gundlapalli AV, Divita G, Redd A, Carter ME, Ko D, Rubin M, Samore M, Strymish J, Krein S, Gupta K, Sales A, Trautner BW. Detecting the presence of an indwelling urinary catheter and urinary symptoms in hospitalized patients using natural language processing. Journal of Biomedical Informatics. 2017 Jul 1; 71S:S39-S45.
  29. Heapy AA, Higgins DM, Goulet JL, LaChappelle KM, Driscoll MA, Czlapinski RA, Buta E, Piette JD, Krein SL, Kerns RD. Interactive Voice Response-Based Self-management for Chronic Back Pain: The COPES Noninferiority Randomized Trial. JAMA internal medicine. 2017 Jun 1; 177(6):765-773.
  30. Sharpe E, Kuhn L, Ratz D, Krein SL, Chopra V. Neonatal Peripherally Inserted Central Catheter Practices and Providers: Results From the Neonatal PICC1 Survey. Advances in neonatal care : official journal of the National Association of Neonatal Nurses. 2017 Jun 1; 17(3):209-221.
  31. Chopra V, Kuhn L, Ratz D, Winter S, Carr PJ, Paje D, Krein SL. Variation in use of technology among vascular access specialists: an analysis of the PICC1 survey. The journal of vascular access. 2017 May 15; 18(3):243-249.
  32. Krein SL, Greene MT, Apisarnthanarak A, Sakamoto F, Tokuda Y, Sakihama T, Fowler KE, Ratz D, Saint S. Infection Prevention Practices in Japan, Thailand, and the United States: Results From National Surveys. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2017 May 15; 64(suppl_2):S105-S111.
  33. Meddings J, Saint S, Krein SL, Gaies E, Reichert H, Hickner A, McNamara S, Mann JD, Mody L. Systematic Review of Interventions to Reduce Urinary Tract Infection in Nursing Home Residents. Journal of hospital medicine. 2017 May 1; 12(5):356-368.
  34. Skelton F, Campbell B, Horwitz D, Krein S, Sales A, Gundlapalli A, Trautner BW. Developing a user-friendly report for electronically assisted surveillance of catheter-associated urinary tract infection. American journal of infection control. 2017 May 1; 45(5):572-574.
  35. Gilliam M, Krein SL, Belanger K, Fowler KE, Dimcheff DE, Solomon G. Novel combined patient instruction and discharge summary tool improves timeliness of documentation and outpatient provider satisfaction. SAGE open medicine. 2017 Mar 29; 5:2050312117701053.
  36. Krein SL, Kuhn L, Ratz D, Winter S, Vaughn VM, Chopra V. The relationship between perceived role and appropriate use of peripherally inserted central catheters: A survey of vascular access nurses in the United States. International journal of nursing studies. 2017 Jun 1; 71:28-33.
  37. Adams MA, Prenovost KM, Dominitz JA, Kerr EA, Krein SL, Saini SD, Rubenstein JH. National Trends in Use of Monitored Anesthesia Care for Outpatient Gastrointestinal Endoscopy in the Veterans Health Administration. JAMA internal medicine. 2017 Mar 1; 177(3):436-438.
  38. Chopra V, Kuhn L, Ratz D, Shader S, Vaughn VM, Saint S, Krein SL. Vascular Access Specialist Training, Experience, and Practice in the United States: Results From the National PICC1 Survey. Journal of infusion nursing : the official publication of the Infusion Nurses Society. 2017 Jan 1; 40(1):15-25.
  39. Manojlovich M, Ratz D, Miller MA, Krein SL. Use of Daily Interruption of Sedation and Early Mobility in US Hospitals. Journal of nursing care quality. 2017 Jan 1; 32(1):71-76.
  40. Mody L, Greene MT, Saint S, Meddings J, Trautner BW, Wald HL, Crnich C, Banaszak-Holl J, McNamara SE, King BJ, Hogikyan R, Edson BS, Krein SL. Comparing Catheter-Associated Urinary Tract Infection Prevention Programs Between Veterans Affairs Nursing Homes and Non-Veterans Affairs Nursing Homes. Infection control and hospital epidemiology. 2017 Mar 1; 38(3):287-293.
  41. Zubkoff L, Neily J, King BJ, Dellefield ME, Krein S, Young-Xu Y, Boar S, Mills PD. Virtual Breakthrough Series, Part 1: Preventing Catheter-Associated Urinary Tract Infection and Hospital-Acquired Pressure Ulcers in the Veterans Health Administration. Joint Commission Journal on Quality and Patient Safety. 2016 Nov 9; 42(11):485-AP2.
  42. Trautner BW, Greene MT, Krein SL, Wald HL, Saint S, Rolle AJ, McNamara S, Edson BS, Mody L. Infection Prevention and Antimicrobial Stewardship Knowledge for Selected Infections Among Nursing Home Personnel. Infection control and hospital epidemiology. 2017 Jan 1; 38(1):83-88.
  43. Heapy AA, Higgins DM, LaChappelle KM, Kirlin J, Goulet JL, Czlapinski RA, Buta E, Piette JD, Krein SL, Richardson CR, Kerns RD. Cooperative pain education and self-management (COPES): study design and protocol of a randomized non-inferiority trial of an interactive voice response-based self-management intervention for chronic low back pain. BMC musculoskeletal disorders. 2016 Feb 16; 17:85.
Journal Other

  1. Evans CT, Jump RL, Krein SL, Bradley SF, Crnich CJ, Gupta K, Perencevich EN, Vander Weg MW, Morgan DJ. Setting a Research Agenda in Prevention of Healthcare-Associated Infections (HAIs) and Multidrug-Resistant Organisms (MDROs) Outside of Acute Care Settings. Infection control and hospital epidemiology. 2018 Feb 1; 39(2):210-213.
  2. Quinn M, Robinson C, Forman J, Krein SL, Rosland AM. Survey Instruments to Assess Patient Experiences With Access and Coordination Across Health Care Settings: Available and Needed Measures. Medical care. 2017 Jul 1; 55 Suppl 7 Suppl 1:S84-S91.
VA Cyberseminars

  1. Krein SL. Notes to Your Future Self: Data Documentation and Data Planning Throughout the Research. Planning for Data: Early, Often and Ongoing [Cyberseminar]. AcademyHealth 2017 Annual Research Meeting. 2017 Jun 25.
  2. Saint SK, Krein SL, Meddings J. Enhancing Patient Safety by Preventing Device-Associated Harm. [Cyberseminar]. 2017 Jan 12.


DRA: Health Systems
DRE: none
Keywords: Capacity Building
MeSH Terms: none