NewYork-Presbyterian Queens/Lang Research Center
The Core Collaboration Team includes Dr. Phyllis August, Dr. Robert Crupi, and Dr. Cynthia Pan from NYP-Queens, Dr. Elizabeth Brondolo from St. John’s University. The CORE team members support all projects. The CHIRP program at NYPQ is funded through a Behavioral Medicine Research Fellowship grant from The Lang Research Institute.
Dr. Joseph Schwartz from Stony Brook (Renaissance Medical School) provides statistical guidance. Dr. Varuna Sundaram from Weill Cornell Medicine, an Attending Surgeon at NewYork-Presbyterian Queens, and Dr. Alison Norfull from Columbia University School of Nursing collaborated on the Frontline Well-Being Study Projects.
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PallComm: Evaluating Training in Palliative Care Communication for Medical Residents
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Project Coordinator: Alexandra Spinelli, M.A.
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alexandra.spinelli18@my.stjohns.edu
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Improving serious illness conversations between patients and providers is critical to facilitate high quality care for patients facing life limiting illness. Previously, we published a paper on AD LAST!, a communication skills training program aimed at healthcare professionals across disciplines (See Pan et al, 2022). The aim of current program of research is to evaluate the effects of an offshoot of AD LAST!, a brief experiential intervention to improve goals of care discussions with patients primarily targeted at medical interns. Participants, including medical interns, receive both didactic training and experiential training using trained actors to promote skills in conducting family meetings around goals of care. The training uses hospital-wide quality improvement goals to focus the communication skills training. The effects of the program on perceived self-efficacy of engaging in ACP related tasks, and perceived distress level with providing EOL care were evaluated.
Working in concert with the NYPQ team (including Drs. Cynthia Pan and Evgenia Livitris), CHIRP Fellows led by Alexandra Spinelli are conducting data analyses and preparing a manuscript presenting the program.
GOComm: Implementing and Evaluating Goals of Care Communication Training Across NYP Sites
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Project Coordinator: Alexandra Spinelli, M.A.
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alexandra.spinelli18@my.stjohns.edu
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GOComm is an interdisciplinary clinical workshop to improve healthcare professionals’ serious illness discussions skills, including advance care planning (ACP) skills and discussing goals of care (GOC). GOComm is an extension of the PallComm and ADLAST workshops, which significantly improved knowledge of ACP & self-efficacy engaging in end-of-life (EOL) communication for interdisciplinary professionals. A GOC and ACP discussion includes opportunities to acknowledge serious illness/EOL, connect emotionally with patients and their families, communicate prognosis, discuss treatment options, and complete advance directives (ADs). Clinicians have reported having fear/discomfort discussing ACP/EOL care due to lack of training/education. The aim of GOComm is to disseminate knowledge and clinical skills to frontline clinicians across all New York-Presbyterian campuses. Working in concert with physicians from NYPQ (including Drs. Cynthia Pan, and Evgenia Livitri), CHIRP Fellows led by Alexandra Spinelli are helping to implement the program and assess outcomes. Analyses will examine changes over time in both participants and in the facilitators.
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COVID-19: Investigating the Hispanic Health Paradox
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Project Coordinator: Patrick Dawid, B.A.
Some health research suggests a Hispanic paradox in the United States, in which most Hispanic groups, even those with low socioeconomic status , have better than expected health and mortality outcomes. Some recent literature has revealed that the coronavirus (COVID-19) pandemic has disproportionately affected Blacks and Hispanics in New York City. While there is greater prevalence of COVID-19 infection among Hispanic populations versus non-Hispanic white populations in NYC, there may still be a group difference in mortality. This project aims to examine data of Hispanic/Latino and non-Hispanic white patients admitted to New York-Presbyterian Queens from 03/15/2020 to 12/31/2020 for COVID-19 and observe mortality from COVID-19 This research aims to investigate the relations of a wide variety of health indicators, neighborhood factors, and presenting symptoms to mortality among Latino/a and White participants. Currently, this project is in an early phase.
Working in concert with physicians from NYPQ and Mt. Sinai (led by Dr. Michael Baek), CHIRP Fellows led by Patrick Dawid are involved in data cleaning and analyses are being planned. CHIRP Fellows also conduct literature reviews on COVID-19 prevalence among different racial/ethnic groups in NYC and methods for their analysis.
Burnout among Frontline Clinical Staff
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Project Coordinator: Rhia Simmons
COVID-19 placed unprecedented demands on frontline healthcare professionals (HCPs). To track the effects of the pandemic on HCP’s burnout and well-being, we developed a brief survey, administered electronically to all HCPs . We monitored participating HCPs every 5 days through the first year of the pandemic. The first two papers from study have been published (see Ju et al, 2022; Pan et al, 2023).
Now we are continuing analyses to examine the effects of redeployment during the crisis on HCP well-being and burnout. In times of crisis, redeployment of healthcare personnel can shift resources to areas in need. However, there are limited data suggesting redeployment may increase risk for mental health symptoms. We collected data from a convenience sample of frontline clinicians every five days for the first year of the COVID-19 pandemic. Analyses which are underway examine acute and prolonged effects of redeployment and investigate differences among professional groups (i.e., nurses, physicians, physician assistants, trainees) in their response to redeployment. Working in concert with physicians from NYPQ, Dr. Aziz Alkattan, CHIRP Fellows conduct qualitative and quantitative analyses and manuscript preparation are underway.
Examining the Associations of Social Determinants of Health to Emergency Department Care and Outcomes
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Project Coordinators: Aimaloghi Eromosele, M.S., and Marcus Joyner, M.A.
aimalogmarcus.joyner21@my.stjohns.edu
marcus.joyner21@my.stjohns.edu
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Social determinants, including individual and neighborhood levels of poverty, racial discrimination and segregation, violence exposure and other factors, are known to contribute to health status and health care access. There is recent evidence that specific social determinants of health (SDOH), including being Black or African American, have been associated with disparities in emergency room treatment and outcomes, including wait times, readmissions, and mortality. This project aims to examine neighborhood factors and constellations of social status variables (e.g., age, gender, race, education) as predictors of emergency department outcomes among patients admitted to NewYork-Presbyterian Queens Hospital. Working in concert with physicians Drs. Manish Sharma, Christine Chen, and Sabrina Rosengarten, CHIRP Fellows led by Aimaloghi Eromosele and Marcus Joyner are examining how clusters of SDOH correlate with poorer outcomes in the emergency department. These findings may guide interventions to improve quality of care. This project is in the planning stages.
Chinese American Physicians’ Perspectives on End-of-life Care
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Project Coordinator: Alexandra Spinelli, M.A.
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There are cultural variations in end-of-life care and in the focus of goals of care conversations. Variations in attitudes towards discussions of death and comfort with the expression of emotion during these discussions may differ between non-Chinese/Asian and Chinese groups. Cultural variations in comfort with patient-provider communication about the end of life may influence care. There is limited research examining factors which influence Chinese physicians’ approach to end-of-life and goals of care communication. This study aims to examine attitudes towards end-of-life communication and beliefs about patient and provider emotional experience and expression among Chinese and non-Chinese physicians. This project is in the planning phase. Working in concert with physicians, including Dr. Cynthia Pan, Robert Crupi, and Phyllis August, CHIRP Fellows led by Alexandra Spinelli, MA are developing the study.
BIPAP: Investigating Plan-Do-Study Act Approaches to Decreasing Length of Time on Non-invasive Ventilation
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Project Coordinator: Ashley Rottkamp, M.S.
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Bilevel Positive Airway Pressure (BiPAP) is a noninvasive form of ventilation (NIV). Research shows BiPAP is an effective “bridging” treatment for patients presenting with diseases/failures of or related to the lungs and heart, however, it can also have adverse consequences. NYPQ initiated a quality improvement project to investigate the effectiveness of a Plan-Do-Study-Act (PDSA) program to reduce the number of days patients spent on BiPAP. Analyses based on 2015-2019 data compare the effects of each of the PDSA cycles (including education, administrative changes, consultation, and interprofessional empowerment) on length of time on BiPAP. The data suggest the length of days were reduced to the desired levels.
Working in concert with physicians from NYPQ (led by Dr. Calvin Hwang), CHIRP Fellows led by Ashley Rottkamp, MA analyzed data and are preparing a manuscript. New studies to investigate the duration of these effects are underway.