Oral Presentation Session II

Background/Significance:

Waterbirth is a pain management option that promotes physiological birth with limited availability in US hospitals. We conducted the first US-based randomized controlled trial (RCT) of hospital waterbirth, finding it was a viable option for low-risk individuals and reduced use of intravenous narcotics and epidural analgesia while increasing satisfaction. To further support person-centered care, it is important to understand which individuals who planned waterbirth ultimately gave birth in water and how preferences and medical needs shifted during labor.

Purpose:

To identify factors linked to waterbirth tub use during labor and successful delivery in water among those planning a waterbirth.

Methods:

We conducted a secondary analysis of participants who were consented and assigned to the waterbirth arm of our RCT, 1/2022-12/2023. Waterbirth participants were offered standard intrapartum care along with the option of waterbirth. We explored tub entry and delivery in water, examining differences in age, pre-gravid BMI, gestational age, cervical dilation, induction, parity, marital status, race and ethnicity, and educational attainment. Fisher’s exact tests were used for categorical variables; Kruskal–Wallis tests for continuous variables. P values < 0.05 were statistically significant.

Results:

Of 116 waterbirth participants, 68 (58%) entered the tub. Hypertension (n=20) and desire for epidural anesthesia (n=10) were common reasons for not entering the tub. Of those who entered the tub, 41 (61%) gave birth in water. Common reasons for leaving the tub were for epidural analgesia (n=14), required cesarean or operative vaginal birth (n=6). When compared to those who did not enter the tub, tub entrants had a higher gestational age (39.7 vs 38.9 weeks, p<0.01), greater cervical dilation at admission (4.3 vs 2.0 cm, p<0.01), and were less likely to be nulliparous (38% vs 90%, p<0.01). Among tub entrants, those who gave birth in water had greater dilation at admission (4.8 vs 3.6 cm, p=0.02), were older (31.2 vs 27.5 years, p=0.01), less likely to be nulliparous (27% vs 56%, p=0.04), and more likely to be married and have higher educational attainment.

Conclusion:

Tub entry was influenced by the well-being of the laboring person and their pain management decisions, while giving birth in the tub was influenced by sociodemographic characteristics. Future work should evaluate how labor support, clinical decision-making, and structural factors shape equitable access to waterbirth.

Background/Significance:

A Seizure Action Plan (SAP) provides individualized seizure management instructions, including medication administration and emergency protocols. SAPs are inconsistently completed at Advocate Children’s Hospital – Oak Lawn (ACH-OL) leading to missed opportunities for patient/caregiver education and potential safety risks during care transitions.

Purpose:

Using quality improvement (QI) methodology, we aimed to improve the SAP completion rate for patients admitted to ACH-OL with seizure from 13% to 75% between 9/1/2025-12/31/2025.

Methods:

English and Spanish speaking patients 0–18 years admitted to ACH-OL with seizure-related diagnoses (identified by ICD-10 codes) and discharged from a general pediatric service between 9/1/25- 12/31/25 were included. Convenience sampling was done by retrospective chart review. The primary outcome measure was the percentage of seizure encounters with an SAP completed before discharge. Secondarily, we trended days between electronic encounters related to seizure management within 14 days of discharge. The process measure was the percentage of SAPs documented in the correct electronic medical record (EMR) location. Staff perceptions of workflow impact were the balancing measure. Two Plan-Do-Study-Act (PDSA) cycles were implemented. The first was education for pediatric residents and hospitalists. Using feedback from the first cycle, the second cycle optimized the EMR workflow by modifying the SAP dot phrase.

Results:140 seizure-related encounters were reviewed. A statistical process control chart was used to trend the mean percentage of encounters with completed SAPs, which increased from 13% to 67%, indicated by achieving special cause variation after cycle 1. Post discharge electronic encounters remain a rare event, with days between events ranging from 5-69. The percentage of SAPs in the correct EMR location increased from 20% to 80%, identified by a nonrandom shift of data on a run chart after cycle 1. Provider surveys revealed 70% agreed or strongly agreed SAPs improve quality of discharge planning, and 90% agree or feel neutral that SAPs add a manageable amount of time to the discharge process.

Conclusion:Using QI methodology, we increased the SAP completion rate from 13% to 67%. While not yet at our goal of 75% completion, we saw significant improvement through cost effective, easily implementable interventions without negatively impacting staff workflow. Future plans include further EMR optimization.

Background/Significance:

Continuous glucose monitors (CGMs), including Dexcom G7 and FreeStyle Libre 3, improve glycemic control and reduce hypoglycemia in insulin-treated patients with diabetes. Despite strong evidence supporting their use, prescribing CGMs in primary care requires detailed documentation to meet Medicare and commercial insurance criteria. Incomplete documentation and uncertainty regarding eligibility can result in delays, denials, and underutilization. Baseline data within our residency clinics suggested inconsistent prescribing patterns and variability in required documentation. We sought to determine whether implementation of a standardized documentation template combined with resident education would increase CGM prescribing utilization and improve workflow efficiency.

Purpose:

To increase CGM prescribing rates and improve documentation standardization in a large (36-resident) urban family medicine residency program across two clinical sites.

Methods:

We conducted this quality improvement project in a large (36-resident) urban family medicine residency program based across two clinical sites. During the 12-month pre-intervention period (June 1, 2024–June 1, 2025), total outpatient CGM prescriptions were recorded. A standardized smart-phrase was developed within the EMR (Epic), incorporating required documentation elements including insulin administration frequency, most recent hemoglobin A1c (HbA1c), diabetes medications with dosages, confirmation of patient training, insurance verification, and required six-month follow-up language. The intervention also included structured resident education on CGM eligibility and prescribing workflow. Post-intervention prescribing data were collected from June 1, 2025, through February 18, 2026. Prescriptions were normalized by time to compare monthly prescribing rates.

Results:

During the pre-intervention period, 34 CGM prescriptions were generated over 12 months (2.8 prescriptions per month). Following implementation, 41 prescriptions were generated over 8.5 months (4.8 prescriptions per month), representing a 71% increase in monthly CGM prescribing rate. Prescribing distribution among residents became more evenly distributed after intervention, suggesting broader adoption. Providers reported improved clarity regarding documentation requirements and increased confidence in prescribing CGMs.

Conclusion:

Implementation of a standardized EMR (Epic) documentation template combined with resident education was associated with a substantial increase in CGM prescribing.

Background/Significance:

Limited studies have shown that Latino/Hispanic populations have disproportionately low breast and colorectal cancer screening rates in the United States. The role of language barriers on these disparities remains understudied. This project evaluated patient and provider-perceived barriers to breast and colorectal cancer (CRC) screening among Spanish-speaking patients.

Purpose:

Given that 16% of the Milwaukee population is Spanish speaking, this project aimed to identify barriers to cancer screening among Spanish-speaking patients receiving primary care at Aurora Healthcare clinics, to inform strategies to improve screening equity.

Methods:

A cross-sectional survey project was conducted among Spanish-speaking patients due for breast or colorectal cancer screening at three Aurora family practice clinics between January 1, 2021, and November 1, 2024. Surveys were administered by telephone with interpreter support and recorded in REDCap. Provider surveys were distributed electronically and collected anonymously.

Results:

88/181 eligible patients (48.6%) completed one or both surveys. Among women eligible for breast cancer screening, 100% reported understanding the importance of mammography, yet 12.1% had never completed screening. The most frequently reported barriers were cost (37.5%) and fear (31.3%). Among patients eligible for CRC screening, 32.9% reported never completing screening; 29.6% were unfamiliar with colonoscopy, and 62.0% were unaware of alternative screening methods. Fear (36.6%) and cost (26.1%) were also the most frequently reported barriers for CRC screening. Language barrier was reported as a problem for 12.5% of women in the breast cancer screening survey and 12.7% for patients participating in the CRC screening survey. Patient portal utilization was low across groups. 51/226 providers (22.6%) completed the survey. 98% of providers reported recommending cancer screening at similar frequencies for Spanish and English-speaking patients, though over 43% perceived lower CRC screening completion among Spanish-speaking patients.

Conclusion:

Cost, fear, and limited knowledge, rather than language alone, were perceived to be the primary reported barriers to breast and CRC screening among Spanish-speaking patients in our clinics. Targeted patient education, improved cost transparency, and increased support for patient portal enrollment may help reduce screening disparities.

Background/Significance:

Oral cavity cancer has historically been more prevalent in men, largely attributed to tobacco use, alcohol consumption, and human papillomavirus (HPV). Emerging data, however, suggests shifting patterns with a rising disease burden among women. This study aims to identify the age groups of women contributing most to this trend.

Purpose:

To evaluate age-specific incidence trends of oral cavity cancer among women over time.

Methods:

We conducted a retrospective, population-based analysis using data from the Surveillance, Epidemiology, and End Results (SEER) Program, Registry 17. In our analysis, female patients diagnosed with oral cavity cancer between 2000 and 2022 were included. Cases were stratified by age group, and age-adjusted incidence rates were calculated for each group using SEER*Stat software for two time periods: 2000-2010 and 2010-2022. Trends within each age group were assessed using annual percentage change (APC) estimates with 95% confidence intervals (CI). APCs were considered statistically significant if the CI did not cross zero. Analyses were further stratified by tumor behavior to determine contributors to observed incidence trends.

Results:

Women aged 60 years and older accounted for the observed increase in oral cavity cancer incidence among women from 2000 to 2022. A statistically significant rise was observed in this age group from 2010 to 2022 (APC 0.4%; 95% CI 0.1–0.7; p<0.05). While no increase occurred from 2000–2010 (APC 0.2%; 95% CI −0.4–0.7; p=0.05). In contrast, women younger than 60 years did not demonstrate a statistically significant change over the same period (APC 0.1%; 95% CI −0.2–0.5; p=0.05). When stratified by tumor behavior, the increase among women aged 60 years and older was driven primarily by malignant oral cavity cancers (APC 0.4%; 95% CI 0.1–0.8; p<0.05), while benign and in situ lesions showed no significant temporal trends (APC 0.7%; 95% CI −0.7–2.1).

Conclusion:

Our study shows a growing burden of malignant oral cavity cancer among women aged 60 years and older. Compared with prior SEER analyses suggesting increased incidence in women aged 50–64 years, our study refines this to those aged 60 years and older and highlights invasive malignancies as the primary driver. This pattern suggests potential gaps in early detection and underscores the need for age-targeted screening and prevention strategies. Future studies can further explore associations with risk factors particular to middle-aged women such as HPV vaccination and lifestyle exposure.