Amy Chang

All Publications

• Clinical Decision Support in the Electronic Health Record: A Primer for Antimicrobial Stewards and Infection Preventionists: Work Smarter so End Users Don’t Work Harder Antimicrobial Stewardship & Healthcare Epidemiology Smith, M., Lee, J. J., Holubar, M., Salinas, J., Sampson, M., Medford, R. J., Chang, A. 2024; 4 (1): e204

  Abstract

  Computerized clinical decision support (CDS) assists healthcare professionals in making decisions to improve patient care. In the realms of antimicrobial stewardship (ASP) and infection prevention (IP) programs, CDS interventions can play a crucial role in optimizing antibiotic prescribing practices, reducing healthcare-associated infections, and promoting diagnostic stewardship when optimally designed. This primer article aims to provide ASP and IP professionals with a practical framework for the development, design, and evaluation of CDS interventions.Large academic medical center design: Established frameworks of CDS evaluation, "Five Rights" of CDS and the "Ten Commandments of Effective Clinical Decision Support", were applied to two real-world examples of CDS tools, a Vancomycin Best Practice Advisory and a Clostridioides Difficile order panel, to demonstrate a structured approach to developing and enhancing the functionality of ASP/IP CDS interventions to promote efficacy and reduce unintended consequences of CDS.By outlining a structured approach for the development and evaluation of CDS interventions, with focus on end user engagement, efficiency and feasibility, ASP and IP professionals can leverage CDS to enhance IP/ASP quality improvement initiatives aimed to improve antibiotic utilization, diagnostic stewardship, and adherence to IP protocols.

  View details for DOI 10.1017/ash.2024.448

  View details for PubMedCentralID PMC11574583

• Sustained Reduction in Urgent Care Antibiotic Prescribing During the Coronavirus Disease 2019 Pandemic: An Academic Medical Center's Experience. Open forum infectious diseases Ha, D., Ong'uti, S., Chang, A., Mui, E., Nelligan, I., Betts, B., Lentz, C., Alegria, W., Fox, E., Meng, L., Stenehjem, E., Hersh, A. L., Deresinski, S., Artandi, M., Holubar, M. 1800; 9 (2): ofab662

  Abstract

  We compared antibiotic prescribing before and during the -coronavirus disease 2019 (COVID-19) pandemic at 2 academic urgent care clinics and found a sustained decrease in prescribing driven by respiratory encounters and despite transitioning to telemedicine. Antibiotics were rarely prescribed during encounters for COVID-19 or COVID-19 symptoms. COVID-19 revealed opportunities for outpatient stewardship programs.

  View details for DOI 10.1093/ofid/ofab662

  View details for PubMedID 35111874

• Strongyloides Hyperinfection After Immunosuppression in an Immigrant From El Salvador A Case for Early Diagnosis and Treatment JCR-JOURNAL OF CLINICAL RHEUMATOLOGY Hoppenfeld, M., Kennedy, V., Sheth, K., Chang, A., Nelson, J., Fairchild, R. 2021; 27 (4): E128-+

  View details for Web of Science ID 000657235500003

• Outpatient hydroxychloroquine prescribing at a large academic health system during the COVID-19 pandemic. Infection control and hospital epidemiology Ha, D. R., Kuo, J., Aung, P. S., Chang, T., Witt, L. G., Alegria, W., Chang, A., Meng, L., Deresinski, S. P. 2020: 1–8

  View details for DOI 10.1017/ice.2020.243

  View details for PubMedID 32412404

• Correction to: Cardiovascular Complications in Patients with COVID-19: Consequences of Viral Toxicities and Host Immune Response. Current cardiology reports Zhu, H., Rhee, J., Cheng, P., Waliany, S., Chang, A., Witteles, R. M., Maecker, H., Davis, M. M., Nguyen, P. K., Wu, S. M. 2020; 22 (5): 36

  Abstract

  It has been pointed out that the second paragraph of the section "Treatments for SARS-CoV-2 Infection" contains an error. The original article has been corrected.

  View details for DOI 10.1007/s11886-020-01302-4

  View details for PubMedID 32405913

• Cardiovascular Complications in Patients with COVID-19: Consequences of Viral Toxicities and Host Immune Response Curr Cardiol Rep Zhu, H., Rhee, J., Cheng, P., Waliany, S., Chang, A., Witteles, R. M., Maecker, H., Davis, M. M., Nguyen, P. K., Wu, S. M. 2020; 22 (5)

  View details for DOI 10.1007/s11886-020-01292-3

• Strongyloides Hyperinfection After Immunosuppression in an Immigrant From El Salvador: A Case for Early Diagnosis and Treatment. Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases Hoppenfeld, M. S., Kennedy, V., Sheth, K., Chang, A., Nelson, J., Fairchild, R. M. 2018

  View details for PubMedID 30074914

• A 36-Year-Old Woman From West Africa With Newly Diagnosed AIDS and a Spinal Cord Mass CLINICAL INFECTIOUS DISEASES Hitchcock, M. M., Aggarwal, I., Chang, A., Weiel, J. J., Szumowski, J. D. 2018; 66 (7): 1147–49

  View details for DOI 10.1093/cid/cix894

  View details for Web of Science ID 000427897000028

• A survey of prognosis discussions held by health-care providers who request palliative care consultation PALLIATIVE MEDICINE Chang, A., Datta-Barua, I., McLaughlin, B., Daly, B. 2014; 28 (4): 312–17

  Abstract

  Patient misunderstandings about prognosis may be related to lack of communication.This study aimed to examine prognosis discussions held with hospitalized patients for whom palliative care consultations were requested, and if prognosis discussions did not occur, to explore why not.This was a survey conducted over the telephone from a convenience sample of health-care providers who requested palliative care consultations. Respondents were asked about whether prognosis had been discussed with the patient and the topics addressed.A total of 65 health-care providers who called to request a consultation from the palliative care team in a large academic medical center in the United States.Of the 65 responses, 45 (69.2%) subjects reported that a prognosis discussion had occurred, while 15 (23.1%) reported that a prognosis discussion had not taken place. Among the surveys reporting a prognosis discussion, a majority of providers responded that most aspects of prognosis were discussed, with the exceptions of life expectancy, survival rates/statistics, and psychosocial concerns. When the prognosis discussion had not occurred, the most common reasons for omitting the prognosis discussion included difficulty in determining prognosis, the perception that the patient already knew his or her prognosis, and the belief that the prognosis discussion was better suited for a different specialty.The results of this study highlight the uncertainty that primary team providers in the academic hospital environment have with prognostication, which is a complex process for which this set of providers, composed primarily of medical trainees and nurses, may not have had sufficient training.

  View details for DOI 10.1177/0269216313514126

  View details for Web of Science ID 000332823900004

  View details for PubMedID 24327660