Michael John Losak

All Publications

• Feasibility of Measuring Smartphone Accelerometry Data During a Weekly Instrumented Timed Up-and-Go Test After Emergency Department Discharge: Prospective Observational Cohort Study. JMIR aging Suffoletto, B., Kim, D., Toth, C., Mayer, W., Glaister, S., Cinkowski, C., Ashenburg, N., Lin, M., Losak, M. 2024; 7: e57601

  Abstract

  Older adults discharged from the emergency department (ED) face elevated risk of falls and functional decline. Smartphones might enable remote monitoring of mobility after ED discharge, yet their application in this context remains underexplored.This study aimed to assess the feasibility of having older adults provide weekly accelerometer data from an instrumented Timed Up-and-Go (TUG) test over an 11-week period after ED discharge.This single-center, prospective, observational, cohort study recruited patients aged 60 years and older from an academic ED. Participants downloaded the GaitMate app to their iPhones that recorded accelerometer data during 11 weekly at-home TUG tests. We measured adherence to TUG test completion, quality of transmitted accelerometer data, and participants' perceptions of the app's usability and safety.Of the 617 approached patients, 149 (24.1%) consented to participate, and of these 149 participants, 9 (6%) dropped out. Overall, participants completed 55.6% (912/1639) of TUG tests. Data quality was optimal in 31.1% (508/1639) of TUG tests. At 3-month follow-up, 83.2% (99/119) of respondents found the app easy to use, and 95% (114/120) felt safe performing the tasks at home. Barriers to adherence included the need for assistance, technical issues with the app, and forgetfulness.The study demonstrates moderate adherence yet high usability and safety for the use of smartphone TUG tests to monitor mobility among older adults after ED discharge. Incomplete TUG test data were common, reflecting challenges in the collection of high-quality longitudinal mobility data in older adults. Identified barriers highlight the need for improvements in user engagement and technology design.

  View details for DOI 10.2196/57601

  View details for PubMedID 39258924

• Mobile application adjunct to the WHO basic emergency care course: a mixed methods study. BMJ open Tenner, A. G., Greenberg, A. L., Nicholaus, P., Rose, C. C., Addo, N., Shari, C. R., Friedman, A., George, U. N., Losak, M. J., Mfinanga, J. A., Sawe, H. R. 2022; 12 (7): e056763

  Abstract

  OBJECTIVES: The WHO developed a 5-day basic emergency care (BEC) course using the traditional lecture format. However, adult learning theory suggests that lecture-based courses alone may not promote long-term knowledge retention. We assessed whether a mobile application adjunct (BEC app) can have positive impact on knowledge acquisition and retention compared with the BEC course alone and evaluated perceptions, acceptability and barriers to adoption of such a tool.DESIGN: Mixed-methods prospective cohort study.PARTICIPANTS: Adult healthcare workers in six health facilities in Tanzania who enrolled in the BEC course and were divided into the control arm (BEC course) or the intervention arm (BEC course plus BEC app).MAIN OUTCOME MEASURES: Changes in knowledge assessment scores, self-efficacy and perceptions of BEC app.RESULTS: 92 enrolees, 46 (50%) in each arm, completed the BEC course. 71 (77%) returned for the 4-month follow-up. Mean test scores were not different between the two arms at any time period. Both arms had significantly improved test scores from enrolment (prior to distribution of materials) to day 1 of the BEC course and from day 1 of BEC course to immediately after BEC course completion. The drop-off in mean scores from immediately after BEC course completion to 4months after course completion was not significant for either arm. No differences were observed between the two arms for any self-efficacy question at any time point. Focus groups revealed five major themes related to BEC app adoption: educational utility, clinical utility, user experience, barriers to access and barriers to use.CONCLUSION: The BEC app was well received, but no differences in knowledge retention and self-efficacy were observed between the two arms and only a very small number of participants reported using the app. Technologic-based, linguistic-based and content-based barriers likely limited its impact.

  View details for DOI 10.1136/bmjopen-2021-056763

  View details for PubMedID 35798522

• Congress Should Provide Student Debt Relief To Frontline Health Care Workers Losak, M., Gowda, V., Rose, C. Health Affairs Forefront. 2022
• COVID-19 has roared back in California. Essential worker protections have not. Losak, M., Rose, C. San Francisco Chronicle. 2022
• Financial Incentives to Enhance Participation of Resident Physicians in Hospital-Based Quality Improvement Projects. Joint Commission journal on quality and patient safety Chen, E. H., Losak, M. J., Hernandez, A., Addo, N., Huen, W., Mercer, M. P. 2021

  Abstract

  Methods to promote successful trainee participation in quality improvement projects are poorly studied. This project studied the effects of a trainee pay-for-performance program and quality improvement education at a safety-net hospital.In this program, trainees worked with quality improvement faculty, participated in projects aligned with the hospital's priorities, and designed their program-specific project. Each trainee who worked at least 88 days in the institution was eligible to earn $400 for every target achieved for at least six months (maximum of $1,200).Among hospitalwide goals, needlestick injuries per quarter decreased from [mean (standard deviation; SD)] 18 (4.6) to 12 (2.6), 95% confidence interval (CI) = -10.1-1.9, p = 0.02; percentage of excellent provider communication improved from 76.8% to [mean (SD)] 80.5% (2.9), 95% CI = 0.8-8.3, p = 0.08; and mean length of stay for discharged emergency department patients requiring specialist consultation decreased from [mean (SD)] 523 (120) to 461 (40) minutes, 95% CI = -162-37.2, p = 0.11. Among resident-initiated projects, the percentage of Family Medicine patients undergoing colorectal screening increased from 65.1% to [mean (SD)] 67.7% (0.4), 95% CI = 1.7-3.5, p = 0.01; percentage of at-risk patients receiving naloxone at hospital discharge increased from 9% to [mean (SD)] 63% (7.2), 95% CI = 36.1-71.9, p = 0.01; percentage of adolescents screened for chlamydia increased from 34% to [mean (SD)] 55.8% (6.4), 95% CI = 5.9-37.6, p = 0.03; and percentage of high-dose opioid prescriptions following cesarean section decreased from 28% to [mean (SD)] 1.7% (2.9), 95% CI = -33.5 to -19.2, p = 0.001. Eleven of 14 programs achieved three goals. All resident-led goals were met.A pay-for-performance improvement program that aligns educational and hospital priorities can provide meaningful experiential learning for trainees and improve patient care.

  View details for DOI 10.1016/j.jcjq.2021.04.004

  View details for PubMedID 34023276