Jessica Keim-Malpass

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Verified

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• Doctor of Philosophy
• Professor (Associate) at University of Virginia

Background: This pragmatic randomized controlled trial aimed to assess the effect of a passive display of artificial intelligence (AI)-based predictive analytics on hours free of clinical deterioration events among medical and surgical patients in an acute care cardiology medical-surgical ward. Methods: 10,422 inpatient visits were randomly assigne...

Background A pulse oximetry warning system (POWS) to analyze heart rate and oxygen saturation data and predict risk of sepsis was developed for very low birth weight (VLBW) infants. Methods We determined the clinical correlates and positive predictive value (PPV) of a high POWS score in VLBW infants. In a two-NICU retrospective study, we identifie...

101 Background: Prognostic assessment in HR+ HER2- early breast cancer (EBC) remains challenging given relatively low rates of disease progression. Modern artificial intelligence (AI)-based techniques have already provided substantial medical progress, particularly in prostate cancer. We have leveraged ArteraAI’s multimodal artificial intelligence...

Very few predictive models have been externally validated in a prospective cohort following the implementation of an artificial intelligence analytic system. This type of real-world validation is critically important due to the risk of data drift, or changes in data definitions or clinical practices over time, that could impact model performance in...

Background Children with medical complexity represent a heterogeneous group of children with multiple chronic health care conditions. Caregivers of children with medical complexity experience a high intensity of caregiving that is often variable, extends across several networks of care, and often lasts for the entirety of the child’s life. The spil...

BACKGROUND Children with medical complexity (CMC) represent a heterogeneous group of children with multiple, chronic healthcare conditions. Caregivers of CMC experience a high intensity of caregiving that is often variable, extends across several networks of care, and often lasts for the entirety of the child’s life. The economic impacts of caregiv...

Background: Prognostic assessment in HR+ HER2- early breast cancer (EBC) remains challenging given relatively low rates of disease progression. Nuanced risk stratification is needed for decisions regarding systemic therapy. Modern artificial intelligence (AI)-based techniques have already provided substantial medical progress, particularly in prost...

Objective The study aimed to characterize the experiences of primary caregivers of children with medical complexity (CMC) in engaging with other members of the child’s caregiving network, thereby informing the design of health information technology (IT) for the caregiving network. Caregiving networks include friends, family, community members, and...

Introduction Respiratory failure is a common organ failure syndrome in hospitalized patients ¹ . Vital sign monitoring (like respiratory rate & oximetry) is a necessary aspect of risk stratification, but it is not sufficient. In one study of hospitalized patients, 46% of the patients had no significant vital sign change in the 24 hours before an un...

Very few predictive models have been externally validated in a prospective cohort following the implementation of an artificial intelligence analytic system. This type of real-world validation is critically important due to the risk of data drift, or changes in data definitions or clinical practices over time, that could impact model performance in...

Background Persons diagnosed with serious chronic illnesses and their caretakers experience multiple types of financial costs that strain their income and generate financial distress. Many turn to medical crowdfunding (MCF) to mitigate the harms of these costs on their health and quality of life. Objective This scoping review aims to summarize the...

There has been an increased focus on the practices associated with dissemination for the translation of research to clinical practice and ultimately, policy. Simultaneously, there has been attention placed on the role of the clinical research workforce in supporting optimal dissemination efforts for impact and societal benefit. Curriculums focused...

Background: Caregivers of children with medical complexity (CMC) navigate complex family management tasks for their child both in the hospital and home-based setting. The roles and relationships of members of their social network and the dynamic evolution of these family management tasks have been underexamined. Objective: The purpose of this st...

BACKGROUND Caregivers of children with medical complexity (CMC) navigate complex family management tasks for their child both in the hospital and home-based setting. The roles and relationships of members of their social network and the dynamic evolution of these family management tasks have been underexamined. OBJECTIVE The purpose of this study...

There has been an increased focus on the practices associated with dissemination for the translation of clinical research to practice and ultimately, policy. Simultaneously, there has been attention placed on the role of the clinical research workforce in supporting optimal dissemination efforts for impact and societal benefit. Curriculums focused...

Introduction We characterized the challenges and innovations of states’ Ryan White HIV/AIDS Program (RWHAP) Part B programs, including AIDS Drug Assistance Programs (ADAPs), during the COVID-19 pandemic. In the United States, these are important safety net programs for HIV healthcare, providing essential medical and support services, and medication...

The COVID-19 pandemic has led to numerous delays in cancer-related care and cancer-specific screening, but the extent is not fully understood. For those that experience a delay or disruption in care, health related self-management is required to re-engage in care pathways and the role of health literacy in this pathway has not been explored. The pu...

Objectives: The authors' objective is to present an overarching framework of an analytic ecosystem using diverse data domains and data science approaches that can be used and implemented across the cancer continuum. Analytic ecosystems can improve quality practices and offer enhanced anticipatory guidance in the era of precision oncology nursing....

Long driving times from hospice providers to patients lead to poor quality of care, which may exacerbate in rural and highly isolated areas of Appalachia. This study aimed to investigate geographic patterns of pediatric hospice care across Appalachia. Using person-level Medicaid claims of 1,788 pediatric hospice enrollees who resided in the Appalac...

Background Pediatric clinical trials are particularly vulnerable to challenges in participant accrual, making them more likely to encounter early termination. Objective To describe clinical trial characteristics of phase 1 pediatric oncology clinical trials registered in ClinicalTrials.gov through 2017. Method We identified a retrospective cohort...

Instrumental variable analysis (IVA) has been widely used in many fields, including health care, to determine the comparative effectiveness of a treatment, intervention, or policy. However, its application in pediatric end-of-life care research has been limited. This article provides a brief overview of IVA and its assumptions. It illustrates the u...

Currently, little is known about how geographic information systems (GIS) has been utilized to study end-of-life care in pediatric populations. The purpose of this review was to collect and examine the existing evidence on how GIS methods have been used in pediatric end-of-life research over the last 20 years. Scoping review method was used to summ...

Sepsis is a significant cause of mortality among people living with human immunodeficiency virus (HIV) in sub-Saharan Africa. In the planning period prior to the start of a large multi-country clinical trial studying the efficacy of the immediate empiric addition of anti-tuberculosis therapy to standard-of-care antibiotics for sepsis in people livi...

BACKGROUND Persons diagnosed with serious chronic illnesses and their caretakers experience multiple types of financial costs that strain their income and generate financial distress. Many turn to medical crowdfunding (MCF) to mitigate the harms of these costs on their health and quality of life. OBJECTIVE This scoping review aims to summarize the...

The idea that we can detect subacute potentially catastrophic illness earlier by using statistical models trained on clinical data is now well-established. We review evidence that supports the role of continuous cardiorespiratory monitoring in these predictive analytics monitoring tools. In particular, we review how continuous ECG monitoring reflec...

Background: Children aged 5-14 years who are household contacts of index pulmonary TB cases have limited coverage for TB preventive therapy (TPT) due to variable uptake of the national guideline recommendations in the Philippines. We conducted a cost effectiveness analysis evaluating the expansion of latent TB testing and treatment among pediatric...

Given that pediatric concurrent hospice care has been available for more than a decade, it is appropriate to seek an understanding of the value of this care delivery approach. Value is the cost associated with achieving beneficial health outcomes. In pursuit of this goal, the current literature on pediatric concurrent hospice care was synthesized a...

The COVID-19 pandemic has led to numerous delays in cancer-related care and cancer-specific screening, but the extent is not fully understood. For those that experience a delay or disruption in care, health related self-management is required to re-engage in care pathways and the role of health literacy in this pathway has not been explored. The pu...

Acute respiratory failure requiring the initiation of invasive mechanical ventilation remains commonplace in the pediatric intensive care unit (PICU). Early recognition of patients at risk for respiratory failure may provide clinicians with the opportunity to intervene and potentially improve outcomes. Through the development of a random forest mod...

Problem: Many states cover mental health home and community-based services (HCBS) for youth through 1915(c) Medicaid HCBS waivers that allow states to waive certain Medicaid eligibility criteria and define high-risk populations based on age, medical condition(s), and disability status. We sought to evaluate how States are covering children and ado...

Purpose: Considering growing disparities in health outcomes between rural and urban areas of Appalachia, this study compared the incremental Medicaid costs of pediatric concurrent care (implemented by the Patient Protection and Affordable Care Act) versus standard hospice care. Methods: Data on 1,788 pediatric hospice patients, from the Appalach...

Purpose Cervical cancer screening (CCS) rates are lower for foreign-born women in the United States (U.S.) compared with the overall population. This study aimed to determine the CCS rate and predictors among refugees who were identified as female attending a family medicine clinic. Methods A retrospective chart review included refugee individuals...

As the informatics community grows in its ability to address health disparities, there is an opportunity to expand our impact by focusing on the disability community as a health disparity population. Although informaticians have primarily catered design efforts to one disability at a time, digital health technologies can be enhanced by approaching...

As part of the Ryan White HIV/AIDs Program, the federally-funded, state-administered AIDS Drug Assistance Program (ADAP) provides prescription drug medications, including antiretroviral therapy, for people with HIV (PWH) who are uninsured/underinsured and have a low income. ADAP expenditures are ∼$2.4 billion annually, but there is a dearth of form...

Introduction Artificial‐intelligence (AI)‐based predictive analytics provide new opportunities to leverage rich sources of continuous data to improve patient care through early warning of the risk of clinical deterioration and improved situational awareness.Part of the success of predictive analytic implementation relies on integration of the analy...

Background Asthma is a disease with tremendous phenotypic heterogeneity, and the patients who are most severely impacted by the disease are high utilizers of the United States healthcare system. In the past decade, there has been many advances in asthma therapy for those with severe disease, including the use of a procedure called bronchial thermop...

Nursing science contributes to advancements in patient care, public health, and innovation within numerous scientific domains. Despite commonality with United States Department of Education definitions of a science, technology, engineering, and mathematics (STEM) educational programs, nursing continues to be excluded from Department of Homeland Sec...

Background: Implementation of concurrent hospice care led to a new hybrid payment model that combines hospice payments with payments for non-hospice medical care. Little is known about the cost implications of this new hybrid payment model. Objective: The purpose was to identify costs and compare concurrent care and standard hospice care costs b...

UNSTRUCTURED n/a - Research letter

Purpose: Infants with single ventricle physiology experience numerous vulnerable transitions, and the interstage period for shunt-dependent children represents the time of highest risk for morbidity and mortality. Data exchange, physiological monitoring, and communication between clinicians and caregivers through interstage home monitoring are cri...

Illness dynamics and patterns of recovery may be essential features in understanding the critical illness course. We propose a method to characterize individual illness dynamics in patients who experienced sepsis in the pediatric intensive care unit. We defined illness states based on illness severity scores generated from a multi-variable predicti...

Objective: The goal of this study was to compare rural and urban pediatric hospice patients in Appalachia. Methods: Using a retrospective, nonexperimental design, we sought to compare characteristics of Appalachian rural and urban children younger than 21 years enrolled in the Medicaid hospice benefit. Descriptive statistics were calculated on t...

Purpose: Adolescents and young adults (AYA) with advanced cancer have unequal access to and enrollment in clinical trials. Many AYA use online platforms to share their treatment experiences. The purpose of this analysis was to explore how AYA discuss clinical trials and their access to novel therapeutics through their blogs. Methods: We studied ill...

Motor disability is common in children born preterm. Interventions focusing on environmental enrichment and emotional connection can positively impact outcomes. The NICU-based rehabilitation (NeoRehab) program consists of evidence-based interventions provided by a parent in addition to usual care. The program combines positive sensory experiences (...

Using a sample of 18,152 pediatric hospice patients, this study assessed the cost-effectiveness of concurrent care over standard hospice care. Analysis of incremental cost-effectiveness ratios with bootstrapping simulations showed that concurrent care was more effective but at a higher cost.

Background: Families increasingly desire to bring their children home from the acute care setting at end of life. This transition includes home to rural or remote areas. Little is known about the end-of-life care for children who reside in rural areas. Objective: The purpose of this study was to comprehensively review and summarize the evidence...

Background The 2010 Patient Protection and Affordable Care Act (ACA) mandated landmark hospice care legislation for children at end of life. Little is known about the impact of pediatric concurrent hospice care. Objective The purpose of this study was to examine the effect of pediatric concurrent vs standard hospice care on end-of-life care contin...

Constipation is a distressing and uncomfortable symptom children experience at end of life. There is a gap in knowledge about how different approaches to hospice care delivery might improve pediatric symptom management of constipation. The purpose of this study was to evaluate the effectiveness of pediatric concurrent hospice versus standard hospic...

As the global response to COVID-19 continues, nurses will be tasked with appropriately triaging patients, responding to events of clinical deterioration, and developing family-centered plans of care within a healthcare system exceeding capacity. Predictive analytics monitoring, an artificial intelligence (AI)-based tool that translates streaming cl...

Background Moral distress is recognized as a problem affecting healthcare professionals globally. Unaddressed moral distress may lead to withdrawal from the moral dimensions of patient care, burnout, or leaving the profession. Despite the importance, studies related to moral distress are scant in Thailand. Objective This study aims to describe the...

Objective The purpose of this ethnographic study was to evaluate the cultural impacts of an emergency department (ED) move from an old to new physical space. Method Fieldwork was conducted over 14 months at an academic medical center ED in the United States. Primary data sources included participant observations and semistructured interviews. R...

Objective: Burnout is a public health crisis that impacts 1 in 3 registered nurses in the United States and the safe provision of patient care. This study sought to understand the cost of nurse burnout-attributed turnover using hypothetical hospital scenarios. Methods: A cost-consequence analysis with a Markov model structure was used to assess...

Pediatric sepsis is a heterogeneous disease with varying physiological dynamics associated with recovery, disability, and mortality. Using risk scores generated from a sepsis prediction model to define illness states, we used Markov chain modeling to describe disease dynamics over time by describing how children transition among illness states. We...

Background: Given the large numbers of people with HIV (PWH) with Medicaid coverage, it's important to understand the patient experience with Medicaid. Understanding experiences with and attitudes around the program have important policy and clinical implications. The objective was to understand the patient perspective of PWH in Virginia who trans...

Children with cerebral palsy (CP) often experience distressing symptoms. It is estimated that 3 in 4 have chronic pain and 1 in 5 have a sleep disorder, with the highest frequency and severity occurring in children with the greatest impairment. Sleep impairment and pain can adversely impact activities, participation and quality of life; however, pr...

Objective: To explore the relationship between well child visit (WCV) attendance during early childhood and age at autism spectrum disorder (ASD) diagnosis using data drawn from a statewide all-payer claims database. Study design: We used a correlational study design with longitudinal data drawn from the Virginia All-Payer Claims Database. All c...

Beaulieu-Jones and coworkers propose a litmus test for the field of predictive analytics-performance improvements must be demonstrated to be the result of non-clinician-initiated data, otherwise, there should be caution in assuming that predictive models could improve clinical decision-making (Beaulieu-Joneset al2021). They demonstrate substantial...

Background: Motor disability is common in children born preterm. Interventions focusing on environmental enrichment and emotional connection can positively impact outcomes. The NICU-based rehabilitation (NeoRehab) program consists of evidence-based interventions provided by a parent in addition to usual care. The program combines positive sensory e...

Background: Medical errors were largely concealed prior to the landmark report “To Err Is Human”. The purpose of this systematic scoping review was to determine the extent pediatric surgery defines and studies errors, and to explore themes among papers focused on errors in pediatric surgery. Methods: The methodological framework used to conduct thi...

Background Children at end of life have unique and complex care needs. Although there is increasing evidence about pediatric concurrent hospice care, the health care services received while in hospice have not received sufficient attention. Objectives To examine the health care services, unique clusters of health care services, and characteristics...

A correction to this paper has been published: https://doi.org/10.1245/s10434-021-10216-6

Background The Cancer and Leukemia Group-B 9343 (CALGB 9343) trial demonstrated that women aged ≥ 70 years with early-stage breast cancer can safely omit radiation therapy (RT) and be treated with breast-conserving surgery (BCS) and adjuvant endocrine therapy (AET) alone. AET adherence is low, leaving an undertreated cohort who may be at increased...

Aim: The aims of this analysis are to (1) identify the concept of rural resiliency in cancer survivors in the nursing literature and (2) propose a conceptual framework that may help nurses leverage rural resilience to improve survivorship care. Background: Rural cancer survivors demonstrate rural resiliency by utilizing aspects of rural culture to...

Misidentification of illness severity may lead to patients being admitted to a ward bed then unexpectedly transferring to an ICU as their condition deteriorates. Our objective was to develop a predictive analytic tool to identify emergency department (ED) patients that required upgrade to an intensive or intermediate care unit (ICU or IMU) within 2...

Purpose Children should attend well child visits (WCVs) during early childhood so that developmental disorders may be identified as early as possible, so treatment can begin. The aim of this research was to determine if rurality impacts access to WCV during early childhood, and if altering rurality measurement methods impacts outcomes. Design and...

Purpose: Concurrent hospice care provides important end-of-life care for youth under 21 years. Those nearing 21 years must decide whether to shift to adult hospice or leave hospice for life-prolonging care. This decision may be challenging for young adults with cancer, given the intensity of oncology care. Yet, little is known about their needs. We...

BACKGROUND Patients on acute care wards who deteriorate and are emergently transferred to intensive care units have poor outcomes. Early identification of decompensating patients might allow for earlier clinical intervention and reduced morbidity and mortality. Advances in bedside continuous predictive analytics monitoring (i.e., artificial intelli...

Background: Patients on acute care wards who deteriorate and are emergently transferred to intensive care units have poor outcomes. Early identification of decompensating patients might allow for earlier clinical intervention and reduced morbidity and mortality. Advances in bedside continuous predictive analytics monitoring (i.e., artificial intel...

Purpose Pediatric hospice is a comprehensive model of care for medically complex children at end of life. The Affordable Care Act changed regulatory requirements for pediatric Medicaid enrollees to allow for enrollment into hospice services while still receiving life‐prolonging therapy. There are gaps in understanding factors associated with pediat...

Background Diagnosing sepsis remains challenging. Data compiled from continuous monitoring and electronic health records allow for new opportunities to compute predictions based on machine learning techniques. There has been a lack of consensus identifying best practices for model development and validation towards early identification of sepsis....

When the 2010 Patient Protection and Affordable Care Act (ACA) was passed, it fundamentally changed end-of-life care for children. Concurrent Care for Children (ACA, section 2302) enables Medicaid/Children's Health Insurance Program children with a prognosis of 6 months to live to use hospice care while continuing treatment for their terminal illne...

Purpose: To describe cervical cancer control practices from common countries of origin for women who resettle in the United States as refugees to highlight this persistent health inequity. Methods: Describe presence/type of national cervical cancer screening program, screening coverage percentage, and human papillomavirus (HPV) vaccination program...

This cross-sectional study uses data from the 2016 Behavioral Risk Factor Surveillance System data set to examine the association of age at cancer diagnosis with patients’ participation in clinical trials among cancer survivors.

Background Whether to repair nonsevere tricuspid regurgitation (TR) during surgery for ischemic mitral valve regurgitation (IMR) remains uncertain. Objectives The goal of this study was to investigate the incidence, predictors, and clinical significance of TR progression and presence of ≥moderate TR after IMR surgery. Methods Patients (n = 492) w...

Congenital melanocytic nevus (CMN) or nevi, also known as dark moles, are present at birth. While small CMN are quite common, large and giant nevi are rare and can be associated with significant psychological distress and the potential for further clinical sequelae. Neonatal clinicians can offer anticipatory guidance to families through distributio...

PurposeToday, male and female adult and pediatric cancer patients, individuals transitioning between gender identities, and other individuals facing health extending but fertility limiting treatments can look forward to a fertile future. This is, in part, due to the work of members associated with the Oncofertility Consortium.Methods The Oncofertil...

Background The results of the Cancer and Leukemia Group B (CALGB) 9343 trial showed that radiation therapy (RT) did not improve survival for women older than 70 y with early-stage estrogen receptor + breast cancer treated with breast conserving surgery and adjuvant endocrine therapy. In 2005, guidelines were modified to allow for RT omission; howev...

Purpose: The CALGB 9343 trial demonstrated that women age 70 or older with early-stage, estrogen receptor positive (ER +) breast cancer (BC) may safely forgo radiation therapy (RT) and be treated with breast conserving surgery followed by adjuvant endocrine therapy (AET) alone. However, most patients in this population still undergo RT in part bec...

Background: Current approaches to early detection of clinical deterioration in children have relied on intermittent track-and-trigger warning scores such as the Pediatric Early Warning Score (PEWS) that relies on periodic assessment and vital sign entry. There is limited data on the utility of these scores prior to events of decompensation leading...

BACKGROUND Current approaches to early detection of clinical deterioration in children have relied on intermittent track-and-trigger warning scores such as the Pediatric Early Warning Score (PEWS) that rely on periodic assessment and vital sign entry. There are limited data on the utility of these scores prior to events of decompensation leading to...

Purpose Children should attend well child visits (WCVs) during early childhood so that developmental disorders may be identified as early as possible, and if indicated treatment can begin. The aim of this research was to determine if rurality impacts access to WCV during early childhood, and if altering rurality measurement methods impacts outcomes...

To the Editors Dr Bonafide and colleagues found variability among hospitals in the use of pulse oximetry after discontinuation of oxygen therapy in children hospitalized for bronchiolitis.¹ They suggested that oxygen monitoring should be deimplemented. We have 3 concerns.

More than 55,000 children die each year in the United States, and hospice is used for very few of them at the end of their lives. Nearly one-third of pediatric deaths are a result of chronic, complex conditions, and the majority of these children are enrolled in Medicaid because of disability status or the severity of their disease. Changes in Medi...

Objective: The aim of this study was to explore clinical nurses' perspectives of shift length. Background: Discussions about scheduling practices, work rotations, and shift length are pervasive among nurses and nursing leadership. However, the science surrounding nurse perceptions of longer shifts is limited. Methods: A survey instrument was d...

Patients who deteriorate while on the acute care ward and are emergently transferred to the Intensive Care Unit (ICU) experience high rates of mortality. To date, risk scores for clinical deterioration applied to the acute care wards rely on static or intermittent inputs of vital sign and assessment parameters. We propose the use of continuous pred...

Insurance enrollment is complex for people living with HIV (PLWH) and people at increased risk for HIV, in part due to needing to ensure access to adequate provider networks and appropriate formularies. Insurance for PLWH facilitates access to HIV care/treatment and, ultimately, viral suppression, which has the individual benefit of longevity and t...

Background: The incorporation of spillover effects in health economic research is recognized by regulatory agencies as useful for valuing health interventions and technologies. To date, spillover effects are not universally used within economic evaluations and conceptual definitions of spillover effects are vague within the context of health econom...