COMET Research


Accessibility of Over-the-counter Birth Control in the United States: a Snapshot of the Country

Liz Jahng; Bianca Kennel; Steven Lin, MD  More 

In the vast majority of the United States, women are required to have a prescription from a health care provider in order to obtain birth control pills. Studies have shown that this policy presents a barrier toward preventing unintended pregnancies and abortions. In recent years, some states have passed legislation that allow pharmacists to prescribe birth control, thus allowing women to obtain oral contraceptives “over-the-counter”. Our objective was to create a snapshot of the country by illustrating which states are progressing toward over-the-counter birth control access, and which states are not. 


Effectiveness of a Smartphone App for Guiding Pediatric ADHD Medication Selection

Anu Tirupasur; Steven Lin, MD  More 

Attention deficit hyperactivity disorder (ADHD) is an increasingly prevalent pediatric chronic disease in the United State. There is a myriad of medications available to treat pediatric ADHD; however, many primary care physicians lack access to decision support tools at the point of care to help choose ADHD medications in an evidence-based way. Our objective was to create a smartphone app with a simple, easy-to-use decision tree for choosing ADHD medications, and to measure the effects of the app on the confidence level of family physicians in treating ADHD.


Going Beyond “an Apple a Day”: What Patients Want Their Primary Care Physicians to Know About Nutritional Counseling

Julia Hafer; Terry Lou; Tracy Rydel, MD; Steven Lin, MD  More 

Despite the fact that both patients and physicians feel that doctors are critical sources of nutritional advice, many physicians report feeling poorly equipped to provide this counseling. Medical schools have begun exploring ideas for nutrition curriculum improvements from an academic perspective, but to our knowledge, little is known about the patients’ point of view. This pilot study aims to explore the patient perspective, with the ultimate goal of helping primary care physicians more effectively target their nutritional counseling and informing future improvements to nutrition curricula in medical school.


Identifying Best Practices For Nurturing Effective Scribe-Physician Partnerships

Tuan Nguyen; Eugenia Jernick; Steven Lin, MD  More 

Scribes are the newest members of the health care team, yet relatively little is known about the factors that contribute to effective scribe-physician relationships in the workplace. Since 2015, Stanford University School of Medicine has offered a 1-year post-baccalaureate scribe fellowship for pre-medical students, who work alongside primary care physicians and provide documentation support. Our aim was to identify the factors that contribute to effective scribe-physician relationships, and to disseminate these findings through an orientation video for new physicians who are not familiar with scribes.


Identifying Opportunities to Improve Domestic Violence Screening in a Primary Care System

Laurel Sharpless; Steven Lin, MD  More 

The U.S. Preventive Services Task Force (USPSTF) recommends that physicians screen women of childbearing age for domestic violence, but research shows that the rates of screening in primary care settings are low. The aim of this quality improvement project was to determine the rates of domestic violence screening in 5 primary care clinics at a large academic medical center. We also sought to determine whether screening initiated by medical assistants or physicians resulted in more documented screens.


Identifying Psychosocial Barriers to Behavioral Activation in Seniors With Depression

Kevin Lee; Jennifer Milan; Jamie Yang; Andrew Yoon; Steven Lin, MD  More 

Behavioral activation (BA) has substantial evidence as an effective intervention to treat late life depression. By encouraging adaptive behaviors and planned pleasant activities, BA has been shown to significantly decrease symptoms of depression. However, the primary barriers that prevent depressed older adults from participating in BA remain unclear. This quality improvement (QI) study aimed to identify the most commonly encountered barriers to BA in older adult patients with depression.


2017 Abstracts

Creating a tool to measure the effectiveness of sexual orientation and gender identity sensitivity training
Tuan Nguyen, Dr. Benjamin Laniakea, Dr. Steven Lin, and Dr. Catherine Forest   More 

Stanford has rolled out a brief, targeted sexual orientation and gender identity (SOGI) sensitivity training for physicians with the aims of improving the quality of health care for patients in the gender and sexual minority (GSM) community. Before the training was implemented, a pre- and post-assessment tool was developed to measure the effectiveness of the intervention. The tool was formulated to assess provider knowledge in 3 areas: SOGI terminology, proper use of gender pronouns, and the importance of integrating SOGI data fields into the electronic health record (EHR). With our findings, we plan to analyze changes in baseline knowledge, provider use of SOGI data fields, and the overall impact of training on provider comfort in caring for GSM patients.


Creating an Antidepressant Wheel to Help Family Physicians Choose Antidepressants
Jimmy Yao and Dr. Steven Lin   More 

There are currently few point-of-care decision support tools to help family physicians choose antidepressants in a rational, evidence-based manner. We aimed to design a handheld circular wheel as an educational point-of-care decision support tool to help family physicians choose antidepressants based on a symptom cluster approach, originally published in 2014. This antidepressant wheel is a novel point-of-care decision support tool that may help family physicians choose antidepressants based on an evidence-based model.


Impact of Scribes on Medical Student Education: A Pilot Study
Xibin Wu and Dr. Steven Lin   More 

Academic family medicine practices are starting to incorporate scribes into their clinical workflow. There is a lack of data on the impact of scribes on medical students’ learning. We conducted a mixed methods study to determine the impact of scribes on medical student education in a university-based family medicine practice. This research will be presented at the Society of Teachers in Family Medicine’s national conference in May of 2017.


On the Fence Between Family Medicine and OB/GYN? How to Mentor Undecided Students
Eugenia Jernick and Dr. Steven Lin   More 

Family medicine focuses on providing longitudinal and comprehensive health care; however, it is losing a key role in maternity care. We conducted a mixed methods study of family medicine faculty and residents at our institution to examine their perspectives on maternity care. Participants reported that maternity care was an important factor in their career choice. This research will be presented at a roundtable discussion at the Society of Teachers in Family Medicine's national conference. It will engage participants in a discussion of the importance of maternity care in family medicine, how to mentor medical students on making a choice between OB/GYN and family medicine, and what the future of maternity care in family medicine may look like.


Transforming the role of medical scribes to increase clinician and staff capacity
Vincent N. Le, Michelle Tay, Xibin Wu, Dr. Steven Lin   More 

To meet the growing demands on primary care and achieve the Triple Aim, many healthcare settings are redistributing responsibilities among non-physician members of their care teams. Increasingly, the responsibility of documenting patient encounters is being delegated to medical scribes, and healthcare systems that have already done so are reporting increased productivity and greater physician satisfaction. This project will be presented as a roundtable discussion at the Society of Teachers in Family Medicine's national conference in May of 2017. We will describe the motivation for, and our experience of, transforming the role of medical scribes to include other administrative elements of patient care, such as rooming patients, taking vitals, reviewing health maintenance reminders, writing after-visit summaries, and prepping procedures.