Kristen Rundell

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• Person-Rennell, N., Rivers, P., Hollister, J., Dinsmore, A., Bratsch, N., Ortiz, J., Rundell, K., & Lutrick, K. (2026). Cesarean Section Rates and Mobile Health’s Role in Equitable Access to Prenatal Care. International Journal of Environmental Research and Public Health, 23(Issue 3). doi:10.3390/ijerph23030288
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  Highlights: Public health relevance—How does this work relate to a public health issue? Cesarean section (CS) rates have risen globally, and while an often lifesaving and necessary intervention, CS deliveries increase future maternal/neonatal risks and are costly to both patients and healthcare systems. This work examines CS rates in the setting of a free mobile health clinic for uninsured patients. Public health significance—Why is this work of significance to public health? The provision of maternity care in a mobile healthcare setting has not been significantly evaluated in the literature, and this work would add data regarding the quality of maternity care provision using standardized outcomes in the setting of maternity care, specific to mobile healthcare. This work examines CS rates in a free mobile health clinic for uninsured patients to examine quality obstetric metrics and evaluate if this clinical work is consistent with low/at goal CS rates. Public health implications—What are the key implications or messages for practitioners, policy makers and/or researchers in public health? These findings suggest that access to free prenatal care through a mobile health delivery model may contribute to favorable obstetric outcomes among uninsured individuals and have implications for addressing maternal and neonatal health inequities among those who face multiple barriers to receiving adequate prenatal care. Supporting mobile clinics targeting uninsured or other vulnerable groups may provide a method of meeting national CS targets and average rates in a higher-risk population. Cesarean section (CS) rates have risen globally, and while an often lifesaving and necessary intervention, CS deliveries increase future maternal/neonatal risks and are costly to both patients and healthcare systems. The U.S. Department of Health and Human Services has set a national low-risk pregnancy CS (NTSV) target of 23.9% under the Healthy People 2030 initiative. This analysis compares NTSV rates of uninsured patients receiving prenatal care from a mobile clinic to the national target and also compares overall mobile health CS rates with national and state CS rates. Through reviewing 5 years of electronic medical records, we calculated an NTSV CS rate of 25.0% among our University of Arizona Mobile Health Program prenatal patients, an uninsured and medically vulnerable patient group. This rate is similar to both the most recent Arizona state average of 23.4% and the national target of 23.9%. The MHP total CS rate is 26% over our study period, which is less than the most recent National and Arizona rates of 32.3% and 29.0%. These findings suggest that access to free prenatal care through a mobile health delivery model may contribute to favorable obstetric outcomes among uninsured individuals and have implications for addressing maternal and neonatal health inequities among those who face multiple barriers to receiving adequate prenatal care.
• Coe, C., Santen, S., Reboli, A., Boscamp, J., Stoltz, A., Latif, E., Dodson, L., Hunsaker, M., Paavuluri, A., Brenner, J., Ramanathan, S., Macerollo, A., Leong, S., Strano-Paul, L., Traba, C., Jones, B., Rundell, K., Gonzalez-Flores, A., Crump, W., , Vining, M., et al. (2024). Accelerated 3YMD programs: the last decade of growth of the Consortium of Accelerated Medical Pathway Programs (CAMPP). Medical Education Online, 29(1). doi:10.1080/10872981.2024.2400394
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  Introduction: Over the past decade, the growth of accelerated three-year MD (3YMD) programs has flourished. In 2015, with support from the Josiah Macy Jr. Foundation, the Consortium of Medical Pathway Programs (CAMPP) started with eight North American medical schools. The objective of this paper is to evaluate the current state of the 3YMD programs. Material and Methods: Since 2015, the CAMPP has tracked new and prospective 3YMD programs. An electronic survey collecting curricular and programmatic information about the programs was disseminated to all members of the CAMPP in August 2023. The survey included elements related to year of initiation, number of graduates, and curricular elements. Results: Of the schools with known established three-year MD programs, 29 of 32 programs responded (response rate 90%). There is growth of Accelerated Medical Pathway Programs over time with almost 20% of United States Allopathic Medical Schools having or developing an accelerated program. There have been 817 graduates from these programs from 2013–2023. Most schools include an opportunity for a ‘directed pathway’ experience for students. A directed pathway is where a student completes the MD degree in three-years and then has a direct placement into an affiliated residency program, provided they meet the goals and objectives of the curriculum. Most of the schools report a mission to reduce medical student debt and build a workforce for a specialty, for a population of patients, or geographical distribution. Conclusions: Accelerated three-year medical pathway programs have grown significantly over the last decade, consistent with an overall effort to redesign medical curricula, reduce debt and contribute to the workforce.
• Nair, S., Rodríguez, J. E., Elwood, S., Wilson, E., Ramanathan, A., Stulberg, D., Vail, B., Rundell, K., & Peek, C. J. (2024). Departmental Metrics to Guide Equity, Diversity, and Inclusion for Academic Family Medicine Departments. Family Medicine. doi:10.22454/fammed.2024.865619
• Rundell, K., & Nair, S. (2022). Managing TIA: Early action and essential risk-reduction steps. Journal of Family Practice, 71(4). doi:10.12788/jfp.0398
• Fernandes, A., Ecklar, P., Rundell, K., Luster, G., & Cavalcanti, M. (2019). Integrating Simulated Patients in TBL: a Strategy for Success in Medical Education. Medical Science Educator, 29(2). doi:10.1007/s40670-019-00727-z
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  Background: Successful use of team-based learning (TBL) and simulated patients (SP) in medical schools is growing. We hypothesized that integrating SPs into TBL would enhance the traditional TBL. Activity: From 2016 to 2018, we taught fourth-year medical students through an SP-TBL hybrid, utilizing an integrated SP interview. A 9-item evaluation was analyzed (n = 114). Results and Discussion: Students expressed favorable attitudes toward the SP-TBL hybrid with Likert-scale items (mean 4.26/5). Qualitatively, four positive themes emerged: (1) practice; (2) engagement; (3) SP use; and (4) feedback. Integrating SPs into TBL avoids disadvantages with both traditional TBL and OSCEs. Practice, engagement, and immediate feedback are advantages over traditional TBL.
• Rundell, K., & Panchal, B. (2019). In reply. American Family Physician, 99(3). doi:10.1016/j.jacc.2016.08.068
• Rundell, K., Oza, R., Greco, L., & Cruzado, E. (2019). Caring for patients with co-occurring mental health & substance use disorders. Journal of Family Practice, 68(7).
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  Consider substance abuse if Tx for mood or anxiety disorders is ineffective. Don't defer treating a mental health issue until a substance use disorder is resolved.
• Khan, M., Splinter, A., Kman, N., Leung, C., Rundell, K., Davis, J., & McCallister, J. (2017). Transition to Residency: Using Specialty-Specific Clinical Tracks and Advanced Competencies to Prepare Medical Students for Internship. Medical Science Educator, 27(1). doi:10.1007/s40670-016-0355-3
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  Recent discussions have sparked a debate about the purpose and function of the fourth year of medical school and the transition from undergraduate to graduate medical education. Our institution recently reformed our medical school curriculum into a three-part, competency-based curriculum that spans for 4 years, called Lead, Serve, Inspire (LSI). We present a novel way to structure the fourth year of medical school to better prepare our students for the next phase of their education in two ways, the development of Clinical Tracks and Advanced Competencies. The Clinical Tracks form individualized specialty-specific educational plans for students, preparing them to obtain the skills needed to be proficient interns in the specialty in which they hope to match. The Advanced Competencies are experiences that offer enhanced content that map to one of the Core Educational Objectives of the College of Medicine. They are often interdisciplinary and generalizable to multiple practice areas in both clinical and non-clinical activities. Ultimately, the goal of this revision is to create a competency-based, specialty-specific curriculum during the fourth year that will allow students to obtain the skills needed to function as interns on the first day of their postgraduate year 1 (PGY-1) of residency.
• Leong, S., Cangiarella, J., Fancher, T., Dodson, L., Grochowski, C., Harnik, V., Hustedde, C., Jones, B., Kelly, C., Macerollo, A., Reboli, A., Rosenfeld, M., Rundell, K., Thompson, T., Whyte, R., & Pusic, M. (2017). Roadmap for creating an accelerated three-year medical education program. Medical Education Online, 22(1). doi:10.1080/10872981.2017.1396172
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  Medical education is undergoing significant transformation. Many medical schools are moving away from the concept of seat time to competency-based education and introducing flexibility in the curriculum that allows individualization. In response to rising student debt and the anticipated physician shortage, 35% of US medical schools are considering the development of accelerated pathways. The roadmap described in this paper is grounded in the experiences of the Consortium of Accelerated Medical Pathway Programs (CAMPP) members in the development, implementation, and evaluation of one type of accelerated pathway: the three-year MD program. Strategies include developing a mission that guides curricular development–meeting regulatory requirements, attaining institutional buy-in and resources necessary to support the programs, including student assessment and mentoring–and program evaluation. Accelerated programs offer opportunities to innovate and integrate a mission benefitting students and the public. Abbreviations: CAMPP: Consortium of accelerated medical pathway programs; GME: Graduate medical education; LCME: Liaison committee on medical education; NRMP: National residency matching program; UME: Undergraduate medical education.
• Rundell, K., & Panchal, B. (2017). Preterm labor: Prevention and management. American Family Physician, 95(6).
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  In the United States, preterm delivery is the leading cause of neonatal morbidity and is the most common reason for hospitalization during pregnancy. The rate of preterm delivery (before 37 weeks’ gestation) has been declining since 2007. Clinical diagnosis of preterm labor is made if there are regular contractions and concomitant cervical change. Less than 10% of women with a clinical diagnosis of preterm labor will deliver within seven days of initial presentation. Women with a history of spontaneous preterm delivery are 1.5 to two times more likely to have a subsequent preterm delivery. Antenatal progesterone is associated with a significant decrease in subsequent preterm delivery in certain pregnant women. Current recommendations are to prescribe vaginal progesterone in women with a shortened cervix and no history of preterm delivery, and to use progesterone supplementation regardless of cervical length in women with a history of spontaneous preterm delivery. Cervical cerclage has been used to help correct structural defects or cervical weakening in high-risk women with a shortened cervix. A course of corticosteroids is the only antenatal intervention that has been shown to improve postdelivery neonatal outcomes, including a reduction in neonatal mortality, intracranial hemorrhage, necrotizing enterocolitis, and neonatal infection. Tocolytics, especially prostaglandin inhibitors and calcium channel blockers, may allow time for the administration of antenatal corticosteroids and transfer to a tertiary care facility if necessary. When used in specific at-risk populations, magnesium sulfate provides neuroprotection and decreases the incidence of cerebral palsy in preterm infants.
• Sieck, C., Hefner, J., Schnierle, J., Florian, H., Agarwal, A., Rundell, K., & McAlearney, A. (2017). The rules of engagement: Perspectives on secure messaging from experienced ambulatory patient portal users. JMIR Medical Informatics, 5(3). doi:10.2196/medinform.7516
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  Background: Patient portals have shown promise in engaging individuals in self-management of chronic conditions by allowing patients to input and track health information and exchange secure electronic messages with their providers. Past studies have identified patient barriers to portal use including usability issues, low health literacy, and concerns about loss of personal contact as well as provider concerns such as increased time spent responding to messages. However, to date, studies of both patient and provider perspectives on portal use have focused on the pre-implementation or initial implementation phases and do not consider how these issues may change as patients and providers gain greater experience with portals. Objective: Our study examined the following research question: Within primary care offices with high rates of patient-portal use, what do experienced physician and patient users of the ambulatory portal perceive as the benefits and challenges of portal use in general and secure messaging in particular? Methods: This qualitative study involved 42 interviews with experienced physician and patient users of an ambulatory patient portal, Epic's MyChart. Participants were recruited from the Department of Family Medicine at a large Academic Medical Center (AMC) and included providers and their patients, who had been diagnosed with at least one chronic condition. A total of 29 patients and 13 primary care physicians participated in the interviews. All interviews were conducted by telephone and followed a semistructured interview guide. Interviews were transcribed verbatim to permit rigorous qualitative analysis. Both inductive and deductive methods were used to code and analyze the data iteratively, paying particular attention to themes involving secure messaging. Results: Experienced portal users discussed several emergent themes related to a need for greater clarity on when and how to use the secure messaging feature. Patient concerns included worry about imposing on their physician's time, the lack of provider compensation for responding to secure messages, and uncertainty about when to use secure messaging to communicate with their providers. Similarly, providers articulated a lack of clarity as to the appropriate way to communicate via MyChart and suggested that additional training for both patients and providers might be important. Patient training could include orienting patients to the "rules of engagement" at portal sign-up, either in the office or through an online tutorial. Conclusions: As secure messaging through patient portals is increasingly being used as a method of physician-patient communication, both patients and providers are looking for guidance on how to appropriately engage with each other using this tool. Patients worry about whether their use is appropriate, and providers are concerned about the content of messages, which allow them to effectively manage patient questions. Our findings suggest that additional training may help address the concerns of both patients and providers, by providing "rules of engagement" for communication via patient portals.
• Rundell, K. (2004). Encourage varicella vaccination, except for the immunocompromised. Journal of Family Practice, 53(6).
• Yohn, J., Morelli, J., Walchak, S., Rundell, K., Norris, D., & Zamora, M. (1993). Cultured human keratinocytes synthesize and secrete endothelin-1. Journal of Investigative Dermatology, 100(1). doi:10.1111/1523-1747.ep12349932
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  The human epidermal-melanin unit exists as a complex interplay of cell-cell interactions. Melanocytes synthesize melanin and transfer it to the surrounding keratinocytes, which, in turn, produce factors that affect melanocyte homeostasis, growth, and melanization. Endothelin-1 (ET-1), a vasocon strictor peptide produced by endothelial cells, has recently been shown to stimulate human melanocyte proliferation and tyrosinase activity. To investigate the possibility that keratinocytes synthesize and secrete ET-1, we grew human keratinocytes in a defined serum-free medium and measured ET-1 levels in the keratinocytes and the keratinocyte-conditioned medium. Northern analysis of keratinocyte total RNA also was performed. We found that human keratinocytes express preproET-1 mRNA and translate the message to ET-1 protein, which is secreted into the keratinocyte medium. Human keratinocytes produced ET-1 in a time-dependent manner with total production of 20.1 ± 1.1 pg ET-1/ 106 cells at 24 h (n = 7). Although total ET-1 production (secreted plus cell-associated ET-1) was similar, the proportion of secreted versus cell-associated ET-1 varied widely among the different donors. We have found that human keratinocytes synthesize and secrete ET-1 in vitro. From these data we believe that the keratinocyte could be an in vivo epidermal source of this melanocyte growth and pigmentation factor. © 1993.