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Rosenberg SM, McCue S, He J, Lafky JM, Carey LA, Galanis E, Leonard JP, Meyerhardt J, Ng K, Schwartz GK, Stock W, Paskett ED, Partridge AH, George S. Alliance A151945: Accrual and characteristics of adolescent and young adult patients in Alliance trials from 2000 to 2017. Cancer 2024; 130:750-769. [PMID: 37916800 PMCID: PMC10922614 DOI: 10.1002/cncr.35078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 08/29/2023] [Accepted: 09/29/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Identifying patient- and disease-specific characteristics associated with clinical trial enrollment of adolescents and young adults (AYAs) with cancer may target efforts to improve accrual. METHODS Alliance for Clinical Trials in Oncology (Alliance) trials opened from January 1, 2000, and closed before January 1, 2018, for common AYA cancers were identified. Proportions of AYAs (aged 18-39 years old) versus non-AYAs (aged ≥40 years old) enrolled by cancer type were summarized by descriptive statistics. Among studies with ≥20 AYAs enrolled, demographic and disease characteristics of AYAs versus non-AYAs were compared with χ2 and Kruskal-Wallis tests. A qualitative review was also conducted of therapeutic trials included in analysis in PubMed through December 31, 2021, that reported AYA-specific survival. RESULTS Among 188 trials enrolling 40,396 patients, AYAs represented 11% (4468 of 40,396) of accrual. AYA accrual varied by cancer type (leukemia, 23.6%; breast, 9.9%; lymphoma, 14.8%; colorectal, 6.2%; central nervous system, 8.1%; melanoma, 11.8%; sarcoma, 12%). Across ages, the proportion of Black and Hispanic patients enrolled was 1%-10%. Compared to non-AYAs, AYAs in breast and colorectal cancer trials were less likely to be White and more likely to be Hispanic. Disease characteristics differed by age for selected trials. Two trials reported AYA-specific survival, with no significant differences observed by age. CONCLUSIONS AYA accrual to Alliance trials was comparable to or exceeded population-based, age-specific prevalence estimates for most cancer types. Greater proportional representation of Hispanic and non-White patients among AYAs reflects US demographic trends. The small number of minority patients enrolled across ages underscores the persistent challenge of ensuring equitable access to trials, including for AYAs.
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Affiliation(s)
| | - Shaylene McCue
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Jun He
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Lisa A Carey
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
| | | | | | | | - Kimmie Ng
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Gary K Schwartz
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, New York, USA
| | - Wendy Stock
- University of Chicago, Chicago, Illinois, USA
| | - Electra D Paskett
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | | | - Suzanne George
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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102
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Feinberg E, Eilenberg JS. Role of Community Health Workers in Promoting Health Equity in Pediatrics. Acad Pediatr 2024; 24:199-200. [PMID: 37739310 PMCID: PMC10939957 DOI: 10.1016/j.acap.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/25/2023] [Accepted: 09/18/2023] [Indexed: 09/24/2023]
Affiliation(s)
- Emily Feinberg
- Brown University School of Public Health (E. Feinberg), Hassenfeld Child Health Innovation Institute, Providence, RI.
| | - Jenna Sandler Eilenberg
- Boston University (JS Eilenberg), Department of Psychological & Brain Sciences, Boston, Mass.
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103
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Mao Y, Li Y, McGarry B, Wang J, Temkin-Greener H. Home time and state regulations among Medicare beneficiaries in assisted living communities. J Am Geriatr Soc 2024; 72:742-752. [PMID: 38064278 PMCID: PMC10947931 DOI: 10.1111/jgs.18709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 10/06/2023] [Accepted: 11/12/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND Home time is an important patient-centric quality metric, which has been largely unexamined among assisted living (AL) residents. Our objectives were to assess variation in home time among AL residents in the year following admission and to examine the associations with state regulations for direct care workers (DCW) training and staffing and for licensed nurse staffing. METHODS Medicare beneficiaries who entered AL communities in 2018 were identified, and their home time in the year following admission was measured. Home time was calculated as the percentage of time spent at home per day being alive. Resident characteristics and state regulations in DCW staffing, DCW training, and licensed staffing were measured. We used a multivariate linear regression model with AL-level fixed effects to estimate the relationship between person-level characteristics and home time. Linear regression models adjusting for resident characteristics were used to estimate the association between state regulations and residents' home time. RESULTS The study sample included 59,831 new Medicare beneficiary residents in 12,143 ALs. In the year following AL admission, residents spent 94% (standard deviation = 14.6) of their time at home. Several resident characteristics were associated with lower home time: Medicare-Medicaid dual eligibility, having more chronic conditions, and specific chronic conditions, for example, dementia. In states with greater regulatory specificity for DCW training and staffing, and lower specificity for licensed staffing, residents had longer adjusted home time. CONCLUSION/IMPLICATIONS Home time varied substantially among AL residents depending on resident characteristics and state-level regulatory specificity. AL residents eligible for Medicare and Medicaid had substantially shorter home time than the Medicare-only residents, largely due to longer time spent in nursing homes. State AL regulatory specificity for DCWs and licensed staff also impacted AL residents' home time. These findings may guide AL operators and state legislators in efforts to improve this important quality of life metric.
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Affiliation(s)
- Yunjiao Mao
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Yue Li
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Brian McGarry
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
- Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Jinjiao Wang
- Elaine Hubbard Center for Nursing Research on Aging, University of Rochester School of Nursing, Rochester, New York, USA
| | - Helena Temkin-Greener
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
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Mahler SA, Ashburn NP, Paradee BE, Stopyra JP, O'Neill JC, Snavely AC. Safety and Effectiveness of the High-Sensitivity Cardiac Troponin HEART Pathway in Patients With Possible Acute Coronary Syndrome. Circ Cardiovasc Qual Outcomes 2024; 17:e010270. [PMID: 38328912 DOI: 10.1161/circoutcomes.123.010270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 12/14/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND The HEART Pathway (History, Electrocardiogram, Age, Risk factors, Troponin) can be used with high-sensitivity cardiac troponin to risk stratify emergency department patients with possible acute coronary syndrome. However, data on whether a high-sensitivity HEART Pathway (hs-HP) are safe and effective is lacking. METHODS An interrupted time series study was conducted at 5 North Carolina sites in 26 126 adult emergency department patients being investigated for possible acute coronary syndrome and without ST-segment-elevation myocardial infarction. Patients were accrued into 16-month preimplementation and postimplementation cohorts with a 6-month wash-in phase. Preimplementation (January 2019 to April 2020), the traditional HEART Pathway was used with 0- and 3-hour contemporary troponin measures (Siemens). In the postimplementation period (November 2020 to February 2022), a modified hs-HP was used with 0- and 2-hour high-sensitivity cardiac troponin (Beckman Coulter) measures. The primary safety and effectiveness outcomes were 30-day all-cause death or myocardial infarction and 30-day hospitalizations. These outcomes and early discharge rate (emergency department discharge without stress testing or coronary angiography) were determined from health records and death index data. Outcomes were compared preimplementation versus postimplementation using χ2 tests and multivariable logistic regression to adjust for potential confounders. RESULTS Preimplementation and postimplementation cohorts included 12 317 and 13 809 patients, respectively, of them 52.7% (13 767/26 126) were female with a median age of 54 years (interquartile range, 42-66). Rates of 30-day death or MI were 6.8% (945/13 809) postimplementation and 7.7% (948/12 317) preimplementation (adjusted odds ratio, 1.00 [95% CI, 0.90-1.11]). hs-HP implementation was associated with 19.9% (95% CI, 18.7%-21.1%) higher early discharges (post versus pre: 63.6% versus 43.7%; adjusted odds ratio, 2.22 [95% CI, 2.10-2.35]). The hs-HP was also associated with 16.1% (95% CI, 14.9%-17.3%) lower 30-day hospitalizations (postimplementation versus preimplementation, 31.4% versus 47.5%; adjusted odds ratio, 0.51 [95% CI, 0.48-0.54]). Among early discharge patients, death or myocardial infarction occurred in 0.5% (41/8780) postimplementation versus 0.4% (22/5383) preimplementation (P=0.61). CONCLUSIONS hs-HP implementation is associated with increased early discharges without increasing adverse events. These findings support the use of a modified hs-HP to improve chest pain care.
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Affiliation(s)
- Simon A Mahler
- Department of Emergency Medicine (S.A.M., N.P.A., B.E.P., J.P.S., J.C.O., A.C.S.), Wake Forest University School of Medicine, Winston-Salem, NC
- Department of Implementation Science (S.A.M.), Wake Forest University School of Medicine, Winston-Salem, NC
- Department of Epidemiology and Prevention (S.A.M.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Nicklaus P Ashburn
- Department of Emergency Medicine (S.A.M., N.P.A., B.E.P., J.P.S., J.C.O., A.C.S.), Wake Forest University School of Medicine, Winston-Salem, NC
- Section on Cardiovascular Medicine, Department of Internal Medicine (N.P.A.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Brennan E Paradee
- Department of Emergency Medicine (S.A.M., N.P.A., B.E.P., J.P.S., J.C.O., A.C.S.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Jason P Stopyra
- Department of Emergency Medicine (S.A.M., N.P.A., B.E.P., J.P.S., J.C.O., A.C.S.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - James C O'Neill
- Department of Emergency Medicine (S.A.M., N.P.A., B.E.P., J.P.S., J.C.O., A.C.S.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Anna C Snavely
- Department of Emergency Medicine (S.A.M., N.P.A., B.E.P., J.P.S., J.C.O., A.C.S.), Wake Forest University School of Medicine, Winston-Salem, NC
- Department of Biostatistics and Data Science (A.C.S.), Wake Forest University School of Medicine, Winston-Salem, NC
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Quigley DD, Elliott MN, Slaughter ME, Lerner C, Hays RD. Narrative comments about pediatric inpatient experiences yield substantial information beyond answers to closed-ended CAHPS survey questions. J Pediatr Nurs 2024:S0882-5963(24)00059-9. [PMID: 38431461 DOI: 10.1016/j.pedn.2024.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/01/2024] [Accepted: 02/17/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE Adults' comments on patient experience surveys explain variation in provider ratings, with negative comments providing more actionable information than positive comments. We investigate if narrative comments on the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey of inpatient pediatric care (Child HCAHPS) account for global perceptions of the hospital beyond that explained by reports about specific aspects of care. METHODS We analyzed 545 comments from 927 Child HCAHPS surveys completed by parents and guardians of hospitalized children with at least a 24-h hospital stay from July 2017 to December 2020 at an urban children's hospital. Comments were coded for valence (positive/negative/mixed) and actionability and used to predict Overall Hospital Rating and Willingness to Recommend the Hospital along with Child HCAHPS composite scores. RESULTS Comments were provided more often by White and more educated respondents. Negative comments and greater actionability of comments were significantly associated with Child HCAHPS global rating measures, controlling for responses to closed-ended questions, and child and respondent characteristics. Each explained an additional 8% of the variance in respondents' overall hospital ratings and an additional 5% in their willingness to recommend the hospital. CONCLUSIONS Child HCAHPS narrative comment data provide significant additional information about what is important to parents and guardians during inpatient pediatric care beyond closed-ended composites. PRACTICE IMPLICATIONS Quality improvement efforts should include a review of narrative comments alongside closed-ended responses to help identify ways to improve inpatient care experiences. To promote health equity, comments should be encouraged for racial-and-ethnic minority patients and those with less educational attainment.
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Affiliation(s)
- Denise D Quigley
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, United States of America.
| | - Marc N Elliott
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, United States of America.
| | - Mary E Slaughter
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, United States of America.
| | - Carlos Lerner
- UCLA David Geffen School of Medicine, Department of Medicine, 1100 Glendon Avenue, Los Angeles, CA 90024-1736, United States of America; UCLA Mattel Children's Hospital, 757 Westwood Plaza, Los Angeles, CA 90095, United States of America.
| | - Ron D Hays
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, United States of America; UCLA David Geffen School of Medicine, Department of Medicine, 1100 Glendon Avenue, Los Angeles, CA 90024-1736, United States of America.
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106
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Alanazi AH, Almuntashiri S, Sikora A, Zhang D, Somanath PR. Secondary Analysis of Fluids and Catheters Treatment Trial (FACTT) data reveal poor clinical outcomes in acute respiratory distress syndrome patients with diabetes. Respir Med 2024; 223:107540. [PMID: 38290602 PMCID: PMC10985622 DOI: 10.1016/j.rmed.2024.107540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 01/23/2024] [Accepted: 01/25/2024] [Indexed: 02/01/2024]
Abstract
OBJECTIVES Conflicting reports exist about the link between diabetes mellitus (DM) and acute respiratory distress syndrome (ARDS). Our study examines the impact of pre-existing DM on ARDS patients within the Fluid and Catheter Treatment Trial (FACTT). DESIGN Conducting a secondary analysis of FACTT data, we incorporated 967 participants with identified DM status (173 with DM, 794 without DM) and examined outcomes like 90-day mortality, hospital and ICU stays, and ventilator days until unassisted breathing. The primary outcome of hospital mortality at day 90 was evaluated through logistic regression using IBM SPSS software. Additionally, we assessed plasma cytokines and chemokines utilizing a human magnetic bead-based multiplex assay. RESULTS Patients with pre-existing DM exhibited a lower survival rate compared to non-DM patients (61.3 vs. 72.3 %, p = 0.006). Subjects with DM experienced significantly longer hospital lengths of stay (24.5 vs. 19.7 days; p = 0.008) and prolonged ICU stays (14.8 vs. 12.4 days; p = 0.029). No significant difference was found in ventilator days until unassisted breathing between the two groups (11.7 vs. 10; p = 0.1). Cytokine/chemokine analyses indicated a non-significant trend toward heightened levels of cytokines (TNF-α, IL-10, and IL-6) and chemokines (CRP, MCP-1) in DM patients compared to non-DM on both days 0 and 1. Notably, lipopolysaccharide-binding protein (LBP) exhibited significantly higher levels in DM compared to non-DM individuals. CONCLUSIONS ARDS patients with DM suffered worse clinical outcomes compared to non-DM patients, indicating that DM may negatively affect the respiratory functions in these subjects. Further comprehensive clinical and pre-clinical studies will strengthen this relationship.
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Affiliation(s)
- Abdulaziz H Alanazi
- Clinical and Experimental Therapeutics, University of Georgia, Augusta, GA, USA; Charlie Norwood VA Medical Center, Augusta, GA, USA; Department of Clinical Practice, College of Pharmacy, Northern Border University, Rafha, 76313, Saudi Arabia
| | - Sultan Almuntashiri
- Clinical and Experimental Therapeutics, University of Georgia, Augusta, GA, USA; Charlie Norwood VA Medical Center, Augusta, GA, USA
| | - Andrea Sikora
- Department of Clinical and Administrative Pharmacy, College of Pharmacy, University of Georgia, Augusta, GA, 30901, USA; Department of Pharmacy, Augusta University Medical Center, Augusta, GA, 30912, USA
| | - Duo Zhang
- Clinical and Experimental Therapeutics, University of Georgia, Augusta, GA, USA; Charlie Norwood VA Medical Center, Augusta, GA, USA
| | - Payaningal R Somanath
- Clinical and Experimental Therapeutics, University of Georgia, Augusta, GA, USA; Charlie Norwood VA Medical Center, Augusta, GA, USA.
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Latour CD, Kahrs JC, Miller EM, Van Wickle K, Wood ME. Re. Emulating a Target Trial of Interventions Initiated During Pregnancy With Healthcare Databases: The Example of COVID-19 Vaccination. Epidemiology 2024; 35:e6-e7. [PMID: 38290148 PMCID: PMC11052565 DOI: 10.1097/ede.0000000000001686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Affiliation(s)
- Chase D. Latour
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jacob C. Kahrs
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Elyse M. Miller
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kimi Van Wickle
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mollie E. Wood
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Toma CL, Hwang J, Kakonge L, Morrow EL, Turkstra LS, Mutlu B, Duff MC. Does Facebook Use Provide Social Benefits to Adults with Traumatic Brain Injury? Cyberpsychol Behav Soc Netw 2024; 27:214-220. [PMID: 38466929 PMCID: PMC10924117 DOI: 10.1089/cyber.2023.0211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
Drawing on the social compensation hypothesis, this study investigates whether Facebook use facilitates social connectedness for individuals with traumatic brain injury (TBI), a common and debilitating medical condition that often results in social isolation. In a survey (N = 104 participants; n = 53 with TBI, n = 51 without TBI), individuals with TBI reported greater preference for self-disclosure on Facebook (vs. face-to-face) compared to noninjured individuals. For noninjured participants, a preference for Facebook self-disclosure was associated with the enactment of relational maintenance behaviors on Facebook, which was then associated with greater closeness with Facebook friends. However, no such benefits emerged for individuals with TBI, whose preference for Facebook self-disclosure was not associated with relationship maintenance behaviors on Facebook, and did not lead to greater closeness with Facebook friends. These findings show that the social compensation hypothesis has partial utility in the novel context of TBI, and suggest the need for developing technological supports to assist this vulnerable population on social media platforms.
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Affiliation(s)
- Catalina L. Toma
- Department of Communication Arts, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Juwon Hwang
- School of Media and Strategic Communications, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Lisa Kakonge
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Emily L. Morrow
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lyn S. Turkstra
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Bilge Mutlu
- Department of Computer Sciences, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Melissa C. Duff
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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109
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Goldman S, Zhao J, Bieber B, Pisoni RL, Horowitz L, Nessim SJ, Piraino B, Lambie M, Kanjanabuch T, Ito Y, Boudville N, Teitelbaum I, Schreiber M, Perl J. Gastric Acid Suppression Therapy and Its Association with Peritoneal Dialysis-Associated Peritonitis in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS). Kidney360 2024; 5:370-379. [PMID: 38019215 PMCID: PMC11000729 DOI: 10.34067/kid.0000000000000325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 11/15/2023] [Indexed: 11/30/2023]
Abstract
Key Points In a large multinational cohort of PD patients, any GAS use was not associated with an increased risk of all-organism peritonitis. For peritonitis, risks were particularly high among certain classes of organisms particularly for Gram-negative, enteric, and streptococcal peritonitis episodes. The association with enteric peritonitis appeared to be stronger among H2RA users. Background Peritonitis is a major peritoneal dialysis–related complication. We determined whether gastric acid suppression (GAS) (proton pump inhibitor [PPI] or histamine-2 receptor antagonists [H2RAs]) use was associated with all-cause and organism-specific peritonitis in peritoneal dialysis patients. Methods In the Peritoneal Dialysis Outcomes and Practice Patterns Study (595 facilities, eight countries, years 2014–2022), associations between GAS use and time to first episode of all-cause peritonitis were examined using Cox proportional hazards models. The primary exposure of interest was GAS and secondarily PPI or H2RA use. Secondary outcomes were organism-specific peritonitis, peritonitis cure rates, and death. Results Among patients (N =23,797) at study baseline, 6020 (25.3%) used PPIs, and 1382 (5.8%) used H2RAs. Overall risks of GAS use and peritonitis risk (adjusted hazard ratio [AHR]=1.05, 95% confidence interval [CI], 0.98 to 1.13]) and use of PPI (AHR 1.06 [95% CI, 0.99 to 1.14]) or H2RA (AHR 1.02 [95% CI, 0.88 to 1.18]) did not reach statistical significance. In organism-specific analyses, GAS users displayed higher peritonitis risks for Gram-negative (AHR 1.29, 95% CI, 1.05 to 1.57), Gram-positive (AHR 1.15, 95% CI, 1.01 to 1.31), culture-negative (AHR 1.20, 95% CI, 1.01 to 1.42), enteric (AHR 1.23, 95% CI, 1.03 to 1.48), and particularly Streptococcal (AHR 1.47, 95% CI, 1.15 to 1.89) peritonitis episodes. GAS was also associated with higher overall mortality (AHR 1.13 [95% CI, 1.05 to 1.22]). Conclusion The association between GAS use and peritonitis risk was weaker (hazard ratio [HR] 1.05 [0.98 to 1.13]) than for streptococcal (HR 1.57 [1.15 to 1.89]) and Gram-negative (HR 1.29 [1.05 to 1.57]) peritonitis. A better understanding of mechanisms surrounding the differential effects of GAS subtype on peritonitis risks is needed. Clinicians should be cautious when prescribing GAS. The impact of GAS deprescribing on peritonitis risk requires further evaluation.
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Affiliation(s)
- Shira Goldman
- Division of Nephrology, St. Michael's Hospital, Toronto, Ontario, Canada
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Nephrology and Hypertension, Rabin Medical Center, Petach-Tikva, Israel
| | - Junhui Zhao
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
| | - Brian Bieber
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
| | | | - Laura Horowitz
- Division of Nephrology, McGill University Health Center, Montreal, Quebec, Canada
| | - Sharon J. Nessim
- Division of Nephrology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Beth Piraino
- Renal Electrolyte Division, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Mark Lambie
- School of Medicine, Keele University, Keele, Staffordshire, United Kingdom
| | - Talerngsak Kanjanabuch
- Division of Nephrology, Department of Medicine, and Center of Excellence in Kidney Metabolic Disorders, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Yasuhiko Ito
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Japan
| | - Neil Boudville
- Medical School, University of Western Australia, Perth, Australia
| | | | | | - Jeffrey Perl
- Department of Medicine, Division of Nephrology, St. Michael's Hospital and the Keenan Research Center in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
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LEE YUNASH, GROB RACHEL, NEMBHARD INGRID, SHALLER DALE, SCHLESINGER MARK. Leveraging Patients' Creative Ideas for Innovation in Health Care. Milbank Q 2024; 102:233-269. [PMID: 38090879 PMCID: PMC10938936 DOI: 10.1111/1468-0009.12682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 10/13/2023] [Accepted: 11/16/2023] [Indexed: 03/16/2024] Open
Abstract
Policy Points Patients' creative ideas may inform learning and innovation that improve patient-centered care. Routinely collected patient experience surveys provide an opportunity to invite patients to share their creative ideas for improvement. We develop and assess a methodological strategy that validates question wording designed to elicit creative ideas from patients. Health care organizations should consider how to report and use these data in health care delivery and quality improvement, and policymakers should consider promoting the use of narrative feedback to better understand and respond to patients' experiences. CONTEXT Learning health systems (LHSs) have been promoted for a decade to achieve high-quality, patient-centered health care. Innovation driven by knowledge generated through day-to-day health care delivery, including patient insights, is critical to LHSs. However, the pace of translating patient insights into innovation is slow and effectiveness inadequate. This study aims to evaluate a method for systematically eliciting patients' creative ideas, examine the value of such ideas as a source of insight, and examine patients' creative ideas regarding how their experiences could be improved within the context of their own health systems. METHODS The first stage of the study developed a survey and tested strategies for elicitation of patients' creative ideas with 600 patients from New York State. The second stage deployed the survey with the most generative open-ended question sequence within a health care system and involved analysis of 1,892 patients' responses, including 2,948 creative ideas. FINDINGS Actionable, creative feedback was fostered by incorporating a request for transformative feedback into a sequence of narrative elicitation questions. Patients generate more actionable and creative ideas when explicitly invited to share such ideas, especially patients with negative health care experiences, those from minority racial/ethnic backgrounds, and those with chronic illness. The most frequently elicited creative ideas focused on solving challenges, proposing interventions, amplifying exceptional practices, and conveying hopes for the future. CONCLUSIONS A valid and reliable method for eliciting creative ideas from patients can be deployed as part of routine patient experience surveys that include closed-ended survey items and open-ended narrative items in which patients share their experiences in their own words. The elicited creative ideas are promising for patient engagement and innovation efforts. This study highlights the benefits of engaging patients for quality improvement, offers a rigorously tested method for cultivating innovation using patient-generated knowledge, and outlines how creative ideas can enable organizational learning and innovation.
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Affiliation(s)
| | - RACHEL GROB
- Qualitative and Health Experiences Lab, Center for Patient Partnerships, University of Wisconsin
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111
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Gard CC, Tice JA, Miglioretti DL, Sprague BL, Bissell MC, Henderson LM, Kerlikowske K. Extending the Breast Cancer Surveillance Consortium Model of Invasive Breast Cancer. J Clin Oncol 2024; 42:779-789. [PMID: 37976443 PMCID: PMC10906584 DOI: 10.1200/jco.22.02470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 08/08/2023] [Accepted: 09/18/2023] [Indexed: 11/19/2023] Open
Abstract
PURPOSE We extended the Breast Cancer Surveillance Consortium (BCSC) version 2 (v2) model of invasive breast cancer risk to include BMI, extended family history of breast cancer, and age at first live birth (version 3 [v3]) to better inform appropriate breast cancer prevention therapies and risk-based screening. METHODS We used Cox proportional hazards regression to estimate the age- and race- and ethnicity-specific relative hazards for family history of breast cancer, breast density, history of benign breast biopsy, BMI, and age at first live birth for invasive breast cancer in the BCSC cohort. We evaluated calibration using the ratio of expected-to-observed (E/O) invasive breast cancers in the cohort and discrimination using the area under the receiver operating characteristic curve (AUROC). RESULTS We analyzed data from 1,455,493 women age 35-79 years without a history of breast cancer. During a mean follow-up of 7.3 years, 30,266 women were diagnosed with invasive breast cancer. The BCSC v3 model had an E/O of 1.03 (95% CI, 1.01 to 1.04) and an AUROC of 0.646 for 5-year risk. Compared with the v2 model, discrimination of the v3 model improved most in Asian, White, and Black women. Among women with a BMI of 30.0-34.9 kg/m2, the true-positive rate in women with an estimated 5-year risk of 3% or higher increased from 10.0% (v2) to 19.8% (v3) and the improvement was greater among women with a BMI of ≥35 kg/m2 (7.6%-19.8%). CONCLUSION The BCSC v3 model updates an already well-calibrated and validated breast cancer risk assessment tool to include additional important risk factors. The inclusion of BMI was associated with the largest improvement in estimated risk for individual women.
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Affiliation(s)
- Charlotte C. Gard
- Department of Economics, Applied Statistics, and International Business, New Mexico State University, Las Cruces, NM
| | - Jeffrey A. Tice
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Diana L. Miglioretti
- University of California, Davis, Davis, CA
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | - Brian L. Sprague
- Department of Surgery, University of Vermont Cancer Center, Burlington, VT
- Department of Radiology, University of Vermont Cancer Center, Burlington, VT
| | | | | | - Karla Kerlikowske
- General Internal Medicine Section, Department of Veteran Affairs, University of California, San Francisco, San Francisco, CA
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
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112
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Milliren CE, Ozonoff A, Fournier KA, Welcher J, Landschaft A, Kimia AA. Enhancing Pressure Injury Surveillance Using Natural Language Processing. J Patient Saf 2024; 20:119-124. [PMID: 38147064 PMCID: PMC10922576 DOI: 10.1097/pts.0000000000001193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
Abstract
OBJECTIVE This study assessed the feasibility of nursing handoff notes to identify underreported hospital-acquired pressure injury (HAPI) events. METHODS We have established a natural language processing-assisted manual review process and workflow for data extraction from a corpus of nursing notes across all medical inpatient and intensive care units in a tertiary care pediatric center. This system is trained by 2 domain experts. Our workflow started with keywords around HAPI and treatments, then regular expressions, distributive semantics, and finally a document classifier. We generated 3 models: a tri-gram classifier, binary logistic regression model using the regular expressions as predictors, and a random forest model using both models together. Our final output presented to the event screener was generated using a random forest model validated using derivation and validation sets. RESULTS Our initial corpus involved 70,981 notes during a 1-year period from 5484 unique admissions for 4220 patients. Our interrater human reviewer agreement on identifying HAPI was high ( κ = 0.67; 95% confidence interval [CI], 0.58-0.75). Our random forest model had 95% sensitivity (95% CI, 90.6%-99.3%), 71.2% specificity (95% CI, 65.1%-77.2%), and 78.7% accuracy (95% CI, 74.1%-83.2%). A total of 264 notes from 148 unique admissions (2.7% of all admissions) were identified describing likely HAPI. Sixty-one described new injuries, and 64 describe known yet possibly evolving injuries. Relative to the total patient population during our study period, HAPI incidence was 11.9 per 1000 discharges, and incidence rate was 1.2 per 1000 bed-days. CONCLUSIONS Natural language processing-based surveillance is proven to be feasible and high yield using nursing handoff notes.
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Affiliation(s)
- Carly E. Milliren
- Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, Boston, MA
| | - Al Ozonoff
- Division of Infectious Diseases, Boston Children’s Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Kerri A. Fournier
- Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, Boston, MA
| | - Jennifer Welcher
- Department of Ophthalmology, Boston Children’s Hospital, Boston, MA
| | - Assaf Landschaft
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, MA
| | - Amir A. Kimia
- Department of Pediatrics, Harvard Medical School, Boston, MA
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, MA
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Vu DM, Elze T, Miller JW, Lorch AC, VanderVeen DK, Oke I. Risk Factors for Glaucoma Diagnosis and Surgical Intervention following Pediatric Cataract Surgery in the IRIS® Registry. Ophthalmol Glaucoma 2024; 7:131-138. [PMID: 37683729 PMCID: PMC10915110 DOI: 10.1016/j.ogla.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 09/10/2023]
Abstract
PURPOSE To compare demographic and clinical factors associated with glaucoma following cataract surgery (GFCS) and glaucoma surgery rates between infants, toddlers, and older children using a large, ophthalmic registry. DESIGN Retrospective cohort study. PARTICIPANTS Patients in the IRIS® Registry (Intelligent Research in Sight) who underwent cataract surgery at ≤ 17 years old and between January 1, 2013 and December 31, 2020. METHODS Glaucoma diagnosis and procedural codes were extracted from the electronic health records of practices participating in the IRIS Registry. Children with glaucoma diagnosis or surgery before cataract removal were excluded. The Kaplan-Meier estimator was used to determine the cumulative probability of GFCS diagnosis and glaucoma surgery after cataract surgery. Multivariable Cox regression was used to identify factors associated with GFCS and glaucoma surgery. MAIN OUTCOME MEASURES Cumulative probability of glaucoma diagnosis and surgical intervention within 5 years after cataract surgery. RESULTS The study included 6658 children (median age, 10.0 years; 46.2% female). The 5-year cumulative probability of GFCS was 7.1% (95% confidence interval [CI], 6.1%-8.1%) and glaucoma surgery was 2.6% (95% CI, 1.9%-3.2%). The 5-year cumulative probability of GFCS for children aged < 1 year was 22.3% (95% CI, 15.7%-28.4%). Risk factors for GFCS included aphakia (hazard ratio [HR], 2.63; 95% CI, 1.96-3.57), unilateral cataract (HR, 1.48; 95% CI, 1.12-1.96), and Black race (HR, 1.61; 95% CI, 1.12-2.32). The most common surgery was glaucoma drainage device insertion (32.6%), followed by angle surgery (23.3%), cyclophotocoagulation (15.1%), and trabeculectomy (5.8%). CONCLUSIONS Glaucoma following cataract surgery diagnosis in children in the IRIS Registry was associated with young age, aphakia, unilateral cataract, and Black race. Glaucoma drainage device surgery was the preferred surgical treatment, consistent with the World Glaucoma Association 2013 consensus recommendations for GFCS management. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Daniel M Vu
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts.
| | - Tobias Elze
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Joan W Miller
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Alice C Lorch
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Deborah K VanderVeen
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Isdin Oke
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
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Montembeau SC, Rao BR, Mitchell AR, Speight CD, Allen LA, Halpern SD, Ko YA, Matlock DD, Moore MA, Morris AA, Scherer LD, Ubel P, Dickert NW. Integrating Cost into Shared Decision-Making for Heart Failure with Reduced Ejection Fraction (POCKET-COST-HF): A Trial Providing Out-of-Pocket Costs for Heart Failure Medications during Clinical Encounters. Am Heart J 2024; 269:84-93. [PMID: 38096946 PMCID: PMC11002964 DOI: 10.1016/j.ahj.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 11/05/2023] [Accepted: 11/20/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Evidence-based medical therapy for heart failure with reduced ejection fraction (HFrEF) often entails substantial out-of-pocket costs that can vary appreciably between patients. This has raised concerns regarding financial toxicity, equity, and adherence to medical therapy. In spite of these concerns, cost discussions in the HFrEF population appear to be rare, partly because out-of-pocket costs are generally unavailable during clinical encounters. In this trial, out-of-pocket cost information is given to patients and clinicians during outpatient encounters with the aim to assess the impact of providing this information on medication discussions and decisions. HYPOTHESIS Cost-informed decision-making will be facilitated by providing access to patient-specific out-of-pocket cost estimates at the time of clinical encounter. DESIGN Integrating Cost into Shared Decision-Making for Heart Failure with Reduced Ejection Fraction (POCKET-COST-HF) is a multicenter trial based at Emory Healthcare and University of Colorado Health. Adapting an existing patient activation tool from the EPIC-HF trial, patients and clinicians are presented a checklist with medications approved for treatment of HFrEF with or without patient-specific out-of-pocket costs (obtained from a financial navigation firm). Clinical encounters are audio-recorded, and patients are surveyed about their experience. The trial utilizes a stepped-wedge cluster randomized design, allowing for each site to enroll control and intervention group patients while minimizing contamination of the control arm. DISCUSSION This trial will elucidate the potential impact of robust cost disclosure efforts and key information regarding patient and clinician perspectives related to cost and cost communication. It also will reveal important challenges associated with providing out-of-pocket costs for medications during clinical encounters. Acquiring medication costs for this trial requires an involved process and outsourcing of work. In addition, costs may change throughout the year, raising questions regarding what specific information is most valuable. These data will represent an important step towards understanding the role of integrating cost discussions into heart failure care. CLINICALTRIALS GOV IDENTIFIER NCT04793880.
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Affiliation(s)
- Sarah C Montembeau
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA.
| | - Birju R Rao
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Andrea R Mitchell
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Candace D Speight
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Larry A Allen
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Scott D Halpern
- Palliative and Advanced Illness Research (PAIR) Center and Department of Medicine, Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Yi-An Ko
- Department of Biostatistics, Emory University Rollins School of Public Health, Atlanta, GA
| | - Daniel D Matlock
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Miranda A Moore
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA
| | - Alanna A Morris
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Laura D Scherer
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Peter Ubel
- Duke University Fuqua School of Business, Durham, NC
| | - Neal W Dickert
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA; Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA
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Sheehan MM, Zilberberg MD, Lindenauer PK, Higgins TL, Imrey PB, Guo N, Deshpande A, Haessler SD, Rothberg MB. Associations between Present-on-Admission Do-Not-Resuscitate Orders and Short-Term Outcomes in Patients with Pneumonia. South Med J 2024; 117:165-171. [PMID: 38428939 PMCID: PMC10914325 DOI: 10.14423/smj.0000000000001663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Abstract
OBJECTIVES Do-not-resuscitate (DNR) orders are used to express patient preferences for cardiopulmonary resuscitation. This study examined whether early DNR orders are associated with differences in treatments and outcomes among patients hospitalized with pneumonia. METHODS This is a retrospective cohort study of 768,015 adult patients hospitalized with pneumonia from 2010 to 2015 in 646 US hospitals. The exposure was DNR orders present on admission. Secondary analyses stratified patients by predicted in-hospital mortality. Main outcomes included in-hospital mortality, length of stay, cost, intensive care admission, invasive mechanical ventilation, noninvasive ventilation, vasopressors, and dialysis initiation. RESULTS Of 768,015 patients, 94,155 (12.3%) had an early DNR order. Compared with those without, patients with DNR orders were older (mean age 80.1 ± 10.6 years vs 67.8 ± 16.4 years), with higher comorbidity burden, intensive care use (31.6% vs 30.6%), and in-hospital mortality (28.2% vs 8.5%). After adjustment via propensity score weighting, these patients had higher mortality (odds ratio [OR] 2.39, 95% confidence interval [CI] 2.33-2.45) and lower use of intensive therapies such as vasopressors (OR 0.83, 95% CI 0.81-0.85) and invasive mechanical ventilation (OR 0.68, 95% CI 0.66-0.70). Although there was little relationship between predicted mortality and DNR orders, among those with highest predicted mortality, DNR orders were associated with lower intensive care use compared with those without (66.7% vs 80.8%). CONCLUSIONS Patients with early DNR orders have higher in-hospital mortality rates than those without, but often receive intensive care. These orders have the most impact on the care of patients with the highest mortality risk.
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Affiliation(s)
| | | | - Peter K. Lindenauer
- Departments of Healthcare Delivery and Population Sciences and Medicine, University of Massachusetts Chan Medical School-Baystate, Springfield
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester
| | - Thomas L. Higgins
- The Center for Case Management, Natick, Massachusetts
- Departments of Medicine and Anesthesiology, Division of Pulmonary and Critical Care Medicine, University of Massachusetts Chan Medical School-Baystate, Springfield
| | - Peter B. Imrey
- Department of Quantitative Health Sciences, Cleveland, Ohio
| | - Ning Guo
- Department of Quantitative Health Sciences, Cleveland, Ohio
| | | | - Sarah D. Haessler
- Department of Medicine, Division of Infectious Diseases, University of Massachusetts Chan Medical School-Baystate, Springfield, Massachusetts
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116
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Oke I, Slopen N, Galbraith AA, Hunter DG, Wu AC. Gaps in the Vision Screening Pathway for School-Aged US Children. JAMA Ophthalmol 2024; 142:268-270. [PMID: 38270959 PMCID: PMC10811585 DOI: 10.1001/jamaophthalmol.2023.6316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 11/24/2023] [Indexed: 01/26/2024]
Abstract
This cross-sectional study uses a nationally representative survey of the US pediatric population to identify gaps in the vision screening pathway.
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Affiliation(s)
- Isdin Oke
- Department of Ophthalmology, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Natalie Slopen
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts
| | - Alison A. Galbraith
- Department of Pediatrics, Boston Medical Center and Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - David G. Hunter
- Department of Ophthalmology, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ann Chen Wu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
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Daw JR, MacCallum-Bridges CL, Kozhimannil KB, Admon LK. Continuous Medicaid Eligibility During the COVID-19 Pandemic and Postpartum Coverage, Health Care, and Outcomes. JAMA Health Forum 2024; 5:e240004. [PMID: 38457131 PMCID: PMC10924249 DOI: 10.1001/jamahealthforum.2024.0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 12/31/2023] [Indexed: 03/09/2024] Open
Abstract
Importance Pursuant to the Families First Coronavirus Response Act (FFCRA), continuous Medicaid eligibility during the COVID-19 public health emergency (PHE) created a de facto national extension of pregnancy Medicaid eligibility beyond 60 days postpartum. Objective To evaluate the association of continuous Medicaid eligibility with postpartum health insurance, health care use, breastfeeding, and depressive symptoms. Design, Setting, and Participants This cohort study using a generalized difference-in-differences design included 21 states with continuous prepolicy (2017-2019) and postpolicy (2020-2021) participation in the Pregnancy Risk Assessment Monitoring System (PRAMS). Exposures State-level change in Medicaid income eligibility after 60 days postpartum associated with the FFCRA measured as a percent of the federal poverty level (FPL; ie, the difference in 2020 income eligibility thresholds for pregnant people and low-income adults/parents). Main Outcomes and Measures Health insurance, postpartum visit attendance, contraceptive use (any effective method; long-acting reversible contraceptives), any breastfeeding and depressive symptoms at the time of the PRAMS survey (mean [SD], 4 [1.3] months postpartum). Results The sample included 47 716 PRAMS respondents (64.4% aged <30 years; 18.9% Hispanic, 26.2% non-Hispanic Black, 36.3% non-Hispanic White, and 18.6% other race or ethnicity) with a Medicaid-paid birth. Based on adjusted estimates, a 100% FPL increase in postpartum Medicaid eligibility was associated with a 5.1 percentage point (pp) increase in reported postpartum Medicaid enrollment, no change in commercial coverage, and a 6.6 pp decline in uninsurance. This represents a 40% reduction in postpartum uninsurance after a Medicaid-paid birth compared with the prepolicy baseline of 16.7%. In subgroup analyses by race and ethnicity, uninsurance reductions were observed only among White and Black non-Hispanic individuals; Hispanic individuals had no change. No policy-associated changes were observed in other outcomes. Conclusions and Relevance In this cohort study, continuous Medicaid eligibility during the COVID-19 PHE was associated with significantly reduced postpartum uninsurance for people with Medicaid-paid births, but was not associated with postpartum visit attendance, contraception use, breastfeeding, or depressive symptoms at approximately 4 months postpartum. These findings, though limited to the context of the COVID-19 PHE, may offer preliminary insight regarding the potential impact of post-pandemic postpartum Medicaid eligibility extensions. Collection of longer-term and more comprehensive follow-up data on postpartum health care and health will be critical to evaluating the effect of ongoing postpartum policy interventions.
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Affiliation(s)
- Jamie R. Daw
- Department of Health Policy and Management, Columbia University Mailman School of Public Health, New York, New York
| | | | - Katy B. Kozhimannil
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis
| | - Lindsay K. Admon
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor
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Darling KE, Warnick J, Guerry WB, Rancourt D. Adolescent Females' Dyadic Conversations About Body, Weight, and Appearance. J Adolesc Res 2024; 39:487-510. [PMID: 38414661 PMCID: PMC10896266 DOI: 10.1177/07435584221120111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
Body talk among adolescent females has been associated with negative outcomes, including depressed mood, disordered eating, and body dissatisfaction. Yet, little work has investigated the manifestation of body talk in actual conversations between adolescent females or explored pathways through which body talk is spread (e.g., co-rumination). The present study examined body talk among adolescent female dyads (N = 23 dyads) ages 13 to 17 (Mage = 15.12) using an observational design. Reciprocally nominated dyads were recruited from a high school in the southeastern United States. Conversations between dyads were qualitatively coded using an applied thematic analysis approach. Identified themes were related to weight, appearance, and personality. Results provide insight into the social context in which sociocultural norms of weight stigma, body dissatisfaction, and eating-related psychopathology may be reinforced. Findings have implications for informing the development of interventions to reduce co-rumination of negative weight- and appearance-related body talk and to promote positive body image and healthy weight among adolescent girls.
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119
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Hoffmann JA, Kshetrapal A, Pergjika A, Foster AA, Wnorowska JH, Johnson JK. A Qualitative Assessment of Barriers and Proposed Interventions to Improve Acute Agitation Management for Children With Mental and Behavioral Health Conditions in the Emergency Department. J Acad Consult Liaison Psychiatry 2024; 65:167-177. [PMID: 38070778 PMCID: PMC11032221 DOI: 10.1016/j.jaclp.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/11/2023] [Accepted: 12/04/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Mental health visits to the emergency department (ED) by children are rising in the United States, and acute agitation during these visits presents safety risks to patients and staff. OBJECTIVE We sought to assess barriers and strategies for providing high-quality care to children who experience acute agitation in the ED. METHODS We conducted semistructured interviews with 6 ED physicians, 6 ED nurses, 6 parents, and 6 adolescents at high risk for developing agitation. We asked participants about their experiences with acute agitation care in the ED, barriers and facilitators to providing high-quality care, and proposed interventions. Interviews were coded and analyzed thematically. RESULTS Participants discussed identifying risk factors for acute agitation, worrying about safety and the risk of injury, feeling moral distress, and shifting the culture toward patient-centered, trauma-informed care. Barriers and facilitators included using a standardized care pathway, identifying environmental barriers and allocating resources, partnering with the family and child, and communicating among team members. Nine interventions were proposed: opening a behavioral observation unit with dedicated staff and space, asking screening questions to identify risk of agitation, creating personalized care plans in the electronic health record, using a standardized agitation severity scale, implementing a behavioral response team, providing safe activities and environmental modifications, improving the handoff process, educating staff, and addressing bias and inequities. CONCLUSIONS Understanding barriers can inform solutions to improve care for children who experience acute agitation in the ED. The perspectives of families and patients should be considered when designing interventions to improve care.
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Affiliation(s)
- Jennifer A Hoffmann
- Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Anisha Kshetrapal
- Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Alba Pergjika
- Prtizker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Ashley A Foster
- Department of Emergency Medicine, University of California San Francisco, UCSF Benioff Children's Hospital, San Francisco, CA
| | | | - Julie K Johnson
- Department of Surgery, Northwestern Quality Improvement Research and Education in Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
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Whittington C, Skains RM, Zhang Y, Osborne JD, O'Leary T, Freeman HB, Martin RC, Vickers JK, Flood KL, Markland AD, Buford TW, Brown CJ, Kennedy RE. Delirium Due to Potentially Avoidable Hospitalizations Among Older Adults. J Gerontol A Biol Sci Med Sci 2024; 79:glad256. [PMID: 37940689 DOI: 10.1093/gerona/glad256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Delirium is a common complication during acute care hospitalizations in older adults. A substantial percentage of admissions are for ambulatory care-sensitive conditions (ACSCs) or potentially avoidable hospitalizations-conditions that might be treated early in the outpatient setting to prevent hospitalization and hospital complications. METHODS This retrospective cross-sectional study examined rates of delirium among older adults hospitalized for ACSCs. Participants were 39 933 older adults ≥65 years of age admitted from January 1, 2015 to December 31, 2019 to general inpatient units and ICUs of a large Southeastern academic medical center. Delirium was defined as a score ≥ 2 on the Nursing Delirium Screening Scale or positive on the Confusion Assessment Method for the Intensive Care Unit during admission, and ACSCs were identified from the primary admission diagnosis using standardized definitions. Generalized linear mixed models were used to examine the association between ACSCs and delirium, compared with admissions for non-ACSC diagnoses, adjusting for covariates and repeated observations for individuals with multiple admissions. RESULTS Delirium occurred in 15.6% of admissions for older adults. Rates were lower for ACSC admissions versus admissions for other conditions (13.9% vs 15.8%, p < .001). Older age and higher comorbidity were significant predictors of the development of delirium. CONCLUSIONS Rates of delirium among older adults hospitalized for ACSCs were lower than rates for non-ACSC hospitalization but still substantial. Optimizing the treatment of ACSCs in the outpatient setting is an important goal not only for reducing hospitalizations but also for reducing risks for hospital-associated complications such as delirium.
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Affiliation(s)
- Caroline Whittington
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Rachel M Skains
- Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Yue Zhang
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - John D Osborne
- Division of General Internal Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Tobias O'Leary
- Division of General Internal Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Hyun B Freeman
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Roy C Martin
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jasmine K Vickers
- Department of Nursing Research and Scholarship, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kellie L Flood
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Alayne D Markland
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Department of Veterans Affairs, Birmingham, Alabama, USA
| | - Thomas W Buford
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Department of Veterans Affairs, Birmingham, Alabama, USA
| | - Cynthia J Brown
- Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Richard E Kennedy
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Wadhwani SI, Pantell MS, Winestone LE. Subspecialty Pediatrics: An Unmet Opportunity to Address Unmet Social Risks. Acad Pediatr 2024; 24:204-207. [PMID: 37499795 PMCID: PMC10811277 DOI: 10.1016/j.acap.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 07/17/2023] [Accepted: 07/20/2023] [Indexed: 07/29/2023]
Affiliation(s)
| | | | - Lena E Winestone
- Department of Pediatrics, University of California San Francisco
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Jensen CE, Deal AM, Nyrop KA, Logan M, Mangieri NJ, Strayhorn MD, Miller J, Muss HB, Lichtman EI, Rubinstein SM, Tuchman SA. Geriatric assessment-guided interventions for older adults with multiple myeloma: A feasibility and acceptability study. J Geriatr Oncol 2024; 15:101680. [PMID: 38104482 PMCID: PMC10922464 DOI: 10.1016/j.jgo.2023.101680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 10/11/2023] [Accepted: 11/29/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Geriatric assessment (GA)-guided supportive care programs have been successful in improving treatment outcomes for older adults with solid-organ cancers. This study aimed to evaluate the feasibility of a GA-guided supportive care program among older adults treated for multiple myeloma (MM). MATERIALS AND METHODS The study utilized an existing registry of adults with plasma cell disorders at the University of North Carolina. Patients with MM, aged 60 or older, and having a GA-identified deficit in one or more problem area were offered referrals to supportive care resources during routine visits. Problem areas included physical function deficits, polypharmacy, and anxiety or depression. Patients with physical function deficits were offered referral to physical therapy (PT), those with polypharmacy to an Oncology Clinical Pharmacist Practitioner (CPP), and those with mental health symptoms to the Comprehensive Cancer Support Program (CCSP). RESULTS Of the 58 individuals identified as having at least one deficit on the GA, PT was the most commonly identified relevant resource (79%), followed by CPP visits (57%). Among individuals that were offered referral(s) to at least one new supportive care resource, the acceptance rate was 50%. Referral acceptance rates were highest among those recommended for a CPP visit (55% of those approached) and lowest for CCSP (0%). DISCUSSION The study examined the feasibility and acceptability of a referral program for supportive care resources among older adults with MM who have deficits on GA. The most commonly identified deficit was physical functioning, followed by polypharmacy and mental health. The study found that physical interventions and referrals to CPPs were the most accepted interventions. However, the low proportion of patients who accepted physical therapy referrals indicates the need for tailored and more personalized approaches. Further research is needed to explore the feasibility and impact of supportive care referral programs for older adults with MM.
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Affiliation(s)
- Christopher E Jensen
- Division of Hematology, Department of Medicine, University of North Carolina at Chapel Hill, 170 Manning Drive, Physicians Office Building, CB# 7305, Chapel Hill, NC 27599, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC 27599, USA.
| | - Allison M Deal
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC 27599, USA.
| | - Kirsten A Nyrop
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC 27599, USA; Division of Oncology, Department of Medicine, University of North Carolina at Chapel Hill, 170 Manning Drive, Physicians Office Building, CB# 7305, Chapel Hill, NC 27599, USA.
| | - Maya Logan
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC 27599, USA.
| | - Nicholas J Mangieri
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC 27599, USA.
| | - Martha D Strayhorn
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC 27599, USA.
| | - Jordan Miller
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC 27599, USA.
| | - Hyman B Muss
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC 27599, USA; Division of Oncology, Department of Medicine, University of North Carolina at Chapel Hill, 170 Manning Drive, Physicians Office Building, CB# 7305, Chapel Hill, NC 27599, USA.
| | - Eben I Lichtman
- Division of Hematology, Department of Medicine, University of North Carolina at Chapel Hill, 170 Manning Drive, Physicians Office Building, CB# 7305, Chapel Hill, NC 27599, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC 27599, USA.
| | - Samuel M Rubinstein
- Division of Hematology, Department of Medicine, University of North Carolina at Chapel Hill, 170 Manning Drive, Physicians Office Building, CB# 7305, Chapel Hill, NC 27599, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC 27599, USA.
| | - Sascha A Tuchman
- Division of Hematology, Department of Medicine, University of North Carolina at Chapel Hill, 170 Manning Drive, Physicians Office Building, CB# 7305, Chapel Hill, NC 27599, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC 27599, USA.
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Rucci JM, Law AC, Bolesta S, Quinn EK, Garcia MA, Gajic O, Boman K, Yus S, Goodspeed VM, Kumar V, Kashyap R, Walkey AJ. Variation in Sedative and Analgesic Use During the COVID-19 Pandemic and Associated Outcomes. CHEST Crit Care 2024; 2:100047. [PMID: 38576856 PMCID: PMC10994221 DOI: 10.1016/j.chstcc.2024.100047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
BACKGROUND Providing analgesia and sedation is an essential component of caring for many mechanically ventilated patients. The selection of analgesic and sedative medications during the COVID-19 pandemic, and the impact of these sedation practices on patient outcomes, remain incompletely characterized. RESEARCH QUESTION What were the hospital patterns of analgesic and sedative use for patients with COVID-19 who received mechanical ventilation (MV), and what differences in clinical patient outcomes were observed across prevailing sedation practices? STUDY DESIGN AND METHODS We conducted an observational cohort study of hospitalized adults who received MV for COVID-19 from February 2020 through April 2021 within the Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS) COVID-19 Registry. To describe common sedation practices, we used hierarchical clustering to group hospitals based on the percentage of patients who received various analgesic and sedative medications. We then used multivariable regression models to evaluate the association between hospital analgesia and sedation cluster and duration of MV (with a placement of death [POD] approach to account for competing risks). RESULTS We identified 1,313 adults across 35 hospitals admitted with COVID-19 who received MV. Two clusters of analgesia and sedation practices were identified. Cluster 1 hospitals generally administered opioids and propofol with occasional use of additional sedatives (eg, benzodiazepines, alpha-agonists, and ketamine); cluster 2 hospitals predominantly used opioids and benzodiazepines without other sedatives. As compared with patients in cluster 2, patients admitted to cluster 1 hospitals underwent a shorter adjusted median duration of MV with POD (β-estimate, -5.9; 95% CI, -11.2 to -0.6; P = .03). INTERPRETATION Patients who received MV for COVID-19 in hospitals that prioritized opioids and propofol for analgesia and sedation experienced shorter adjusted median duration of MV with POD as compared with patients who received MV in hospitals that primarily used opioids and benzodiazepines.
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Affiliation(s)
- Justin M Rucci
- Pulmonary Center, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine
- Center for Healhcare Organization and Implementation Research, VA Boston Healthcare System
| | - Anica C Law
- Pulmonary Center, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine
| | - Scott Bolesta
- Department of Pharmacy Practice, Nesbitt School of Pharmacy, Wilkes University, Wilkes-Barre, PA
| | - Emily K Quinn
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, University of Massachusetts Chan School of Medicine, Worcester MA
| | - Michael A Garcia
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington Medicine Valley Medical Center, Renton, WA
| | - Ognjen Gajic
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Karen Boman
- Society of Critical Care Medicine, Mount Prospect, IL
| | - Santiago Yus
- Department of Intensive Care Medicine, La Paz University Hospital, Madrid, Spain
| | - Valerie M Goodspeed
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, University of Massachusetts Chan School of Medicine, Worcester MA
| | | | - Rahul Kashyap
- Department of Anesthesia and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Allan J Walkey
- Division of Health Systems Science, Department of Medicine, University of Massachusetts Chan School of Medicine, Worcester MA
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Valentine-King M, Hansen MA, Zoorob R, Schlueter M, Matas JL, Willis SE, Danek LCK, Muldrew K, Zare M, Hudson F, Atmar RL, Chou A, Trautner BW, Grigoryan L. Determining a urinary-specific antibiogram and risk factors of trimethoprim/sulfamethoxazole, ciprofloxacin and multidrug resistance among Enterobacterales in primary care. J Antimicrob Chemother 2024; 79:559-563. [PMID: 38217846 PMCID: PMC10904720 DOI: 10.1093/jac/dkae004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 01/02/2024] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Risk factors for ciprofloxacin or MDR in primary care urine specimens are not well defined. OBJECTIVES We created a primary care-specific antibiogram for Escherichia coli isolates from cases with complicated and uncomplicated urinary tract infection (UTI) and evaluated risk factors for ciprofloxacin, trimethoprim/sulfamethoxazole and MDR among Enterobacterales. METHODS We conducted a cross-sectional study to determine resistance and risk factors by collecting urine cultures from all patients (≥18 years) presenting with provider-suspected UTI at two primary care, safety-net clinics in Houston, TX, USA between November 2018 and March 2020. RESULTS Among 1262 cultures, 308 cultures grew 339 uropathogens. Patients with Enterobacterales (n = 199) were mostly female (93.5%) with a mean age of 48.5 years. E. coli was the predominant uropathogen isolated (n = 187/339; 55%) and had elevated trimethoprim/sulfamethoxazole (43.6%) and ciprofloxacin (29.5%) resistance, low nitrofurantoin (1.8%) resistance, and no fosfomycin resistance. Among E. coli, 10.6% were ESBL positive and 24.9% had MDR. Birth outside the U.S.A., prior (2 year) trimethoprim/sulfamethoxazole resistance, and diabetes mellitus were associated with trimethoprim/sulfamethoxazole resistance. Prior (60 day) fluoroquinolone use, prior ciprofloxacin resistance and both diabetes mellitus and hypertension were strongly associated with ciprofloxacin resistance. Prior fluoroquinolone use and a history of resistance to any studied antibiotic were associated with MDR, while pregnancy was protective. CONCLUSIONS We found elevated resistance to UTI-relevant antimicrobials and novel factors associated with resistance; these data can be incorporated into clinical decision tools to improve organism and drug concordance.
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Affiliation(s)
- Marissa Valentine-King
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Michael A Hansen
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Roger Zoorob
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
| | | | - Jennifer L Matas
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Samuel E Willis
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
- Harris Health System, Houston, TX, USA
| | - Lisa C K Danek
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
- Harris Health System, Houston, TX, USA
| | - Kenneth Muldrew
- Harris Health System, Houston, TX, USA
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, USA
- School of Health Professions, University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Pathology and Laboratory Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Mohammad Zare
- Harris Health System, Houston, TX, USA
- Department of Family and Community Medicine, University of Texas McGovern Medical School, Houston, TX, USA
| | | | - Robert L Atmar
- Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Andrew Chou
- Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Pain Research, Informatics, Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, USA
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, West Haven, CT, USA
| | - Barbara W Trautner
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Larissa Grigoryan
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
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Hughes PM, Easterly CW, Thomas KC, Shea CM, Domino ME. North Carolina Medicaid System Perspectives on Substance Use Disorder Treatment Policy Changes During the COVID-19 Pandemic. J Addict Med 2024; 18:e1-e7. [PMID: 38345239 PMCID: PMC10940189 DOI: 10.1097/adm.0000000000001272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
OBJECTIVE This study aimed to describe perspectives from stakeholders involved in the Medicaid system in North Carolina regarding substance use disorder (SUD) treatment policy changes during the coronavirus disease 2019 pandemic. METHODS We conducted semistructured interviews in early 2022 with state agency representatives, Medicaid managed care organizations, and Medicaid providers (n = 22) as well as 3 focus groups of Medicaid beneficiaries with SUD (n = 14). Interviews and focus groups focused on 4 topics: policies, meeting needs during COVID, demand for SUD services, and staffing. RESULTS Overall, policy changes, such as telehealth and take-home methadone, were considered beneficial, with participants displaying substantial support for both policies. Shifting demand for services, staffing shortages, and technology barriers presented significant challenges. Innovative benefits and services were used to adapt to these challenges, including the provision of digital devices and data plans to improve access to telehealth. CONCLUSIONS Perspectives from Medicaid stakeholders, including state organizations to beneficiaries, support the continuation of SUD policy changes that occurred. Staffing shortages remain a substantial barrier. Based on the participants' positive responses to the SUD policy changes made during the coronavirus disease 2019 pandemic, such as take-home methadone and telehealth initiation of buprenorphine, these changes should be continued. Additional steps are needed to ensure payment parity for telehealth services.
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Affiliation(s)
- Phillip M. Hughes
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy
- Division of Research, UNC Health Sciences at MAHEC, Asheville, NC
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Caleb W. Easterly
- MD/PhD Program, UNC School of Medicine, Chapel Hill, NC
- Department of Health Policy and Management, Gillings School of Global Public Health, UNC Chapel Hill
| | - Kathleen C. Thomas
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Christopher M. Shea
- Department of Health Policy and Management, Gillings School of Global Public Health, UNC Chapel Hill
| | - Marisa Elena Domino
- Center for Health Information and Research (CHiR), College of Health Solutions, Arizona State University, Phoenix, AZ
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Lang K, Atchison TJ, Singh P, Kline DM, Odei JB, Martin JL, Smyer JF, Day SR, Hebert CL. Describing the monthly variability of hospital-onset Clostridioides difficile during early coronavirus disease 2019 (COVID-19) using electronic health record data. Infect Control Hosp Epidemiol 2024; 45:329-334. [PMID: 37807908 PMCID: PMC10933504 DOI: 10.1017/ice.2023.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 11/04/2022] [Accepted: 06/25/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE To assess the relative risk of hospital-onset Clostridioides difficile (HO-CDI) during each month of the early coronavirus disease 2019 (COVID-19) pandemic and to compare it with historical expectation based on patient characteristics. DESIGN This study used a retrospective cohort design. We collected secondary data from the institution's electronic health record (EHR). SETTING The Ohio State University Wexner Medical Center, Ohio, a large tertiary healthcare system in the Midwest. PATIENTS OR PARTICIPANTS All adult patients admitted to the inpatient setting between January 2018 and May 2021 were eligible for the study. Prisoners, children, individuals presenting with Clostridioides difficile on admission, and patients with <4 days of inpatient stay were excluded from the study. RESULTS After controlling for patient characteristics, the observed numbers of HO-CDI cases were not significantly different than expected. However, during 3 months of the pandemic period, the observed numbers of cases were significantly different from what would be expected based on patient characteristics. Of these 3 months, 2 months had more cases than expected and 1 month had fewer. CONCLUSIONS Variations in HO-CDI incidence seemed to trend with COVID-19 incidence but were not fully explained by our case mix. Other factors contributing to the variability in HO-CDI incidence beyond listed patient characteristics need to be explored.
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Affiliation(s)
- Kaiting Lang
- Division of Epidemiology, College of Public Health, Columbus, Ohio
| | - T. J. Atchison
- College of Medicine, The Ohio State University, Columbus, Ohio
| | - Priti Singh
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio
| | - David M. Kline
- Department of Biostatistics and Data Science, Wake Forest University, School of Medicine, Winston-Salem, North Carolina
| | - James B. Odei
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, Ohio
| | - Jennifer L. Martin
- Department of Clinical Epidemiology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Justin F. Smyer
- Department of Clinical Epidemiology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Shandra R. Day
- Division of Infectious Diseases, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Courtney L. Hebert
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio
- Division of Infectious Diseases, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Levander XA, VanDerSchaaf H, Barragán VG, Choxi H, Hoffman A, Morgan E, Wong E, Wusirika R, Cheng A. The Role of Human-Centered Design in Healthcare Innovation: a Digital Health Equity Case Study. J Gen Intern Med 2024; 39:690-695. [PMID: 37973709 DOI: 10.1007/s11606-023-08500-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 10/20/2023] [Indexed: 11/19/2023]
Abstract
Healthcare delivery has become more complicated, particularly with the addition of digital tools and advanced technologies that can further exacerbate existing disparities. New approaches to solve complex, multi-faceted problems are needed. Human-centered design (HCD), also known as design thinking, is an innovative set of methods to develop solutions to these types of issues using collaborative, team-based, and empathetic approaches focused on end user experiences. Originally advanced in technology sectors, HCD has garnered growing attention in quality improvement, healthcare redesign, and public health and medical education. During the COVID-19 pandemic, our healthcare organization recognized notable differences in utilization of virtual (video-based) services among specific patient populations. In response, we mobilized, and using HCD, we collectively brainstormed ideas, rapidly developed prototypes, and iteratively adapted solutions to work toward addressing this digital divide and clinic and systems-level struggles with improving and maintaining digital health access. HCD approaches create a cohesive team-based structure that permits the dismantling of organizational hierarchies and departmental silos. Here we share lessons learned on implementing HCD into clinical care settings and how HCD can result in the development of site-specific, patient-centered innovations to address access disparities and to improve digital health equity.
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Affiliation(s)
- Ximena A Levander
- Department of Medicine, Division of General Internal Medicine & Geriatrics, Oregon Health & Science University, Portland, OR, USA.
| | - Hans VanDerSchaaf
- Office of Digital Health, Oregon Health & Science University, Portland, OR, USA
| | - Vanessa Guerrero Barragán
- Office of Digital Health, Oregon Health & Science University, Portland, OR, USA
- Digital Strategy, Oregon Health & Science University, Portland, OR, USA
| | - Hetal Choxi
- Department of Family Medicine, Division of Center for Women's Health, Oregon Health & Science University, Portland, OR, USA
| | - Amber Hoffman
- Office of Digital Health, Oregon Health & Science University, Portland, OR, USA
| | - Emily Morgan
- Department of Medicine, Division of General Internal Medicine & Geriatrics, Oregon Health & Science University, Portland, OR, USA
| | - Eva Wong
- Office of Digital Health, Oregon Health & Science University, Portland, OR, USA
| | - Raghav Wusirika
- Department of Medicine, Division of Nephrology & Hypertension, Oregon Health & Science University, Portland, OR, USA
| | - Anthony Cheng
- Office of Digital Health, Oregon Health & Science University, Portland, OR, USA
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
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Bratches RWR, Onsando W, Puga F, Odom JN, Barr PJ. Family Caregiver Comfort with Telehealth Technologies: Differences by Race and Ethnicity in a Cross-Sectional Survey. Telemed J E Health 2024; 30:685-691. [PMID: 37651216 PMCID: PMC11019774 DOI: 10.1089/tmj.2023.0314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Abstract
Background: Telehealth has seen widespread use since the onset of the COVID-19 pandemic, and 82% patients required assistance in accessing their telehealth appointments. This assistance commonly comes from a family caregiver who may or may not be comfortable using the technologies associated with telehealth. The objective of our study was to analyze a demographically representative survey of U.S. family caregivers to understand the level of comfort using telehealth technologies among family caregivers. Methods: A secondary analysis of survey data collected during the COVID-19 pandemic in 2020. Level of caregiver comfort using computers, smartphones, and tablets was determined through three Likert-style questions. Proportional odds logistic regression was used to understand the associations between demographic variables and level of caregiver comfort using each technology, when adjusting for covariates. Results: A total of 340 caregivers were included in the analysis. Compared with non-Hispanic white caregivers, Asian caregivers had higher odds (odds ratio [OR] 3.14; 95% confidence interval [CI] 1.36, 8.02; p = 0.01) of expressing comfort using computers; black caregivers (OR 0.46; 95% CI 0.21, 0.98; p = 0.04) and Hispanic caregivers (OR 0.36; 95% CI 0.17, 0.79; p = 0.01) expressed lower odds of comfort using smartphones; and Asian caregivers had higher odds (OR 4.64; 95% CI 2.05, 11.69; p = 0.001) of expressing comfort using tablets. Conclusion and Implications: There are identified disparities in the level of technological comfort using computers, smartphones, and tablets by different racial and ethnic groups. Health systems should consider early stakeholder involvement in the design of telehealth technologies, culturally responsive training materials on telehealth technology use to reduce disparities in comfort using telehealth technologies.
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Affiliation(s)
- Reed W R Bratches
- School of Nursing, the University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Wambui Onsando
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, New Hampshire, USA
| | - Frank Puga
- School of Nursing, the University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - J Nicholas Odom
- School of Nursing, the University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Paul J Barr
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, New Hampshire, USA
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Hider AM, Gomez-Rexrode AE, Agius J, MacEachern MP, Ibrahim AM, Regenbogen SE, Berlin NL. Association of bundled payments with spending, utilization, and quality for surgical conditions: A scoping review. Am J Surg 2024; 229:83-91. [PMID: 38148257 DOI: 10.1016/j.amjsurg.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/17/2023] [Accepted: 12/09/2023] [Indexed: 12/28/2023]
Abstract
OBJECTIVES To assess the body of literature examining episode-based bundled payment models effect on health care spending, utilization, and quality of care for surgical conditions. BACKGROUND SUMMARY Episode-based bundled payments were developed as a strategy to lower healthcare spending and improve coordination across phases of healthcare. Surgical conditions may be well-suited targets for bundled payments because they often have defined periods of care and widely variable healthcare spending. In bundled payment models, hospitals receive financial incentives to reduce spending on care provided to patients during a predefined clinical episode. Despite the recent proliferation of bundles for surgical conditions, a collective understanding of their effect is not yet clear. METHODS A scoping review was conducted, and four databases were queried from inception through September 27, 2021, with search strings for bundled payments and surgery. All studies were screened independently by two authors for inclusion. RESULTS Our search strategy yielded a total of 879 unique articles of which 222 underwent a full-text review and 28 met final inclusion criteria. Of these studies, most (23 of 28) evaluated the impact of voluntary bundled payments in orthopedic surgery and found that bundled payments are associated with reduced spending on total care episodes, attributed primarily to decreases in post-acute care spending. Despite reduced spending, clinical outcomes (e.g., readmissions, complications, and mortality) were not worsened by participation. Evidence supporting the effects of bundled payments on cost and clinical outcomes in other non-orthopedic surgical conditions remains limited. CONCLUSIONS Present evaluations of bundled payments primarily focus on orthopedic conditions and demonstrate cost savings without compromising clinical outcomes. Evidence for the effect of bundles on other surgical conditions and implications for quality and access to care remain limited.
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Affiliation(s)
- Ahmad M Hider
- University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Josh Agius
- University of Michigan, Ann Arbor, MI, USA
| | - Mark P MacEachern
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, MI, USA
| | - Andrew M Ibrahim
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; Center for Healthcare Outcomes and Policy, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Scott E Regenbogen
- Center for Healthcare Outcomes and Policy, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA; Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Nicholas L Berlin
- Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA.
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Petrik AF, Johnson ES, Slaughter M, Leo MC, Thompson J, Mummadi R, Jimenez R, Hussain S, Coronado G. The recalibration and redevelopment of a model to calculate patients' probability of completing a colonoscopy following an abnormal fecal test. J Med Screen 2024; 31:28-34. [PMID: 37661831 PMCID: PMC10909915 DOI: 10.1177/09691413231195568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
OBJECTIVES Fecal immunochemical testing (FIT) is an effective screening tool for colorectal cancer. If an FIT is abnormal, a follow-up colonoscopy is necessary to remove polyps or find cancers. We sought to develop a usable risk prediction model to identify patients unlikely to complete a colonoscopy following an abnormal FIT test. METHODS We recalibrated and then redeveloped a prediction model in federally qualified health centers (FQHCs), using a retrospective cohort of patients aged 50-75 with an abnormal FIT test and clinical data. Logistic and Cox regressions were used to recalibrate and then redevelop the model. RESULTS The initial risk model used data from eight FQHCs (26 clinics) including 1723 patients. When we applied the model to a single large FQHC (34 clinics, 884 eligible patients), the model did not recalibrate successfully (c-statistic dropped more than 0.05, from 0.66 to 0.61). The model was redeveloped in the same FQHC in a cohort of 1401 patients with a c-statistic of 0.65. CONCLUSIONS The original model developed in a group of FQHCs did not adequately recalibrate in the single large FQHC. Health system, patient characteristics or data differences may have led to the inability to recalibrate the model. However, the redeveloped model provides an adequate model for the single FQHC.
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Affiliation(s)
- Amanda F. Petrik
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Eric S. Johnson
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Matthew Slaughter
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Michael C. Leo
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Jamie Thompson
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Raj Mummadi
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | | | - Syed Hussain
- SeaMar Community Health Centers, Seattle, Washington
| | - Gloria Coronado
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
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Gurewitsch Allen E. Prescriptive and proscriptive lessons for managing shoulder dystocia: a technical and videographical tutorial. Am J Obstet Gynecol 2024; 230:S1014-S1026. [PMID: 38462247 PMCID: PMC10925798 DOI: 10.1016/j.ajog.2022.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/04/2022] [Accepted: 03/07/2022] [Indexed: 03/12/2024]
Abstract
This tutorial of the intrapartum management of shoulder dystocia uses drawings and videos of simulated and actual deliveries to illustrate the biomechanical principles of specialized delivery maneuvers and examine missteps associated with brachial plexus injury. It is intended to complement haptic, mannequin-based simulation training. Demonstrative explication of each maneuver is accompanied by specific examples of what not to do. Positive (prescriptive) instruction prioritizes early use of direct fetal manipulation and stresses the importance of determining the alignment of the fetal shoulders by direct palpation, and that the biacromial width should be manually adjusted to an oblique orientation within the pelvis-before application of traction to the fetal head, the biacromial width is manually adjusted to an oblique orientation within the pelvis. Negative (proscriptive) instructions includes the following: to avoid more than usual and/or laterally directed traction, to use episiotomy only as a means to gain access to the posterior shoulder and arm, and to use a 2-step procedure in which a 60-second hands-off period ("do not do anything") is inserted between the emergence of the head and any initial attempts at downward traction to allow for spontaneous rotation of the fetal shoulders. The tutorial presents a stepwise approach focused on the delivering clinician's tasks while including the role of assistive techniques, including McRoberts, Gaskin, and Sims positioning, suprapubic pressure, and episiotomy. Video footage of actual deliveries involving shoulder dystocia and permanent brachial plexus injury demonstrates ambiguities in making the diagnosis of shoulder dystocia, risks of improper traction and torsion of the head, and overreliance on repeating maneuvers that prove initially unsuccessful.
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Affiliation(s)
- Edith Gurewitsch Allen
- Department of Obstetrics, Gynecology, and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY.
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Keim G, Nishisaki A. Improving Noninvasive Ventilation for Bronchiolitis: It Is Here to Stay! Pediatr Crit Care Med 2024; 25:274-275. [PMID: 38451798 PMCID: PMC11031121 DOI: 10.1097/pcc.0000000000003435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Affiliation(s)
- Garrett Keim
- Both authors: Department of Anesthesiology, Critical Care Medicine, Pediatrics University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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Varagur K, Zubovic E, Skolnick GB, Buss J, Snyder-Warwick A, Reinisch J, Patel KB. Porous Polyethylene Versus Autologous Costochondral Reconstruction for Microtia: Incidence and Analysis of Secondary Procedures. Cleft Palate Craniofac J 2024; 61:365-372. [PMID: 36217745 DOI: 10.1177/10556656221132034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To examine the frequency of autologous and alloplastic ear reconstructions for patients with microtia in the United States, and describe post-index procedure rates associated with each method. DESIGN Retrospective cohort study. SETTING Claims data from 500 + hospitals from IBM® MarketScan® Commercial and Multi-State Medicaid databases. PATIENTS/PARTICIPANTS A total of 649 patients aged 1 to 17 years with International Classification of Diseases, ninth/tenth revision (ICD-9/10) diagnoses for microtia, congenital absence of the ear, or hemifacial microsomia. INTERVENTIONS Alloplastic or autologous ear reconstruction between 2006 and 2018. MAIN OUTCOME MEASURE Post-index procedures performed within 1 year following the index repair, analyzed across the study period and separately for each half of the study period (2006-2012, 2012-2018). RESULTS A total of 486 (75%) qualifying patients received autologous and 163 (25%) received alloplastic reconstruction. Secondary procedure rates were significantly higher in the autologous group at 90 days (P = .034), 180 days (P < .001), and at 365 days (P < .001). Alloplastic reconstruction accounted for 23.2% of reconstructions in the first half of the study period compared with 26.7% in the second half (P = .319). One-year secondary procedure rates in the autologous group were not significantly different between both halves of the study period (69.7% vs 67.1%, P = .558), but were significantly lower in the second half for the alloplastic group (44.9% vs 20.2%, P = .001). CONCLUSIONS In these databases, autologous reconstruction is more common than alloplastic reconstruction. Autologous reconstruction is staged, with most undergoing a secondary procedure between 3 months and 1 year postoperatively. Secondary procedure rates decreased over time in patients undergoing alloplastic reconstruction.
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Affiliation(s)
- Kaamya Varagur
- Division of Plastic and Reconstructive Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Ema Zubovic
- Division of Plastic and Reconstructive Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Gary B Skolnick
- Division of Plastic and Reconstructive Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Joanna Buss
- Institute of Clinical and Translational Sciences, Division of Infectious Diseases, Washington University in St. Louis, St. Louis, MO, USA
| | - Alison Snyder-Warwick
- Division of Plastic and Reconstructive Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - John Reinisch
- Division of Plastic Surgery, Department of Surgery, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Kamlesh B Patel
- Division of Plastic and Reconstructive Surgery, Washington University in St. Louis, St. Louis, MO, USA
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Gaffey AE, Rollman BL, Burg MM. Strengthening the Pillars of Cardiovascular Health: Psychological Health is a Crucial Component. Circulation 2024; 149:641-643. [PMID: 38408143 PMCID: PMC10924771 DOI: 10.1161/circulationaha.123.066132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Affiliation(s)
- Allison E. Gaffey
- Department of Internal Medicine (Cardiovascular Medicine), Yale School of Medicine, New Haven, CT
- VA Connecticut Healthcare System, West Haven, CT
| | - Bruce L. Rollman
- Center for Behavioral Health, Media, and Technology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Matthew M. Burg
- Department of Internal Medicine (Cardiovascular Medicine), Yale School of Medicine, New Haven, CT
- VA Connecticut Healthcare System, West Haven, CT
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT
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135
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Goodman KE, Yi PH, Morgan DJ. AI-Generated Clinical Summaries Require More Than Accuracy. JAMA 2024; 331:637-638. [PMID: 38285439 DOI: 10.1001/jama.2024.0555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
This Viewpoint discusses AI-generated clinical summaries and the necessity of transparent development of standards for their safe rollout.
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Affiliation(s)
- Katherine E Goodman
- Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore
- The University of Maryland Institute for Health Computing, North Bethesda
| | - Paul H Yi
- Department of Diagnostic Radiology and Nuclear Medicine, The University of Maryland School of Medicine, Baltimore
| | - Daniel J Morgan
- Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore
- VA Maryland Healthcare System, Baltimore
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136
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Worsham CM, Bray CF, Jena AB. Optimal timing of influenza vaccination in young children: population based cohort study. BMJ 2024; 384:e077076. [PMID: 38383038 PMCID: PMC10879981 DOI: 10.1136/bmj-2023-077076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 02/23/2024]
Abstract
OBJECTIVE To assess optimal timing of influenza vaccination in young children. DESIGN Population based cohort study. SETTING United States. PARTICIPANTS Commercially insured children aged 2-5 years who were vaccinated against influenza during 2011-18. MAIN OUTCOME MEASURE Rates of diagnosis of influenza among children who were vaccinated against influenza, by birth month. RESULTS Overall, 819 223 children aged 2-5 received influenza vaccination. Children vaccinated in November and December were least likely to have a diagnosis of influenza, a finding that may be confounded by unmeasured factors that influence the timing of vaccination and risk of influenza. Vaccination commonly occurred on days of preventive care visits and during birth months. Children born in October were disproportionately vaccinated in October and were, on average, vaccinated later than children born in August and earlier than those born in December. Children born in October had the lowest rate of influenza diagnosis (for example, 2.7% (6016/224 540) versus 3.0% (6462/212 622) for those born in August; adjusted odds ratio 0.88, 95% confidence interval 0.85 to 0.92). CONCLUSIONS In a quasi-experimental analysis of young children vaccinated against influenza, birth month was associated with the timing of vaccination through its influence on the timing of preventive care visits. Children born in October were most likely to be vaccinated in October and least likely to have a diagnosis of influenza, consistent with recommendations promoting October vaccination.
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Affiliation(s)
- Christopher M Worsham
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Charles F Bray
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Anupam B Jena
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- National Bureau of Economic Research, Cambridge, MA, USA
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Bradford W, Figgatt M, Scott KS, Marshall S, Eaton EF, Dye DW. Xylazine co-occurrence with illicit fentanyl is a growing threat in the Deep South: a retrospective study of decedent data. Harm Reduct J 2024; 21:46. [PMID: 38378660 PMCID: PMC10880285 DOI: 10.1186/s12954-024-00959-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/08/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Xylazine is a dangerous veterinary sedative found mainly in illicit fentanyl in the Northeast and Midwest. Its role in the Deep South overdose crisis is not well-characterized. METHODS We conducted a retrospective review of autopsy data in Jefferson County, Alabama to identify trends in xylazine prevalence among people who fatally overdosed from June 2019 through June 2023. RESULTS 165 decedents met inclusion criteria. While the first identified xylazine-associated overdose was in June 2019, xylazine has become consistently prevalent since January 2021. All cases of xylazine-associated fatal overdoses were accompanied by fentanyl, and most (75.4%) involved poly-drug stimulant use. The average age was 42.2, and most decedents were white (58.8%) and male (68.5%). Overall, 18.2% of people were unhoused at the time of death. DISCUSSION Xylazine is prevalent in the Deep South. Efforts to promote harm reduction, publicly viewable drug supply trends, and legalization of drug checking and syringe service programs should be prioritized.
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Affiliation(s)
- William Bradford
- Division of Infectious Diseases, University of Alabama at Birmingham, Boshell Diabetes Building 8th Floor 1808 7th Ave S, Birmingham, AL, 35233, USA.
| | - Mary Figgatt
- Division of Infectious Diseases, University of Alabama at Birmingham, Boshell Diabetes Building 8th Floor 1808 7th Ave S, Birmingham, AL, 35233, USA
| | - Karen S Scott
- Division of Laboratory Medicine, University of Alabama at Birmingham, Birmingham, USA
- Department of Pathology, University of Alabama at Birmingham, Birmingham, USA
| | - Stacy Marshall
- Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - Ellen F Eaton
- Division of Infectious Diseases, University of Alabama at Birmingham, Boshell Diabetes Building 8th Floor 1808 7th Ave S, Birmingham, AL, 35233, USA
| | - Daniel W Dye
- Jefferson County Coroner/Medical Examiner's Office, Birmingham, USA
- Department of Pathology, University of Alabama at Birmingham, Birmingham, USA
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138
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Barwise AK, Curtis S, Diedrich DA, Pickering BW. Using artificial intelligence to promote equitable care for inpatients with language barriers and complex medical needs: clinical stakeholder perspectives. J Am Med Inform Assoc 2024; 31:611-621. [PMID: 38099504 PMCID: PMC10873784 DOI: 10.1093/jamia/ocad224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 11/14/2023] [Indexed: 02/18/2024] Open
Abstract
OBJECTIVES Inpatients with language barriers and complex medical needs suffer disparities in quality of care, safety, and health outcomes. Although in-person interpreters are particularly beneficial for these patients, they are underused. We plan to use machine learning predictive analytics to reliably identify patients with language barriers and complex medical needs to prioritize them for in-person interpreters. MATERIALS AND METHODS This qualitative study used stakeholder engagement through semi-structured interviews to understand the perceived risks and benefits of artificial intelligence (AI) in this domain. Stakeholders included clinicians, interpreters, and personnel involved in caring for these patients or for organizing interpreters. Data were coded and analyzed using NVIVO software. RESULTS We completed 49 interviews. Key perceived risks included concerns about transparency, accuracy, redundancy, privacy, perceived stigmatization among patients, alert fatigue, and supply-demand issues. Key perceived benefits included increased awareness of in-person interpreters, improved standard of care and prioritization for interpreter utilization; a streamlined process for accessing interpreters, empowered clinicians, and potential to overcome clinician bias. DISCUSSION This is the first study that elicits stakeholder perspectives on the use of AI with the goal of improved clinical care for patients with language barriers. Perceived benefits and risks related to the use of AI in this domain, overlapped with known hazards and values of AI but some benefits were unique for addressing challenges with providing interpreter services to patients with language barriers. CONCLUSION Artificial intelligence to identify and prioritize patients for interpreter services has the potential to improve standard of care and address healthcare disparities among patients with language barriers.
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Affiliation(s)
- Amelia K Barwise
- Biomedical Ethics Research Program, Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN 55902, United States
| | - Susan Curtis
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN 55902, United States
| | - Daniel A Diedrich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN 55902, United States
| | - Brian W Pickering
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN 55902, United States
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139
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Lu Y, Keeley EC, Barrette E, Cooper-DeHoff RM, Dhruva SS, Gaffney J, Gamble G, Handke B, Huang C, Krumholz H, Rowe C, Schulz W, Shaw K, Smith M, Woodard J, Young P, Ervin K, Ross J. Use of Electronic Health Records to Characterize Patients with Uncontrolled Hypertension in Two Large Health System Networks. Res Sq 2024:rs.3.rs-3943912. [PMID: 38410433 PMCID: PMC10896369 DOI: 10.21203/rs.3.rs-3943912/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
Background Improving hypertension control is a public health priority. However, consistent identification of uncontrolled hypertension using computable definitions in electronic health records (EHR) across health systems remains uncertain. Methods In this retrospective cohort study, we applied two computable definitions to the EHR data to identify patients with controlled and uncontrolled hypertension and to evaluate differences in characteristics, treatment, and clinical outcomes between these patient populations. We included adult patients (≥ 18 years) with hypertension receiving ambulatory care within Yale-New Haven Health System (YNHHS; a large US health system) and OneFlorida Clinical Research Consortium (OneFlorida; a Clinical Research Network comprised of 16 health systems) between October 2015 and December 2018. We identified patients with controlled and uncontrolled hypertension based on either a single blood pressure (BP) measurement from a randomly selected visit or all BP measurements recorded between hypertension identification and the randomly selected visit). Results Overall, 253,207 and 182,827 adults at YNHHS and OneFlorida were identified as having hypertension. Of these patients, 83.1% at YNHHS and 76.8% at OneFlorida were identified using ICD-10-CM codes, whereas 16.9% and 23.2%, respectively, were identified using elevated BP measurements (≥ 140/90 mmHg). Uncontrolled hypertension was observed among 32.5% and 43.7% of patients at YNHHS and OneFlorida, respectively. Uncontrolled hypertension was disproportionately higher among Black patients when compared with White patients (38.9% versus 31.5% in YNHHS; p < 0.001; 49.7% versus 41.2% in OneFlorida; p < 0.001). Medication prescription for hypertension management was more common in patients with uncontrolled hypertension when compared with those with controlled hypertension (overall treatment rate: 39.3% versus 37.3% in YNHHS; p = 0.04; 42.2% versus 34.8% in OneFlorida; p < 0.001). Patients with controlled and uncontrolled hypertension had similar rates of short-term (at 3 and 6 months) and long-term (at 12 and 24 months) clinical outcomes. The two computable definitions generated consistent results. Conclusions Our findings illustrate the potential of leveraging EHR data, employing computable definitions, to conduct effective digital population surveillance in the realm of hypertension management.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Keondae Ervin
- National Evaluation System for health Technology Coordinating Center (NESTcc), Medical Device Innovation Consortium
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140
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Kimpel CC, Lauderdale J, Schlundt DG, Dietrich MS, Ratcliff AC, Maxwell CA. Life-Stage and Contextual Factors of Advance Care Planning Among Older Adults With Limited Income. J Appl Gerontol 2024:7334648241230024. [PMID: 38350612 DOI: 10.1177/07334648241230024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
Patient perspectives are essential to understand healthcare disparities such as low rates of advance care planning (ACP) among adults with limited income. We completed twenty semi-structured interviews using purposive and snowball sampling. Initial and final themes emerged from inductive inclusion of recurring codes and deductive application of the cumulative disadvantage theory. Four themes emerged: (1) structural, (2) life-stage, (3) social stressors and resources, and (4) individual stress responses and ACP readiness. ACP resources among participants included positive structural and social support and previous familial death experiences that were mitigated by stress avoidance and competing priorities. Structural resources and healthcare stressors should be addressed with policy and research to improve continuous healthcare participation and support early, comprehensive ACP.
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Affiliation(s)
| | | | - David G Schlundt
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - Mary S Dietrich
- Department of Biostatistics, Vanderbilt University Schools of Medicine and Nursing, Nashville, TN, USA
| | - Amy C Ratcliff
- Department of Infectious Diseases, Tennessee Valley Healthcare System VA, Nashville, TN, USA
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141
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Iglesia EGA, Kwan M, Virkud YV, Iweala OI. Management of Food Allergies and Food-Related Anaphylaxis. JAMA 2024; 331:510-521. [PMID: 38349368 DOI: 10.1001/jama.2023.26857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Importance An estimated 7.6% of children and 10.8% of adults have IgE-mediated food-protein allergies in the US. IgE-mediated food allergies may cause anaphylaxis and death. A delayed, IgE-mediated allergic response to the food-carbohydrate galactose-α-1,3-galactose (alpha-gal) in mammalian meat affects an estimated 96 000 to 450 000 individuals in the US and is currently a leading cause of food-related anaphylaxis in adults. Observations In the US, 9 foods account for more than 90% of IgE-mediated food allergies-crustacean shellfish, dairy, peanut, tree nuts, fin fish, egg, wheat, soy, and sesame. Peanut is the leading food-related cause of fatal and near-fatal anaphylaxis in the US, followed by tree nuts and shellfish. The fatality rate from anaphylaxis due to food in the US is estimated to be 0.04 per million per year. Alpha-gal syndrome, which is associated with tick bites, is a rising cause of IgE-mediated food anaphylaxis. The seroprevalence of sensitization to alpha-gal ranges from 20% to 31% in the southeastern US. Self-injectable epinephrine is the first-line treatment for food-related anaphylaxis. The cornerstone of IgE-food allergy management is avoidance of the culprit food allergen. There are emerging immunotherapies to desensitize to one or more foods, with one current US Food and Drug Administration-approved oral immunotherapy product for treatment of peanut allergy. Conclusions and Relevance IgE-mediated food allergies, including delayed IgE-mediated allergic responses to red meat in alpha-gal syndrome, are common in the US, and may cause anaphylaxis and rarely, death. IgE-mediated anaphylaxis to food requires prompt treatment with epinephrine injection. Both food-protein allergy and alpha-gal syndrome management require avoiding allergenic foods, whereas alpha-gal syndrome also requires avoiding tick bites.
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Affiliation(s)
- Edward G A Iglesia
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mildred Kwan
- Thurston Arthritis Research Center, Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill
| | - Yamini V Virkud
- University of North Carolina Food Allergy Initiative, Division of Allergy and Immunology, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill
| | - Onyinye I Iweala
- Thurston Arthritis Research Center, Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill
- University of North Carolina Food Allergy Initiative, Division of Allergy and Immunology, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill
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142
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Semere W, Yank V, Lisha NE, Lindquist LA, Huang AJ. Older adults with overlapping caregiving responsibilities and care needs in a U.S. national community-based sample. J Am Geriatr Soc 2024. [PMID: 38344822 DOI: 10.1111/jgs.18794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 01/10/2024] [Accepted: 01/18/2024] [Indexed: 04/24/2024]
Abstract
BACKGROUND Community-dwelling older adults often serve as caregivers despite having their own health concerns and disabilities, yet little is known about their care needs. METHODS Cross-sectional analysis including community-dwelling U.S. adults over age 60 years who self-identified as caregivers in the National Social Life, Health, and Aging Project in 2015-2016. Caregiving was defined by self-reported assistance of another adult with day-to-day activities due to age or disability; overlapping care-receiving was defined by simultaneous receipt of help for at least one activity of daily living (ADL) or independent ADL (IADL). Multivariable logistic regression models examined attributes associated with overlapping care-receiving among older caregivers, adjusted for caregiver characteristics (age, gender, spousal caregiving, self-reported physical and mental health, cognitive function, and household assets). RESULTS Among the 444 caregivers, the mean age was 67.8 (SD 0.29) years, 55.8% were women, 78.1% were non-Hispanic White, 54.7% self-identified as primary caregivers, and 30.7% were caring for a spouse. Thirty-two percent of older caregivers were caregiving while themselves receiving assistance with at least one ADL or IADL. Thirty-four percent of caregivers reported <$50,000 in household assets and 10% did not answer the question. Given prior research that supports that most nonrespondents fall into the low-income group, subjects were combined. Analyses with and without nonrespondents did not substantially change the results. Compared to caregivers who were not simultaneously receiving care, caregivers reporting overlapping care-receiving had greater odds of being older (AOR 1.30, 95% confidence interval [CI] [1.14, 1.48] per each 5-year age increase), caregiving for a spouse (AOR 1.93, 95% CI [1.20, 3.13]), having limited household assets (AOR 2.10, 95% CI [1.17, 3.80], for <$50,000 compared to ≥$50,000), and having poor or fair self-reported physical health (AOR 2.94, 95% CI [1.43, 6.02]). CONCLUSIONS Over 30% of older adult caregivers report simultaneously receiving care for their own daily activities. Older caregivers who receive care are more likely to be older, spousal caregivers, and have limited assets and worse physical health. Targeted strategies are needed to support older caregivers who are uniquely vulnerable due to their overlapping care needs.
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Affiliation(s)
- Wagahta Semere
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Veronica Yank
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Nadra E Lisha
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Lee A Lindquist
- Division of Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Alison J Huang
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
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Tsung C, Quinn PL, Ejaz A. Management of Intrahepatic Cholangiocarcinoma: A Narrative Review. Cancers (Basel) 2024; 16:739. [PMID: 38398130 PMCID: PMC10886475 DOI: 10.3390/cancers16040739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/02/2024] [Accepted: 02/04/2024] [Indexed: 02/25/2024] Open
Abstract
The management of resectable intrahepatic cholangiocarcinoma remains a challenge due to the high risk of recurrence. Numerous clinical trials have identified effective systemic therapies for advanced biliary tract cancer; however, fewer trials have evaluated systemic therapies in the perioperative period. The objective of this review is to summarize the current recommendations regarding the diagnosis, surgical resection, and systemic therapy for anatomically resectable intrahepatic cholangiocarcinoma. Our review demonstrates that surgical resection with microscopic negative margins and lymphadenectomy remains the cornerstone of treatment. High-level evidence regarding specific systemic therapies for use in resectable intrahepatic cholangiocarcinoma remains sparse, as most of the evidence is extrapolated from trials involving heterogeneous tumor populations. Targeted therapies are an evolving practice for intrahepatic cholangiocarcinoma with most evidence coming from phase II trials. Future research is required to evaluate the use of neoadjuvant therapy for patients with resectable and borderline resectable disease.
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Affiliation(s)
- Carolyn Tsung
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; (C.T.); (P.L.Q.)
| | - Patrick L. Quinn
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; (C.T.); (P.L.Q.)
| | - Aslam Ejaz
- Department of Surgery, University of Illinois at Chicago, Chicago, IL 60612, USA
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Vail EA, Tam VW, Sonnenberg EM, Lavu NR, Reese PP, Abt PL, Martin ND, Hasz RD, Olthoff KM, Kerlin MP, Christie JD, Neuman MD, Potluri VS. Characterizing proximity and transfers of deceased organ donors to donor care units in the United States. Am J Transplant 2024:S1600-6135(24)00133-3. [PMID: 38346499 DOI: 10.1016/j.ajt.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 01/23/2024] [Accepted: 02/06/2024] [Indexed: 02/15/2024]
Abstract
Some United States organ procurement organizations transfer deceased organ donors to donor care units (DCUs) for recovery procedures. We used Organ Procurement and Transplantation Network data, from April 2017 to June 2021, to describe the proximity of adult deceased donors after brain death to DCUs and understand the impact of donor service area (DSA) boundaries on transfer efficiency. Among 19 109 donors (56.1% of the cohort) in 25 DSAs with DCUs, a majority (14 593 [76.4%]) were in hospitals within a 2-hour drive. In areas with DCUs detectable in the study data set, a minority of donors (3582 of 11 532 [31.1%]) were transferred to a DCU; transfer rates varied between DSAs (median, 27.7%, range, 4.0%-96.5%). Median hospital-to-DCU driving times were not meaningfully shorter among transferred donors (50 vs 51 minutes for not transferred, P < .001). When DSA boundaries were ignored, 3241 cohort donors (9.5%) without current DCU access were managed in hospitals within 2 hours of a DCU and thus potentially eligible for transfer. In summary, approximately half of United States deceased donors after brain death are managed in hospitals in DSAs with a DCU. Transfer of donors between DSAs may increase DCU utilization and improve system efficiency.
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Affiliation(s)
- Emily A Vail
- Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Vicky W Tam
- Data Science and Biostatistics Unit, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | | | - Peter P Reese
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Renal-Electrolyte and Hypertension Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Peter L Abt
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Niels D Martin
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Richard D Hasz
- Gift of Life Donor Program, Philadelphia, Pennsylvania, USA
| | - Kim M Olthoff
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Meeta P Kerlin
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jason D Christie
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mark D Neuman
- Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Vishnu S Potluri
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Renal-Electrolyte and Hypertension Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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145
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Semere W, Karter AJ, Lyles CR, Reed ME, Karliner L, Kaplan C, Liu JY, Livaudais-Toman J, Schillinger D. Care Partner Engagement in Secure Messaging Between Patients With Diabetes and Their Clinicians: Cohort Study. JMIR Diabetes 2024; 9:e49491. [PMID: 38335020 PMCID: PMC10891488 DOI: 10.2196/49491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 12/21/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Patient engagement with secure messaging (SM) via digital patient portals has been associated with improved diabetes outcomes, including increased patient satisfaction and better glycemic control. Yet, disparities in SM uptake exist among older patients and racial and ethnic underserved groups. Care partners (family members or friends) may provide a means for mitigating these disparities; however, it remains unclear whether and to what extent care partners might enhance SM use. OBJECTIVE We aim to examine whether SM use differs among older patients with diabetes based on the involvement of care partner proxies. METHODS This is a substudy of the ECLIPPSE (Employing Computational Linguistics to Improve Patient-Provider Secure Emails) project, a cohort study taking place in a large, fully integrated health care delivery system with an established digital patient portal serving over 4 million patients. Participants included patients with type 2 diabetes aged ≥50 years, newly registered on the patient portal, who sent ≥1 English-language message to their clinician between July 1, 2006, and December 31, 2015. Proxy SM was identified by having a registered proxy. To identify nonregistered proxies, a computational linguistics algorithm was applied to detect words and phrases more likely to appear in proxy messages compared to patient-authored messages. The primary outcome was the annual volume of secure messages (sent or received); secondary outcomes were the length of time to the first SM sent by patient or proxy and the number of annual SM exchanges (unique message topics generating ≥1 reply). RESULTS The mean age of the cohort (N=7659) at this study's start was 61 (SD 7.16) years; 75% (n=5573) were married, 15% (n=1089) identified as Black, 10% (n=747) Chinese, 12% (n=905) Filipino, 13% (n=999) Latino, and 30% (n=2225) White. Further, 49% (n=3782) of patients used a proxy to some extent. Compared to nonproxy users, proxy users were older (P<.001), had lower educational attainment (P<.001), and had more comorbidities (P<.001). Adjusting for patient sociodemographic and clinical characteristics, proxy users had greater annual SM volume (20.7, 95% CI 20.2-21.2 vs 10.9, 95% CI 10.7-11.2; P<.001), shorter time to SM initiation (hazard ratio vs nonusers: 1.30, 95% CI 1.24-1.37; P<.001), and more annual SM exchanges (6.0, 95% CI 5.8-6.1 vs 2.9, 95% CI 2.9-3.0, P<.001). Differences in SM engagement by proxy status were similar across patient levels of education, and racial and ethnic groups. CONCLUSIONS Among a cohort of older patients with diabetes, proxy SM involvement was independently associated with earlier initiation and increased intensity of messaging, although it did not appear to mitigate existing disparities in SM. These findings suggest care partners can enhance patient-clinician telecommunication in diabetes care. Future studies should examine the effect of care partners' SM involvement on diabetes-related quality of care and clinical outcomes.
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Affiliation(s)
- Wagahta Semere
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
- Center for Aging in Diverse Communities, University of California San Francisco, San Francisco, CA, United States
| | - Andrew J Karter
- Division of Research, Kaiser Permanente, Oakland, CA, United States
| | - Courtney R Lyles
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
| | - Mary E Reed
- Division of Research, Kaiser Permanente, Oakland, CA, United States
| | - Leah Karliner
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
- Center for Aging in Diverse Communities, University of California San Francisco, San Francisco, CA, United States
| | - Celia Kaplan
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
- Center for Aging in Diverse Communities, University of California San Francisco, San Francisco, CA, United States
| | - Jennifer Y Liu
- Division of Research, Kaiser Permanente, Oakland, CA, United States
| | - Jennifer Livaudais-Toman
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Dean Schillinger
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
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Hernandez SE, Solomon D, Moon J, Parmasad V, Wiegmann D, Bennett NT, Ferren RS, Fitzsimmons AJ, Lepak AJ, O'Horo JC, Pop-Vicas AE, Schulz LT, Safdar N. Understanding clinical implementation coordinators' experiences in deploying evidence-based interventions. Am J Health Syst Pharm 2024; 81:120-128. [PMID: 37897218 DOI: 10.1093/ajhp/zxad272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Indexed: 10/29/2023] Open
Abstract
PURPOSE The fluoroquinolone restriction for the prevention of Clostridioides difficile infection (FIRST) trial is a multisite clinical study in which sites carry out a preauthorization process via electronic health record-based best-practice alert (BPA) to optimize the use of fluoroquinolone antibiotics in acute care settings. Our research team worked closely with clinical implementation coordinators to facilitate the dissemination and implementation of this evidence-based intervention. Clinical implementation coordinators within the antibiotic stewardship team (AST) played a pivotal role in the implementation process; however, considerable research is needed to further understand their role. In this study, we aimed to (1) describe the roles and responsibilities of clinical implementation coordinators within ASTs and (2) identify facilitators and barriers coordinators experienced within the implementation process. METHODS We conducted a directed content analysis of semistructured interviews, implementation diaries, and check-in meetings utilizing the conceptual framework of middle managers' roles in innovation implementation in healthcare from Urquhart et al. RESULTS Clinical implementation coordinators performed a variety of roles vital to the implementation's success, including gathering and compiling information for BPA design, preparing staff, organizing meetings, connecting relevant stakeholders, evaluating clinical efficacy, and participating in the innovation as clinicians. Coordinators identified organizational staffing models and COVID-19 interruptions as the main barriers. Facilitators included AST empowerment, positive relationships with staff and oversight/governance committees, and using diverse implementation strategies. CONCLUSION When implementing healthcare innovations, clinical implementation coordinators facilitated the implementation process through their roles and responsibilities and acted as strategic partners in improving the adoption and sustainability of a fluoroquinolone preauthorization protocol.
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Affiliation(s)
- Sara E Hernandez
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
| | - Demetrius Solomon
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Jukrin Moon
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
| | - Vishala Parmasad
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Douglas Wiegmann
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Nick T Bennett
- Antimicrobial Stewardship Program, Saint Luke's Health System, Kansas City, MO, USA
| | - Ryan S Ferren
- University of Texas Medical Branch, Galveston, TX, USA
| | - Alec J Fitzsimmons
- Department of Medical Research, Gundersen Health System, La Crosse, WI, USA
| | - Alexander J Lepak
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - John C O'Horo
- Mayo Foundation for Medical Education and Research, Rochester, MN, USA
| | - Aurora E Pop-Vicas
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Lucas T Schulz
- Department of Pharmacy, University of Wisconsin Health, Madison, WI, USA
| | - Nasia Safdar
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
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147
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Khera R, Aminorroaya A, Dhingra LS, Thangaraj PM, Camargos AP, Bu F, Ding X, Nishimura A, Anand TV, Arshad F, Blacketer C, Chai Y, Chattopadhyay S, Cook M, Dorr DA, Duarte-Salles T, DuVall SL, Falconer T, French TE, Hanchrow EE, Kaur G, Lau WC, Li J, Li K, Liu Y, Lu Y, Man KK, Matheny ME, Mathioudakis N, McLeggon JA, McLemore MF, Minty E, Morales DR, Nagy P, Ostropolets A, Pistillo A, Phan TP, Pratt N, Reyes C, Richter L, Ross J, Ruan E, Seager SL, Simon KR, Viernes B, Yang J, Yin C, You SC, Zhou JJ, Ryan PB, Schuemie MJ, Krumholz HM, Hripcsak G, Suchard MA. Comparative Effectiveness of Second-line Antihyperglycemic Agents for Cardiovascular Outcomes: A Large-scale, Multinational, Federated Analysis of the LEGEND-T2DM Study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.02.05.24302354. [PMID: 38370787 PMCID: PMC10871374 DOI: 10.1101/2024.02.05.24302354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
Background SGLT2 inhibitors (SGLT2is) and GLP-1 receptor agonists (GLP1-RAs) reduce major adverse cardiovascular events (MACE) in patients with type 2 diabetes mellitus (T2DM). However, their effectiveness relative to each other and other second-line antihyperglycemic agents is unknown, without any major ongoing head-to-head trials. Methods Across the LEGEND-T2DM network, we included ten federated international data sources, spanning 1992-2021. We identified 1,492,855 patients with T2DM and established cardiovascular disease (CVD) on metformin monotherapy who initiated one of four second-line agents (SGLT2is, GLP1-RAs, dipeptidyl peptidase 4 inhibitor [DPP4is], sulfonylureas [SUs]). We used large-scale propensity score models to conduct an active comparator, target trial emulation for pairwise comparisons. After evaluating empirical equipoise and population generalizability, we fit on-treatment Cox proportional hazard models for 3-point MACE (myocardial infarction, stroke, death) and 4-point MACE (3-point MACE + heart failure hospitalization) risk, and combined hazard ratio (HR) estimates in a random-effects meta-analysis. Findings Across cohorts, 16·4%, 8·3%, 27·7%, and 47·6% of individuals with T2DM initiated SGLT2is, GLP1-RAs, DPP4is, and SUs, respectively. Over 5·2 million patient-years of follow-up and 489 million patient-days of time at-risk, there were 25,982 3-point MACE and 41,447 4-point MACE events. SGLT2is and GLP1-RAs were associated with a lower risk for 3-point MACE compared with DPP4is (HR 0·89 [95% CI, 0·79-1·00] and 0·83 [0·70-0·98]), and SUs (HR 0·76 [0·65-0·89] and 0·71 [0·59-0·86]). DPP4is were associated with a lower 3-point MACE risk versus SUs (HR 0·87 [0·79-0·95]). The pattern was consistent for 4-point MACE for the comparisons above. There were no significant differences between SGLT2is and GLP1-RAs for 3-point or 4-point MACE (HR 1·06 [0·96-1·17] and 1·05 [0·97-1·13]). Interpretation In patients with T2DM and established CVD, we found comparable cardiovascular risk reduction with SGLT2is and GLP1-RAs, with both agents more effective than DPP4is, which in turn were more effective than SUs. These findings suggest that the use of GLP1-RAs and SGLT2is should be prioritized as second-line agents in those with established CVD. Funding National Institutes of Health, United States Department of Veterans Affairs.
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Affiliation(s)
- Rohan Khera
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University, New Haven, CT, 06510, USA
- Center for Outcomes Research and Evaluation (CORE), Yale New Haven Hospital, New Haven, CT, 06510, USA
- Section of Health Informatics, Department of Biostatistics, Yale School of Public Health, New Haven, CT, 06520, USA
| | - Arya Aminorroaya
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University, New Haven, CT, 06510, USA
| | - Lovedeep Singh Dhingra
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University, New Haven, CT, 06510, USA
| | - Phyllis M Thangaraj
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University, New Haven, CT, 06510, USA
| | - Aline Pedroso Camargos
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University, New Haven, CT, 06510, USA
| | - Fan Bu
- Department of Biostatistics, University of Michigan - Ann Arbor, Ann Arbor, MI, 48105, USA
| | - Xiyu Ding
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Akihiko Nishimura
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Tara V Anand
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, 10027, USA
| | - Faaizah Arshad
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Clair Blacketer
- Observational Health Data Analytics, Janssen Research and Development, LLC, Titusville, NJ, 8560, USA
| | - Yi Chai
- Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong
| | - Shounak Chattopadhyay
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Michael Cook
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - David A Dorr
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
| | - Talita Duarte-Salles
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, 8007, Spain
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Scott L DuVall
- Veterans Affairs Informatics and Computing Infrastructure, United States Department of Veterans Affairs, Salt Lake City, UT, USA
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Thomas Falconer
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, 10027, USA
| | - Tina E French
- Tennessee Valley Healthcare System, Veterans Affairs Medical Center, Nashville, TN, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Elizabeth E Hanchrow
- Tennessee Valley Healthcare System, Veterans Affairs Medical Center, Nashville, TN, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Guneet Kaur
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, DD1 9SY, United Kingdom
| | - Wallis Cy Lau
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, WC1H 9JP, United Kingdom
- Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong, Hong Kong
| | - Jing Li
- Data Transformation, Analytics, and Artificial Intelligence, Real World Solutions, IQVIA, Durham, NC, USA
| | - Kelly Li
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Yuntian Liu
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University, New Haven, CT, 06510, USA
- Center for Outcomes Research and Evaluation (CORE), Yale New Haven Hospital, New Haven, CT, 06510, USA
| | - Yuan Lu
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University, New Haven, CT, 06510, USA
| | - Kenneth Kc Man
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, WC1H 9JP, United Kingdom
- Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong, Hong Kong
| | - Michael E Matheny
- Tennessee Valley Healthcare System, Veterans Affairs Medical Center, Nashville, TN, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Nestoras Mathioudakis
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jody-Ann McLeggon
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, 10027, USA
| | - Michael F McLemore
- Tennessee Valley Healthcare System, Veterans Affairs Medical Center, Nashville, TN, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Evan Minty
- Faculty of Medicine, O'Brien Institute for Public Health, University of Calgary, Calgary, AB, T2N4N1, Canada
| | - Daniel R Morales
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, DD1 9SY, United Kingdom
| | - Paul Nagy
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anna Ostropolets
- Observational Health Data Analytics, Janssen Research and Development, LLC, Titusville, NJ, 8560, USA
| | - Andrea Pistillo
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, 8007, Spain
| | | | - Nicole Pratt
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, Australia
| | - Carlen Reyes
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, 8007, Spain
| | - Lauren Richter
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, 10027, USA
| | - Joseph Ross
- Section of General Medicine and National Clinician Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Center for Outcomes Research and Evaluation (CORE), Yale New Haven Hospital, New Haven, CT, 06510, USA
| | - Elise Ruan
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, 10027, USA
| | - Sarah L Seager
- Data Transformation, Analytics, and Artificial Intelligence, Real World Solutions, IQVIA, London, UK
| | - Katherine R Simon
- Tennessee Valley Healthcare System, Veterans Affairs Medical Center, Nashville, TN, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Benjamin Viernes
- Veterans Affairs Informatics and Computing Infrastructure, United States Department of Veterans Affairs, Salt Lake City, UT, USA
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jianxiao Yang
- Department of Computational Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Can Yin
- Data Transformation, Analytics, and Artificial Intelligence, Real World Solutions, IQVIA, Shanghai, China
| | - Seng Chan You
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, South Korea
- Institute for Innovation in Digital Healthcare, Yonsei University College of Medicine, Seoul, South Korea
| | - Jin J Zhou
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, 90095, USA
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90024, USA
| | - Patrick B Ryan
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, 10027, USA
| | - Martijn J Schuemie
- Epidemiology, Office of the Chief Medical Officer, Johnson & Johnson, Titusville, NJ, 8560, USA
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation (CORE), Yale New Haven Hospital, New Haven, CT, 06510, USA
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University, New Haven, CT, 06510, USA
- Section of Cardiovascular Medicine, Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, 06510, USA
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, 10027, USA
| | - Marc A Suchard
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, 90095, USA
- Department of Biomathematics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Veterans Affairs Informatics and Computing Infrastructure, United States Department of Veterans Affairs, Salt Lake City, UT, USA
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Kerlikowske K, Zhu W, Su YR, Sprague BL, Stout NK, Onega T, O’Meara ES, Henderson LM, Tosteson ANA, Wernli K, Miglioretti DL. Supplemental magnetic resonance imaging plus mammography compared with magnetic resonance imaging or mammography by extent of breast density. J Natl Cancer Inst 2024; 116:249-257. [PMID: 37897090 PMCID: PMC10852604 DOI: 10.1093/jnci/djad201] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/13/2023] [Accepted: 09/18/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Examining screening outcomes by breast density for breast magnetic resonance imaging (MRI) with or without mammography could inform discussions about supplemental MRI in women with dense breasts. METHODS We evaluated 52 237 women aged 40-79 years who underwent 2611 screening MRIs alone and 6518 supplemental MRI plus mammography pairs propensity score-matched to 65 810 screening mammograms. Rates per 1000 examinations of interval, advanced, and screen-detected early stage invasive cancers and false-positive recall and biopsy recommendation were estimated by breast density (nondense = almost entirely fatty or scattered fibroglandular densities; dense = heterogeneously/extremely dense) adjusting for registry, examination year, age, race and ethnicity, family history of breast cancer, and prior breast biopsy. RESULTS Screen-detected early stage cancer rates were statistically higher for MRI plus mammography vs mammography for nondense (9.3 vs 2.9; difference = 6.4, 95% confidence interval [CI] = 2.5 to 10.3) and dense (7.5 vs 3.5; difference = 4.0, 95% CI = 1.4 to 6.7) breasts and for MRI vs MRI plus mammography for dense breasts (19.2 vs 7.5; difference = 11.7, 95% CI = 4.6 to 18.8). Interval rates were not statistically different for MRI plus mammography vs mammography for nondense (0.8 vs 0.5; difference = 0.4, 95% CI = -0.8 to 1.6) or dense breasts (1.5 vs 1.4; difference = 0.0, 95% CI = -1.2 to 1.3), nor were advanced cancer rates. Interval rates were not statistically different for MRI vs MRI plus mammography for nondense (2.6 vs 0.8; difference = 1.8 (95% CI = -2.0 to 5.5) or dense breasts (0.6 vs 1.5; difference = -0.9, 95% CI = -2.5 to 0.7), nor were advanced cancer rates. False-positive recall and biopsy recommendation rates were statistically higher for MRI groups than mammography alone. CONCLUSION MRI screening with or without mammography increased rates of screen-detected early stage cancer and false-positives for women with dense breasts without a concomitant decrease in advanced or interval cancers.
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Affiliation(s)
- Karla Kerlikowske
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
- General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, CA, USA
| | - Weiwei Zhu
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
| | - Yu-Ru Su
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
| | - Brian L Sprague
- Departments of Surgery and Radiology, University of Vermont, Burlington, VT, USA
| | - Natasha K Stout
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Tracy Onega
- Department of Population Health Sciences, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Ellen S O’Meara
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
| | - Louise M Henderson
- Department of Radiology, University of North Carolina, Chapel Hill, NC, USA
| | - Anna N A Tosteson
- The Dartmouth Institute for Health Policy and Clinical Practice and Dartmouth Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Karen Wernli
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
| | - Diana L Miglioretti
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
- Department of Public Health Sciences, University of California, Davis, CA, USA
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149
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Png CYM, Boitano LT, Srivastava SD, Mohapatra A, Malek JY, Stern JR, Eagleton MJ, Dua A. Room for improvement in patient compliance during peripheral vascular interventions. JVS Vasc Insights 2024; 2:100059. [PMID: 38505294 PMCID: PMC10949838 DOI: 10.1016/j.jvsvi.2024.100059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
Introduction For patients receiving Procedural Sedation and Analgesia (PSA), patient cooperation is crucial as patients remain continuously aware of operating room activity and can be asked to perform tasks such as prolonged breath-holds. This survey aimed to collect information on patient compliance with on-table instructions and its relation to periprocedural outcomes from surgeons nationwide performing peripheral vascular interventions (PVI) under PSA. Methods A 9-question online survey was sent to 383 vascular surgeons (including both vascular surgery attendings and trainees) across the United States through REDCap from August 30 to September 21, 2021, with responses closed on October 30, 2021. The survey response was analyzed with descriptive statistics. Results 83 (21.6%) vascular surgeons responded to the survey, of which 67 (80.7%) were attending vascular surgeons and 16 (19.3%) were vascular surgery trainees. 41 (49.4%) respondents performed 11-20 PVI cases under PSA every month, while 31 (41.0%) respondents performed 1-10 PVI cases under PSA every month. 41 (49.4%) respondents reported that in 1-10% of their cases, additional contrast and/or radiation was administered because patient moved on the table or did not cooperate with breath holds; 25 (30.1%) reported that this occurred in 11-20% of their cases, 12 (14.5%) reported that this occurred in 21-50% of their cases and 4 (4.8%) reported that this occurred in over 50% of their cases. In such cases, the majority of respondents reported a 1-10% increase in contrast volume (59.0%), radiation dosage (62.7%), sedative/analgesia administration (46.3%) and procedural time (54.9%). Of cases being converted to general anesthesia due to inadequate patient cooperation, 35 (42.2%) respondents reported between 1-5 per month, and 3 (3.6%) respondents reported between 6-10 per month. Of cases being aborted due to inadequate patient cooperation, 25 (30.1%) respondents reported between 1-5 per month, and 1 (1.2%) respondents reported between 6-10 per month. Conclusion A significant fraction of PVI cases performed under PSA result in increased radiation and contrast exposure, sedative administration and procedural time due to inadequate patient cooperation. In certain cases, conversion to general anesthesia or case abortion is required. Further research should be performed to investigate strategies to minimize such adverse patient safety events.
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150
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Saif NT, Dooley C, Baghdadi JD, Morgan DJ, Coffey KC. Clinical decision support for gastrointestinal panel testing. Antimicrob Steward Healthc Epidemiol 2024; 4:e22. [PMID: 38415090 PMCID: PMC10897720 DOI: 10.1017/ash.2024.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/02/2024] [Accepted: 01/04/2024] [Indexed: 02/29/2024]
Abstract
Objective This study aimed to assess the impact of clinical decision support (CDS) to improve ordering of multiplex gastrointestinal polymerase chain reaction (PCR) testing panel ("GI panel"). Design Single-center, retrospective, before-after study. Setting Tertiary care Veteran's Affairs (VA) Medical Center provides inpatient, outpatient, and residential care. Patients All patients tested with a GI panel between June 22, 2022 and April 20, 2023. Intervention We designed a CDS questionnaire in the electronic medical record (EMR) to guide appropriate ordering of the GI panel. A "soft stop" reminder at the point of ordering prompted providers to confirm five appropriateness criteria: 1) documented diarrhea, 2) no recent receipt of laxatives, 3) C. difficile is not the leading suspected cause of diarrhea, 4) time period since a prior test is >14 days or prior positive test is >4 weeks and 5) duration of hospitalization <72 hours. The CDS was implemented in November 2022. Results Compared to the pre-implementation period (n = 136), fewer tests were performed post-implementation (n = 92) with an IRR of 0.61 (p = 0.003). Inappropriate ordering based on laxative use or undocumented diarrhea decreased (IRR 0.37, p = 0.012 and IRR 0.25, p = 0.08, respectively). However, overall inappropriate ordering and outcome measures did not significantly differ before and after the intervention. Conclusions Implementation of CDS in the EMR decreased testing and inappropriate ordering based on use of laxatives or undocumented diarrhea. However, inappropriate ordering of tests overall remained high post-intervention, signaling the need for continued diagnostic stewardship efforts.
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Affiliation(s)
- Nadia T. Saif
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Cara Dooley
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jonathan D. Baghdadi
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Daniel J. Morgan
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Medicine, Veteran’s Affairs (VA) Maryland Healthcare System, Baltimore, MD, USA
| | - KC Coffey
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Medicine, Veteran’s Affairs (VA) Maryland Healthcare System, Baltimore, MD, USA
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