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Chamberlain AM, Hade EM, Haller IV, Horne BD, Benziger CP, Lampert BC, Rasmusson KD, Boddicker K, Manemann SM, Roger VL. A large, multi-center survey assessing health, social support, literacy, and self-management resources in patients with heart failure. BMC Public Health 2024; 24:1141. [PMID: 38658888 PMCID: PMC11040866 DOI: 10.1186/s12889-024-18533-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 04/05/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Most patients with heart failure (HF) have multimorbidity which may cause difficulties with self-management. Understanding the resources patients draw upon to effectively manage their health is fundamental to designing new practice models to improve outcomes in HF. We describe the rationale, conceptual framework, and implementation of a multi-center survey of HF patients, characterize differences between responders and non-responders, and summarize patient characteristics and responses to the survey constructs among responders. METHODS This was a multi-center cross-sectional survey study with linked electronic health record (EHR) data. Our survey was guided by the Chronic Care Model to understand the distribution of patient-centric factors, including health literacy, social support, self-management, and functional and mental status in patients with HF. Most questions were from existing validated questionnaires. The survey was administered to HF patients aged ≥ 30 years from 4 health systems in PCORnet® (the National Patient-Centered Clinical Research Network): Essentia Health, Intermountain Health, Mayo Clinic, and The Ohio State University. Each health system mapped their EHR data to a standardized PCORnet Common Data Model, which was used to extract demographic and clinical data on survey responders and non-responders. RESULTS Across the 4 sites, 10,662 patients with HF were invited to participate, and 3330 completed the survey (response rate: 31%). Responders were older (74 vs. 71 years; standardized difference (95% CI): 0.18 (0.13, 0.22)), less racially diverse (3% vs. 12% non-White; standardized difference (95% CI): -0.32 (-0.36, -0.28)), and had higher prevalence of many chronic conditions than non-responders, and thus may not be representative of all HF patients. The internal reliability of the validated questionnaires in our survey was good (range of Cronbach's alpha: 0.50-0.96). Responders reported their health was generally good or fair, they frequently had cardiovascular comorbidities, > 50% had difficulty climbing stairs, and > 10% reported difficulties with bathing, preparing meals, and using transportation. Nearly 80% of patients had family or friends sit with them during a doctor visit, and 54% managed their health by themselves. Patients reported generally low perceived support for self-management related to exercise and diet. CONCLUSIONS More than half of patients with HF managed their health by themselves. Increased understanding of self-management resources may guide the development of interventions to improve HF outcomes.
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Affiliation(s)
- Alanna M Chamberlain
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA.
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Erinn M Hade
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Irina V Haller
- Essentia Institute of Rural Health, Essentia Health, Duluth, MN, USA
| | - Benjamin D Horne
- Intermountain Medical Center Heart Institute, Salt Lake City, UT, USA
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, CA, USA
| | | | - Brent C Lampert
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | | | - Sheila M Manemann
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Véronique L Roger
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
- Epidemiology and Community Health Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
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Phelan SM, Bauer KW, Bradley D, Bradley SM, Haller IV, Mundi MS, Finney Rutten LJ, Schroeder DR, Fischer K, Croghan I. A model of weight-based stigma in health care and utilization outcomes: Evidence from the learning health systems network. Obes Sci Pract 2022; 8:139-146. [PMID: 35388341 PMCID: PMC8976541 DOI: 10.1002/osp4.553] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/19/2021] [Accepted: 07/25/2021] [Indexed: 12/16/2022] Open
Abstract
Objective Obesity is stigmatized and people with obesity report experiencing stigmatizing situations when seeking health care. The implications of these experiences are not well understood. This study tests an indirect effects model of negative care experiences as an intermediate variable between obesity and care avoidance/utilization and switching primary care doctors. Methods A survey was completed by 2380 primary care patients in the Learning Health Systems Network (LHSNet) Clinical Data Research Network with a BMI >25 kg/m2. Measures included scales assessing stigmatizing situations, perceived patient-centered communication, perceived respect, having delayed needed care, and having looked for a new primary doctor in the past 12 months. Sequential and serial indirect effects of care experiences and respect in the association between BMI and care utilization outcomes was modeled. Results The hypothesized model was supported by findings. The associations between BMI and delaying needed care (OR = 1.06, p < 0.001) and attempting to switch primary doctors (OR = 1.02, p = 0.04) was mediated by both stigmatizing situations experienced in a health care context and lower patient-centered communication. Lower perceived respect mediated the association between care experiences and utilization outcomes. Conclusions People with higher BMIs may avoid care or switch doctors as a result of stigmatizing experiences and poor communication with doctors. These outcomes may contribute to morbidity in people with obesity if they delay or avoid care for health concerns when symptoms first present.
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Affiliation(s)
- Sean M. Phelan
- Division of Health Care Delivery ResearchMayo ClinicRochesterMinnesotaUSA
- Robert D. and Patricia E. Kern Center for the Science of Health Care DeliveryMayo ClinicRochesterMinnesotaUSA
| | - Katherine W. Bauer
- Department of Nutritional SciencesUniversity of Michigan School of Public HealthAnn ArborMichiganUSA
| | | | - Steven M. Bradley
- Minneapolis Heart Institute and Minneapolis Heart Institute FoundationMinneapolisMinnesotaUSA
| | - Irina V. Haller
- Essentia Institute of Rural Health, Essentia HealthDuluthMinnesotaUSA
| | - Manpreet S. Mundi
- Division of Endocrinology, Diabetes, Metabolism, and NutritionMayo ClinicRochesterMinnesotaUSA
| | | | | | - Kristin Fischer
- Robert D. and Patricia E. Kern Center for the Science of Health Care DeliveryMayo ClinicRochesterMinnesotaUSA
| | - Ivana Croghan
- Robert D. and Patricia E. Kern Center for the Science of Health Care DeliveryMayo ClinicRochesterMinnesotaUSA
- Department of Quantitative Health SciencesMayo ClinicRochesterMinnesotaUSA
- Department of MedicineDivision of General Internal MedicineMayo ClinicRochesterMinnesotaUSA
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Nanda S, Adusumalli J, Hurt RT, Ghosh K, Fischer KM, Hagenbrock MC, Ganesh R, Ratrout BM, Raslau D, Schroeder DR, Wight EC, Kuhle CL, Thicke LA, Lazik N, Croghan IT. Obesity Management Education Needs Among General Internists: A Survey. J Prim Care Community Health 2021; 12:21501327211013292. [PMID: 33949233 PMCID: PMC8114257 DOI: 10.1177/21501327211013292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective The purpose of this study was to determine self-reported knowledge, attitudes, prior experience, and perceived needs for the management of overweight and obese patients within a General Internal Medicine Practice. Patients and Methods An emailed cross-sectional survey was sent between June 20, 2019 and September 12, 2019 to 194 healthcare workers (93 primary care providers (PCPs) and 101 nurses) which focused on management of patients with weight issues. Results In total, 80 of the eligible 194 participants completed the survey (nurses = 42, PCPs = 38). Up to 87% were white, 74.7% female (74.7%). Most of the responders were either in the age group of 30’s (30%) or 50’s (30%). Among the responders, 48.8% reported some type of specialty training in weight management since their medical training with lectures being the most common form of training (36%). When asked about their interest in either weight management training or strategies to initiate weight conversations, 79% of the respondents reported an interest in education on weight management or strategies to initiate weight conversations, while 65.8% indicated they would be interested in both topics. Conclusion Our study suggests that healthcare workers have a self-reported need for further training in management of overweight and obese patients, irrespective of previous training in this area.
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Novotny PJ, Schroeder D, Sloan JA, Mazza GL, Williams D, Bradley D, Haller IV, Bradley SM, Croghan I. Do Missing Values Influence Outcomes in a Cross-sectional Mail Survey? Mayo Clin Proc Innov Qual Outcomes 2021; 5:84-93. [PMID: 33718787 PMCID: PMC7930870 DOI: 10.1016/j.mayocpiqo.2020.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective To determine the effects of missing and inconsistent data on a weight management mail survey results. Patients and Methods Weight management surveys were sent to 5000 overweight and obese individuals in the Learning Health System Network. Survey information was collected between October 27, 2017, and March 1, 2018. Some participants reported body mass index (BMI) values inconsistent with the intended overweight and obese sampling cohort. Analyses were performed after excluding these surveys and also performed again after setting these low BMI values to missing. Models were run after imputing missing values using expectation-maximization, Markov chain Monte Carlo, random forest imputation, multivariate imputation by chained equations, and multiple imputation and replacing missing BMI values with the minimum, maximum, mean, or median of the known BMI values. Results Of 2799 surveys, 222 (8%) had missing BMI values and 155 (6%) reported invalid BMI values. Overall, 725 of these 2799 surveys (26%) were missing at least 1 variable that was essential to the main analyses. Different imputation methods consistently found that BMI was related to age, sex, race, marital status, and education. Patients with a BMI of 35.0 kg/m2 or greater were more likely to feel judged because of their weight, and patients with a BMI of 40.0 kg/m2 or greater were more likely to feel they were not always treated with respect and treated as an equal. Conclusion Analyses using different imputation methods were consistent with the original published results. Missing data likely did not affect the study results.
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Affiliation(s)
- Paul J. Novotny
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
- Correspondence: Address to Paul J. Novotny, MS, Division of Biomedical Statistics and Informatics, Mayo Clinic, Harwick 8, 200 First St SW, Rochester, MN 55905
| | - Darrell Schroeder
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Jeff A. Sloan
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Gina L. Mazza
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Scottsdale, AZ
| | - David Williams
- Department of Anesthesiology, University of Michigan, Ann Arbor, MN
| | - David Bradley
- Diabetes and Metabolism Research Center, Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, The Ohio State University, Columbus, MN
| | - Irina V. Haller
- Essentia Institute of Rural Health, Essential Health, Duluth, MN
| | - Steven M. Bradley
- Center for Healthcare Delivery Innovation, Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, Minneapolis, MN
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Mundi MS, Hurt RT, Phelan SM, Bradley D, Haller IV, Bauer KW, Bradley SM, Schroeder DR, Clark MM, Croghan IT. Associations Between Experience of Early Childhood Trauma and Impact on Obesity Status, Health, as Well as Perceptions of Obesity-Related Health Care. Mayo Clin Proc 2021; 96:408-419. [PMID: 33549259 DOI: 10.1016/j.mayocp.2020.05.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 05/10/2020] [Accepted: 05/27/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate the association between obesity and history of childhood trauma in an effort to define implications for the provider-patient relationship and possible causes of failure of obesity treatment. METHODS Multisite survey developed by the Patient-Centered Outcomes Research Institute Learning Health Systems Obesity Cohort Workgroup consisting of 49 questions with 2 questions focusing on history of being a victim of childhood physical and/or sexual abuse was mailed to 19,964 overweight or obese patients. Data collection for this survey occurred from October 27, 2017, through March 1, 2018. RESULTS Among the 2211 surveys included in analysis, respondents reporting being a victim of childhood abuse increased significantly with obesity (23.6%, 26.0%, 29.1%, and 36.8% for overweight, class I, class II, and class III obesity, respectively; P<.001). A higher percentage of those who reported being a victim of childhood abuse noted that their weight issues began at an earlier age (P=.002) and were more likely to have weight-related comorbidities (P<.001), even after controlling for body mass index. Impacting physician counseling on weight loss, patients who were childhood victims of abuse reported lower self-esteem (P<.001), were more likely to feel judged by their health care providers (P=.009), and less likely to feel being treated with respect (P=.045). CONCLUSION Overall, being a victim of childhood abuse was significantly associated with obesity, lower self-esteem and negative experiences interacting with health care providers. Health care providers should receive training to ensure open and nonjudgmental visits with obese patients and consider the role of trauma survivorship issues in patients' development of obesity and health care experiences.
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Affiliation(s)
- Manpreet S Mundi
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN.
| | - Ryan T Hurt
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN; Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - Sean M Phelan
- Robert D. and Patricia E. Kern Center of Science and Health Care Delivery, Mayo Clinic, Rochester, MN
| | - David Bradley
- Diabetes and Metabolism Research Center, Division of Endocrinology, Diabetes & Metabolism, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Irina V Haller
- Department of Psychiatry and Psychology, Essentia Institute of Rural Health, Essential Health, Duluth, MN
| | - Katherine W Bauer
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI
| | - Steven M Bradley
- Center for Healthcare Delivery Innovation, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation Minneapolis, MN
| | - Darrell R Schroeder
- Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic, Rochester, MN
| | - Matthew M Clark
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Ivana T Croghan
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center of Science and Health Care Delivery, Mayo Clinic, Rochester, MN; Division of Community Internal Medicine, Mayo Clinic, Rochester, MN; Division of Epidemiology, Department of Health Science Research, Mayo Clinic, Rochester, MN
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De Leon A, Roemmich JN, Casperson SL. Identification of Barriers to Adherence to a Weight Loss Diet in Women Using the Nominal Group Technique. Nutrients 2020; 12:nu12123750. [PMID: 33291249 PMCID: PMC7762133 DOI: 10.3390/nu12123750] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 11/16/2022] Open
Abstract
Background: At any given time, a majority of women are engaged in some type of weight loss diet; however, these efforts are difficult to sustain for long-term weight control. Because women are more likely to develop obesity and suffer a greater severity of obesity-related health and economic consequences, we sought to identify the key factors that make adhering to a weight loss diet difficult for overweight/obese women. Methods: Ten nominal group technique (NGT) sessions aimed at identifying perceived barriers to adherence to a weight loss diet were conducted as part of a weight loss study for overweight/obese women (n = 33) during the controlled feeding weight loss phase. Results: Individual-level barriers to emerge from the sessions included knowing when to stop eating, being able to control cravings and emotional eating, and sustaining healthier dietary habits. Environmental-level barriers included family/social events that bring people together, especially those centered around food and drink, eating out, cost, and busy schedules. Conclusions: These findings offer a deeper understanding of barriers women find most salient to adhering to a weight loss diet, providing direction for the clinical application of weight loss programs.
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Croghan IT, Ebbert JO, Njeru JW, Rajjo TI, Lynch BA, DeJesus RS, Jensen MD, Fischer KM, Phelan S, Kaufman TK, Schroeder DR, Rutten LJF, Crane SJ, Tulledge-Scheitel SM. Identifying Opportunities for Advancing Weight Management in Primary Care. J Prim Care Community Health 2020; 10:2150132719870879. [PMID: 31496342 PMCID: PMC6734618 DOI: 10.1177/2150132719870879] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: Much has been written about the patients' perspective concerning weight management in health care. The purpose of this survey study was to assess perspectives of primary care providers (PCPs) and nurses toward patient weight management and identify possible areas of growth. Patients and Methods: We emailed a weight management-focused survey to 674 eligible participants (437 [64.8%] nurses and 237 [35.2%] PCPs) located in 5 outpatient primary care clinics. The survey focused on opportunities, practices, knowledge, confidence, attitudes, and beliefs. A total of 219 surveys were returned (137 [62.6%] from nurses and 82 [34.4%] from PCPs). Results: Among 219 responders, 85.8% were female and 93.6% were white non-Hispanic. In this study, PCPs and nurses believed obesity to be a major health problem. While PCPs felt more equipped than nurses to address weight management (P < .001) and reported receiving more training than nurses (50.0% vs 17.6%, respectively), both felt the need for more training on obesity (73.8% and 79.4%, respectively). Although, PCPs also spent more patient contact time providing weight management services versus nurses (P < .001), the opportunity/practices score was lower for PCPs than nurses (-0.35 ± 0.44 vs -0.17 ± 0.41, P < .001) with PCPs more likely to say they lacked the time to discuss weight and they worried it would cause a poor patient-PCP relationship. The knowledge/confidence score also differed significantly between the groups, with nurses feeling less equipped to deal with weight management issues than PCPs (-0.42 ± 0.43 vs -0.03 ± 0.55, P < .001). Neither group seemed very confident, with those in the PCP group only answering with an average score of neutral. Conclusion: By asking nurses and PCP general questions about experiences, attitudes, knowledge, and opinions concerning weight management in clinical care, this survey has identified areas for growth in obesity management. Both PCPs and nurses would benefit from additional educational training on weight management.
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DeJesus RS, Bauer KW, Bradley DP, Haller I, Bradley SM, Schroeder DR, St. Sauver J, Phelan SM, Croghan IT. Experience and expectations of patients on weight loss: The Learning Health System Network Experience. Obes Sci Pract 2019; 5:479-486. [PMID: 31687172 PMCID: PMC6820006 DOI: 10.1002/osp4.364] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 07/20/2019] [Accepted: 07/22/2019] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Weight perception and degree of confidence in achieving healthy lifestyle can be determinants of engagement in obesity interventions. This study explored patients' perceived need for weight loss and the degree of self-confidence in ability to lose weight and sought to identify factors associated with patients' self-confidence in ability to lose weight. METHODS The authors analysed data from a survey mailed to primary care patients within five sites of the Learning Health Systems Network that explored participants' prior experience with weight management. RESULTS Among the 2,263 participants who completed the survey section on 'Patients' Experience with Weight Management', perceived need to lose 51 lb or more was statistically significant among those with class III obesity compared with other body mass index (BMI) groups (p value < 0.001). Reported desire to lose weight was also significantly higher among those with the highest BMI than those who were overweight (p value < 0.001). However, this same group had the lowest belief in ability to lose weight (p value < 0.001). In a multiple regression analysis, female gender, higher BMI and need to lose >10 lb were each independently associated with less belief in being able to lose weight. CONCLUSIONS Patients had varying perceptions on weight loss; those with category III obesity had the highest desire to lose weight but had the least confidence in ability to lose weight. Higher BMI, female gender and need to lose >10 lb were associated with decreased self-confidence in ability to lose weight.
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Affiliation(s)
| | - K. W. Bauer
- Department of Nutritional SciencesUniversity of Michigan School of Public HealthAnn ArborMIUSA
| | - D. P. Bradley
- Diabetes and Metabolism Research Center, Division of Endocrinology, Diabetes & Metabolism, Department of Internal MedicineThe Ohio State UniversityColumbusOHUSA
| | - I. Haller
- Essentia Institute of Rural Health, Essential HealthDuluthMNUSA
| | - S. M. Bradley
- Center for Healthcare Delivery InnovationMinneapolis Heart Institute and Minneapolis Heart Institute FoundationMinneapolisMNUSA
| | - D. R. Schroeder
- Department of Health Sciences ResearchMayo ClinicRochesterMNUSA
| | - J. St. Sauver
- Department of Health Sciences ResearchMayo ClinicRochesterMNUSA
- Robert D. and Patricia E. Kern Center for the Science of Health Care DeliveryMayo ClinicRochesterMNUSA
| | - S. M. Phelan
- Department of Health Sciences ResearchMayo ClinicRochesterMNUSA
| | - I. T. Croghan
- Department of MedicineMayo ClinicRochesterMNUSA
- Department of Health Sciences ResearchMayo ClinicRochesterMNUSA
- Robert D. and Patricia E. Kern Center for the Science of Health Care DeliveryMayo ClinicRochesterMNUSA
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