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Leuchter RK, Ma S, Bell DS, Hays RD, Vidorreta FJS, Binder SL, Sarkisian CA. Embedding research study recruitment within the patient portal preCheck-in. J Am Med Inform Assoc 2023; 30:2028-2035. [PMID: 37595575 PMCID: PMC10654868 DOI: 10.1093/jamia/ocad164] [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: 03/20/2023] [Accepted: 08/09/2023] [Indexed: 08/20/2023] Open
Abstract
OBJECTIVE Patient portals are increasingly used to recruit patients in research studies, but communication response rates remain low without tactics such as financial incentives or manual outreach. We evaluated a new method of study enrollment by embedding a study information sheet and HIPAA authorization form (HAF) into the patient portal preCheck-in (where patients report basic information like allergies). MATERIALS AND METHODS Eligible patients who enrolled received an after-visit patient-reported outcomes survey through the patient portal. No additional recruitment/messaging efforts were made. RESULTS A total of 386 of 843 patients completed preCheck-in, 308 of whom signed the HAF and enrolled in the study (37% enrollment rate). Of 93 patients who were eligible to receive the after-visit survey, 45 completed it (48% completion rate). CONCLUSION Enrollment and survey completion rates were higher than what is typically seen with recruitment by patient portal messaging, suggesting that preCheck-in recruitment can enhance research study recruitment and warrants further investigation.
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Affiliation(s)
- Richard K Leuchter
- Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, United States
| | - Suzette Ma
- UCLA Health Information Technology, UCLA Health, Los Angeles, CA 90095, United States
| | - Douglas S Bell
- Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, United States
- Clinical and Translational Science Institute, UCLA, Los Angeles, CA 90095, United States
| | - Ron D Hays
- Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, United States
- Department of Health Policy and Management, Fielding School of Public Health, UCLA, Los Angeles, CA 90095, United States
| | | | - Sandra L Binder
- Clinical and Translational Science Institute, UCLA, Los Angeles, CA 90095, United States
| | - Catherine A Sarkisian
- Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, United States
- VA Greater Los Angeles Healthcare System Geriatric Research Education and Clinical Center, Los Angeles, CA 90073, United States
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Cummins MR, Burr J, Young L, Yeatts SD, Ecklund DJ, Bunnell BE, Dwyer JP, VanBuren JM. Decentralized research technology use in multicenter clinical research studies based at U.S. academic research centers. J Clin Transl Sci 2023; 7:e250. [PMID: 38229901 PMCID: PMC10790101 DOI: 10.1017/cts.2023.678] [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] [Received: 03/27/2023] [Revised: 09/06/2023] [Accepted: 11/02/2023] [Indexed: 01/18/2024] Open
Abstract
Introduction During the COVID-19 pandemic, research organizations accelerated adoption of technologies that enable remote participation. Now, there's a pressing need to evaluate current decentralization practices and develop appropriate research, education, and operations infrastructure. The purpose of this study was to examine current adoption of decentralization technologies in a sample of clinical research studies conducted by academic research organizations (AROs). Methods The setting was three data coordinating centers in the U.S. These centers initiated coordination of 44 clinical research studies during or after 2020, with national recruitment and enrollment, and entailing coordination between one and one hundred sites. We determined the decentralization technologies used in these studies. Results We obtained data for 44/44 (100%) trials coordinated by the three centers. Three technologies have been adopted across nearly all studies (98-100%): eIRB, eSource, and Clinical Trial Management Systems. Commonly used technologies included e-Signature (32/44, 73%), Online Payments Portals (26/44, 59%), ePROs (23/44, 53%), Interactive Response Technology (22/44, 50%), Telemedicine (19/44, 43%), and eConsent (18/44, 41%). Wearables (7/44,16%) and Online Recruitment Portals (5/44,11%) were less common. Rarely utilized technologies included Direct-to-Patient Portals (1/44, 2%) and Home Health Nurse Portals (1/44, 2%). Conclusions All studies incorporated some type of decentralization technology, with more extensive adoption than found in previous research. However, adoption may be strongly influenced by institution-specific IT and informatics infrastructure and support. There are inherent needs, responsibilities, and challenges when incorporating decentralization technology into a research study, and AROs must ensure that infrastructure and informatics staff are adequate.
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Affiliation(s)
- Mollie R. Cummins
- University of Utah, Salt Lake City, UT, USA
- Doxy.me Inc., Rochester, NY, USA
| | - Jeri Burr
- University of Utah, Salt Lake City, UT, USA
| | - Lisa Young
- University of Utah, Salt Lake City, UT, USA
| | | | | | - Brian E. Bunnell
- Doxy.me Inc., Rochester, NY, USA
- University of South Florida, Tampa, FL, USA
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Vaughan EM, Virani S, Al Rifai M, Cardenas VJ, Johnston CA, Porterfield L, Santiago Delgado Z, Samson SL, Schick V, Naik AD. Determining call-to-entry rate and recruitment barriers in clinical studies for community clinics serving low-income populations: a cohort study. BMJ Open 2023; 13:e077819. [PMID: 37898484 PMCID: PMC10619090 DOI: 10.1136/bmjopen-2023-077819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 10/11/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND Recruitment for clinical studies is challenging. To overcome barriers, investigators have previously established call-to-entry rates to assist in planning. However, rates specific to low-income minority populations are needed to account for additional barriers to enrolment these individuals face. OBJECTIVE To obtain a call-to-entry rate in a low-income uninsured Hispanic population with chronic disease. METHODS We used data from four of our randomised clinical studies to determine the call-to-entry rate for individuals (n=1075) with or at risk for type 2 diabetes: participants needed/potential participants contacted=recruitment rate (yield). Research staff contacted potential participants to enrol in a study that evaluated 6 month diabetes programmes at community clinics from 2015 to 2020. We recorded call-to-entry rates, reasons for declining the study, show rates, and attrition. RESULTS The call-to-entry rate was 14.5%. Forty per cent of potential participants could not be contacted, and 30.6%, 19.1%, and 5.4% responded yes, no, and maybe, respectively. No show percentages were 54% for yes and 91.4% for maybe responders. The majority (61.6%) declined due to inability to attend; reasons to decline included work (43%), eligibility (18%), transportation (10%), out of town (9%), did not think they needed the programme (7%) and other/unknown (14%). Being a physician predicted inability to reach participants (adjusted OR 2.91, 95% CI 1.73 to 4.90). Attrition was 6.8%. CONCLUSIONS We described a call-to-entry rate and detailed recruitment data, including reasons to decline the study. This valuable information can assist investigators in study planning and overcoming enrolment barriers in low-income populations. Telehealth-based or strategies that limit transportation needs may increase participant involvement. TRIAL REGISTRATION NUMBER NCT03394456.
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Affiliation(s)
- Elizabeth M Vaughan
- Department of Internal Medicine, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Salim Virani
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- Houston Center for Quality of Care and Utilization Studies, Center for Innovations in Quality Effectiveness and Safety, Houston, Texas, USA
| | - Mahmoud Al Rifai
- Michael E DeBakey VA Medical Center, Houston, Texas, USA
- Houston Methodist Debakey Heart & Vascular Center, Houston, Texas, USA
| | - Victor J Cardenas
- Department of Internal Medicine, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Craig A Johnston
- Health and Human Performance, The University of Houston, Houston, Texas, USA
| | - Laura Porterfield
- Department of Family Medicine, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Zuleica Santiago Delgado
- Department of Family Medicine, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Susan L Samson
- Department of Internal Medicine, Mayo Clinic in Florida, Jacksonville, Florida, USA
| | - Vanessa Schick
- Deparrtment of Management, Policy, and Community Health, University of Texas School of Public Health, Houston, Texas, USA
| | - Aanand D Naik
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- Deparrtment of Management, Policy, and Community Health, University of Texas School of Public Health, Houston, Texas, USA
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Horst G, Miller H, Peeler A, Charleston J, Dell T, Juraschek SP, Brady TM. Experiences with recruitment and retention of adolescents and emerging adults in a weight loss intervention trial. Clin Trials 2023; 20:536-545. [PMID: 37106576 PMCID: PMC10523837 DOI: 10.1177/17407745231167090] [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] [Indexed: 04/29/2023]
Abstract
BACKGROUND/AIMS Efficient and effective participant recruitment is key for successful clinical research. Adolescent and emerging adult recruitment into clinical trials can be particularly challenging, especially when targeting underrepresented groups. This study aimed to determine the most successful recruitment strategies from those employed during a pediatric trial testing the efficacy of a behavioral intervention on adiposity and cardiovascular disease risk. METHODS We determined the effectiveness, cost, and diversity of the final research population by each recruitment method utilized in the EMPower trial, a randomized clinical trial designed to test the effect of a technology-delivered behavioral Healthy Lifestyle intervention on adiposity, blood pressure, and left ventricular mass among adolescents and emerging adults with overweight or obesity. Effectiveness was determined by respondent yield (RY; number of respondents/number contacted), scheduled yield (SY; number scheduled for a baseline visit/number of respondents), enrollment yield (EY; number enrolled/number of respondents), and retention (number completed/number enrolled). Cost-effectiveness of each recruitment method was calculated and demographics of participants recruited via each method was determined. RESULTS A minimum of 109,314 adolescents and emerging adults were contacted by at least one recruitment method (clinic, web-based, postal mailing, electronic medical record (EMR) messaging) leading to 429 respondents. The most successful strategies in terms of RY were clinic-based recruitment (n = 47, 61% RY), community web-postings (n = 109, 5.33% RY), and EMR messaging (n = 163, 0.99% RY); however, website, postal mailings, and EMR recruitment led to more successful SY and EY. Postal mailings were the most costly strategy to employ (US$3261/completed participant) with EMR messaging the second most costly (US$69/completed participant). Community web-postings were free of charge. Clinic-based recruitment did not add additional costs, per se, but did require a substantial amount of personnel time (63.6 h/completed participant). Final cohort diversity primarily came from postal mailings (57% Black) and EMR messages (50% female). CONCLUSION Electronic medical record messaging and web-based recruitment were highly successful and cost-effective strategies in a pediatric clinical trial targeting adolescents and emerging adults, but was less successful in recruiting a diverse cohort. Clinic recruitment and postal mailings, despite being costly and time-consuming, were the strategies that enrolled a greater proportion of underrepresented groups. While online forms of trial recruitment are growing in popularity, clinic-based recruitment and non-web-based strategies may be required to ensure participant diversity and representation.
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Affiliation(s)
| | | | - Anna Peeler
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College, London, UK
| | | | - Thomas Dell
- Johns Hopkins University, Baltimore, MD, USA
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Ogungbe O, Grant JK, Ayoola AS, Bansah E, Miller HN, Plante TB, Sheikhattari P, Commodore-Mensah Y, Turkson-Ocran RAN, Juraschek SP, Martin SS, Lin M, Himmelfarb CR, Michos ED. Strategies for Improving Enrollment of Diverse Populations with a Focus on Lipid-Lowering Clinical Trials. Curr Cardiol Rep 2023; 25:1189-1210. [PMID: 37787858 DOI: 10.1007/s11886-023-01942-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/13/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE OF REVIEW We review under-representation of key demographic groups in cardiovascular clinical trials, focusing on lipid-lowering trials. We outline multilevel strategies to recruit and retain diverse populations in cardiovascular trials. RECENT FINDINGS Barriers to participation in trials occur at the study, participant, health system, sponsor, and policy level, requiring a multilevel approach to effectively increase participation of under-represented groups in research. Increasing the representation of marginalized and under-represented groups in leadership positions in clinical trials can ensure that their perspectives and experiences are considered. Trial design should prioritize patient- and community-indicated needs. Women and individuals from racially/ethnically diverse populations remain under-represented in lipid-lowering and other cardiovascular clinical trials relative to their disease burden in the population. This limits the generalizability of trial results to the broader population in clinical practice. Collaboration between community stakeholders, researchers, and community members can facilitate shared learning about trials and build trust.
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Affiliation(s)
- Oluwabunmi Ogungbe
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jelani K Grant
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 524-B, Baltimore, MD, 21287, USA
| | | | - Eyram Bansah
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Hailey N Miller
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Timothy B Plante
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| | - Payam Sheikhattari
- School of Community Health & Policy, Morgan State University, Baltimore, MD, 21251, USA
- Prevention Sciences Research Center, Morgan State University, Baltimore, MD, 21251, USA
| | - Yvonne Commodore-Mensah
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ruth-Alma N Turkson-Ocran
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Stephen P Juraschek
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Seth S Martin
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 524-B, Baltimore, MD, 21287, USA
| | | | - Cheryl R Himmelfarb
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 524-B, Baltimore, MD, 21287, USA.
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da Graca B, Bennett MM, Gottlieb RL, Douglas ME, Powers MB, Warren AM. Associations of Mental Health and Experience of the COVID-19 Pandemic with United States Adults' Intentions to Be Vaccinated. Popul Health Manag 2023; 26:317-324. [PMID: 37643305 DOI: 10.1089/pop.2023.0136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Abstract
COVID-19 vaccine uptake in the United States has proved challenging. A deeper characterization extending beyond demographics and political ideologies of those hesitating or resisting is needed to guide ongoing conversations. This study examined associations between US adults' vaccination intentions and mental health history, experience of the COVID-19 pandemic, and mental health outcomes. An online population-based cross-sectional survey was administered nationwide during January 4-7, 2021. Participants were questioned about past and current mental health, and completed the Patient Health Questionnaire 8 (PHQ-8), Generalized Anxiety Disorder 7-item (GAD-7), and Posttraumatic Diagnostic Scale (PDS)-5 (to capture symptoms of depression, anxiety, and traumatic stress, respectively). Experience of the pandemic included cumulative county-level COVID case and death rates, self-reported COVID-19 testing/exposure/diagnosis, and self-reported impact on routines, resources, and relationships. Of 936 respondents, 66% intended to be vaccinated, 14.7% responded "maybe," and 19.6% "no." Past diagnosis of obsessive compulsive disorder, less impact on routines or social supports, not having been screened or tested for COVID-19, not knowing someone who tested positive, and not self-isolating were associated with less intention to vaccinate. After controlling for demographic and pandemic experience factors, symptoms of traumatic stress, but not other mental health outcomes, were associated with less intention to vaccinate. The apparent contradiction between less negative impact of the pandemic and symptoms of traumatic stress being associated with less intention to be vaccinated indicates the complex nature of barriers to vaccine uptake. Results from this study contribute to the evidence base needed to improve ongoing and future communications about, and strategies to increase uptake of, vaccination.
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Affiliation(s)
| | | | | | | | - Mark B Powers
- Baylor Scott & White Research Institute, Dallas, Texas, USA
- Baylor University Medical Center, Dallas, Texas, USA
| | - Ann Marie Warren
- Baylor Scott & White Research Institute, Dallas, Texas, USA
- Baylor University Medical Center, Dallas, Texas, USA
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Le D, Almaw RD, Rinaldi D, Ivanochko NK, Harris S, Benjamin A, Maly MR. Barriers and strategies for recruiting participants who identify as racial minorities in musculoskeletal health research: a scoping review. Front Public Health 2023; 11:1211520. [PMID: 37601207 PMCID: PMC10433765 DOI: 10.3389/fpubh.2023.1211520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 06/20/2023] [Indexed: 08/22/2023] Open
Abstract
Objective Visible minorities are disproportionately affected by musculoskeletal disorders (MSD) and other diseases; yet are largely underrepresented in health research. The purpose of this scoping review was to identify barriers and strategies associated with increasing recruitment of visible minorities in MSD research. Methods Electronic databases (MEDLINE, EMBASE, CINAHL, and PsycInfo) were searched. Search strategies used terms related to the concepts of 'race/ethnicity', 'participation', 'research' and 'musculoskeletal'. All research designs were included. Two reviewers independently screened titles and abstracts, completed full-text reviews, and extracted data. Papers that did not focus on musculoskeletal research, include racial minorities, or focus on participation in research were excluded. Study characteristics (study location, design and methods; sample characteristics (size, age, sex and race); MSD of interest) as well as barriers and strategies to increasing participation of visible minorities in MSD research were extracted from each article and summarized in a table format. Results Of the 4,282 articles identified, 28 met inclusion criteria and were included. The majority were conducted in the United States (27 articles). Of the included studies, the groups of visible minorities represented were Black (25 articles), Hispanic (14 articles), Asian (6 articles), Indigenous (3 articles), Middle Eastern (1 article), and Multiracial (1 article). The most commonly cited barriers to research participation were mistrust, logistical barriers (e.g., transportation, inaccessible study location, financial constraints), and lack of awareness or understanding of research. Strategies for increasing diversity were ensuring benefit of participants, recruiting through sites serving the community of interest, and addressing logistical barriers. Conclusion Understanding the importance of diversity in MSD research, collaborating with communities of visible minorities, and addressing logistical barriers may be effective in reducing barriers to the participation of visible minorities in health research. This review presents strategies to aid researchers in increasing inclusion in MSD-related research.
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Affiliation(s)
- Denise Le
- Department of Biology, University of Waterloo, Waterloo, ON, Canada
| | - Rachel D. Almaw
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Daniel Rinaldi
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Natasha K. Ivanochko
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Sheereen Harris
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada
| | - Ashley Benjamin
- Department of Chemistry, University of Waterloo, Waterloo, ON, Canada
| | - Monica R. Maly
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
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Turkson-Ocran RAN, Cluett JL, Fitzpatrick SL, Kraemer KM, McManus K, Mukamal KJ, Davis RB, Elborki M, Ferro K, Ismail N, Laura Aidoo E, Larbi Kwapong F, Castilla-Ojo N, Grobman B, Seager R, Hines AL, Miller ER, Crews DC, Juraschek SP. Rationale and Design of the Groceries for Black Residents of Boston to Stop Hypertension Among Adults Without Treated Hypertension (GoFresh) Trial. Am J Hypertens 2023; 36:256-263. [PMID: 37061794 PMCID: PMC11004932 DOI: 10.1093/ajh/hpad008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 01/10/2023] [Indexed: 04/17/2023] Open
Abstract
BACKGROUND Poor diet quality significantly contributes to hypertension disparities affecting Black adults. While the Dietary Approaches to Stop Hypertension (DASH) eating pattern lowers blood pressure (BP), access to DASH-patterned groceries is a major barrier for residents of urban food deserts. METHODS The Groceries for Black Residents of Boston to Stop Hypertension among Adults without Treated Hypertension (GoFresh) study is one of five projects in the RESTORE Network, an AHA-funded initiative focused on hypertension prevention. GoFresh is testing whether online, dietitian-assisted, home-delivered, DASH-patterned groceries lowers BP among Black adults with elevated BP. This individual-level, parallel-arm trial will enroll up to 176 Black adults with SBP (systolic blood pressure) between 120 and <150 mm Hg residing in Boston-area communities with reduced grocery store access. Following randomization, half of the participants will be assigned to weekly sessions with a dietitian who will assist participants in ordering DASH-patterned groceries online for home delivery; the remainder will receive a $500 monthly stipend. Both interventions will last 3 months, followed by a 9-month maintenance phase. RESULTS The primary outcome is the difference in SBP after 3 months. Secondary outcomes include a change in 24-hour ambulatory BP, body mass index, 24-hour urine sodium and potassium, hemoglobin A1C, lipids, fruit and vegetable intake, and saturated fat intake. Qualitative interviews with 45 participants 6 months after baseline assessments will determine barriers and facilitators to long-term maintenance of DASH-patterned grocery shopping. DISCUSSION Findings from this study will inform ongoing work on scalable interventions to prevent hypertension among Black adults with implications for public and healthcare-based food supplementation programs. TRIAL REGISTRATION NCT05121337. Registered on 16 November 2021, at ClinicalTrials.gov: https://clinicaltrials.gov/ct2/show/NCT05121337.
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Affiliation(s)
- Ruth-Alma N Turkson-Ocran
- Division of General Medicine, Section for Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer L Cluett
- Division of General Medicine, Section for Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | | | - Kristen M Kraemer
- Division of General Medicine, Section for Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Kathy McManus
- Department of Nutrition, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Kenneth J Mukamal
- Division of General Medicine, Section for Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Roger B Davis
- Division of General Medicine, Section for Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Marwa Elborki
- Division of General Medicine, Section for Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Kayla Ferro
- Division of General Medicine, Section for Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Norah Ismail
- Division of General Medicine, Section for Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Emily Laura Aidoo
- Division of General Medicine, Section for Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Fredrick Larbi Kwapong
- Division of General Medicine, Section for Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | | - Ben Grobman
- Harvard Medical School, Boston, Massachusetts, USA
| | - Reva Seager
- Division of General Medicine, Section for Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Anika L Hines
- Health Behaviour and Policy, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Edgar R Miller
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Deidra C Crews
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Stephen P Juraschek
- Division of General Medicine, Section for Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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9
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Recruitment of diverse community health center patients in a pragmatic weight gain prevention trial. J Clin Transl Sci 2023; 7:e22. [PMID: 36755547 PMCID: PMC9879902 DOI: 10.1017/cts.2022.475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 11/07/2022] Open
Abstract
Introduction Pragmatic trials are needed to establish evidence-based obesity treatment in primary care settings, particularly in community health centers (CHCs) that serve populations at heightened risk of obesity. Recruiting a representative trial sample is a critical first step to informing care for diverse communities. We described recruitment strategies utilized in a pragmatic obesity trial and assessed the sociodemographic characteristics and odds of enrollment by recruitment strategy. Methods We analyzed data from Balance, a pragmatic trial implemented within a network of CHCs. We recruited participants via health center-based and electronic health record (EHR)-informed mail recruitment. We analyzed associations between sociodemographic characteristics and the return rate of patient authorization forms (required for participation) from EHR-informed mail recruitment. We also compared sociodemographic characteristics and randomization odds by recruitment strategy after returning authorization forms. Results Of the individuals recruited through EHR-informed mail recruitment, females were more likely than males to return authorization forms; however, there were no differences in rates of return by preferred language (English/Spanish) or age. Females; underrepresented racial and ethnic groups; Spanish speakers; younger adults; and those with lower education levels were recruited more successfully in the health center. In contrast, their counterparts were more responsive to mail recruitment. Once authorization forms were returned, the odds of being randomized did not significantly differ by recruitment method. Conclusion Health center-based recruitment was essential to meeting recruitment targets in a pragmatic weight gain prevention trial, specifically for Hispanic and Spanish-speaking communities. Future pragmatic trials should consider leveraging in-person recruitment for underrepresented groups in research.
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DeGroot L, Pavlovic N, Perrin N, Gilotra NA, Dy SM, Davidson PM, Szanton SL, Saylor MA. Palliative Care Needs of Physically Frail Community-Dwelling Older Adults With Heart Failure. J Pain Symptom Manage 2023; 65:500-509. [PMID: 36736499 DOI: 10.1016/j.jpainsymman.2023.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/29/2022] [Accepted: 01/13/2023] [Indexed: 02/03/2023]
Abstract
CONTEXT Physical frailty is emerging as a potential "trigger" for palliative care (PC) consultation, but the PC needs of physically frail persons with heart failure (HF) in the outpatient setting have not been well described. OBJECTIVES This study describes the PC needs of community dwelling, physically frail persons with HF. METHODS We included persons with HF ≥50 years old who experienced ≥1 hospitalization in the prior year and excluded those with moderate/severe cognitive impairment, hospice patients, or non-English speaking persons. Measures included the FRAIL scale (0-5: 0 = robust, 1-2 = prefrail, 3-5 = frail) and the Integrated Palliative Outcome Scale (IPOS) (17 items, score 0-68; higher score = higher PC needs). Multiple linear regression tested the association between frailty group and palliative care needs. RESULTS Participants (N = 286) had a mean age of 68 (range 50-92) were majority male (63%) and White (68%) and averaged two hospitalizations annually. Most were physically frail (44%) or prefrail (41%). Mean PC needs (IPOS) score was 19.7 (range 0-58). On average, participants reported 5.86 (SD 4.28) PC needs affecting them moderately, severely, or overwhelmingly in the last week. Patient-perceived family/friend anxiety (58%) weakness/lack of energy (58%), and shortness of breath (47%) were the most prevalent needs. Frail participants had higher mean PC needs score (26) than prefrail (16, P < 0.001) or robust participants (11, P < 0.001). Frail participants experienced an average of 8.32 (SD 3.72) moderate/severe/overwhelming needs compared to prefrail (4.56, SD 3.77) and robust (2.39, SD 2.91) participants (P < 0.001). Frail participants reported higher prevalence of weakness/lack of energy (83%), shortness of breath (66%), and family/friend anxiety (69%) than prefrail (48%, 39%, 54%) or robust (13%, 14%, 35%) participants (P < 0.001). CONCLUSION Physically frail people with HF have higher unmet PC needs than those who are nonfrail. Implementing PC needs and frailty assessments may help identify vulnerable patients with unmet needs requiring further assessment and follow-up.
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Affiliation(s)
- Lyndsay DeGroot
- Johns Hopkins University School of Nursing (L.D., N.P., N.P., S.L.S., M.A.S.), Baltimore, Maryland, USA.
| | - Noelle Pavlovic
- Johns Hopkins University School of Nursing (L.D., N.P., N.P., S.L.S., M.A.S.), Baltimore, Maryland, USA
| | - Nancy Perrin
- Johns Hopkins University School of Nursing (L.D., N.P., N.P., S.L.S., M.A.S.), Baltimore, Maryland, USA
| | - Nisha A Gilotra
- Johns Hopkins University School of Medicine (N.A.G), Baltimore, Maryland, USA
| | - Sydney M Dy
- Johns Hopkins University School of Public Health (S.M.D), Baltimore, Maryland, USA
| | | | - Sarah L Szanton
- Johns Hopkins University School of Nursing (L.D., N.P., N.P., S.L.S., M.A.S.), Baltimore, Maryland, USA
| | - Martha Abshire Saylor
- Johns Hopkins University School of Nursing (L.D., N.P., N.P., S.L.S., M.A.S.), Baltimore, Maryland, USA
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11
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Miller HN, Lindo S, Fish LJ, Roberts J, Stover J, Schwark EH, Eberlein N, Mack D, Falkovic M, Makarushka C, Chatterjee R. Describing current use, barriers, and facilitators of patient portal messaging for research recruitment: Perspectives from study teams and patients at one institution. J Clin Transl Sci 2023; 7:e96. [PMID: 37125060 PMCID: PMC10130833 DOI: 10.1017/cts.2023.522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 03/28/2023] [Accepted: 03/30/2023] [Indexed: 05/02/2023] Open
Abstract
Introduction The electronic health record (EHR) and patient portal are used increasingly for clinical research, including patient portal recruitment messaging (PPRM). Use of PPRM has grown rapidly; however, best practices are still developing. In this study, we examined the use of PPRM at our institution and conducted qualitative interviews among study teams and patients to understand experiences and preferences for PPRM. Methods We identified study teams that sent PPRMs and patients that received PPRMs in a 60-day period. We characterized these studies and patients, in addition to the patients' interactions with the PPRMs (e.g., viewed, responded). From these groups, we recruited study team members and patients for semi-structured interviews. A pragmatic qualitative inquiry framework was used by interviewers. Interviews were audio-recorded and analyzed using a rapid qualitative analysis exploratory approach. Results Across ten studies, 35,037 PPRMs were sent, 33% were viewed, and 17% were responded to. Interaction rates varied across demographic groups. Six study team members completed interviews and described PPRM as an efficient and helpful recruitment method. Twenty-eight patients completed interviews. They were supportive of receiving PPRMs, particularly when the PPRM was relevant to their health. Patients indicated that providing more information in the PPRM would be helpful, in addition to options to set personalized preferences. Conclusions PPRM is an efficient recruitment method for study teams and is acceptable to patients. Engagement with PPRMs varies across demographic groups, which should be considered during recruitment planning. Additional research is needed to evaluate and implement recommended changes by study teams and patients.
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Affiliation(s)
| | - Sierra Lindo
- Duke Clinical and Translational Science Institute, Recruitment Innovation Center, Duke University, Durham, NC, USA
| | - Laura J. Fish
- Duke Cancer Institute, Behavioral Health and Survey Research Core, Duke University, Durham, NC, USA
- Department of Family Medicine and Community Health, Duke University, Durham, NC, USA
| | | | - John Stover
- Duke University School of Medicine, Durham, NC 27710, USA
| | | | - Nicholas Eberlein
- Duke Clinical and Translational Science Institute, Recruitment Innovation Center, Duke University, Durham, NC, USA
| | - Dalia Mack
- Duke University School of Medicine, Durham, NC 27710, USA
| | - Margaret Falkovic
- Duke Cancer Institute, Behavioral Health and Survey Research Core, Duke University, Durham, NC, USA
| | - Christina Makarushka
- Duke Cancer Institute, Behavioral Health and Survey Research Core, Duke University, Durham, NC, USA
| | - Ranee Chatterjee
- Duke Clinical and Translational Science Institute, Recruitment Innovation Center, Duke University, Durham, NC, USA
- Duke University School of Medicine, Durham, NC 27710, USA
- Address for correspondence: R. Chatterjee, MD, MPH, 710 W. Main Street, 1st floor, Durham, NC 27701, USA.
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12
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Sherman SE, Langford AT, Chodosh J, Hampp C, Trachtman H. Use of patient portals to support recruitment into clinical trials and health research studies: results from studies using MyChart at one academic institution. JAMIA Open 2022; 5:ooac092. [PMID: 36325306 PMCID: PMC9614350 DOI: 10.1093/jamiaopen/ooac092] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 08/26/2022] [Accepted: 10/20/2022] [Indexed: 11/07/2022] Open
Abstract
Electronic health records (EHRs) are often used for recruitment into research studies, as they efficiently facilitate targeted outreach. While studies increasingly are reaching out to potential participants through the EHR patient portal, there is little available information about which approaches are most effective. We surveyed all investigators at one academic medical center who had used the Epic MyChart patient portal for recruitment. We found that messages were typically adapted for a large group, but not tailored further for individual subgroups. The vast majority of studies sent a message only once. Recruitment costs were modest, averaging $431/study. The results show some promise for recruiting through the patient portal but also identified ways in which messages could be optimized.
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Affiliation(s)
- Scott E Sherman
- Corresponding Author: Scott E. Sherman, MD, MPH, Department of Population Health, 180 Madison Avenue, New York, NY 10016, USA;
| | - Aisha T Langford
- Department of Population Health, NYU Langone Health, NYU Grossman School of Medicine, New York, New York, USA,Clinical and Translational Science Institute, NYU Langone Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Joshua Chodosh
- Department of Population Health, NYU Langone Health, NYU Grossman School of Medicine, New York, New York, USA,Department of Medicine, NYU Langone Health, NYU Grossman School of Medicine, New York, New York, USA,Department of Medicine, VA New York Harbor Healthcare System, New York, New York, USA
| | - Carina Hampp
- Clinical and Translational Science Institute, NYU Langone Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Howard Trachtman
- Clinical and Translational Science Institute, NYU Langone Health, NYU Grossman School of Medicine, New York, New York, USA,Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
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13
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Bennett MM, Douglas M, da Graca B, Sanchez K, Powers MB, Warren AM. Attitudes and personal beliefs about the COVID-19 vaccine among people with COVID-19: a mixed-methods analysis. BMC Public Health 2022; 22:1936. [PMID: 36258176 PMCID: PMC9579584 DOI: 10.1186/s12889-022-14335-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/29/2022] [Accepted: 10/12/2022] [Indexed: 12/04/2022] Open
Abstract
Background Little research is available regarding vaccination attitudes among those recently diagnosed with COVID-19. This is important to investigate, particularly among those experiencing mild-to-moderate illness, given the ongoing need to improve uptake of both initial vaccine series and booster doses, and the divergent ways such an experience could impact attitudes. Methods From September 3 – November 12, 2021, all patients enrolled in Baylor Scott & White’s “COVID-19 Digital Care Journey for Home Monitoring” were invited to participate in an online survey that included questions about vaccination status and attitudes/opinions regarding COVID-19 and the COVID-19 vaccines. Following an item asking about accordance of COVID-19 vaccination with religious/personal beliefs, participants were asked to describe those beliefs and how they relate to taking/not taking the vaccine. Results Of 8,075 patients age ≥ 18 years diagnosed with COVID-19 and invited to join the survey during the study period, 3242 (40.2%) were fully vaccinated. In contrast, among the 149 who completed the questionnaire, 95(63.8%) reported full vaccination. Responses differed significantly between vaccination groups. The vaccinated group strongly agreed that COVID-19 is a major public health problem, the vaccines are safe and effective, and their decision to vaccinate included considering community benefit. The unvaccinated group responded neutrally to most questions addressing safety and public health aspects of the vaccine, while strongly disagreeing with statements regarding vaccine effectiveness and other preventative public health measures. The vaccinated group strongly agreed that taking the vaccine accorded with their religious/personal beliefs, while the unvaccinated group was neutral. In qualitative analysis of the free text responses “risk perception/calculation” and “no impact” of religious/personal beliefs on vaccination decisions were frequent themes/subthemes in both groups, but beliefs related to the “greater good” were a strong driver among the vaccinated, while statements emphasizing “individual choice” were a third frequent theme for the unvaccinated. Conclusion Our results show that two of the three factors that drive vaccine hesitancy (complacency, and lack of confidence in the vaccines) are present among unvaccinated adults recently diagnosed with COVID-19. They also show that beliefs emphasizing the importance of the greater good promote public health participation. Supplementary information The online version contains supplementary material available at 10.1186/s12889-022-14335-x.
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Affiliation(s)
| | - Megan Douglas
- Baylor Scott & White Research Institute, Dallas, TX, USA
| | | | - Katherine Sanchez
- Baylor Scott & White Research Institute, Dallas, TX, USA.,School of Social Work, University of Texas at Arlington, Arlington, TX, USA
| | - Mark B Powers
- Baylor Scott & White Research Institute, Dallas, TX, USA.,Baylor University Medical Center, Dallas, TX, USA.,Texas A&M University - College of Medicine, Dallas, TX, USA
| | - Ann Marie Warren
- Baylor Scott & White Research Institute, Dallas, TX, USA.,Baylor University Medical Center, Dallas, TX, USA.,Texas A&M University - College of Medicine, Dallas, TX, USA
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14
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Harnessing Electronic Medical Records in Cardiovascular Clinical Practice and Research. J Cardiovasc Transl Res 2022:10.1007/s12265-022-10313-1. [DOI: 10.1007/s12265-022-10313-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 08/29/2022] [Indexed: 10/14/2022]
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15
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Hoyo V, Shah RC, Dave G, Volkov BB. Integrating special and underserved populations in translational research: Environmental scan of adaptive capacity and preparedness of Clinical and Translational Science Award (CTSA) program hubs. J Clin Transl Sci 2022; 6:e89. [PMID: 35989859 PMCID: PMC9379934 DOI: 10.1017/cts.2022.414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/26/2022] [Accepted: 05/31/2022] [Indexed: 11/25/2022] Open
Abstract
The COVID-19 pandemic has exacerbated health disparities and rendered them acutely more visible. Special and underrepresented populations need to be fully integrated into the translational research process from the very beginning and all the way through. This article presents findings and rapid analysis mini-case studies from the Environmental Scan (E-Scan) of adaptive capacity and preparedness of Clinical and Translational Science Award hubs, specific to the goal of integrating special and vulnerable populations in different institutional research settings. In our discussion of the findings and case studies, we flexibly apply local adaptive capacity framework concepts and characteristics, and, whenever possible, we present ideas on how to enhance capacity in those areas, based on the challenges and practices identified through the E-Scan. Although the past year has recorded incredible achievements in vaccine development, clinical trials, diagnostics, and overall biomedical research, these successes continue to be hampered by our inability to turn them into achievements equally available and accessible to all populations.
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Affiliation(s)
- Verónica Hoyo
- Northwestern University Clinical and Translational Sciences Institute (NUCATS), Northwestern University, Chicago, IL, USA
- Clinical and Translational Research Institute, University of California, San Diego, La Jolla, CA, USA
| | - Raj C. Shah
- Institute for Translational Medicine, The University of Chicago, Rush University Medical Center, Chicago, IL, USA
- Department of Family Medicine, Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA
- Center for Community Health Equity, Rush University, DePaul University, Chicago, IL, USA
| | - Gaurav Dave
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
- North Carolina Translational and Clinical Sciences Institute, University of North Carolina, Chapel Hill, NC, USA
| | - Boris B. Volkov
- University of Minnesota Clinical and Translational Science Institute, Minneapolis, MN, USA
- Institute for Health Informatics and Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
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16
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Volkov BB, Ragon B, Doyle JM, Bredella MA. Adaptive capacity and preparedness of Clinical and Translational Science Award Program hubs: Overview of an environmental scan. J Clin Transl Sci 2022; 7:e31. [PMID: 36845304 PMCID: PMC9947610 DOI: 10.1017/cts.2022.400] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/06/2022] [Accepted: 05/06/2022] [Indexed: 11/06/2022] Open
Abstract
The ability of research networks and individual institutions to effectively and efficiently prepare, respond, and adapt to emergent challenges is essential for the biomedical research enterprise. At the beginning of 2021, a special Working Group was formed by individuals in the Clinical and Translational Science Award (CTSA) consortium and approved by the CTSA Steering Committee to explore "Adaptive Capacity and Preparedness (AC&P) of CTSA Hubs." The AC&P Working Group took a pragmatic Environmental Scan (E-Scan) approach of utilizing the diverse data that had been collected through existing mechanisms. The Local Adaptive Capacity framework was adapted to illustrate the interconnectedness of CTSA programs and services, while exposing how the demands of the pandemic forced them to quickly pivot and adapt. This paper presents a synopsis of the themes and lessons learned that emerged from individual sections of the E-Scan. Lessons learned from this study may improve our understanding of adaptive capacity and preparedness at different levels, as well as help strengthen the core service models, strategies, and foster innovation in clinical and translational science research.
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Affiliation(s)
- Boris B. Volkov
- University of Minnesota Clinical and Translational Science Institute, Minneapolis, MN, USA
- Institute for Health Informatics, Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Bart Ragon
- integrated Translational Health Research Institute of Virginia, University of Virginia, Charlottesville, VA, USA
| | - Jamie Mihoko Doyle
- Division of Clinical Innovation, National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, MD, USA
| | - Miriam A. Bredella
- Massachusetts General Hospital and Harvard Catalyst, The Harvard Clinical and Translational Science Center, Harvard Medical School, Boston, MA, USA
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17
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Pogue JR, Graca BMD, Adams M, Kruegar C, Patel R, Bennett M, Powers MB, Warren AM. Strategies and lessons learned from a longitudinal study to maximize recruitment in the midst of a global pandemic. Proc AMIA Symp 2022; 35:309-314. [DOI: 10.1080/08998280.2022.2034494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
| | | | - Maris Adams
- Baylor Scott & White Research Institute, Dallas, Texas
| | | | - Rupande Patel
- Baylor Scott & White Research Institute, Dallas, Texas
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18
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Hasson Charles RM, Sosa E, Patel M, Erhunmwunsee L. Health Disparities in Recruitment and Enrollment in Research. Thorac Surg Clin 2022; 32:75-82. [PMID: 34801198 PMCID: PMC8611804 DOI: 10.1016/j.thorsurg.2021.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Despite advances in thoracic oncology research, the benefits of new discoveries are not universally experienced. A lack of representation of racial/ethnic minorities and individuals of low socioeconomic status in clinical trials and thoracic research contributes to persistent health care disparities. It is critical that improved racial, ethnic, and socioeconomic diversity is achieved in our trials and research, if we are to attain generalizability of findings and reduction of health care disparities. Culturally tailored and community-based approaches can help improve recruitment and enrollment of marginalized groups in thoracic research, which is an essential step toward achieving health equity and advancing medical science.
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Affiliation(s)
- Rian M. Hasson Charles
- Dartmouth-Hitchcock Medical Center Geisel School of Medicine at Dartmouth, One Medical Center Drive, Lebanon, NH 03756
| | - Ernesto Sosa
- City of Hope Comprehensive Cancer Center, 1500 E Duarte Rd, Duarte CA 91010
| | - Meghna Patel
- City of Hope Comprehensive Cancer Center, 1500 E Duarte Rd, Duarte CA 91010
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19
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Fletcher SA, Bivalacqua TJ, Brawley OW, Kates M. Race, ethnicity, and gender reporting in North American clinical trials for BCG-unresponsive non-muscle invasive bladder cancer. Urol Oncol 2021; 40:195.e13-195.e18. [PMID: 34949513 DOI: 10.1016/j.urolonc.2021.11.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/06/2021] [Accepted: 11/15/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The National Institutes of Health (NIH) Revitalization Act of 1993 established guidelines for the inclusion of racial/ethnic minorities and women in clinical research. However, the reporting rate of such patient demographic data in clinical trials for BCG-unresponsive non-muscle invasive bladder cancer is not well characterized. METHODS We identified published clinical trials of all phases (I -III) for BCG-unresponsive non-muscle invasive bladder cancer conducted in the US and/or Canada. We calculated the proportion of studies reporting patient gender and race/ethnicity, tabulating these data when present. We compared reported trial participant race, ethnicity and gender with the number of new bladder cancer cases and deaths using the Centers for Disease Control and Prevention (CDC) and National Cancer Institute (NCI) U.S. Cancer Statistics data from 2013 -2017. RESULTS We identified 27 trials published from 1998 -2021 enrolling a total of 1673 patients. While all trials included data on patient gender (22% women overall), only 40.7% included any data on patient race/ethnicity. Among those that did, trial participants were reported as white (94%), Black (2.1%), Hispanic (0.6%), Asian (0.9%), and Other (2.3%). Racial/ethnic minorities were underrepresented in clinical trials relative to their proportion of new bladder cancer cases and deaths. CONCLUSION Most clinical trials that have been conducted for BCG-unresponsive non-muscle invasive bladder cancer do not report data on patient race or ethnicity despite NIH guidelines advocating for inclusion of such data. Racial/ethnic minorities remain underrepresented in these trials relative to the burden of bladder cancer prevalence and mortality faced by these groups.
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Affiliation(s)
- Sean A Fletcher
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD.
| | | | - Otis W Brawley
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology, Bloomberg School of Public Health, Baltimore, MD
| | - Max Kates
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD
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20
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Peeler A, Miller H, Ogungbe O, Lewis Land C, Martinez L, Guerrero Vazquez M, Carey S, Murli S, Singleton M, Lacanienta C, Gleason K, Ford D, Himmelfarb CR. Centralized registry for COVID-19 research recruitment: Design, development, implementation, and preliminary results. J Clin Transl Sci 2021; 5:e152. [PMID: 34462668 PMCID: PMC8387691 DOI: 10.1017/cts.2021.819] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/30/2021] [Accepted: 07/08/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The Coronavirus Disease 2019 (COVID-19) pandemic has had substantial global morbidity and mortality. Clinical research related to prevention, diagnosis, and treatment of COVID-19 is a top priority. Effective and efficient recruitment is challenging even without added constraints of a global pandemic. Recruitment registries offer a potential solution to slow or difficult recruitment. OBJECTIVES The purpose of this paper is to describe the design and implementation of a digital research recruitment registry to optimize awareness and participant enrollment for COVID-19-related research in Baltimore and to report preliminary results. METHODS Planning began in March 2020, and the registry launched in July 2020. The primary recruitment mechanisms include electronic medical record data, postcards distributed at testing sites, and digital advertising campaigns. Following consent in a Research Electronic Data Capture survey, participants answer questions related to COVID-19 exposure, testing, and willingness to participate in research. Branching logic presents participants with studies they might be eligible for. RESULTS As of March 24, 2021, 9010 participants have enrolled, and 64.2% are female, 80.6% are White, 9.4% are Black or African American, and 6% are Hispanic or Latino. Phone outreach has had the highest response rate (13.1%), followed by email (11.9%), text (11.4%), and patient portal message (9.4%). Eleven study teams have utilized the registry, and 4596 matches have been made between study teams and interested volunteers. CONCLUSION Effective and efficient recruitment strategies are more important now than ever due to the time-limited nature of COVID-19 research. Pilot efforts have been successful in connecting interested participants with recruiting study teams.
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Affiliation(s)
- Anna Peeler
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
- Johns Hopkins University Institute for Clinical and Translational Research, Baltimore, MD, USA
| | - Hailey Miller
- Johns Hopkins University Institute for Clinical and Translational Research, Baltimore, MD, USA
- Duke University School of Nursing, Durham, NC, USA
| | - Oluwabunmi Ogungbe
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
- Johns Hopkins University Institute for Clinical and Translational Research, Baltimore, MD, USA
| | - Cassia Lewis Land
- Johns Hopkins University Institute for Clinical and Translational Research, Baltimore, MD, USA
| | - Liz Martinez
- Johns Hopkins University Institute for Clinical and Translational Research, Baltimore, MD, USA
| | - Monica Guerrero Vazquez
- Johns Hopkins School of Medicine, Baltimore, MD, USA
- Center for Salud/Health and Opportunity for Latinos, Baltimore, MD, USA
| | - Scott Carey
- Johns Hopkins University Institute for Clinical and Translational Research, Baltimore, MD, USA
| | - Sumati Murli
- Johns Hopkins University Institute for Clinical and Translational Research, Baltimore, MD, USA
| | - Megan Singleton
- Johns Hopkins University Institute for Clinical and Translational Research, Baltimore, MD, USA
| | - Cyd Lacanienta
- Johns Hopkins University Institute for Clinical and Translational Research, Baltimore, MD, USA
| | - Kelly Gleason
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
- Johns Hopkins University Institute for Clinical and Translational Research, Baltimore, MD, USA
| | - Daniel Ford
- Johns Hopkins University Institute for Clinical and Translational Research, Baltimore, MD, USA
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Cheryl R. Himmelfarb
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
- Johns Hopkins University Institute for Clinical and Translational Research, Baltimore, MD, USA
- Johns Hopkins School of Medicine, Baltimore, MD, USA
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21
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Bierle DM, Ganesh R, Wilker CG, Hanson SN, Moehnke DE, Jackson TA, Ramar P, Rosedahl JK, Philpot LM, Razonable RR. Influence of Social and Cultural Factors on the Decision to Consent for Monoclonal Antibody Treatment among High-Risk Patients with Mild-Moderate COVID-19. J Prim Care Community Health 2021; 12:21501327211019282. [PMID: 34032171 PMCID: PMC8155772 DOI: 10.1177/21501327211019282] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The clinical outcomes of patients who decline anti-spike monoclonal antibody therapies for coronavirus disease-2019 (COVID-19) is not known. Factors associated with the decision to accept or decline the offer for anti-spike monoclonal antibody therapies are not established. This study aimed to identify factors impacting the decision to consent for monoclonal antibody therapies and assess the differences in clinical outcomes of patients who accepted compared to those who declined these therapies. METHODS This retrospective cohort study enrolled 2820 adult patients who were offered monoclonal antibody therapies, bamlanivimab and casirivimab-imdevimab, for COVID-19 at Mayo Clinic in the Midwest between 11/19/2020 and 12/31/2020. The primary endpoint is the decision to accept or decline monoclonal antibody treatment. Secondary endpoints were patient-level factors that could have impacted the decision to accept treatment (age, gender, race, ethnicity, primary language spoken, and medical comorbidities). The main clinical endpoint was hospitalization within 28 days of COVID-19 diagnosis. RESULTS 59.1% (n = 1669) chose to accept monoclonal antibody therapy, and 40.9% (n = 1151) chose to decline the offer for treatment. Patients were more likely to accept treatment if they were non-Hispanic White, English speaking, identified a spouse or life partner, had a religious affiliation, and possessed more medical comorbidities. Overall, 28-day hospitalization rate was 2.6% (n = 72/2820) and was higher among those who declined (3.3%) than those who accepted monoclonal antibody therapy (2.0%; Rate Ratio = 0.62, 95% Confidence Interval, 0.39-0.98). CONCLUSIONS Despite having more comorbidities, patients who accepted monoclonal antibody treatments had a lower rate of hospitalization compared to patients who declined treatment. Several social and cultural factors were associated with the decision to decline therapy, including race, language, ethnicity, and lack of social support. These findings can inform public health efforts to reduce social disparities in the treatment of COVID-19 and increase utilization of monoclonal antibody therapies in high risk populations.
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22
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Juraschek SP, Miller ER, Wu B, White K, Charleston J, Gelber AC, Rai SK, Carson KA, Appel LJ, Choi HK. A Randomized Pilot Study of DASH Patterned Groceries on Serum Urate in Individuals with Gout. Nutrients 2021; 13:nu13020538. [PMID: 33562216 PMCID: PMC7914968 DOI: 10.3390/nu13020538] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/19/2021] [Accepted: 01/28/2021] [Indexed: 02/07/2023] Open
Abstract
The Dietary Approaches to Stop Hypertension (DASH) diet reduces serum urate (SU); however, the impact of the DASH diet has not been previously evaluated among patients with gout. We conducted a randomized, controlled, crossover pilot study to test the effects of ~$105/week ($15/day) of dietitian-directed groceries (DDG), patterned after the DASH diet, on SU, compared with self-directed grocery shopping (SDG). Participants had gout and were not taking urate lowering therapy. Each intervention period lasted 4 weeks; crossover occurred without a washout period. The primary endpoint was SU. Compliance was assessed by end-of-period fasting spot urine potassium and sodium measurements and self-reported consumption of daily servings of fruit and vegetables. We randomized 43 participants (19% women, 49% black, mean age 59 years) with 100% follow-up. Mean baseline SU was 8.1 mg/dL (SD, 0.8). During Period 1, DDG lowered SU by 0.55 mg/dL (95% CI: 0.07, 1.04) compared to SDG by 0.0 mg/dL (95% CI: −0.44, 0.44). However, after crossover (Period 2), the SU difference between groups was the opposite: SDG reduced SU by −0.48 mg/dL (95% CI: −0.98, 0.01) compared to DDG by −0.05 mg/dL (95% CI: −0.48, 0.38; P for interaction by period = 0.11). Nevertheless, DDG improved self-reported intake of fruit and vegetables (3.1 servings/day; 95% CI: 1.5, 4.8) and significantly reduced total spot urine sodium excretion by 22 percentage points (95% CI: −34.0, −8.6). Though relatively small in scale, this pilot study suggests that dietitian-directed, DASH-patterned groceries may lower SU among gout patients not on urate-lowering drugs. However, behavior intervention crossover trials without a washout period are likely vulnerable to strong carryover effects. Definitive evaluation of the DASH diet as a treatment for gout will require a controlled feeding trial, ideally with a parallel-design.
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Affiliation(s)
- Stephen P. Juraschek
- Beth Israel Deaconess Medical Center, General Medicine, Boston, MA 02215, USA
- Correspondence: ; Tel.: +1-617-754-1416
| | - Edgar R. Miller
- Johns Hopkins Bloomberg School of Public Health, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (E.R.M.III); (B.W.); (K.W.); (J.C.); (A.C.G.); (K.A.C.); (L.J.A.)
| | - Beiwen Wu
- Johns Hopkins Bloomberg School of Public Health, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (E.R.M.III); (B.W.); (K.W.); (J.C.); (A.C.G.); (K.A.C.); (L.J.A.)
| | - Karen White
- Johns Hopkins Bloomberg School of Public Health, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (E.R.M.III); (B.W.); (K.W.); (J.C.); (A.C.G.); (K.A.C.); (L.J.A.)
| | - Jeanne Charleston
- Johns Hopkins Bloomberg School of Public Health, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (E.R.M.III); (B.W.); (K.W.); (J.C.); (A.C.G.); (K.A.C.); (L.J.A.)
| | - Allan C. Gelber
- Johns Hopkins Bloomberg School of Public Health, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (E.R.M.III); (B.W.); (K.W.); (J.C.); (A.C.G.); (K.A.C.); (L.J.A.)
| | - Sharan K. Rai
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02215, USA;
| | - Kathryn A. Carson
- Johns Hopkins Bloomberg School of Public Health, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (E.R.M.III); (B.W.); (K.W.); (J.C.); (A.C.G.); (K.A.C.); (L.J.A.)
| | - Lawrence J. Appel
- Johns Hopkins Bloomberg School of Public Health, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (E.R.M.III); (B.W.); (K.W.); (J.C.); (A.C.G.); (K.A.C.); (L.J.A.)
| | - Hyon K. Choi
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02215, USA;
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