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Kelleher KJ, Gardner W, Kemper AR, Chavez L, Pajer K, Rosic T. Principles for Primary Care Screening in the Context of Population Health. Acad Pediatr 2024; 24:719-727. [PMID: 38458490 DOI: 10.1016/j.acap.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 11/16/2023] [Accepted: 02/29/2024] [Indexed: 03/10/2024]
Abstract
A key component of primary care pediatrics is health promotion through screening: applying a test or procedure to detect a previously unrecognized disease or disease risk. How do we decide whether to screen? In 1965, Wilson and Jungner published an influential set of screening principles focused on the health problem's importance, the screening tool's performance, and the evidence for treatment efficacy. However, if we want realistic estimates of the population effects of routine screening, we must also account for the health care system's real-world functioning and disparities in care. We offer revised principles to guide discussions about routine screening in the primary care setting. We add to Wilson and Jungner's principles: 1. A focus on life course epidemiology and its consequences for population health, 2. A need to screen for the early stages of chronic health problems, 3. A concern for screening's acceptability to providers and the community, 4. A recommendation for estimating the uncertainty in benefits and harms in evaluating screening, 5. Inclusion of systematic plans for population data collection and monitoring, and 6. Recognition that achieving population health improvement requires a high-performing system with sufficient throughput and monitoring to deliver accessible, affordable, and effective care, especially for the groups experiencing the greatest inequities in access. Above all, instead of assuming best practices in treatment delivery and monitoring after screening, we argue for realism about the health care system functioning in routine practice.
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Affiliation(s)
- Kelly J Kelleher
- Department of Pediatrics (KJ Kelleher), The Ohio State University, and The Abigail Wexner Research Institute Nationwide Children's Hospital, Columbus, Ohio.
| | - William Gardner
- School of Epidemiology and Public Health and CHEO Research Institute (W Gardner), Ottawa, Ontario, Canada
| | - Alex R Kemper
- Department of Pediatrics (AR Kemper and L Chavez), The Ohio State University, and The Abigail Wexner Research Institute Nationwide Children's Hospital, Columbus, Ohio
| | - Laura Chavez
- Department of Pediatrics (AR Kemper and L Chavez), The Ohio State University, and The Abigail Wexner Research Institute Nationwide Children's Hospital, Columbus, Ohio
| | - Kathleen Pajer
- Department of Psychiatry (K Pajer), University of Ottawa, and CHEO Research Institute, Ottawa, Ontario, Canada
| | - Tea Rosic
- Department of Health Research Methodology, Children's Hospital of Eastern Ontario (T Rosic), Ottawa, Ontario, Canada
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Rabin BA, Cain KL, Watson P, Oswald W, Laurent LC, Meadows AR, Seifert M, Munoz FA, Salgin L, Aldous J, Diaz EA, Villodas M, Vijaykumar S, O'Leary ST, Stadnick NA. Scaling and sustaining COVID-19 vaccination through meaningful community engagement and care coordination for underserved communities: hybrid type 3 effectiveness-implementation sequential multiple assignment randomized trial. Implement Sci 2023; 18:28. [PMID: 37443044 DOI: 10.1186/s13012-023-01283-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 06/18/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND COVID-19 inequities are abundant in low-income communities of color. Addressing COVID-19 vaccine hesitancy to promote equitable and sustained vaccination for underserved communities requires a multi-level, scalable, and sustainable approach. It is also essential that efforts acknowledge the broader healthcare needs of these communities including engagement in preventive services. METHODS This is a hybrid type 3 effectiveness-implementation study that will include a multi-level, longitudinal, mixed-methods data collection approach designed to assess the sustained impact of a co-created multicomponent strategy relying on bidirectional learning, shared decision-making, and expertise by all team members. The study capitalizes on a combination of implementation strategies including mHealth outreach with culturally appropriate messaging, care coordination to increase engagement in high priority preventive services, and the co-design of these strategies using community advisory boards led by Community Weavers. Community Weavers are individuals with lived experience as members of an underserved community serving as cultural brokers between communities, public health systems, and researchers to co-create community-driven, culturally sensitive public health solutions. The study will use an adaptive implementation approach operationalized in a sequential multiple assignment randomized trial design of 300 participants from three sites in a Federally Qualified Health Center in Southern California. This design will allow examining the impact of various implementation strategy components and deliver more intensive support to those who benefit from it most. The primary effectiveness outcomes are COVID-19 vaccine completion, engagement in preventive services, and vaccine confidence. The primary implementation outcomes are reach, adoption, implementation, and maintenance of the multicomponent strategy over a 12-month follow-up period. Mixed-effects logistic regression models will be used to examine program impacts and will be triangulated with qualitative data from participants and implementers. DISCUSSION This study capitalizes on community engagement, implementation science, health equity and communication, infectious disease, and public health perspectives to co-create a multicomponent strategy to promote the uptake of COVID-19 vaccination and preventive services for underserved communities in San Diego. The study design emphasizes broad engagement of our community and clinic partners leading to culturally sensitive and acceptable strategies to produce lasting and sustainable increases in vaccine equity and preventive services engagement. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05841810 May 3, 2023.
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Affiliation(s)
- Borsika A Rabin
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA.
- Dissemination and Implementation Science Center, University of California San Diego Altman Clinical and Translational Research Institute, La Jolla, CA, USA.
| | - Kelli L Cain
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Paul Watson
- The Global Action Research Center, San Diego, CA, USA
| | | | - Louise C Laurent
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, CA, USA
| | - Audra R Meadows
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, CA, USA
- Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Marva Seifert
- Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | | | | | | | | | - Miguel Villodas
- Department of Psychology, San Diego State University, CA, San Diego, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - Santosh Vijaykumar
- Department of Psychology, Northumbria University, Newcastle Upon Tyne, UK
| | - Sean T O'Leary
- Department of Pediatrics-Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Nicole A Stadnick
- Dissemination and Implementation Science Center, University of California San Diego Altman Clinical and Translational Research Institute, La Jolla, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
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3
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Lyles CR, Nguyen OK, Khoong EC, Aguilera A, Sarkar U. Multilevel Determinants of Digital Health Equity: A Literature Synthesis to Advance the Field. Annu Rev Public Health 2023; 44:383-405. [PMID: 36525960 PMCID: PMC10329412 DOI: 10.1146/annurev-publhealth-071521-023913] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Current digital health approaches have not engaged diverse end users or reduced health or health care inequities, despite their promise to deliver more tailored and personalized support to individuals at the right time and the right place. To achieve digital health equity, we must refocus our attention on the current state of digital health uptake and use across the policy, system, community, individual, and intervention levels. We focus here on (a) outlining a multilevel framework underlying digital health equity; (b) summarizingfive types of interventions/programs (with example studies) that hold promise for advancing digital health equity; and (c) recommending future steps for improving policy, practice, and research in this space.
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Affiliation(s)
- Courtney R Lyles
- Department of Medicine, Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, University of California-San Francisco, San Francisco, California, USA;
- Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, California, USA
- Center for Vulnerable Populations, University of California-San Francisco, San Francisco, California, USA
- School of Public Health, University of California-Berkeley, Berkeley, California, USA
| | - Oanh Kieu Nguyen
- Center for Vulnerable Populations, University of California-San Francisco, San Francisco, California, USA
- Department of Medicine, Division of Hospital Medicine at Zuckerberg San Francisco General Hospital, University of California-San Francisco, San Francisco, California, USA
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - Elaine C Khoong
- Department of Medicine, Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, University of California-San Francisco, San Francisco, California, USA;
- Center for Vulnerable Populations, University of California-San Francisco, San Francisco, California, USA
| | - Adrian Aguilera
- Center for Vulnerable Populations, University of California-San Francisco, San Francisco, California, USA
- School of Social Welfare, University of California-Berkeley, Berkeley, California, USA
- Department of Psychiatry, University of California-San Francisco, San Francisco, California, USA
| | - Urmimala Sarkar
- Department of Medicine, Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, University of California-San Francisco, San Francisco, California, USA;
- Center for Vulnerable Populations, University of California-San Francisco, San Francisco, California, USA
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Greenberg KL, Poupko T, Sorotzkin D, Keidar O, Zwas DR. Development and usage of a health recommendation web tool (HeaRT) designed to inform women of personalized preventive health recommendations. Internet Interv 2022; 31:100599. [PMID: 36618777 PMCID: PMC9813537 DOI: 10.1016/j.invent.2022.100599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 11/15/2022] [Accepted: 12/23/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Implementation of guidelines for evidence-based screening and disease prevention remains a core challenge in health care. The lack of access to accurate and personalized health recommendations may contribute to sub-optimal performance of medical screening, and ultimately increased risk for communicable and non-communicable disease. Many women do not monitor their cardiovascular disease (CVD) risk or receive regular medical screenings. A health recommendation tool (HeaRT) that provides women with profiled, individually tailored information about recommended tests and screening was designed to improve women's engagement in preventive health. This study characterized utilization of the tool in a real world setting. OBJECTIVE To describe the development and usage patterns of HeaRT, a novel health web-tool that provides personalized health recommendations for women. METHODS Extracted web-tool data including user input (age, BMI, smoking status and family history of CVD) and time spent in the results screen were analysed. Engagement was assessed by time spent in each results category, number of clicks and whether the user emailed/printed the recommendations. Usage patterns were analysed using multivariate analyses, logistic regression and cluster analyses. RESULTS HeaRT was used 13,749 times in the years between its launch and data extraction three years later. Web-tool analysis found that 68.6 % of users accessed results and approximately 15 % printed or emailed the list of recommendations. Further analysis found that almost all the users entered the nutrition category (78 %), followed by the risk-factor category (69.5 %) and Physical activity category (61.9 %). Three usage patterns were identified by cluster analysis, including a nutrition/physical activity cluster, a risk-factor cluster and an all-categories cluster. Cluster affiliation analysis found BMI and smoking status were not predictors of cluster affiliation, whereas users over the age of 65 were more likely to solely enter the risk-factor tab (P < .001) and users with family history of CVD were more likely to either enter only the risk-factor tab or to enter all tabs (P < .01). CONCLUSIONS HeaRT users looked at health recommendations on a variety of health topics, and 15 % printed or emailed the recommendations. A tailored health recommendation web-tool may empower women to seek preventive-care and health maintenance, and help them interact with health care providers from a position of shared responsibility. This tool and similar programs may enable health care consumers to actively participate in directing their own health maintenance by providing consumers with personalized health recommendations. Additionally, user characteristics may inform future web-tool designers on target population profile and usage patterns.
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Affiliation(s)
- Keren L. Greenberg
- The Linda Joy Pollin Cardiovascular Wellness Center for Women, Hadassah University Medical Center, P.O.B 12000, Jerusalem, Israel,Corresponding author at: The Linda Joy Pollin Cardiovascular Wellness Center for Women, Hadassah University Medical Center, P.O.B 12000, Jerusalem, Israel.
| | - Tamar Poupko
- The Linda Joy Pollin Cardiovascular Wellness Center for Women, Hadassah University Medical Center, P.O.B 12000, Jerusalem, Israel
| | - Devorah Sorotzkin
- The Linda Joy Pollin Cardiovascular Wellness Center for Women, Hadassah University Medical Center, P.O.B 12000, Jerusalem, Israel
| | - Osnat Keidar
- The Linda Joy Pollin Cardiovascular Wellness Center for Women, Hadassah University Medical Center, P.O.B 12000, Jerusalem, Israel,The Braun School of Public Health and Community Medicine, Hebrew University and Hadassah University Medical Center, P.O.B 12272, Jerusalem, Israel
| | - Donna R. Zwas
- The Linda Joy Pollin Cardiovascular Wellness Center for Women, Hadassah University Medical Center, P.O.B 12000, Jerusalem, Israel
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Zanwar PP, Davis MM, Horner-Johnson W. Assessing Intersectional Disparities in Cervical Cancer Screening by Disability Status, Race, and Ethnicity. AJPM FOCUS 2022; 1:100019. [PMID: 37791247 PMCID: PMC10546533 DOI: 10.1016/j.focus.2022.100019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Introduction Separate bodies of research have studied disparities by disability status and by race or ethnicity in receipt of cervical cancer screening. Much less is known about how these disparities intersect. The purpose of this study was to evaluate disparities in compliance with the U.S. Preventive Services Task Force guidelines for Pap testing in age-eligible women at the intersection of disability and race or ethnicity. Methods We conducted cross-sectional analyses of the Medical Expenditure Panel Survey Household Component deidentified public data files pooled for years 2007-2016, using a modified Poisson regression analysis to compute prevalence ratios for being up to date with Pap testing by disability status and race or ethnicity. We also calculated predicted marginal proportions adjusting for demographic and socioeconomic covariates. Results The analytic sample included 68,507 women with nonmissing covariates; 15.6% had a disability. Overall, the proportion current with Pap testing was significantly lower among women with disabilities than among those without disabilities (82.1% vs 88.6%, p<0.0001). Furthermore, within each racial and ethnic group, women with disabilities were less likely than those without disabilities to be current with Pap testing. In adjusted analyses, prevalence ratios for White women with disabilities (adjusted prevalence ratio=0.94; 95% CI=0.92, 0.96) and other race women with and without disabilities (adjusted prevalence ratio=0.91; 95% CI=0.86, 0.95 and adjusted prevalence ratio=0.91; 95% CI=0.89, 0.95, respectively) were significantly below those for the reference group of White women without disabilities. Hispanic women with disabilities did not differ significantly from White women without disabilities, and Black women with disabilities had significantly higher adjusted prevalence ratios than White women without disabilities (adjusted prevalence ratio=1.07; 95% CI=1.05, 1.09). When taking covariates into account, the proportion of Black women with disabilities current with screening was only slightly lower than the estimated proportion for Black women without disabilities (92% vs 93%). The gap in screening between White women with and without disabilities narrowed somewhat (from 9 percentage points to 4 percentage points) but remained significant. Conclusions Our results extend previous research focused separately on disability or race and ethnicity. Women with disabilities in all racial and ethnic groups fell short of Healthy People 2020 goals for cervical cancer screening.
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Affiliation(s)
- Preeti Pushpalata Zanwar
- Applied Health Economics & Outcomes Research & Health Policy, Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania
- NIA Funded Network on Life Course Health Dynamics & Disparities, University of Southern California, Los Angeles, California
| | - Melinda M. Davis
- Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon
- Department of Family Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
- Oregon Rural Practice-based Research Network, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Willi Horner-Johnson
- Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon
- Institute on Development and Disability, School of Medicine, Oregon Health & Science University, Portland, Oregon
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6
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Paguio JA, Ojikutu BO, Alfonso PG, Yao JS, Amen TB, Dee EC, Escota GV. Association of culturally competent care with influenza vaccination coverage in the United States. Vaccine 2022; 40:6607-6615. [PMID: 36208977 DOI: 10.1016/j.vaccine.2022.08.066] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 08/24/2022] [Accepted: 08/28/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Cultural minority groups in the United States have lower vaccination rates or worse influenza-related outcomes. Culturally competent care, which aims to engage the social, cultural, and linguistic needs of all patients, may address some of these disparities. OBJECTIVE We investigate how self-reported measures of culturally competent care is associated with influenza vaccination rates in the United States. METHODS The National Health Interview Survey (NHIS) 2017 was queried for respondents asked a set of questions which assessed respondents' access to culturally competent care in the past year. The outcome of interest was self-reported receipt of the annual influenza vaccine. Sample-weighted multivariable logistic regressions estimated the adjusted odds ratios and 95 % confidence intervals (95 %CI) of influenza vaccination with response to the cultural competency survey questions as the dependent variable of interest. Subsequent marginal modeling predicted the adjusted vaccination rates among cultural minorities (racial/ethnic minorities, LGBTQ + adults, foreign-born individuals, and non-English speakers) and respondents with high-risk comorbidities for worse influenza outcomes. Models were adjusted for other known determinants of vaccination coverage. RESULTS 20,303 sample adults were included in the analyses. There were significantly higher odds of influenza vaccination among respondents who were "always" or "most of the time" treated with respect by their providers (aOR 1.53, 95 %CI [1.23-1.90], P < 0.001), given easy-to-understand information (aOR 1.37, 95 %CI [1.19-1.58], P < 0.001), asked about their opinions or beliefs about their care (aOR 1.29, 95 %CI [1.19-1.39], P < 0.001), and seen by providers who shared or understood their culture (aOR 1.15 95 %CI [1.01-1.30], P = 0.03), compared to their counterparts who responded with "some" or "none of the time" to the same survey questions. Higher adjusted influenza vaccination rates were seen among multiple racial/ethnic groups, LGBTQ + adults, foreign-born individuals, non-English speakers, and individuals with high-risk comorbidities who reported positive responses to the cultural competency survey questions. CONCLUSIONS We demonstrate a positive association between self-reported frequency of access to culturally competent care and receipt of the annual influenza vaccine. These findings support future efforts to evaluate vaccination outcomes among patients who receive components of culturally competent care, such as linguistically appropriate services, race-concordant healthcare workforce, and community engagement.
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Affiliation(s)
- Joseph Alexander Paguio
- Department of Internal Medicine, Albert Einstein Medical Center, Philadelphia, PA, United States.
| | - Bisola O Ojikutu
- Harvard Medical School, Boston, MA, United States; Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | | | - Jasper Seth Yao
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Troy B Amen
- Harvard Medical School, Boston, MA, United States; Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, United States
| | - Edward Christopher Dee
- Harvard Medical School, Boston, MA, United States; Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Gerome V Escota
- Division of Infectious Diseases, Washington University School of Medicine, Saint Louis, MO, United States
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7
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Jacobs PD, Abdus S. Changes in preventive service use by race and ethnicity after medicare eligibility in the United States. Prev Med 2022; 157:106996. [PMID: 35189202 DOI: 10.1016/j.ypmed.2022.106996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/27/2022] [Accepted: 02/14/2022] [Indexed: 10/19/2022]
Abstract
Use of recommended preventive care services in the United States is not universal and varies considerably by socio-economic status. We examine whether widespread eligibility for Medicare at age 65 narrows disparate preventive service use by race and ethnicity. Using data across 12 cycles of the Household Component of the Medical Expenditure Panel Survey (2005-2016), we employ a regression discontinuity design to assess changes in the use of preventive services. Our sample included: 8847 Hispanic respondents, 9908 non-Hispanic Black respondents, and 29,527 non-Hispanic White respondents. We examined six preventive services: routine check-ups, blood cholesterol screenings, receipt of the influenza vaccine, blood pressure screenings, mammograms, and colorectal cancer screenings. For non-Hispanic Black adults, we found that preventive service use increased after age 65 across a range of measures including a 4.8 percentage-point (95% confidence interval (CI)1.4, 8.2) increase in blood cholesterol screening, and a 9.1 percentage-point (95% CI 2.1, 15.9) increase in mammograms for Black women. For all four preventive health measures that were lower for Hispanic adults compared with non-Hispanic White adults prior to age 65, service use was indistinguishable (p > 0.10) between these groups after reaching the Medicare eligibility age. Medicare eligibility appeared to reduce most racial and ethnic disparities in preventive service use.
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Affiliation(s)
- Paul D Jacobs
- U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality, Division of Research and Modeling, 5600 Fishers Lane, Rockville, MD 20850, USA.
| | - Salam Abdus
- U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality, Division of Research and Modeling, 5600 Fishers Lane, Rockville, MD 20850, USA
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8
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Croswell JM, Corley DA, Lafata JE, Haas JS, Inadomi JM, Kamineni A, Ritzwoller DP, Vachani A, Zheng Y. Cancer screening in the U.S. through the COVID-19 pandemic, recovery, and beyond. Prev Med 2021; 151:106595. [PMID: 34217414 PMCID: PMC8722181 DOI: 10.1016/j.ypmed.2021.106595] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 04/29/2021] [Accepted: 05/01/2021] [Indexed: 01/08/2023]
Abstract
COVID-19 has proved enormously disruptive to the provision of cancer screening, which does not just represent an initial test but an entire process, including risk detection, diagnostic follow-up, and treatment. Successful delivery of services at all points in the process has been negatively affected by the pandemic. There is a void in empirical high-quality evidence to support a specific strategy for administering cancer screening during a pandemic and its resolution phase, but several pragmatic considerations can help guide prioritization efforts. Targeting guideline-eligible people who have never been screened, or those who are significantly out of date with screening, has the potential to maximize benefits now and into the future. Disruptions to care due to the pandemic could represent an unparalleled opportunity to reassess early detection programs towards an explicit, thoughtful, and just prioritization of populations historically experiencing cancer disparities. By focusing screening services on populations that have the most to gain, and by careful and deliberate planning for the period following the pandemic, we can positively affect cancer outcomes for all.
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Affiliation(s)
- Jennifer M Croswell
- Division of Cancer Control and Population Sciences, National Cancer Institute, USA.
| | - Douglas A Corley
- The Permanente Medical Group, Kaiser Permanente, Northern California, USA
| | - Jennifer Elston Lafata
- University of North Carolina Lineberger Comprehensive Cancer Center and Eshelman School of Pharmacy, USA
| | - Jennifer S Haas
- Division of General Internal Medicine, Massachusetts General Hospital, USA
| | - John M Inadomi
- Department of Internal Medicine, University of Utah School of Medicine, USA
| | - Aruna Kamineni
- Kaiser Permanente Washington Health Research Institute, USA
| | | | - Anil Vachani
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, USA
| | - Yingye Zheng
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, USA
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9
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Bandi K, Vargas MC, Lopez A, Cameron KA, Ackermann RT, Mohr L, Williams GC, Fagerlin A, Kirley K, Hodge H, Kandula NR, O'Brien MJ. Development and Evaluation of a Prediabetes Decision Aid in Primary Care: Examining Patient-Reported Outcomes by Language Preference and Educational Attainment. Sci Diabetes Self Manag Care 2021; 47:216-227. [PMID: 34000911 DOI: 10.1177/26350106211009189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study was to examine the development and preliminary effectiveness of a novel Prediabetes Decision Aid on adoption of intensive lifestyle interventions (ILIs) and metformin. Little research has focused on increasing uptake of these evidence-based treatments, especially among non-English speakers and those with low educational attainment. METHODS Investigators developed an English and Spanish decision aid displaying information about type 2 diabetes (T2DM) risk and treatments to prevent T2DM and prompting patients to identify next steps for management. This pilot study was a single-arm, pretest-posttest trial of 40 adult patients with prediabetes, obesity, and ≥1 office visit within the prior 12 months. Participants reviewed this tool briefly with a study team member, and data were collected on 3 coprimary outcomes: knowledge about T2DM risk, decisional conflict, and intention to adopt treatment. Exploratory outcomes included subsequent documentation of prediabetes in chart notes and adoption of ILIs or metformin. RESULTS Almost all participants were women, with nearly half expressing Spanish language preference and low educational attainment. A nonsignificant increase in knowledge was observed across all subgroups. Decisional conflict was significantly reduced from pretest to posttest and was similar between subgroups defined by language preference and educational attainment. While intention to adopt ILIs increased across all subgroups, this change was only significant among Spanish speakers and participants with low educational attainment. At 6 months, 17 participants had subsequent provider documentation of prediabetes, and 12 adopted ILIs or metformin. CONCLUSIONS The decision aid improved patient-reported outcomes and promoted treatment adoption in a diverse patient sample.
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Affiliation(s)
- Keerthi Bandi
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Maria C Vargas
- Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Azucena Lopez
- Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kenzie A Cameron
- Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ronald T Ackermann
- Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Geoffrey C Williams
- Collaborative Science and Innovation, Billings Clinic, Billings, Montana.,Center for Community Health and Prevention, University of Rochester, Rochester, New York
| | - Angela Fagerlin
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah.,Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS), Center for Innovation, Salt Lake City, Utah
| | - Kate Kirley
- American Medical Association, Chicago, Illinois
| | | | - Namratha R Kandula
- Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Matthew J O'Brien
- Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Winkfield KM, Regnante JM, Miller-Sonet E, González ET, Freund KM, Doykos PM. Development of an Actionable Framework to Address Cancer Care Disparities in Medically Underserved Populations in the United States: Expert Roundtable Recommendations. JCO Oncol Pract 2021; 17:e278-e293. [PMID: 33464925 PMCID: PMC8202060 DOI: 10.1200/op.20.00630] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/09/2020] [Accepted: 11/06/2020] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Cancer disparities persist among medically underserved populations despite widespread efforts to address them. We describe the development of a framework for addressing cancer care disparities across the cancer care continuum (CCC), guided by the CCC domains established by the Institute of Medicine/National Academies of Sciences, Engineering, and Medicine (IOM/NAS). MATERIALS AND METHODS An environmental scan was conducted to identify strategies and associated experts who are providing or have successfully provided community- and/or patient-centric IOM/NAS-defined domain standards to our target populations. A multistakeholder expert roundtable working group was convened for framework development. A premeeting survey informed agenda development, documented expert practices for target populations, and identified priority areas for meeting focus. RESULTS The environmental scan identified 84 unique experts across 8 stakeholder groups and 44 patient organizations; 50 were invited to the roundtable and 33 participated. They broadly represented disease sites, geography, and experience with target populations and all CCC domains. The premeeting survey (16 responses) identified coordination of care or patient navigation (66.7%), community engagement (60.0%), and healthcare system changes (53.3%) as priority focus areas. The experts identified access and treatment barriers or gaps within and between CCC domains, specified key notable practices to address these, and developed an actionable framework and recommendations for each priority focus area. CONCLUSION The framework and recommendations are intended to guide researchers, healthcare leaders, advocates, community- and patient-focused service organizations, and policy leaders to address and promote health equity in cancer care access and treatment outcomes.
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Affiliation(s)
- Karen M. Winkfield
- Meharry-Vanderbilt Alliance, Vanderbilt University Medical Center, Nashville, TN
| | | | | | - Evelyn T. González
- Fox Chase Cancer Center/Temple University Health System, Philadelphia, PA
| | - Karen M. Freund
- Sara Murray Jordan Professor of Medicine, Tufts University School of Medicine, Boston, MA
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The CTSA program’s role in improving rural public health: Community-engaged disease prevention and health care innovation. J Clin Transl Sci 2020; 4:373-376. [PMID: 33244424 PMCID: PMC7681121 DOI: 10.1017/cts.2020.541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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12
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Nelson HD, Cantor A, Wagner J, Jungbauer R, Fu R, Kondo K, Stillman L, Quiñones A. Effectiveness of Patient Navigation to Increase Cancer Screening in Populations Adversely Affected by Health Disparities: a Meta-analysis. J Gen Intern Med 2020; 35:3026-3035. [PMID: 32700218 PMCID: PMC7573022 DOI: 10.1007/s11606-020-06020-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 06/30/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study evaluates the effectiveness of patient navigation to increase screening for colorectal, breast, and cervical cancer in populations adversely affected by health care disparities. METHODS Eligible studies were identified through English-language searches of Ovid® MEDLINE®, PsycINFO®, SocINDEX, and Veterans Affairs Health Services database (January 1, 1996, to July 5, 2019) and manual review of reference lists. Randomized trials and observational studies of relevant populations that evaluated the effectiveness of patient navigation on screening rates for colorectal, breast, or cervical cancer compared with usual or alternative care comparison groups were included. Two investigators independently abstracted study data and assessed study quality and applicability using criteria adapted from the U.S. Preventive Services Task Force. Discrepancies were resolved by consensus with a third reviewer. Results were combined using profile likelihood random effects models. RESULTS Thirty-seven studies met inclusion criteria (28 colorectal, 11 breast, 4 cervical cancers including 3 trials with multiple cancer types). Screening rates were higher with patient navigation for colorectal cancer overall (risk ratio [RR] 1.64; 95% confidence interval [CI] 1.42 to 1.92; I2 = 93.7%; 22 trials) and by type of test (fecal occult blood or immunohistochemistry testing [RR 1.69; 95% CI 1.33 to 2.15; I2 = 80.5%; 6 trials]; colonoscopy/endoscopy [RR 2.08; 95% CI 1.08 to 4.56; I2 = 94.6%; 6 trials]). Screening was also higher with navigation for breast cancer (RR 1.50; 95% CI 1.22 to 1.91; I2 = 98.6%; 10 trials) and cervical cancer (RR 1.11; 95% CI 1.05 to 1.19; based on the largest trial). The high heterogeneity of cervical cancer studies prohibited meta-analysis. Results were similar for colorectal and breast cancer regardless of prior adherence to screening guidelines, follow-up time, and study quality. CONCLUSIONS In populations adversely affected by disparities, colorectal, breast, and cervical cancer screening rates were higher in patients provided navigation services. Registration: PROSPERO: CRD42018109263.
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Affiliation(s)
- Heidi D Nelson
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA. .,Department of Medicine, Oregon Health & Science University, Portland, OR, USA.
| | - Amy Cantor
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA.,Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Jesse Wagner
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
| | - Rebecca Jungbauer
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
| | - Rongwei Fu
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA.,School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR, USA
| | - Karli Kondo
- Evidence-based Synthesis Program, Portland VA Health Care System, Portland, OR, USA.,Office of Research Integrity, Oregon Health & Science University, Portland, OR, USA
| | - Lucy Stillman
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
| | - Ana Quiñones
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR, USA
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Bretthauer M, Kalager M. Disparities in Preventive Health Services: Targeting Minorities and Majorities. Ann Intern Med 2020; 172:287-288. [PMID: 31931529 DOI: 10.7326/m19-3899] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - Mette Kalager
- University of Oslo and Oslo University Hospital, Oslo Norway (M.K.)
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