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Ford JS, Mousa MA, Voong S, Matsumoto CG, Chechi T, Tran N, May L. Risk factors for HIV infection at a large urban emergency department: a cross-sectional study. Sex Transm Infect 2023; 99:404-408. [PMID: 37015802 DOI: 10.1136/sextrans-2022-055513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 03/20/2023] [Indexed: 04/06/2023] Open
Abstract
OBJECTIVES In 2019, the US Preventative Services Task Force released updated guidelines recommending HIV screening in all individuals aged 15-64 years and all pregnant females. In the current study, we aimed to identify risk factors for HIV infection in an emergency department (ED) population. METHODS We performed a cross-sectional study that employed a post hoc risk factor analysis of ED patients ≥18 years who were screened for HIV between 27 November 2018 and 26 November 2019, at a single urban, quaternary referral academic hospital. Patients were screened using HIV antigen/antibody testing and diagnoses were confirmed using HIV-1/HIV-2 antibody testing. The outcome of interest was the number of positive HIV tests. Multiple logistic regression models were used to identify risk factors associated with HIV positivity. RESULTS 14 335 adult patients were screened for HIV (mean age: 43±14 years; 52% female). HIV seroprevalence was 0.7%. Independent risk factors for HIV positivity included male sex (adjusted OR (aOR) 3.1 (95% CI 1.7 to 5.6)), unhoused status (aOR 2.9 (95% CI 1.7 to 4.9)), history of illicit drug use (aOR 1.8 (95% CI 1.04 to 3.13)) and Medicare insurance status (aOR 2.2 (95% CI 1.1 to 4.4)). CONCLUSIONS The study ED services a high-risk population with regard to HIV infection. These data support universal screening of ED patients for HIV. Risk factor profiles could improve targeted screening at institutions without universal HIV testing protocols.
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Affiliation(s)
- James S Ford
- Department of Emergency Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Mohammad A Mousa
- Department of Emergency Medicine, University of California Davis Health, Sacramento, CA, USA
| | - Stephanie Voong
- Department of Emergency Medicine, University of California Davis Health, Sacramento, CA, USA
| | - Cynthia G Matsumoto
- Department of Population Health and Accountable Care, University of California Davis Health, Sacramento, CA, USA
| | - Tasleem Chechi
- Department of Emergency Medicine, University of California Davis Health, Sacramento, CA, USA
| | - Nam Tran
- Department of Pathology and Laboratory Medicine, University of California Davis Health, Sacramento, CA, USA
| | - Larissa May
- Department of Emergency Medicine, University of California Davis Health, Sacramento, CA, USA
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Morse B, Kim KK, Xu Z, Matsumoto CG, Schilling LM, Ohno-Machado L, Mak SS, Keller MS. Patient and researcher stakeholder preferences for use of electronic health record data: a qualitative study to guide the design and development of a platform to honor patient preferences. J Am Med Inform Assoc 2023; 30:ocad058. [PMID: 37141581 PMCID: PMC10198527 DOI: 10.1093/jamia/ocad058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 02/10/2023] [Accepted: 04/13/2023] [Indexed: 05/06/2023] Open
Abstract
OBJECTIVE This qualitative study aimed to understand patient and researcher perspectives regarding consent and data-sharing preferences for research and a patient-centered system to manage consent and data-sharing preferences. MATERIALS AND METHODS We conducted focus groups with patient and researcher participants recruited from three academic health centers via snowball sampling. Discussions focused on perspectives on the use of electronic health record (EHR) data for research. Themes were identified through consensus coding, starting from an exploratory framework. RESULTS We held two focus groups with patients (n = 12 patients) and two with researchers (n = 8 researchers). We identified two patient themes (1-2), one theme common to patients and researchers (3), and two researcher themes (4-5). Themes included (1) motivations for sharing EHR data, (2) perspectives on the importance of data-sharing transparency, (3) individual control of personal EHR data sharing, (4) how EHR data benefits research, and (5) challenges researchers face using EHR data. DISCUSSION Patients expressed a tension between the benefits of their data being used in studies to benefit themselves/others and avoiding risk by limiting data access. Patients resolved this tension by acknowledging they would often share their data but wanted greater transparency on its use. Researchers expressed concern about incorporating bias into datasets if patients opted out. CONCLUSIONS A research consent and data-sharing platform must consider two competing goals: empowering patients to have more control over their data and maintaining the integrity of secondary data sources. Health systems and researchers should increase trust-building efforts with patients to engender trust in data access and use.
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Affiliation(s)
- Brad Morse
- Division of General Internal Medicine, Department of Medicine, University of Colorado—Anschutz Medical Campus, Denver, Colorado, USA
| | - Katherine K Kim
- School of Medicine, Department of Public Health Sciences, University of California-Davis, Davis, California, USA
| | - Zixuan Xu
- School of Medicine, Department of Public Health Sciences, University of California-Davis, Davis, California, USA
| | - Cynthia G Matsumoto
- Office of Population Health and Accountable Care, University of California Davis Health, Sacramento, California, USA
| | - Lisa M Schilling
- Division of General Internal Medicine, Department of Medicine, University of Colorado—Anschutz Medical Campus, Denver, Colorado, USA
| | - Lucila Ohno-Machado
- Department of Biomedical Informatics, University of California-San Diego, La Jolla, California, USA
- Section of Biomedical Informatics & Data Science, Yale School of Medicine, New Haven, Connecticut, USA
| | - Selene S Mak
- Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Michelle S Keller
- Division of General Internal Medicine-Health Services Research, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Division of Informatics, Department of Biomedical Research, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Ford JS, Morgan Bustamante BL, Virk MK, Ramirez N, Matsumoto CG, Lee DJ, MacDonald S, May L. Use of clinical decision support for antibiotic stewardship in the emergency department and outpatient clinics: An interrupted time-series analysis. Antimicrob Steward Healthc Epidemiol 2023; 3:e80. [PMID: 37205319 PMCID: PMC10186615 DOI: 10.1017/ash.2023.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 05/21/2023]
Abstract
Objective To evaluate the impact of implementing clinical decision support (CDS) tools for outpatient antibiotic prescribing in the emergency department (ED) and clinic settings. Design We performed a before-and-after, quasi-experimental study that employed an interrupted time-series analysis. Setting The study institution was a quaternary, academic referral center in Northern California. Participants We included prescriptions for patients in the ED and 21 primary-care clinics within the same health system. Intervention We implemented a CDS tool for azithromycin on March 1, 2020, and a CDS tool for fluoroquinolones (FQs; ie, ciprofloxacin, levofloxacin, and moxifloxacin) on November 1, 2020. The CDS added friction to inappropriate ordering workflows while adding health information technology (HIT) features to easily perform recommended actions. The primary outcome was the number of monthly prescriptions for each antibiotic type, by implementation period (before vs after). Results Immediately after azithromycin-CDS implementation, monthly rates of azithromycin prescribing decreased significantly in both the ED (-24%; 95% CI, -37% to -10%; P < .001) and outpatient clinics (-47%; 95% CI, -56% to -37%; P < .001). In the first month after FQ-CDS implementation in the clinics, there was no significant drop in ciprofloxacin prescriptions; however, there was a significant decrease in ciprofloxacin prescriptions over time (-5% per month; 95% CI, -6% to -3%; P < .001), suggesting a delayed effect of the CDS. Conclusion Implementing CDS tools was associated with an immediate decrease in azithromycin prescriptions, in both the ED and clinics. CDS may serve as a valuable adjunct to existing antimicrobial stewardship programs.
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Affiliation(s)
- James S. Ford
- Department of Emergency Medicine, University of California–San Francisco, San Francisco, California
| | | | - Mehr Kaur Virk
- Department of Emergency Medicine, University of California Davis, School of Medicine. Sacramento, California
| | - Nancy Ramirez
- Department of Emergency Medicine, University of California Davis, School of Medicine. Sacramento, California
| | - Cynthia G. Matsumoto
- Office of Population Health and Accountable Care, University of California Davis, Sacramento, California
| | - Daniel Jin Lee
- Department of Emergency Medicine, University of California Davis, School of Medicine. Sacramento, California
| | - Scott MacDonald
- Department of Clinical Informatics, University of California Davis Health, Sacramento, California
| | - Larissa May
- Department of Emergency Medicine, University of California Davis, School of Medicine. Sacramento, California
- Author for correspondence: Larissa May, University of California–Davis Medical Center, 2315 Stockton Blvd, Sacramento, CA95817. E-mail:
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Ngo V, Matsumoto CG, Joseph JG, Bell JF, Bold RJ, Davis A, Reed SC, Kim KK. The Personal Health Network Mobile App for Chemotherapy Care Coordination: Qualitative Evaluation of a Randomized Clinical Trial. JMIR Mhealth Uhealth 2020; 8:e16527. [PMID: 32452814 PMCID: PMC7284410 DOI: 10.2196/16527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 01/30/2020] [Accepted: 02/01/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Cancer care coordination addresses the fragmented and inefficient care of individuals with complex care needs. The complexity of care coordination can be aided by innovative technology. Few examples of information technology-enabled care coordination exist beyond the conventional telephone follow-up. For this study, we implemented a custom-designed app, the Personal Health Network (PHN)-a Health Insurance Portability and Accountability Act-compliant social network built around a patient to enable patient-centered health and health care activities in collaboration with clinicians, care team members, caregivers, and others designated by the patient. The app facilitates a care coordination intervention for patients undergoing chemotherapy. OBJECTIVE This study aimed to understand patient experiences with PHN technology and assess their perspectives on the usability and usefulness of PHNs with care coordination during chemotherapy. METHODS A two-arm randomized clinical trial was conducted to compare the PHN and care coordination with care coordination alone over a 6-month period beginning with the initiation of chemotherapy. A semistructured interview guide was constructed based on a theoretical framework of technology acceptance addressing usefulness, usability, and the context of use of the technology within the participant's life and health care setting. All participants in the intervention arm were interviewed on completion of the study. Interviews were recorded and transcribed verbatim. A summative thematic analysis was completed for the transcribed interviews. Features of the app were also evaluated. RESULTS A total of 27 interviews were completed. The resulting themes included the care coordinator as a partner in care, learning while sick, comparison of other technology to make sense of the PHN, communication, learning, usability, and usefulness. Users expressed that the nurse care coordinators were beneficial to them because they helped them stay connected to the care team and answered their questions. They shared that the mobile app gave them access to the health information they were seeking. Users expressed that the mobile app would be more useful if it was fully integrated with the electronic health record. CONCLUSIONS The findings highlight the value of care coordination from the perspectives of cancer patients undergoing chemotherapy and the important role of technology, such as the PHN, in enhancing this process by facilitating better communication and access to information regarding their illness.
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Affiliation(s)
- Victoria Ngo
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, CA, United States
| | - Cynthia G Matsumoto
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, CA, United States
| | - Jill G Joseph
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, CA, United States
| | - Janice F Bell
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, CA, United States
| | - Richard J Bold
- Comprehensive Cancer Center, University of California Davis Health, Sacramento, CA, United States
| | - Andra Davis
- Washington State University College of Nursing - Vancouver, Vancouver, WA, United States
| | - Sarah C Reed
- Division of Social Work, California State University Sacramento, Sacramento, CA, United States
| | - Katherine K Kim
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, CA, United States
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Matsumoto CG, Drew BJ, Ide B. Why should nurses closely monitor the ECG during insertion or exchange of a central venous catheter? Prog Cardiovasc Nurs 2000; 15:29, 31. [PMID: 10723791 DOI: 10.1111/j.0889-7204.2000.80384.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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