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Ängeby K, VanGompel EW, Johansson K, Edqvist M. Labor unit culture and attitudes toward supporting vaginal birth-The Swedish version of the labor culture survey (S-LCS)-Psychometric properties. Birth 2024; 51:163-175. [PMID: 37803969 DOI: 10.1111/birt.12777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 06/27/2023] [Accepted: 09/12/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND In order to evaluate interventions aimed at reducing cesarean births, care practitioners' attitudes are important to measure. The Labor Culture Survey (LCS) is a scale that measures individual and unit attitudes towards supporting vaginal birth. As no equivalent scale exists in Sweden, the aim was to translate, adapt, and validate the LCS and to investigate whether there were differences in attitudes toward supporting vaginal birth between maternity care practitioners. METHODS A cross-sectional study including midwives, physicians, and nurse assistants working with intrapartum care in five labor wards in Sweden. The original LCS was translated into Swedish, and six context-specific items were developed for the Swedish setting (SLCS). The translation was tested for face validity. Psychometric analysis was conducted using exploratory factor analysis with principal component analysis, parallel analysis, and principal axis factoring. Reliability was estimated using Cronbach's alpha. One-way ANOVA and Tukey HSD were calculated to analyze differences in attitudes between professions on the subscales of the S-LCS. RESULTS A total of 539 midwives, physicians, and nurse assistants participated. The final S-LCS showed a five-factor solution with the following subscales: Best Practices to reduce cesarean overuse, Unpredictability of vaginal birth, Unit Microculture, Maternal Agency, and Organizational Oversight. Chronbach alpha values varied from 0.60 to 0.83. Midwives were more supportive towards vaginal birth and less fearful of potential consequences of vaginal birth compared with physicians. CONCLUSIONS The S-LCS demonstrated satisfactory psychometric properties for use in Swedish maternity care. Further work to improve the scale should include additional items reflecting the subscale Maternal Agency.
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Affiliation(s)
- Karin Ängeby
- Centre for Clinical Research and Education, Region Värmland, Sweden
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Emily White VanGompel
- Departments of Family Medicine and Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, Illinois, USA
- The University of Chicago, Pritzker School of Medicine, Chicago, Illinois, USA
| | - Kari Johansson
- Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
- Department of Women's Health, Karolinska University Hospital, Stockholm, Sweden
| | - Malin Edqvist
- Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
- Department of Women's Health, Karolinska University Hospital, Stockholm, Sweden
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2
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White VanGompel E, Carlock F, Singh L, Keer E, Brown J, Kane Low L. Attitudes of Clinicians and Patient Safety Culture Before and After the ARRIVE Trial. J Obstet Gynecol Neonatal Nurs 2023; 52:211-222. [PMID: 36720433 PMCID: PMC10544748 DOI: 10.1016/j.jogn.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE To assess the attitudes of intrapartum clinicians about elective induction of labor before and after A Randomized Trial of Induction Versus Expectant Management (ARRIVE) and to assess the effect of different attitudes on patient safety culture. DESIGN Repeated cross-sectional design. SETTING Online surveys. PARTICIPANTS Clinicians (883 nurses and 201 physicians in the before-ARRIVE group and 1,741 nurses and 574 physicians in the after-ARRIVE group) who provided intrapartum care at 35 hospitals in California in 2017 and 57 hospitals in Michigan in 2020 and participated in statewide quality improvement efforts to reduce use of cesarean. METHODS We used annual nulliparous, term, singleton, vertex cesarean rates to stratify hospitals into performance quartiles. We used cumulative proportional odds logistic regression to examine induction attitudes before and after ARRIVE by role and hospital performance quartile as well as induction attitudes and patient safety culture among clinicians. We used content analysis to examine qualitative data. RESULTS After ARRIVE, physicians' attitudes shifted in favor of induction at hospitals within the top three performance categories (top quartile: M = 3.48 vs. 2.81, p < .0001), whereas nurses' attitudes did not change (p = .388). After ARRIVE, attitudes among clinicians were more aligned at hospitals with stronger patient safety cultures. Qualitative themes included The Timing of Induction is Important, Who Should Have Inductions, Need for Clear Protocols and More Staff, and Ideas to Improve the Induction of Labor Process. CONCLUSION Physician attitudes about induction were significantly different before versus after ARRIVE, whereas nurse attitudes were not. Differences in attitudes may erode the quality of team-based care; intentional interdisciplinary engagement is essential when implementing ARRIVE findings.
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Ren M, Shireman H, VanGompel EW, Bello JK, Carlock F, McHugh A, Stulberg D. Preconception, Interconception, and reproductive health screening tools: A systematic review. Health Serv Res 2023; 58:458-488. [PMID: 36573542 PMCID: PMC10012234 DOI: 10.1111/1475-6773.14123] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To identify and describe the standardized interconception and preconception screening tools for reproductive health needs that are applicable in general outpatient clinical practice. DATA SOURCES AND STUDY SETTING This systematic review identifies research on pregnancy intention screening and counseling tools, and standardized approaches to preconception and interconception care. We focus on tools designed for clinical settings, but also include research tools with potential for clinical implementation. These tools may include a component of contraceptive counseling, but those focusing solely on contraceptive counseling were excluded. Data were collected from studies done in the United States between January 2000 and March 2022. STUDY DESIGN We performed a systematic literature search to generate a list of unique tools, assessed the quality of evidence supporting each tool, and described the peer-reviewed clinical applications of each. We used the Mixed Methods Appraisal Tool to appraise the quality of individual studies. DATA COLLECTION/EXTRACTION METHODS We searched PubMed, Web of Science, and CINAHL databases for standardized preconception and interconception health screening tools published in English from January 2000 through March 2022. We used keywords "preconception care," "interconception care," "family planning," "contraception," "reproductive health services," and "counseling." Utilizing the Preferred Reporting Items for Systematic Reviews guidelines, we screened titles and abstracts to identify studies for full text review. PRINCIPAL FINDINGS The search resulted in 15,399 studies. After removing 4172 duplicates, we screened 11,227 titles/abstracts and advanced 207 for full-text review. From these, we identified 53 eligible studies representing 22 tools/standardized approaches, of which 10 had evidence from randomized clinical trials. These ranged widely in design, setting, and population of study. CONCLUSIONS Clinicians have a choice of tools when implementing standard reproductive screening services. A growing body of research can inform the selection of an appropriate tool, and more study is needed to establish effects on long-term patient outcomes.
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Affiliation(s)
- Megan Ren
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Hannah Shireman
- Department of Family Medicine, University of Chicago, Chicago, Illinois, USA
| | - Emily White VanGompel
- Department of Family Medicine, University of Chicago, Chicago, Illinois, USA.,Northshore University Healthsystem, Evanston, Illinois, USA
| | - Jennifer K Bello
- Department of Family and Community Medicine, Saint Louis University, St Louis, Missouri, USA
| | | | - Ashley McHugh
- Department of Family Medicine, University of Chicago, Chicago, Illinois, USA
| | - Debra Stulberg
- Department of Family Medicine, University of Chicago, Chicago, Illinois, USA
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4
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Tout W, Oyola S, Sharif Z, VanGompel EW. Applicant Evaluation of Residency Programs in a Virtual Format: A Mixed-Methods Study. Fam Med 2022; 54:804-813. [PMID: 36350745 DOI: 10.22454/fammed.2022.148473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND AND OBJECTIVES The first all-virtual residency application cycle took place in 2021. Virtual programming can reduce cost, time, and travel burden; these may be especially beneficial to applicants with fewer resources and those from underrepresented backgrounds (URM). Little is known about how applicants evaluate key ranking factors, especially in a virtual format. This study aimed to assess how applicants evaluated programs in the virtual cycle. METHODS We surveyed 271 fourth-year students at three Chicago medical schools after rank-list submission and prior to receiving match results in March 2021. The survey included questions on online content and importance of different ranking factors as well as open-ended questions on how participants evaluated their most important factors. We analyzed quantitative data using descriptive statistics and χ2 tests. We analyzed qualitative data using thematic content analysis. RESULTS Applicants cited goodness of fit, geographic location, program reputation, fellowship opportunities, and work/life balance as the top-five most important factors. URM applicants were more likely to prioritize diversity at institution or location (P<.0001). Interactions with residents and faculty and opportunities to observe interprogram dynamics were key to assessing fit but were often limited by the virtual format. Additional emergent themes provided recommendations for future cycles. Program websites and videos were rated as the most important online content types. CONCLUSIONS This study provides information about how applicants evaluated the factors they deemed most important in assessing and ranking programs, which can help residency programs improve their recruitment efforts.
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Affiliation(s)
- Wala Tout
- University of Chicago NorthShore Family Medicine Residency Program, Glenview, IL
| | - Sonia Oyola
- University of Chicago Pritzker School of Medicine, Chicago, IL
| | | | - Emily White VanGompel
- University of Chicago NorthShore Family Medicine Residency Program, Glenview, IL
- University of Chicago Pritzker School of Medicine, Chicago, IL
- and NorthShore University HealthSystem Research Institute, Evanston, IL
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5
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White VanGompel E, Lai J, Davis D, Carlock F, Camara TL, Taylor B, Clary C, McCorkle‐Jamieson AM, McKenzie‐Sampson S, Gay C, Armijo A, Lapeyrolerie L, Singh L, Scott KA. Psychometric validation of a patient-reported experience measure of obstetric racism© (The PREM-OB Scale™ suite). Birth 2022; 49:514-525. [PMID: 35301757 PMCID: PMC9544169 DOI: 10.1111/birt.12622] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 01/28/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Perinatal quality improvement lacks valid tools to measure adverse hospital experiences disproportionately impacting Black mothers and birthing people. Measuring and mitigating harm requires using a framework that centers the lived experiences of Black birthing people in evaluating inequitable care, namely, obstetric racism. We sought to develop a valid patient-reported experience measure (PREM) of Obstetric Racism© in hospital-based intrapartum care designed for, by, and with Black women as patient, community, and content experts. METHODS PROMIS© instrument development standards adapted with cultural rigor methodology. Phase 1 included item pool generation, modified Delphi method, and cognitive interviews. Phase 2 evaluated the item pool using factor analysis and item response theory. RESULTS Items were identified or written to cover 7 previously identified theoretical domains. 806 Black mothers and birthing people completed the pilot test. Factor analysis concluded a 3 factor structure with good fit indices (CFI = 0.931-0.977, RMSEA = 0.087-0.10, R2 > .3, residual correlation < 0.15). All items in each factor fit the IRT model and were able to be calibrated. Factor 1, "Humanity," had 31 items measuring experiences of safety and accountability, autonomy, communication, and empathy. A 12-item short form was created to ease respondent burden. Factor 2, "Racism," had 12 items measuring experiences of neglect and mistreatment. Factor 3, "Kinship," had 7 items measuring hospital denial and disruption of relationships between Black mothers and their child or support system. CONCLUSIONS The PREM-OB Scale™ suite is a valid tool to characterize and quantify obstetric racism for use in perinatal improvement initiatives.
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Affiliation(s)
- Emily White VanGompel
- Departments of Family Medicine and Obstetrics and GynecologyPritzker School of MedicineThe University of ChicagoChicagoIllinoisUSA,NorthShore University HealthSystem (NSUHS) Research InstituteEvanstonIllinoisUSA
| | - Jin‐Shei Lai
- Departments of Medical Social Sciences and PediatricsNorthwestern University Feinberg School of MedicineEvanstonIllinoisUSA
| | - Dána‐Ain Davis
- Queens CollegeCity University of New YorkNew YorkNew YorkUSA
| | - Francesca Carlock
- NorthShore University HealthSystem (NSUHS) Research InstituteEvanstonIllinoisUSA
| | | | - Brianne Taylor
- California Preterm Birth InitiativeUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Chakiya Clary
- California Preterm Birth InitiativeUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Ashlee M. McCorkle‐Jamieson
- Department of Obstetrics, Gynecology, and Reproductive SciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA,Department of Obstetrics and GynecologyHighland General HospitalAlameda Health SystemOaklandCaliforniaUSA
| | - Safyer McKenzie‐Sampson
- California Preterm Birth InitiativeUniversity of CaliforniaSan FranciscoCaliforniaUSA,Department of Epidemiology & BiostatisticsUniversity of California San Francisco School of MedicineSan FranciscoCaliforniaUSA
| | - Caryl Gay
- Department of Family Health Care NursingUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Amanda Armijo
- Department of Obstetrics, Gynecology, and Reproductive SciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Lillie Lapeyrolerie
- Department of Obstetrics, Gynecology, and Reproductive SciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Lavisha Singh
- Queens CollegeCity University of New YorkNew YorkNew YorkUSA
| | - Karen A. Scott
- Birthing Cultural Rigor, LLCOaklandCaliforniaUSA,Departments of Obstetrics, Gynecology, and Reproductive Sciences, and Humanities and Social SciencesUniversity of California San Francisco School of MedicineSan FranciscoCaliforniaUSA
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6
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Ferketa M, Schueler K, Song B, Carlock F, Stulberg DB, White VanGompel E. Facilitators of and Barriers to Successful Implementation of the One Key Question ® Pregnancy Intention Screening Tool. Womens Health Rep (New Rochelle) 2022; 3:326-334. [PMID: 35415707 PMCID: PMC8994428 DOI: 10.1089/whr.2021.0100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/05/2022] [Indexed: 12/05/2022]
Abstract
Background: One Key Question® (OKQ) is a tool that embeds a patient-centered screening into routine visits with the goal of making pregnancy intention screening universal, but widespread implementation has not yet been adopted. We aimed to explore the barriers and facilitators of OKQ implementation to better understand how to best implement the tool across different settings. Methods: We invited staff and clinicians from one obstetrics and gynecology clinic and one family medicine clinic, which previously implemented OKQ, to complete surveys and qualitative interviews about their experiences with the tool. The interview guide and thematic analysis of the interview transcripts were informed by the Consolidated Framework for Implementation Research (CFIR). Main Findings: Major facilitators of OKQ implementation are the simplicity of the tool, engagement of clinic leadership, and compatibility between the perceived goals of the tool and those of practice staff and clinicians. Although participants indicated that OKQ had a minimal impact on clinic workflow during its implementation, preimplementation time concerns were a major barrier to implementation in both clinics. Barriers seen in the family medicine practice included OKQ distracting from the visit agenda, and concerns about the OKQ gold standard protocol of screening each patient at every visit. Participants even suggested asking OKQ only during annual check-up appointments. Conclusions: The perceived alignment between the tool's goals and those of clinic stakeholders was an important facilitator of OKQ implementation success. However, characteristics of the clinic setting, such as competing medical priorities and time constraints, influenced initial attitudes toward the feasibility of the intervention. Clinical Trial Registration Number: NCT03947788
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Affiliation(s)
- Meron Ferketa
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Kellie Schueler
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Bonnie Song
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Francesca Carlock
- NorthShore University HealthSystem (NSUHS) Research Institute, Evanston, Illinois, USA
| | - Debra B Stulberg
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA.,Department of Family Medicine, University of Chicago, Chicago, Illinois, USA
| | - Emily White VanGompel
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA.,NorthShore University HealthSystem (NSUHS) Research Institute, Evanston, Illinois, USA
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7
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Reamer C, Chi WN, Gordon R, Sarswat N, Gupta C, Gaznabi S, White VanGompel E, Szum I, Morton-Jost M, Vaughn J, Larimer K, Victorson D, Erwin J, Halasyamani L, Solomonides A, Padman R, Shah NS. Continuous remote patient monitoring in heart failure patients (CASCADE study): mixed methods feasibility protocol (Preprint). JMIR Res Protoc 2022; 11:e36741. [PMID: 36006689 PMCID: PMC9459840 DOI: 10.2196/36741] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 05/24/2022] [Accepted: 06/16/2022] [Indexed: 11/29/2022] Open
Abstract
Background Heart failure (HF) is a prevalent chronic disease and is associated with increases in mortality and morbidity. HF is a leading cause of hospitalizations and readmissions in the United States. A potentially promising area for preventing HF readmissions is continuous remote patient monitoring (CRPM). Objective The primary aim of this study is to determine the feasibility and preliminary efficacy of a CRPM solution in patients with HF at NorthShore University HealthSystem. Methods This study is a feasibility study and uses a wearable biosensor to continuously remotely monitor patients with HF for 30 days after discharge. Eligible patients admitted with an HF exacerbation at NorthShore University HealthSystem are being recruited, and the wearable biosensor is placed before discharge. The biosensor collects physiological ambulatory data, which are analyzed for signs of patient deterioration. Participants are also completing a daily survey through a dedicated study smartphone. If prespecified criteria from the physiological data and survey results are met, a notification is triggered, and a predetermined electronic health record–based pathway of telephonic management is completed. In phase 1, which has already been completed, 5 patients were enrolled and monitored for 30 days after discharge. The results of phase 1 were analyzed, and modifications to the program were made to optimize it. After analysis of the phase 1 results, 15 patients are being enrolled for phase 2, which is a calibration and testing period to enable further adjustments to be made. After phase 2, we will enroll 45 patients for phase 3. The combined results of phases 1, 2, and 3 will be analyzed to determine the feasibility of a CRPM program in patients with HF. Semistructured interviews are being conducted with key stakeholders, including patients, and these results will be analyzed using the affective adaptation of the technology acceptance model. Results During phase 1, of the 5 patients, 2 (40%) were readmitted during the study period. The study completion rate for phase 1 was 80% (4/5), and the study attrition rate was 20% (1/5). There were 57 protocol deviations out of 150 patient days in phase 1 of the study. The results of phase 1 were analyzed, and the study protocol was adjusted to optimize it for phases 2 and 3. Phase 2 and phase 3 results will be available by the end of 2022. Conclusions A CRPM program may offer a low-risk solution to improve care of patients with HF after hospital discharge and may help to decrease readmission of patients with HF to the hospital. This protocol may also lay the groundwork for the use of CRPM solutions in other groups of patients considered to be at high risk. International Registered Report Identifier (IRRID) DERR1-10.2196/36741
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Affiliation(s)
- Courtney Reamer
- Department of Medicine, NorthShore University HealthSystem, Evanston, IL, United States
| | - Wei Ning Chi
- Outcomes Research Network, NorthShore University HealthSystem, Evanston, IL, United States
| | - Robert Gordon
- Department of Medicine, NorthShore University HealthSystem, Evanston, IL, United States
| | - Nitasha Sarswat
- Department of Medicine, NorthShore University HealthSystem, Evanston, IL, United States
- Department of Medicine, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Charu Gupta
- Department of Medicine, NorthShore University HealthSystem, Evanston, IL, United States
| | - Safwan Gaznabi
- Department of Medicine, NorthShore University HealthSystem, Evanston, IL, United States
| | - Emily White VanGompel
- Department of Family Medicine, NorthShore University HealthSystem, Evanston, IL, United States
| | - Izabella Szum
- Home and Hospice Services, NorthShore University HealthSystem, Evanston, IL, United States
| | - Melissa Morton-Jost
- Home and Hospice Services, NorthShore University HealthSystem, Evanston, IL, United States
| | | | | | - David Victorson
- Department of Medical Social Sciences, Northwestern University, Evanston, IL, United States
| | - John Erwin
- Department of Medicine, NorthShore University HealthSystem, Evanston, IL, United States
- Department of Medicine, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Lakshmi Halasyamani
- Department of Medicine, NorthShore University HealthSystem, Evanston, IL, United States
- Department of Medicine, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Anthony Solomonides
- Outcomes Research Network, NorthShore University HealthSystem, Evanston, IL, United States
| | - Rema Padman
- Heinz College of Information Systems and Public Policy, Carnegie Mellon University, Pittsburgh, PA, United States
| | - Nirav S Shah
- Department of Medicine, NorthShore University HealthSystem, Evanston, IL, United States
- Department of Medicine, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
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8
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Chi WN, Reamer C, Gordon R, Sarswat N, Gupta C, White VanGompel E, Dayiantis J, Morton-Jost M, Ravichandran U, Larimer K, Victorson D, Erwin J, Halasyamani L, Solomonides A, Padman R, Shah NS. Continuous Remote Patient Monitoring: Evaluation of the Heart Failure Cascade Soft Launch. Appl Clin Inform 2021; 12:1161-1173. [PMID: 34965606 PMCID: PMC8716190 DOI: 10.1055/s-0041-1740480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE We report on our experience of deploying a continuous remote patient monitoring (CRPM) study soft launch with structured cascading and escalation pathways on heart failure (HF) patients post-discharge. The lessons learned from the soft launch are used to modify and fine-tune the workflow process and study protocol. METHODS This soft launch was conducted at NorthShore University HealthSystem's Evanston Hospital from December 2020 to March 2021. Patients were provided with non-invasive wearable biosensors that continuously collect ambulatory physiological data, and a study phone that collects patient-reported outcomes. The physiological data are analyzed by machine learning algorithms, potentially identifying physiological perturbation in HF patients. Alerts from this algorithm may be cascaded with other patient status data to inform home health nurses' (HHNs') management via a structured protocol. HHNs review the monitoring platform daily. If the patient's status meets specific criteria, HHNs perform assessments and escalate patient cases to the HF team for further guidance on early intervention. RESULTS We enrolled five patients into the soft launch. Four participants adhered to study activities. Two out of five patients were readmitted, one due to HF, one due to infection. Observed miscommunication and protocol gaps were noted for protocol amendment. The study team adopted an organizational development method from change management theory to reconfigure the study protocol. CONCLUSION We sought to automate the monitoring aspects of post-discharge care by aligning a new technology that generates streaming data from a wearable device with a complex, multi-provider workflow into a novel protocol using iterative design, implementation, and evaluation methods to monitor post-discharge HF patients. CRPM with structured escalation and telemonitoring protocol shows potential to maintain patients in their home environment and reduce HF-related readmissions. Our results suggest that further education to engage and empower frontline workers using advanced technology is essential to scale up the approach.
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Affiliation(s)
- Wei Ning Chi
- Outcomes Research Network, NorthShore University HealthSystem, Evanston, Illinois, United States,Address for correspondence Wei Ning Chi, MBBS, MPH Research Institute, 1001 University PlEvanston, IL 60201United States
| | - Courtney Reamer
- Department of Medicine, NorthShore University HealthSystem, Evanston, Illinois, United States
| | - Robert Gordon
- Department of Medicine, NorthShore University HealthSystem, Evanston, Illinois, United States
| | - Nitasha Sarswat
- Department of Medicine, NorthShore University HealthSystem, Evanston, Illinois, United States,Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois, United States
| | - Charu Gupta
- Department of Medicine, NorthShore University HealthSystem, Evanston, Illinois, United States
| | - Emily White VanGompel
- Department of Family Medicine, NorthShore University HealthSystem, Evanston, Illinois, United States,Department of Family Medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois, United States
| | - Julie Dayiantis
- Home and Hospice Services, NorthShore University HealthSystem, Evanston, Illinois, United States
| | - Melissa Morton-Jost
- Home and Hospice Services, NorthShore University HealthSystem, Evanston, Illinois, United States
| | - Urmila Ravichandran
- Health Information Technology, NorthShore University HealthSystem, Evanston, Illinois, United States
| | - Karen Larimer
- Clinical Department, physIQ, Inc., Chicago, Illinois, United States
| | - David Victorson
- Northwestern University Feinberg School of Medicine, Evanston, Illinois, United States
| | - John Erwin
- Department of Medicine, NorthShore University HealthSystem, Evanston, Illinois, United States,Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois, United States
| | - Lakshmi Halasyamani
- Department of Family Medicine, NorthShore University HealthSystem, Evanston, Illinois, United States,Department of Family Medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois, United States
| | - Anthony Solomonides
- Outcomes Research Network, NorthShore University HealthSystem, Evanston, Illinois, United States
| | - Rema Padman
- The Heinz College of Information Systems and Public Policy, Carnegie Mellon University, Pittsburgh, Pennsylvania, United States
| | - Nirav S. Shah
- Department of Medicine, NorthShore University HealthSystem, Evanston, Illinois, United States,Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois, United States
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VanGompel EW, Singh L, Lai J, Carlock F, Brown J, Low LK. Patient Safety Culture or Embracing Low Intervention
Evidence‐Based
Care to Support Vaginal Birth: Where Should Hospitals Start? Health Serv Res 2021. [DOI: 10.1111/1475-6773.13823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Emily White VanGompel
- University of Chicago Pritzker School of Medicine Chicago Illinois USA
- NorthShore University HealthSystem Research Institute Evanston Illinois USA
| | - Lavisha Singh
- NorthShore University HealthSystem Research Institute Evanston Illinois USA
| | - Jin‐Shei Lai
- M/C 811, Northwestern University Chicago Illinois USA
| | - Francesca Carlock
- NorthShore University HealthSystem Research Institute Evanston Illinois USA
| | - Jill Brown
- University of Michigan Ann Arbor Michigan USA
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Scott KA, Chambers BD, McKenzie‐Sampson S, Camara TL, VanGompel EW, Davis D, Lyndon A. The Virtual Perinatal Quality Improvement Prioritization By Affected Communities (
V‐QPAC
) Protocol. Health Serv Res 2021. [DOI: 10.1111/1475-6773.13776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
| | - Brittany D. Chambers
- UCSF School of Medicine San Francisco California USA
- California Preterm Birth Initiative, UCSF San Francisco California USA
| | - Safyer McKenzie‐Sampson
- UCSF School of Medicine San Francisco California USA
- California Preterm Birth Initiative, UCSF San Francisco California USA
| | | | | | - Dána‐Ain Davis
- Queens College and Graduate Center City University of New York New York California USA
| | - Audrey Lyndon
- New York University Rory Meyers College of Nursing New York New York USA
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Song B, White VanGompel E, Wang C, Guzman S, Carlock F, Schueler K, Stulberg D. Corrigendum to "Effects of Clinic-level Implementation of One Key Question® on Reproductive Health Counseling and Patient Satisfaction" [Contraception 103 (2021): 6-12]. Contraception 2021; 104:324-325. [PMID: 34049694 DOI: 10.1016/j.contraception.2021.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Bonnie Song
- Pritzker School of Medicine, University of Chicago; 924 E 57th St, Ste #104 Chicago, IL USA 60637
| | - Emily White VanGompel
- Pritzker School of Medicine, University of Chicago; 924 E 57th St, Ste #104 Chicago, IL USA 60637; Department of Family Medicine, University of Chicago; 5841 S Maryland Ave., Chicago, IL USA 60637; NorthShore University HealthSystem (NSUHS) Research Institute; 1001 University Pl, Evanston, IL USA 60201
| | - Chi Wang
- NorthShore University HealthSystem (NSUHS) Research Institute; 1001 University Pl, Evanston, IL USA 60201
| | - Suzette Guzman
- Pritzker School of Medicine, University of Chicago; 924 E 57th St, Ste #104 Chicago, IL USA 60637
| | - Francesca Carlock
- NorthShore University HealthSystem (NSUHS) Research Institute; 1001 University Pl, Evanston, IL USA 60201
| | - Kellie Schueler
- Pritzker School of Medicine, University of Chicago; 924 E 57th St, Ste #104 Chicago, IL USA 60637
| | - Debra Stulberg
- Pritzker School of Medicine, University of Chicago; 924 E 57th St, Ste #104 Chicago, IL USA 60637; Department of Family Medicine, University of Chicago; 5841 S Maryland Ave., Chicago, IL USA 60637.
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Affiliation(s)
- Emily White VanGompel
- Departments of Family Medicine and Obstetrics and Gynecology, University of Chicago Pritzker School of Medicine, Evanston, IL, USA
| | - Elliott K Main
- Obstetrics and Gynecology / California Maternal Quality Care Collaborative, Stanford University School of Medicine, Palo Alto, CA, USA
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Song B, White VanGompel E, Wang C, Guzman S, Carlock F, Schueler K, Stulberg DB. Effects of clinic-level implementation of One Key Question® on reproductive health counseling and patient satisfaction. Contraception 2020; 103:6-12. [PMID: 33130107 DOI: 10.1016/j.contraception.2020.10.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE We evaluated the effect of clinic level implementation of the One Key Question (OKQ) intervention, including physician and staff training and workflow adjustments, on reproductive counseling and patient satisfaction in primary care and ob/gyn. STUDY DESIGN We implemented the OKQ intervention in one primary care and one ob/gyn practice, while observing another primary care and ob/gyn practice that each provided usual care (control practices). We surveyed separate patient cohorts at two time points: 26 before and 33 after the primary care practice implemented OKQ, 38 before and 36 after the ob/gyn practice implemented OKQ, 26 and 37 at the primary care control practice, and 31 and 37 at the ob/gyn control practice. We used chi square tests to assess OKQ's effects on counseling rates and patient satisfaction, comparing intervention to control practices across time points. RESULTS In primary care, from before to after implementation, the intervention practice did not significantly increase reproductive counseling (69-76%, p = 0.58), but increased patient satisfaction (81-97%, p = 0.04) while the control practice demonstrated a decrease in patient satisfaction over the same time periods. In the ob/gyn clinics, no significant change in reproductive counseling or patient satisfaction was seen in the intervention practice, while the control practice demonstrated a decrease in patient satisfaction. CONCLUSIONS Implementing OKQ appears to increase patient satisfaction. Larger studies are needed to assess whether this clinic-level intervention may increase reproductive counseling. IMPLICATIONS Further studies of the impact of clinic-level implementation of OKQ are needed.
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Affiliation(s)
- Bonnie Song
- Pritzker School of Medicine, University of Chicago, 924 E 57th St, Ste #104, Chicago, IL 60637, USA
| | - Emily White VanGompel
- Pritzker School of Medicine, University of Chicago, 924 E 57th St, Ste #104, Chicago, IL 60637, USA; Department of Family Medicine, University of Chicago, 5841 S Maryland Ave., MC 7110, Chicago, IL 60637, USA; NorthShore University HealthSystem (NSUHS) Research Institute, 1001 University Pl, Evanston, IL, 60201, USA
| | - Chi Wang
- NorthShore University HealthSystem (NSUHS) Research Institute, 1001 University Pl, Evanston, IL, 60201, USA
| | - Suzette Guzman
- Pritzker School of Medicine, University of Chicago, 924 E 57th St, Ste #104, Chicago, IL 60637, USA
| | - Francesca Carlock
- NorthShore University HealthSystem (NSUHS) Research Institute, 1001 University Pl, Evanston, IL, 60201, USA
| | - Kellie Schueler
- Pritzker School of Medicine, University of Chicago, 924 E 57th St, Ste #104, Chicago, IL 60637, USA
| | - Debra B Stulberg
- Pritzker School of Medicine, University of Chicago, 924 E 57th St, Ste #104, Chicago, IL 60637, USA; Department of Family Medicine, University of Chicago, 5841 S Maryland Ave., MC 7110, Chicago, IL 60637, USA.
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Stulberg DB, Datta A, White VanGompel E, Schueler K, Rocca CH. One Key Question® and the Desire to Avoid Pregnancy Scale: A comparison of two approaches to asking about pregnancy preferences. Contraception 2020; 101:231-236. [DOI: 10.1016/j.contraception.2019.12.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 12/05/2019] [Accepted: 12/09/2019] [Indexed: 10/25/2022]
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Oyola S, VanGompel EW. PURL: USPSTF expands options for cervical cancer screening. J Fam Pract 2020; 69:E7-E9. [PMID: 32724915 PMCID: PMC7492071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Women ages 30 to 65 years now have a third cervical cancer screening option.
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Affiliation(s)
- Sonia Oyola
- Department of Family Medicine, University of Chicago, USA
| | - Emily White VanGompel
- University HealthSystem, Evanston, IL and Department of Family Medicine, University of Chicago, USA
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White VanGompel E, Perez S, Wang C, Datta A, Cape V, Main E. Measuring labor and delivery unit culture and clinicians' attitudes toward birth: Revision and validation of the Labor Culture Survey. Birth 2019; 46:300-310. [PMID: 30407646 DOI: 10.1111/birt.12406] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 10/02/2018] [Accepted: 10/03/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cesarean delivery rates in the United States vary widely between hospitals, which cannot be fully explained by hospital or patient factors. Cultural factors are hypothesized to play a role in cesarean overuse, yet tools to measure labor culture are lacking. The aim of this study was to revise and validate a survey tool to measure hospital culture specific to cesarean overuse. METHODS A panel of clinicians and researchers compiled an item bank from validated surveys, added newly created items, and performed four rounds of iterative revision and consolidation. Obstetricians, family physicians, midwives, anesthesiologists, and labor nurses were recruited from 79 hospitals in California. Exploratory factor analysis was used to reduce the number of survey items and identify latent constructs to form the basis of subscales. Confirmatory factor analysis examined reliability in 31 additional hospitals. Poisson regression assessed associations between hospitals' mean score on each individual item and cesarean rates. RESULTS A total of 1718 individuals from 70 hospitals were included in the exploratory factor analysis. The final Labor Culture Survey (LCS) consisted of 29 items and six subscales: "Best Practices to Reduce Cesarean Overuse," "Fear of Vaginal Birth," "Unit Microculture," "Physician Oversight," "Maternal Agency," and "Cesarean Safety." CONCLUSIONS The revised LCS is a valid and reliable tool to measure constructs shown to be associated with cesarean rates. These findings support prior research that has shown that hospital culture is measurable, and that clinician attitudes are predictive of clinician behaviors. Unique to our survey is the construct of labor and delivery unit microculture.
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Affiliation(s)
- Emily White VanGompel
- The University of Chicago Pritzker School of Medicine, Chicago, Illinois.,NorthShore University HealthSystem, Evanston, Illinois
| | - Susan Perez
- California State University, Sacramento, Sacramento, California
| | - Chi Wang
- NorthShore University HealthSystem, Evanston, Illinois
| | - Avisek Datta
- NorthShore University HealthSystem, Evanston, Illinois
| | - Valerie Cape
- California Maternal Quality Care Collaborative, Stanford University, Stanford, California
| | - Elliott Main
- Department of Obstetrics and Gynecology, California Maternal Quality Care Collaborative, Stanford University School of Medicine, Stanford, California
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Abstract
OBJECTIVE To assess hospital unit culture and clinician attitudes associated with varying rates of primary cesarean delivery. DATA SOURCES/STUDY SETTING Intrapartum nurses, midwives, and physicians recruited from 79 hospitals in California participating in efforts to reduce cesarean overuse. STUDY DESIGN Labor unit culture and clinician attitudes measured using a survey were linked to the California Maternal Data Center for birth outcomes and hospital covariates. METHODS Association with primary cesarean delivery rates was assessed using multivariate Poisson regression adjusted for hospital covariates. PRINCIPAL FINDINGS 1718 respondents from 70 hospitals responded to the Labor Culture Survey. The "Unit Microculture" subscale was strongly associated with primary cesarean rate; the higher a unit scored on 8-items describing a culture supportive of vaginal birth (eg, nurses are encouraged to spend time in rooms with patients, and doulas are welcomed), the cesarean rate decreased by 41 percent (95% CI = -47 to -35 percent, P < 0.001). Discordant attitudes between nurses and physicians were associated with increased cesarean rates. CONCLUSIONS Hospital unit culture, clinician attitudes, and consistency between professions are strongly associated with primary cesarean rates. Improvement efforts to reduce cesarean overuse must address culture of care as a key part of the change process.
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Affiliation(s)
- Emily White VanGompel
- The University of Chicago Pritzker School of MedicineEvanstonIllinois
- NorthShore University HealthSystemEvanstonIllinois
| | - Susan Perez
- Department of Kinesiology and Health ScienceCalifornia State University, SacramentoSacramentoCalifornia
| | - Avisek Datta
- NorthShore University HealthSystemEvanstonIllinois
| | - Chi Wang
- Biostatistics and ResearchNorthShore University HealthSystemEvanstonIllinois
| | - Valerie Cape
- California Maternal Quality Care CollaborativeStanford UniversityStanfordCalifornia
| | - Elliott Main
- Department of Obstetrics and GynecologyStanford University School of MedicineStanfordCalifornia
- California Maternal Quality Care CollaborativeStanford University School of MedicineStanfordCalifornia
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White VanGompel E, Main EK, Tancredi D, Melnikow J. Do provider birth attitudes influence cesarean delivery rate: a cross-sectional study. BMC Pregnancy Childbirth 2018; 18:184. [PMID: 29843622 PMCID: PMC5975533 DOI: 10.1186/s12884-018-1756-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 04/19/2018] [Indexed: 11/12/2022] Open
Abstract
Background When used judiciously, cesarean sections can save lives; but in the United States, prior research indicates that cesarean birth rates have risen beyond the threshold to help women and infants and become a contributor to increased maternal mortality and rising healthcare costs. Healthy People 2020 has set the goal for nulliparous, term, singleton, vertex (NTSV) cesarean birth rate at no more than 23.9% of births. Currently, cesarean rates vary from 6% to 69% in US hospitals, unexplained by clinical or demographic factors. This wide variation in cesarean use is also seen among individual providers of intrapartum care. Previous research of birth attitudes found providers of intrapartum care hold widely differing views, which may be a key underlying factor influencing practice variation; however, further study is needed to determine if differences in attitudes are associated with differences in clinical outcomes. The purpose of this study was to estimate the association between individual provider attitudes towards birth and their low-risk primary cesarean rate. Methods Four hundred providers were drawn from a stratified random sample of all California providers of intrapartum care in 2013 and surveyed for their attitudes towards various aspects of labor and birth. Providers’ NTSV cesarean birth rates were obtained for 2013 and 2014. Covariates included gender, years of experience, practice location, and primary hospital’s NTSV cesarean rate. We used adjusted multivariate Poisson regression to compare cesarean rates and linear regression to compare attitude scores of providers meeting versus not meeting the Healthy People 2020 (HP2020) goal. Results Two hundred nine total participants (obstetricians, family physicians, and midwives) completed surveys, of which 109 perform cesareans. Providers’ NTSV cesarean rate was significantly associated with their composite attitudes score [IRR for each one-point increase 1.21 (95% CI 1.002–1.45)]. Physicians meeting the HP2020 goal held attitudes which were significantly more favorable towards vaginal birth: mean 2.70 (95% CI 2.58–2.83) versus 2.91 (95% CI 2.82–3.00), p < 0.01. Conclusions Provider attitudinal differences are associated with NTSV cesarean rates. Those meeting the HP2020 goal hold attitudes more favorable towards vaginal birth. These findings may present a modifiable target for quality improvement initiatives to decrease low risk primary cesareans.
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Affiliation(s)
- Emily White VanGompel
- Department of Family Medicine, The University of Chicago, Pritzker School of Medicine, NorthShore University HealthSystem Research Institute, 1001 University Place, Evanston, IL, 60201, USA. .,Department of Obstetrics and Gynecology, The University of Chicago, Pritzker School of Medicine, NorthShore University HealthSystem Research Institute, 1001 University Place, Evanston, IL, 60201, USA.
| | - Elliott K Main
- California Maternal Quality Care Collaborative, Stanford University, Stanford Medical School Office Building, 1265 Welch Road, MS 5415, Stanford, CA, 94305, USA
| | - Daniel Tancredi
- Center for Healthcare Policy and Research and Department of Pediatrics, University of California Davis School of Medicine, 2103 Stockton Blvd, Sacramento, CA, 95817, USA
| | - Joy Melnikow
- Center for Healthcare Policy and Research and Department of Family and Community Medicine, University of California Davis School of Medicine, 2103 Stockton Blvd, Sacramento, CA, 95817, USA
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