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Talal AH, Dharia A, Kapadia SN, Tyson GL, Birch S, Zerzan-Thul J, Sullivan D, Britton E, Wethington E, Gonzalez CJ, Fliss M, Mizroch B, McCall F, Lloyd AR, Shapiro MF, Franco R. Hepatitis C Virus Elimination Programs in Louisiana and Washington: Importance of Screening and Surveillance Systems. J Public Health Manag Pract 2024; 30:208-212. [PMID: 37594263 PMCID: PMC10833194 DOI: 10.1097/phh.0000000000001808] [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] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
The US government has established a national goal of hepatitis C virus (HCV) elimination by 2030. To date, most HCV elimination planning and activity have been at the state level. Fifteen states presently have publicly available HCV elimination plans. In 2019, Louisiana and Washington were the first states to initiate 5-year funded HCV elimination programs. These states differ on motivation for pursuing HCV elimination and ranking on several indicators. Simultaneously, however, they have emphasized several similar elimination components including HCV screening promotion through public awareness, screening expansion, surveillance enhancement (including electronic reporting and task force development), and harm reduction. The 13 other states with published elimination plans have proposed the majority of the elements identified by Louisiana and Washington, but several have notable gaps. Louisiana's and Washington's comprehensive plans, funding approaches, and programs provide a useful framework that can move states and the nation toward HCV elimination.
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Affiliation(s)
- Andrew H. Talal
- Division of Gastroenterology, Hepatology and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York (Drs Talal and Dharia); Divisions of Infectious Diseases (Dr Kapadia) and General Internal Medicine (Drs Gonzalez and Shapiro), Weill Cornell Medicine, New York, New York; Louisiana Department of Health, New Orleans, Louisiana (Drs Tyson, Mizroch, and McCall and Ms Britton); Washington State Healthcare Authority, Olympia, Washington (Drs Sullivan and Zerzan-Thul and Mss Birch and Fliss); Cornell University, Ithaca, New York (Dr Wethington); and Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama (Drs Lloyd and Franco)
| | - Arpan Dharia
- Division of Gastroenterology, Hepatology and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York (Drs Talal and Dharia); Divisions of Infectious Diseases (Dr Kapadia) and General Internal Medicine (Drs Gonzalez and Shapiro), Weill Cornell Medicine, New York, New York; Louisiana Department of Health, New Orleans, Louisiana (Drs Tyson, Mizroch, and McCall and Ms Britton); Washington State Healthcare Authority, Olympia, Washington (Drs Sullivan and Zerzan-Thul and Mss Birch and Fliss); Cornell University, Ithaca, New York (Dr Wethington); and Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama (Drs Lloyd and Franco)
| | - Shashi N. Kapadia
- Division of Gastroenterology, Hepatology and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York (Drs Talal and Dharia); Divisions of Infectious Diseases (Dr Kapadia) and General Internal Medicine (Drs Gonzalez and Shapiro), Weill Cornell Medicine, New York, New York; Louisiana Department of Health, New Orleans, Louisiana (Drs Tyson, Mizroch, and McCall and Ms Britton); Washington State Healthcare Authority, Olympia, Washington (Drs Sullivan and Zerzan-Thul and Mss Birch and Fliss); Cornell University, Ithaca, New York (Dr Wethington); and Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama (Drs Lloyd and Franco)
| | - Gia L. Tyson
- Division of Gastroenterology, Hepatology and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York (Drs Talal and Dharia); Divisions of Infectious Diseases (Dr Kapadia) and General Internal Medicine (Drs Gonzalez and Shapiro), Weill Cornell Medicine, New York, New York; Louisiana Department of Health, New Orleans, Louisiana (Drs Tyson, Mizroch, and McCall and Ms Britton); Washington State Healthcare Authority, Olympia, Washington (Drs Sullivan and Zerzan-Thul and Mss Birch and Fliss); Cornell University, Ithaca, New York (Dr Wethington); and Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama (Drs Lloyd and Franco)
| | - Susan Birch
- Division of Gastroenterology, Hepatology and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York (Drs Talal and Dharia); Divisions of Infectious Diseases (Dr Kapadia) and General Internal Medicine (Drs Gonzalez and Shapiro), Weill Cornell Medicine, New York, New York; Louisiana Department of Health, New Orleans, Louisiana (Drs Tyson, Mizroch, and McCall and Ms Britton); Washington State Healthcare Authority, Olympia, Washington (Drs Sullivan and Zerzan-Thul and Mss Birch and Fliss); Cornell University, Ithaca, New York (Dr Wethington); and Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama (Drs Lloyd and Franco)
| | - Judy Zerzan-Thul
- Division of Gastroenterology, Hepatology and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York (Drs Talal and Dharia); Divisions of Infectious Diseases (Dr Kapadia) and General Internal Medicine (Drs Gonzalez and Shapiro), Weill Cornell Medicine, New York, New York; Louisiana Department of Health, New Orleans, Louisiana (Drs Tyson, Mizroch, and McCall and Ms Britton); Washington State Healthcare Authority, Olympia, Washington (Drs Sullivan and Zerzan-Thul and Mss Birch and Fliss); Cornell University, Ithaca, New York (Dr Wethington); and Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama (Drs Lloyd and Franco)
| | - Donna Sullivan
- Division of Gastroenterology, Hepatology and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York (Drs Talal and Dharia); Divisions of Infectious Diseases (Dr Kapadia) and General Internal Medicine (Drs Gonzalez and Shapiro), Weill Cornell Medicine, New York, New York; Louisiana Department of Health, New Orleans, Louisiana (Drs Tyson, Mizroch, and McCall and Ms Britton); Washington State Healthcare Authority, Olympia, Washington (Drs Sullivan and Zerzan-Thul and Mss Birch and Fliss); Cornell University, Ithaca, New York (Dr Wethington); and Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama (Drs Lloyd and Franco)
| | - Elizabeth Britton
- Division of Gastroenterology, Hepatology and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York (Drs Talal and Dharia); Divisions of Infectious Diseases (Dr Kapadia) and General Internal Medicine (Drs Gonzalez and Shapiro), Weill Cornell Medicine, New York, New York; Louisiana Department of Health, New Orleans, Louisiana (Drs Tyson, Mizroch, and McCall and Ms Britton); Washington State Healthcare Authority, Olympia, Washington (Drs Sullivan and Zerzan-Thul and Mss Birch and Fliss); Cornell University, Ithaca, New York (Dr Wethington); and Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama (Drs Lloyd and Franco)
| | - Elaine Wethington
- Division of Gastroenterology, Hepatology and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York (Drs Talal and Dharia); Divisions of Infectious Diseases (Dr Kapadia) and General Internal Medicine (Drs Gonzalez and Shapiro), Weill Cornell Medicine, New York, New York; Louisiana Department of Health, New Orleans, Louisiana (Drs Tyson, Mizroch, and McCall and Ms Britton); Washington State Healthcare Authority, Olympia, Washington (Drs Sullivan and Zerzan-Thul and Mss Birch and Fliss); Cornell University, Ithaca, New York (Dr Wethington); and Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama (Drs Lloyd and Franco)
| | - Christopher J. Gonzalez
- Division of Gastroenterology, Hepatology and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York (Drs Talal and Dharia); Divisions of Infectious Diseases (Dr Kapadia) and General Internal Medicine (Drs Gonzalez and Shapiro), Weill Cornell Medicine, New York, New York; Louisiana Department of Health, New Orleans, Louisiana (Drs Tyson, Mizroch, and McCall and Ms Britton); Washington State Healthcare Authority, Olympia, Washington (Drs Sullivan and Zerzan-Thul and Mss Birch and Fliss); Cornell University, Ithaca, New York (Dr Wethington); and Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama (Drs Lloyd and Franco)
| | - Mary Fliss
- Division of Gastroenterology, Hepatology and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York (Drs Talal and Dharia); Divisions of Infectious Diseases (Dr Kapadia) and General Internal Medicine (Drs Gonzalez and Shapiro), Weill Cornell Medicine, New York, New York; Louisiana Department of Health, New Orleans, Louisiana (Drs Tyson, Mizroch, and McCall and Ms Britton); Washington State Healthcare Authority, Olympia, Washington (Drs Sullivan and Zerzan-Thul and Mss Birch and Fliss); Cornell University, Ithaca, New York (Dr Wethington); and Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama (Drs Lloyd and Franco)
| | - Brandon Mizroch
- Division of Gastroenterology, Hepatology and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York (Drs Talal and Dharia); Divisions of Infectious Diseases (Dr Kapadia) and General Internal Medicine (Drs Gonzalez and Shapiro), Weill Cornell Medicine, New York, New York; Louisiana Department of Health, New Orleans, Louisiana (Drs Tyson, Mizroch, and McCall and Ms Britton); Washington State Healthcare Authority, Olympia, Washington (Drs Sullivan and Zerzan-Thul and Mss Birch and Fliss); Cornell University, Ithaca, New York (Dr Wethington); and Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama (Drs Lloyd and Franco)
| | - Frederic McCall
- Division of Gastroenterology, Hepatology and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York (Drs Talal and Dharia); Divisions of Infectious Diseases (Dr Kapadia) and General Internal Medicine (Drs Gonzalez and Shapiro), Weill Cornell Medicine, New York, New York; Louisiana Department of Health, New Orleans, Louisiana (Drs Tyson, Mizroch, and McCall and Ms Britton); Washington State Healthcare Authority, Olympia, Washington (Drs Sullivan and Zerzan-Thul and Mss Birch and Fliss); Cornell University, Ithaca, New York (Dr Wethington); and Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama (Drs Lloyd and Franco)
| | - Audrey R. Lloyd
- Division of Gastroenterology, Hepatology and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York (Drs Talal and Dharia); Divisions of Infectious Diseases (Dr Kapadia) and General Internal Medicine (Drs Gonzalez and Shapiro), Weill Cornell Medicine, New York, New York; Louisiana Department of Health, New Orleans, Louisiana (Drs Tyson, Mizroch, and McCall and Ms Britton); Washington State Healthcare Authority, Olympia, Washington (Drs Sullivan and Zerzan-Thul and Mss Birch and Fliss); Cornell University, Ithaca, New York (Dr Wethington); and Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama (Drs Lloyd and Franco)
| | - Martin F. Shapiro
- Division of Gastroenterology, Hepatology and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York (Drs Talal and Dharia); Divisions of Infectious Diseases (Dr Kapadia) and General Internal Medicine (Drs Gonzalez and Shapiro), Weill Cornell Medicine, New York, New York; Louisiana Department of Health, New Orleans, Louisiana (Drs Tyson, Mizroch, and McCall and Ms Britton); Washington State Healthcare Authority, Olympia, Washington (Drs Sullivan and Zerzan-Thul and Mss Birch and Fliss); Cornell University, Ithaca, New York (Dr Wethington); and Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama (Drs Lloyd and Franco)
| | - Ricardo Franco
- Division of Gastroenterology, Hepatology and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York (Drs Talal and Dharia); Divisions of Infectious Diseases (Dr Kapadia) and General Internal Medicine (Drs Gonzalez and Shapiro), Weill Cornell Medicine, New York, New York; Louisiana Department of Health, New Orleans, Louisiana (Drs Tyson, Mizroch, and McCall and Ms Britton); Washington State Healthcare Authority, Olympia, Washington (Drs Sullivan and Zerzan-Thul and Mss Birch and Fliss); Cornell University, Ithaca, New York (Dr Wethington); and Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama (Drs Lloyd and Franco)
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Choi JJ, Rosen MA, Shapiro MF, Safford MM. Towards diagnostic excellence on academic ward teams: building a conceptual model of team dynamics in the diagnostic process. Diagnosis (Berl) 2023; 10:363-374. [PMID: 37561698 DOI: 10.1515/dx-2023-0065] [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: 06/08/2023] [Accepted: 07/31/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVES Achieving diagnostic excellence on medical wards requires teamwork and effective team dynamics. However, the study of ward team dynamics in teaching hospitals is relatively underdeveloped. We aim to enhance understanding of how ward team members interact in the diagnostic process and of the underlying behavioral, psychological, and cognitive mechanisms driving team interactions. METHODS We used mixed-methods to develop and refine a conceptual model of how ward team dynamics in an academic medical center influence the diagnostic process. First, we systematically searched existing literature for conceptual models and empirical studies of team dynamics. Then, we conducted field observations with thematic analysis to refine our model. RESULTS We present a conceptual model of how medical ward team dynamics influence the diagnostic process, which serves as a roadmap for future research and interventions in this area. We identified three underexplored areas of team dynamics that are relevant to diagnostic excellence and that merit future investigation (1): ward team structures (e.g., team roles, responsibilities) (2); contextual factors (e.g., time constraints, location of team members, culture, diversity); and (3) emergent states (shared mental models, psychological safety, team trust, and team emotions). CONCLUSIONS Optimizing the diagnostic process to achieve diagnostic excellence is likely to depend on addressing all of the potential barriers and facilitators to ward team dynamics presented in our model.
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Affiliation(s)
- Justin J Choi
- Department of Medicine, Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Michael A Rosen
- Department of Anesthesiology and Critical Care Medicine, Armstrong Institute for Patient Safety and Quality, Institute for Clinical and Translational Research, and JHSOM Simulation Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Martin F Shapiro
- Department of Medicine, Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Monika M Safford
- Department of Medicine, Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
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Gonzalez CJ, LeCroy MN, Daviglus ML, Van Horn L, Gallo LC, Gonzalez F, Perreira KM, Llabre MM, Shapiro MF, Isasi CR. Cultural and neighborhood characteristics associated with activity-specific parenting practices in Hispanic/Latino youth: a secondary analysis of the Hispanic Community Children's health study/study of Latino youth. J Behav Med 2023; 46:732-744. [PMID: 36732448 PMCID: PMC10558378 DOI: 10.1007/s10865-023-00395-w] [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] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 01/14/2023] [Indexed: 02/04/2023]
Abstract
Hispanic/Latino youth are less physically active than non-Hispanic/Latino youth. We assessed whether activity-specific parenting practices relate to moderate-to-vigorous physical activity (MVPA) and sedentary behavior among Hispanic/Latino youth, and whether cultural (acculturation) and neighborhood characteristics (perceived barriers to activity) relate to the use of parenting practice patterns. Using the Hispanic Community Children's Health Study/Study of Latino Youth (SOL Youth, n = 976 8-16-year-olds), we modeled linear regression associations between parenting practices and mean daily MVPA and sedentary behavior. Parenting practice patterns were then developed using k-means cluster analysis, and regressed on parental acculturation and neighborhood characteristics. Discipline predicted higher MVPA in females (β 1.89 [95% CI 0.11-3.67]), while Monitoring/Reinforcement predicted higher MVPA in males (β 4.71 [95% CI 0.68-8.74]). Three patterns were then identified: Negative Reinforcement (high Limit Setting and Discipline use), Positive Reinforcement (high Limit Setting and Monitoring/Reinforcement use), and Permissive Parenting (low parenting practice use). Higher acculturation predicted use of Positive Reinforcement. Activity-specific parenting practices are associated with activity in sex-specific ways among Hispanic/Latino youth, and cultural factors predict the use of parenting practices.
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Affiliation(s)
- Christopher J Gonzalez
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical College, 420 E 70Th St., LH-300, New York, NY, 10065, USA.
| | - Madison N LeCroy
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Martha L Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago, 1819 W. Polk Street, Suite 246 (M/C 764), Chicago, IL, 60612, USA
| | - Linda Van Horn
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 580 North Lake Shore Drive, Chicago, IL, 60611, USA
| | - Linda C Gallo
- Department of Psychology, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, USA
| | - Franklyn Gonzalez
- Department of Biostatistics, University of North Carolina at Chapel Hill, 123 W. Franklin St., CB# 8030, Chapel Hill, NC, 27516, USA
| | - Krista M Perreira
- Department of Social Medicine, School of Medicine, University of North Carolina at Chapel Hill, 333 South Columbia Street, CB #7240, Chapel Hill, NC, 27599, USA
| | - Maria M Llabre
- Department of Psychology, University of Miami, P.O. Box 248185, Coral Gables, FL, 33124, USA
| | - Martin F Shapiro
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical College, 420 E 70Th St., LH-300, New York, NY, 10065, USA
| | - Carmen R Isasi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
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Kapadia SN, Zhang H, Gonzalez CJ, Sen B, Franco R, Hutchings K, Wethington E, Talal A, Lloyd A, Dharia A, Wells M, Bao Y, Shapiro MF. Hepatitis C Treatment Initiation Among US Medicaid Enrollees. JAMA Netw Open 2023; 6:e2327326. [PMID: 37540513 PMCID: PMC10403776 DOI: 10.1001/jamanetworkopen.2023.27326] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/16/2023] [Indexed: 08/05/2023] Open
Abstract
Importance Direct-acting antiviral (DAA) treatment for hepatitis C virus (HCV) infection is highly effective but remains underused. Understanding disparities in the delivery of DAAs is important for HCV elimination planning and designing interventions to promote equitable treatment. Objective To examine variations in the receipt of DAA in the 6 months following a new HCV diagnosis. Design, Setting, and Participants This retrospective cohort study used national Medicaid claims from 2017 to 2019 from 50 states, Washington DC, and Puerto Rico. Individuals aged 18 to 64 years with a new diagnosis of HCV in 2018 were included. A new diagnosis was defined as a claim for an HCV RNA test followed by an International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnosis code, after a 1-year lookback period. Main Outcomes and Measures Outcome was receipt of a DAA prescription within 6 months of diagnosis. Logistic regression was used to examine demographic factors and ICD-10-identified comorbidities associated with treatment initiation. Results Among 87 652 individuals, 43 078 (49%) were females, 12 355 (14%) were age 18 to 29 years, 35 181 (40%) age 30 to 49, 51 282 (46%) were non-Hispanic White, and 48 840 (49%) had an injection drug use diagnosis. Of these individuals, 17 927 (20%) received DAAs within 6 months of their first HCV diagnosis. In the regression analyses, male sex was associated with increased treatment initiation (OR, 1.24; 95% CI, 1.16-1.33). Being age 18 to 29 years (OR, 0.65; 95% CI, 0.50-0.85) and injection drug use (OR, 0.84; 95% CI, 0.75-0.94) were associated with decreased treatment initiation. After adjustment for state fixed effects, Asian race (OR, 0.50; 95% CI, 0.40-0.64), American Indian or Alaska Native race (OR, 0.68; 95% CI, 0.55-0.84), and Hispanic ethnicity (OR, 0.81; 95% CI, 0.71-0.93) were associated with decreased treatment initiation. Adjustment for state Medicaid policy did not attenuate the racial or ethnic disparities. Conclusions In this retrospective cohort study, HCV treatment initiation was low among Medicaid beneficiaries and varied by demographic characteristics and comorbidities. Interventions are needed to increase HCV treatment uptake among Medicaid beneficiaries and to address disparities in treatment among key populations, including younger individuals, females, individuals from minoritized racial and ethnic groups, and people who inject drugs.
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Affiliation(s)
- Shashi N. Kapadia
- Division of Infectious Diseases, Weill Cornell Medicine, New York, New York
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - Hao Zhang
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | | | - Bisakha Sen
- Department of Health Policy and Organization, University of Alabama at Birmingham, Birmingham
| | - Ricardo Franco
- Division of Infectious Diseases, University of Alabama at Birmingham
| | - Kayla Hutchings
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - Elaine Wethington
- Department of Sociology and Department of Psychology, Cornell University, Ithaca, New York
| | - Andrew Talal
- Division of Gastroenterology, Hepatology, and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Audrey Lloyd
- Division of Infectious Diseases, University of Alabama at Birmingham
| | - Arpan Dharia
- Division of Gastroenterology, Hepatology, and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Martin Wells
- Department of Statistics and Data Science, Cornell University, Ithaca, New York
| | - Yuhua Bao
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - Martin F Shapiro
- Division of General Internal Medicine, Weill Cornell Medicine, New York, New York
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Choi JJ, Contractor JH, Patel VL, Shapiro MF. How team clinical reasoning occurs on ward rounds: Implications for learning. Clin Teach 2023:e13599. [PMID: 37382500 DOI: 10.1111/tct.13599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 06/05/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Ward rounds offer a rich environment for learning about team clinical reasoning. We aimed to assess how team clinical reasoning occurs on ward rounds to inform efforts to enhance the teaching of clinical reasoning. METHODS We performed focused ethnography of ward rounds over a 6-week period, during which we observed five different teams. Each day team comprised one senior physician, one senior resident, one junior resident, two interns and one medical student. Twelve 'night-float' residents who discussed new patients with the day team were also included. Field notes were analysed using content analysis. FINDINGS We analysed 41 new patient presentations and discussions on 23 different ward rounds. The median duration of case presentations and discussions was 13.0 minutes (IQR, 10.0-18.0 minutes). More time was devoted to information sharing (median 5.5 minutes; IQR, 4.0-7.0 minutes) than any other activity, followed by discussion of management plans (median 4.0 minutes; IQR, 3.0-7.8 minutes). Nineteen (46%) cases did not include discussion of a differential diagnosis for the chief concern. We identified two themes relevant to learning: (1) linear versus iterative approaches to team-based diagnosis and (2) the influence of hierarchy on participation in clinical reasoning discussions. CONCLUSION The ward teams we observed spent far less time discussing differential diagnoses compared with information sharing. Junior learners such as medical students and interns contributed less frequently to team clinical reasoning discussions. In order to maximise student learning, strategies to engage junior learners in team clinical reasoning discussions on ward rounds may be needed.
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Affiliation(s)
- Justin J Choi
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Jigar H Contractor
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Vimla L Patel
- Cognitive Studies in Medicine and Public Health, The New York Academy of Medicine, New York, New York, USA
| | - Martin F Shapiro
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
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Kapadia SN, Zhang H, Gonzalez CJ, Sen B, Franco RA, Shapiro MF, Bao Y. Specialist and Primary Care Treatment of Hepatitis C Infections in US Medicaid in 2018. J Gen Intern Med 2023; 38:1323-1325. [PMID: 36323823 PMCID: PMC10110770 DOI: 10.1007/s11606-022-07860-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 10/21/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Shashi N Kapadia
- Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, USA.
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA.
| | - Hao Zhang
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | | | - Bisakha Sen
- Department of Health Policy & Organization, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ricardo A Franco
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Martin F Shapiro
- Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Yuhua Bao
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
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Gonzalez CJ, Copeland M, Shapiro MF, Moody J. Associations of peer generational status on adolescent weight across Hispanic immigrant generations: A social network analysis. Soc Sci Med 2023; 323:115831. [PMID: 36931036 DOI: 10.1016/j.socscimed.2023.115831] [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] [Received: 06/21/2022] [Revised: 12/30/2022] [Accepted: 03/06/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Childhood obesity disproportionately impacts Hispanics in the United States (US), the nation's largest ethnic minority population. However, even among Hispanic children, those born in the US are at increased risk of developing obesity than those not born in the US (i.e. first-generation Hispanics). The objective of this study is to assess whether ethnic and generational differences in the friend networks of Hispanic adolescents moderate the association between immigrant generation and weight. METHODS We analyzed data from first-generation, second-generation, and third-generation Hispanic 12 to 19 year-old participants in Wave 1 of the Longitudinal Study of Adolescent to Adult Health (Add Health). Using multivariable linear regression, we examined the association between generational status and body mass index (BMI), and whether the ethnic and generational composition of friends moderated that association. RESULTS Higher generational status was associated with higher BMI. The ethnic and generational composition of friends was not independently associated with BMI among Hispanic adolescents. However, a social network with a greater proportion of second-generation Hispanics was positively associated with BMI among first-generation Hispanics, and negatively associated with BMI among second-generation Hispanics. CONCLUSIONS The generational status of peers in Hispanic adolescents' social networks, particularly the proportion that are second-generation Hispanic, moderates the positive association between immigrant generation and BMI. Moreover, this moderation effect is different across immigrant generations so that the proportion of second-generation adolescents within a social network is associated with higher BMI in first-generation Hispanic adolescents, but with lower BMI among those who are second-generation. These results were confirmed in sensitivity analyses. Our findings suggest that the generational composition of social networks alters the association between the generational status and weight of Hispanic adolescents, and thus that social factors within those networks may contribute to those associations.
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Affiliation(s)
- Christopher J Gonzalez
- Department of Medicine, Weill Medical College of Cornell University, 525 E 68th St., New York, NY, 10065, USA.
| | - Molly Copeland
- Department of Sociology, Michigan State University, East Lansing, MI, 48824, USA
| | - Martin F Shapiro
- Department of Medicine, Weill Medical College of Cornell University, 525 E 68th St., New York, NY, 10065, USA
| | - James Moody
- Department of Sociology, Duke University, Durham, NC, 27708, USA
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Ghosh AK, Ibrahim S, Lee J, Shapiro MF, Ancker J. Comparing Hospital Length of Stay Risk-Adjustment Models in US Value-Based Physician Payments. Qual Manag Health Care 2023; 32:22-29. [PMID: 35383715 PMCID: PMC9530068 DOI: 10.1097/qmh.0000000000000363] [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] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUNG AND OBJECTIVES Under the Affordable Care Act, the US Centers for Medicare & Medicaid Services created the Physician Value-Based Payment Modifier Program and its successor, the Merit-Based Incentive Payment System, to tie physician payments to quality and cost. The addition of hospital length of stay (LOS) to these value-based physician payment models reflects its increasing importance as a metric of health care cost and efficiency and its association with adverse health outcomes. This study compared the Centers for Medicare & Medicaid Services-endorsed LOS risk-adjustment methodology with a novel methodology that accounts for pre-hospitalization clinical, socioeconomic status (SES), and admission-related factors as influential factors of hospital LOS. METHODS Using the 2014 New York, Florida, and New Jersey State Inpatient Database, we compared the observed-to-expected LOS of 2373102 adult admissions for 742 medical and surgical diagnosis-related groups (DRGs) by 3 models: ( a ) current risk-adjustment model (CRM), which adjusted for age, sex, number of chronic conditions, Elixhauser comorbidity score, and DRG severity weight, ( b ) CRM but modeling LOS using a generalized linear model (C-GLM), and (c) novel risk-adjustment model (NRM), which added to the C-GLM covariates for race/ethnicity, SES, discharge destination, weekend admission, and individual intercepts for DRGs instead of severity weights. RESULTS The NRM disadvantaged physicians for fewer medical and surgical DRGs, compared with both the C-GLM and CRM models (medical DRGs: 0.49% vs 13.17% and 10.89%, respectively; surgical DRGs: 0.30% vs 13.17% and 10.98%, respectively). In subgroup analysis, the NRM reduced the proportion of physician-penalizing DRGs across all racial/ethnic and socioeconomic groups, with the highest reduction among Whites, followed by low SES patients, and the lowest reduction among Hispanic patients. CONCLUSIONS After accounting for pre-hospitalization socioeconomic and clinical factors, the adjusted LOS using the NRM was lower than estimates from the current Centers for Medicare & Medicaid Services-endorsed model. The current model may disadvantage physicians serving communities with higher socioeconomic risks.
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Affiliation(s)
- Arnab K. Ghosh
- Department of Medicine, Weill Cornell Medical College, Cornell University, 525 E 68 St., New York, New York, USA 10065
| | - Said Ibrahim
- Department of Population Health Sciences, Weill Cornell Medical College, Cornell University, 402 E 67 St., New York, NY USA 10065
| | - Jennifer Lee
- Department of Medicine, Weill Cornell Medical College, Cornell University, 525 E 68 St., New York, New York, USA 10065
| | - Martin F. Shapiro
- Department of Medicine, Weill Cornell Medical College, Cornell University, 525 E 68 St., New York, New York, USA 10065
| | - Jessica Ancker
- Department of Population Health Sciences, Weill Cornell Medical College, Cornell University, 402 E 67 St., New York, NY USA 10065
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Ghosh AK, Shapiro MF, Abramson D. Closing the Knowledge Gap in the Long-Term Health Effects of Natural Disasters: A Research Agenda for Improving Environmental Justice in the Age of Climate Change. Int J Environ Res Public Health 2022; 19:15365. [PMID: 36430084 PMCID: PMC9692460 DOI: 10.3390/ijerph192215365] [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] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/09/2022] [Accepted: 11/19/2022] [Indexed: 06/16/2023]
Abstract
Natural disasters continue to worsen in both number and intensity globally, but our understanding of their long-term consequences on individual and community health remains limited. As climate-focused researchers, we argue that a publicly funded research agenda that supports the comprehensive exploration of these risks, particularly among vulnerable groups, is urgently needed. This exploration must focus on the following three critical components of the research agenda to promote environmental justice in the age of climate change: (1) a commitment to long term surveillance and care to examine the health impacts of climate change over their life course; (2) an emphasis on interventions using implementation science frameworks; (3) the employment of a transdisciplinary approach to study, address, and intervene on structural disadvantage among vulnerable populations. Without doing so, we risk addressing these consequences in a reactive way at greater expense, limiting the opportunity to safeguard communities and vulnerable populations in the era of climate change.
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Affiliation(s)
- Arnab K. Ghosh
- Department of Medicine, Weill Cornell Medical College, Cornell University, Ithaca, NY 10065, USA
| | - Martin F. Shapiro
- Department of Medicine, Weill Cornell Medical College, Cornell University, Ithaca, NY 10065, USA
| | - David Abramson
- School of Global Public Health, New York University, 715/719 Broadway 12th Floor Room 1214, New York, NY 10003, USA
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10
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Ghosh AK, Demetres MR, Geisler BP, Ssebyala SN, Yang T, Shapiro MF, Setoguchi S, Abramson D. Impact of Hurricanes and Associated Extreme Weather Events on Cardiovascular Health: A Scoping Review. Environ Health Perspect 2022; 130:116003. [PMID: 36448792 PMCID: PMC9710380 DOI: 10.1289/ehp11252] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND The frequency and destructiveness of hurricanes and related extreme weather events (e.g., cyclones, severe storms) have been increasing due to climate change. A growing body of evidence suggests that victims of hurricanes have increased incidence of cardiovascular disease (CVD), likely due to increased stressors around time of the hurricane and in their aftermath. OBJECTIVES The objective was to systematically examine the evidence of the association between hurricanes (and related extreme weather events) and adverse CVD outcomes with the goal of understanding the gaps in the literature. METHODS A comprehensive literature search of population-level and cohort studies focused on CVD outcomes (i.e., myocardial infarction, stroke, and heart failure) related to hurricanes, cyclones, and severe storms was performed in the following databases from inception to December 2021: Ovid MEDLINE, Ovid EMBASE, Web of Science, and The Cochrane Library. Studies retrieved were then screened for eligibility against predefined inclusion/exclusion criteria. Studies were then qualitatively synthesized based on the time frame of the CVD outcomes studied and special populations that were studied. Gaps in the literature were identified based on this synthesis. RESULTS Of the 1,103 citations identified, 48 met our overall inclusion criteria. We identified articles describing the relationship between CVD and extreme weather, primarily hurricanes, based on data from the United States (42), Taiwan (3), Japan (2), and France (1). Outcomes included CVD and myocardial infarction-related hospitalizations (30 studies) and CVVD-related mortality (7 studies). Most studies used a retrospective study design, including one case-control study, 39 cohort studies, and 4 time-series studies. DISCUSSION Although we identified a number of papers that reported evaluations of extreme weather events and short-term adverse CVD outcomes, there were important gaps in the literature. These gaps included a) a lack of rigorous long-term evaluation of hurricane exposure, b) lack of investigation of hurricane exposure on vulnerable populations regarding issues related to environmental justice, c) absence of research on the exposure of multiple hurricanes on populations, and d) absence of an exploration of mechanisms leading to worsened CVD outcomes. Future research should attempt to fill these gaps, thus providing an important evidence base for future disaster-related policy. https://doi.org/10.1289/EHP11252.
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Affiliation(s)
- Arnab K. Ghosh
- Department of Medicine, Weill Cornell Medical College, Cornell University, New York, New York, USA
| | - Michelle R. Demetres
- Samuel J. Wood Library and C.V. Starr Biomedical Information Center, Weill Cornell Medicine, New York, New York, USA
| | - Benjamin P. Geisler
- Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig Maximilian University of Munich, Munich, Germany
| | - Shakirah N. Ssebyala
- Department of Medicine, Weill Cornell Medical College, Cornell University, New York, New York, USA
| | - Tianyi Yang
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Martin F. Shapiro
- Department of Medicine, Weill Cornell Medical College, Cornell University, New York, New York, USA
| | - Soko Setoguchi
- Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, USA
| | - David Abramson
- Center of Public Health Disaster Science, School of Global Public Health, New York University, New York, New York, USA
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11
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Shapiro MF. Are Financial Incentives for Patients an Effective Treatment for Hypertension Attention-Deficit Disorder? Hypertension 2022; 79:2212-2213. [PMID: 36070403 PMCID: PMC9473150 DOI: 10.1161/hypertensionaha.122.19892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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12
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Ghosh AK, Shapiro MF, Abramson DM. Trends in National Institutes of Health Funding on the Health-Related Effects of Climate Change and Natural Disasters. J Gen Intern Med 2022; 37:2885-2887. [PMID: 34981356 PMCID: PMC8722653 DOI: 10.1007/s11606-021-07223-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 10/15/2021] [Indexed: 01/07/2023]
Affiliation(s)
- Arnab K Ghosh
- Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY, USA.
| | - Martin F Shapiro
- Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - David M Abramson
- School of Global Public Health, New York University, New York, NY, USA
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13
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Ghosh AK, Unruh MA, Ibrahim S, Shapiro MF. Association Between Patient Diversity in Hospitals and Racial/Ethnic Differences in Patient Length of Stay. J Gen Intern Med 2022; 37:723-729. [PMID: 34981364 PMCID: PMC8904308 DOI: 10.1007/s11606-021-07239-w] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 10/14/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hospitals serving a disproportionate share of racial/ethnic minorities have been shown to have poorer quality outcomes. It is unknown whether efficiencies in inpatient care, measured by length of stay (LOS), differ based on the proportion patients served by a hospital who are minorities. OBJECTIVE To examine the association between the racial/ethnic diversity of a hospital's patients and disparities in LOS. DESIGN Retrospective cross-sectional study. PARTICIPANTS One million five hundred forty-six thousand nine hundred fifty-five admissions using the 2017 New York State Inpatient Database from the Healthcare Cost and Utilization Project. MAIN MEASURE Differences in mean adjusted LOS (ALOS) between White and Black, Hispanic, and Other (Asian, Pacific Islander, Native American, and Other) admissions by Racial/Ethnic Diversity Index (proportion of non-White patients admitted to total patients admitted to that same hospital) in quintiles (Q1 to Q5), stratified by discharge destination. Mean LOS was adjusted for patient demographic, clinical, and admission characteristics and for individual intercepts for each hospital. KEY RESULTS In both unadjusted and adjusted analysis, Black-White and Other-White mean LOS differences were smallest in the most diverse hospitals (Black-White: unadjusted, -0.07 days [-0.1 to -0.04], and adjusted, 0.16 days [95% CI: 0.16 to 0.16]; Other-White: unadjusted, -0.74 days [95% CI: -0.77 to -0.71], and adjusted, 0.01 days [95% CI: 0.01 to 0.02]). For Hispanic patients, in unadjusted analysis, the mean LOS difference was greatest in the most diverse hospitals (-0.92 days, 95% CI: -0.95 to -0.89) but after adjustment, this was no longer the case. Similar patterns across all racial/ethnic groups were observed after analyses were stratified by discharge destination. CONCLUSION Mean adjusted LOS differences between White and Black patients, and White and patients of Other race was smallest in most diverse hospitals, but not differences between Hispanic and White patients. These findings may reflect specific structural factors which affect racial/ethnic differences in patient LOS.
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Affiliation(s)
- Arnab K Ghosh
- Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY, USA.
| | - Mark A Unruh
- Department of Population Health Sciences, Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Said Ibrahim
- Department of Population Health Sciences, Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Martin F Shapiro
- Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY, USA
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14
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Gonzalez CJ, Hogan CJ, Rajan M, Wells MT, Safford MM, Pinheiro LC, Ghosh AK, Choi JJ, Burchenal CA, Shah PD, Shapiro MF. Predictors of life-threatening complications in relatively lower-risk patients hospitalized with COVID-19. PLoS One 2022; 17:e0263995. [PMID: 35167610 PMCID: PMC8846540 DOI: 10.1371/journal.pone.0263995] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 02/01/2022] [Indexed: 11/18/2022] Open
Abstract
Older individuals with chronic health conditions are at highest risk of adverse clinical outcomes from COVID-19, but there is widespread belief that risk to younger, relatively lower-risk individuals is negligible. We assessed the rate and predictors of life-threatening complications among relatively lower-risk adults hospitalized with COVID-19. Of 3766 adults hospitalized with COVID-19 to three hospitals in New York City from March to May 2020, 963 were relatively lower-risk based on absence of preexisting health conditions. Multivariable logistic regression models examined in-hospital development of life-threatening complications (major medical events, intubation, or death). Covariates included age, sex, race/ethnicity, hypertension, weight, insurance type, and area-level sociodemographic factors (poverty, crowdedness, and limited English proficiency). In individuals ≥55 years old (n = 522), 33.3% experienced a life-threatening complication, 17.4% were intubated, and 22.6% died. Among those <55 years (n = 441), 15.0% experienced a life-threatening complication, 11.1% were intubated, and 5.9% died. In multivariable analyses among those ≥55 years, age (OR 1.03 [95%CI 1.01–1.06]), male sex (OR 1.72 [95%CI 1.14–2.64]), being publicly insured (versus commercial insurance: Medicare, OR 2.02 [95%CI 1.22–3.38], Medicaid, OR 1.87 [95%CI 1.10–3.20]) and living in areas with relatively high limited English proficiency (highest versus lowest quartile: OR 3.50 [95%CI 1.74–7.13]) predicted life-threatening complications. In those <55 years, no sociodemographic factors significantly predicted life-threatening complications. A substantial proportion of relatively lower-risk patients hospitalized with COVID-19 experienced life-threatening complications and more than 1 in 20 died. Public messaging needs to effectively convey that relatively lower-risk individuals are still at risk of serious complications.
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Affiliation(s)
- Christopher J. Gonzalez
- Department of Medicine, Weill Medical College of Cornell University, New York, New York, United States of America
- * E-mail:
| | - Cameron J. Hogan
- Department of Statistics and Data Science, Cornell University, Ithaca, New York, United States of America
| | - Mangala Rajan
- Department of Medicine, Weill Medical College of Cornell University, New York, New York, United States of America
| | - Martin T. Wells
- Department of Statistics and Data Science, Cornell University, Ithaca, New York, United States of America
| | - Monika M. Safford
- Department of Medicine, Weill Medical College of Cornell University, New York, New York, United States of America
| | - Laura C. Pinheiro
- Department of Medicine, Weill Medical College of Cornell University, New York, New York, United States of America
| | - Arnab K. Ghosh
- Department of Medicine, Weill Medical College of Cornell University, New York, New York, United States of America
| | - Justin J. Choi
- Department of Medicine, Weill Medical College of Cornell University, New York, New York, United States of America
| | - Clare A. Burchenal
- Department of Medicine, Weill Medical College of Cornell University, New York, New York, United States of America
| | - Pooja D. Shah
- Department of Medicine, Weill Medical College of Cornell University, New York, New York, United States of America
| | - Martin F. Shapiro
- Department of Medicine, Weill Medical College of Cornell University, New York, New York, United States of America
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15
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Choi JJ, Contractor JH, Cutler TS, Shapiro MF. A Palpable Miss: the Underrepresentation of History and Physical Errors as Identified by Internal Medicine Residents for Morbidity and Mortality Conference. J Gen Intern Med 2022; 37:264-265. [PMID: 33443702 PMCID: PMC8738783 DOI: 10.1007/s11606-020-06374-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 11/30/2020] [Indexed: 01/03/2023]
Affiliation(s)
- Justin J Choi
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
| | - Jigar H Contractor
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Todd S Cutler
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Martin F Shapiro
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
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16
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Gonzalez CJ, Aristega Almeida B, Corpuz GS, Mora HA, Aladesuru O, Shapiro MF, Sterling MR. Challenges with social distancing during the COVID-19 pandemic among Hispanics in New York City: a qualitative study. BMC Public Health 2021; 21:1946. [PMID: 34702228 PMCID: PMC8547302 DOI: 10.1186/s12889-021-11939-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 10/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hispanics in the United States are disproportionately affected by the novel coronavirus (COVID-19). While social distancing and quarantining are effective methods to reduce its spread, Hispanics, who are more likely to be essential workers and live in multigenerational homes than non-Hispanics, may face challenges that limit their ability to carry out these preventative efforts. We elicited the experiences of Hispanic adults with social distancing and self-quarantining during the COVID-19 pandemic in New York. METHODS In this qualitative study, Hispanic adults receiving care at a federally qualified community health center in East Harlem, New York, were recruited for remote one-on-one semi-structured interviews from 5/15/2020 to 11/17/2020. Interviews were conducted by a bilingual interviewer in Spanish or English, using a semi-structured topic guide informed by the Health Belief Model. Audio-recordings were professionally transcribed. We used thematic analysis to iteratively code the data. Each transcript was independently coded by two research team members, then reconciled by a third. Major themes and subthemes were identified. RESULTS Among 20 participants, four major themes emerged; Hispanics were: (1) fearful of contracting and transmitting COVID-19, (2) engaging in practices to reduce transmission of COVID-19, (3) experiencing barriers to social distancing and quarantining, and (4) facing an enduring psychological and physical toll from COVID-19. CONCLUSIONS Despite understanding the risks for contracting COVID-19 and taking appropriate precautions, Hispanics faced numerous challenges to social distancing and quarantining, such as living in crowded, multi-generational households, working as essential workers, and providing unpaid care to family members. Such challenges took a toll on their physical, emotional, and financial well-being. Our findings suggest that a tailored approach to public health messaging and interventions for pandemic planning are warranted among members of this community. Further research is needed to understand and mitigate the long term physical and psychological consequences of the pandemic among Hispanics.
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Affiliation(s)
- Christopher J Gonzalez
- Department of Medicine, Weill Cornell Medical College, Cornell University, 525 E 68th St., New York, NY, 10065, USA.
| | - Bryan Aristega Almeida
- Department of Medicine, Weill Cornell Medical College, Cornell University, 525 E 68th St., New York, NY, 10065, USA
| | - George S Corpuz
- Department of Medicine, Weill Cornell Medical College, Cornell University, 525 E 68th St., New York, NY, 10065, USA
| | - Hector A Mora
- Department of Medicine, Weill Cornell Medical College, Cornell University, 525 E 68th St., New York, NY, 10065, USA
| | - Oluwatobi Aladesuru
- Department of Medicine, Weill Cornell Medical College, Cornell University, 525 E 68th St., New York, NY, 10065, USA
| | - Martin F Shapiro
- Department of Medicine, Weill Cornell Medical College, Cornell University, 525 E 68th St., New York, NY, 10065, USA
| | - Madeline R Sterling
- Department of Medicine, Weill Cornell Medical College, Cornell University, 525 E 68th St., New York, NY, 10065, USA
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17
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Kingery JR, Bf Martin P, Baer BR, Pinheiro LC, Rajan M, Clermont A, Pan S, Nguyen K, Fahoum K, Wehmeyer GT, Alshak MN, Li HA, Choi JJ, Shapiro MF, McNairy ML, Safford MM, Goyal P. Thirty-Day Post-Discharge Outcomes Following COVID-19 Infection. J Gen Intern Med 2021; 36:2378-2385. [PMID: 34100231 PMCID: PMC8183585 DOI: 10.1007/s11606-021-06924-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 05/06/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND The clinical course of COVID-19 includes multiple disease phases. Data describing post-hospital discharge outcomes may provide insight into disease course. Studies describing post-hospitalization outcomes of adults following COVID-19 infection are limited to electronic medical record review, which may underestimate the incidence of outcomes. OBJECTIVE To determine 30-day post-hospitalization outcomes following COVID-19 infection. DESIGN Retrospective cohort study SETTING: Quaternary referral hospital and community hospital in New York City. PARTICIPANTS COVID-19 infected patients discharged alive from the emergency department (ED) or hospital between March 3 and May 15, 2020. MEASUREMENT Outcomes included return to an ED, re-hospitalization, and mortality within 30 days of hospital discharge. RESULTS Thirty-day follow-up data were successfully collected on 94.6% of eligible patients. Among 1344 patients, 16.5% returned to an ED, 9.8% were re-hospitalized, and 2.4% died. Among patients who returned to the ED, 50.0% (108/216) went to a different hospital from the hospital of the index presentation, and 61.1% (132/216) of those who returned were re-hospitalized. In Cox models adjusted for variables selected using the lasso method, age (HR 1.01 per year [95% CI 1.00-1.02]), diabetes (1.54 [1.06-2.23]), and the need for inpatient dialysis (3.78 [2.23-6.43]) during the index presentation were independently associated with a higher re-hospitalization rate. Older age (HR 1.08 [1.05-1.11]) and Asian race (2.89 [1.27-6.61]) were significantly associated with mortality. CONCLUSIONS Among patients discharged alive following their index presentation for COVID-19, risk for returning to a hospital within 30 days of discharge was substantial. These patients merit close post-discharge follow-up to optimize outcomes.
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Affiliation(s)
- Justin R Kingery
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA.
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
| | - Paul Bf Martin
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA
| | - Ben R Baer
- Department of Statistics and Data Science, Cornell University, Ithaca, NY, USA
| | - Laura C Pinheiro
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA
| | - Mangala Rajan
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA
| | | | - Sabrina Pan
- School of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Khoi Nguyen
- School of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Khalid Fahoum
- School of Medicine, Weill Cornell Medicine, New York, NY, USA
| | | | - Mark N Alshak
- School of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Han A Li
- School of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Justin J Choi
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA
| | - Martin F Shapiro
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA
| | - Margaret L McNairy
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Monika M Safford
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA
| | - Parag Goyal
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
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18
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Choi JJ, Contractor JH, Shaw AL, Abdelghany Y, Frye J, Renzetti M, Smith E, Soiefer LR, Lu S, Kingery JR, Krishnan JK, Levine WJ, Safford MM, Shapiro MF. COVID-19-Related Circumstances for Hospital Readmissions: A Case Series From 2 New York City Hospitals. J Patient Saf 2021; 17:264-269. [PMID: 33852540 PMCID: PMC8131259 DOI: 10.1097/pts.0000000000000870] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The aim of the study was to determine the main factors contributing to hospital readmissions and their potential preventability after a coronavirus disease 2019 (COVID-19) hospitalization at 2 New York City hospitals. METHODS This was a retrospective study at 2 affiliated New York City hospitals located in the Upper East Side and Lower Manhattan neighborhoods. We performed case reviews using the Hospital Medicine Reengineering Network framework to determine potentially preventable readmissions among patients hospitalized for COVID-19 between March 3, 2020 (date of first case) and April 27, 2020, and readmitted to either of the 2 hospitals within 30 days of discharge. RESULTS Among 53 readmissions after hospitalization for COVID-19, 44 (83%) were deemed not preventable and 9 (17%) were potentially preventable. Nonpreventable readmissions were mostly due to disease progression or complications of COVID-19 (37/44, 84%). Main factors contributing to potentially preventable readmissions were issues with initial disposition (5/9, 56%), premature discharge (3/9, 33%), and inappropriate readmission (1/9, 11%) for someone who likely did not require rehospitalization. CONCLUSIONS Most readmissions after a COVID-19 hospitalization were not preventable and a consequence of the natural progression of the disease, specifically worsening dyspnea or hypoxemia. Some readmissions were potentially preventable, mostly because of issues with disposition that were directly related to challenges posed by the ongoing COVID-19 pandemic. Clinicians should be aware of challenges with disposition related to circumstances of the COVID-19 pandemic.
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Affiliation(s)
- Justin J. Choi
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | | | - Amy L. Shaw
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | | | - Jesse Frye
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | | | - Emily Smith
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | | | - Shuting Lu
- MD Program, Weill Cornell Medicine, New York, NY
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Choi JJ, Contractor JH, Shapiro MF, Patel VL. What we cannot see in virtual diagnosis: the potential pitfalls of telediagnosis related to teamwork. ACTA ACUST UNITED AC 2021; 9:282-284. [PMID: 33984883 DOI: 10.1515/dx-2021-0040] [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: 03/19/2021] [Accepted: 05/03/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Justin J Choi
- Department of Medicine, Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Jigar H Contractor
- Department of Medicine, Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Martin F Shapiro
- Department of Medicine, Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Vimla L Patel
- Cognitive Studies in Medicine and Public Health, The New York Academy of Medicine, New York, NY, USA
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Sterling MR, Silva AF, Leung PBK, Shaw AL, Tsui EK, Jones CD, Robbins L, Escamilla Y, Lee A, Wiggins F, Sadler F, Shapiro MF, Charlson ME, Kern LM, Safford MM. "It's Like They Forget That the Word 'Health' Is in 'Home Health Aide'": Understanding the Perspectives of Home Care Workers Who Care for Adults With Heart Failure. J Am Heart Assoc 2019; 7:e010134. [PMID: 30571599 PMCID: PMC6405555 DOI: 10.1161/jaha.118.010134] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [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] [Indexed: 01/23/2023]
Abstract
Background Home care workers (HCWs) increasingly provide long‐term and posthospitalization care for community‐dwelling adults with heart failure (HF). They observe, assist, and advise these patients, yet few studies have examined their role in HF. As the foundation for future interventions, we sought to understand the perspectives of HCWs caring for adults with HF. Methods and Results We conducted 8 focus groups in partnership with the Home Care Industry Education Fund, a benefit fund of the 1199 Service Employees International Union United Healthcare Workers East, the largest healthcare union in the United States. English‐ and Spanish‐speaking HCWs with HF clients were eligible to participate. Data were analyzed thematically. Forty‐six HCWs employed by 21 unique home care agencies participated. General and HF‐specific themes emerged. Generally, HCWs (1) feel overworked and undervalued; (2) find communication and care to be fragmented; (3) are dedicated to clients and families but are caught in the middle; and, despite this, (4) love their job. With respect to HF, HCWs (1) find it frightening and unpredictable; (2) are involved in HF self‐care without any HF training; and (3) find the care plan problematic. Conclusions Although frequently involved in HF self‐care, most HCWs have not received HF training. In addition, many felt poorly supported by other healthcare providers and the care plan, especially when their clients’ symptoms worsened. Interventions that provide HF‐specific training and aim to improve communication between members of the home health care team may enhance HCWs’ ability to care for adults with HF and potentially lead to better patient outcomes.
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Affiliation(s)
- Madeline R Sterling
- 1 Division of General Internal Medicine Department of Medicine Weill Cornell Medicine New York NY
| | - Ariel F Silva
- 1 Division of General Internal Medicine Department of Medicine Weill Cornell Medicine New York NY
| | - Peggy B K Leung
- 1 Division of General Internal Medicine Department of Medicine Weill Cornell Medicine New York NY
| | - Amy L Shaw
- 2 Division of Geriatrics and Palliative Medicine Department of Medicine Weill Cornell Medicine New York NY
| | - Emma K Tsui
- 3 Department of Community Health and Social Sciences Graduate School of Public Health and Health Policy City University of New York NY
| | | | | | | | - Ann Lee
- 6 1199SEIU - Home Care Industry Education Fund New York NY
| | - Faith Wiggins
- 6 1199SEIU - Home Care Industry Education Fund New York NY
| | - Frances Sadler
- 6 1199SEIU - Home Care Industry Education Fund New York NY
| | - Martin F Shapiro
- 1 Division of General Internal Medicine Department of Medicine Weill Cornell Medicine New York NY
| | - Mary E Charlson
- 7 Division of Clinical Epidemiology and Evaluative Science Research Department of Medicine Weill Cornell Medicine New York NY
| | - Lisa M Kern
- 1 Division of General Internal Medicine Department of Medicine Weill Cornell Medicine New York NY
| | - Monika M Safford
- 1 Division of General Internal Medicine Department of Medicine Weill Cornell Medicine New York NY
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George S, Vassar SD, Norris K, Coleman B, Gonzalez C, Ishimori M, Morris D, Mtume N, Shapiro MF, Lucas-Wright A, Brown AF. Researcher perspectives on embedding community stakeholders in T1-T2 research: A potential new model for full-spectrum translational research - ADDENDUM. J Clin Transl Sci 2019; 3:290. [PMID: 31680693 PMCID: PMC6815765 DOI: 10.1017/cts.2019.399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Shapiro MF. The Last Breath-Enriching End-of-Life Moments. JAMA Intern Med 2019; 179:865-866. [PMID: 31135811 DOI: 10.1001/jamainternmed.2019.1451] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Martin F Shapiro
- Department of Medicine, Weill Cornell Medical College, New York, New York
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23
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George S, Vassar SD, Norris K, Coleman B, Gonzalez C, Ishimori M, Morris D, Mtume N, Shapiro MF, Lucas-Wright A, Brown AF. Researcher perspectives on embedding community stakeholders in T1-T2 research: A potential new model for full-spectrum translational research. J Clin Transl Sci 2019; 3:120-124. [PMID: 31660235 PMCID: PMC6802407 DOI: 10.1017/cts.2019.384] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/17/2019] [Accepted: 05/21/2019] [Indexed: 02/01/2023] Open
Abstract
Effective community engagement in T3-T4 research is widespread, however, similar stakeholder involvement is missing in T1-T2 research. As part of an effort to embed community stakeholders in T1-T2 research, an academic community partnered team conducted discussion groups with researchers to assess perspectives on (1) barriers/challenges to including community stakeholders in basic science, (2) skills/training required for stakeholders and researchers, and (3) potential benefits of these activities. Engaging community in basic science research was perceived as challenging but with exciting potential to incorporate "real-life" community health priorities into basic research, resulting in a new full-spectrum translational research model.
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Affiliation(s)
- Sheba George
- Charles R Drew University of Medicine and Science, Los Angeles, CA, USA
- UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Stefanie D. Vassar
- UCLA Division of General Internal Medicine & Health Services Research, Los Angeles, CA, USA
- Olive View Olive View-UCLA Medical Center, Sylmar, CA, USA
| | - Keith Norris
- UCLA Division of General Internal Medicine & Health Services Research, Los Angeles, CA, USA
| | - Bernice Coleman
- Cedars-Sinai Medical Center, Division of Rheumatology, Los Angeles, CA, USA
| | - Cynthia Gonzalez
- Charles R Drew University of Medicine and Science, Los Angeles, CA, USA
| | - Mariko Ishimori
- Cedars-Sinai Medical Center, Division of Rheumatology, Los Angeles, CA, USA
| | - D’Ann Morris
- UCLA Division of General Internal Medicine & Health Services Research, Los Angeles, CA, USA
| | | | - Martin F. Shapiro
- Weill Cornell Medicine, Joan and Sanford I. Weill Department of Medicine, New York City, NY, USA
| | - Anna Lucas-Wright
- Charles R Drew University of Medicine and Science, Los Angeles, CA, USA
- UCLA Division of General Internal Medicine & Health Services Research, Los Angeles, CA, USA
| | - Arleen F. Brown
- UCLA Division of General Internal Medicine & Health Services Research, Los Angeles, CA, USA
- Olive View Olive View-UCLA Medical Center, Sylmar, CA, USA
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Tsujimoto T, Kajio H, Shapiro MF, Sugiyama T. Risk of All-Cause Mortality in Diabetic Patients Taking β-Blockers. Mayo Clin Proc 2018; 93:409-418. [PMID: 29545006 DOI: 10.1016/j.mayocp.2017.11.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 10/10/2017] [Accepted: 11/03/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To assess the relationship between use of β-blockers and all-cause mortality in patients with and without diabetes. PATIENTS AND METHODS Using data from the US National Health and Nutrition Examination Survey 1999-2010, we conducted a prospective cohort study. The study participants were followed-up from the survey participation date until December 31, 2011. We used a Cox proportional hazards model for all-cause mortality analysis. The multivariate-adjusted hazard ratios (HRs) of the participants taking β-blockers were compared with those of the participants not taking β-blockers. RESULTS This study included 2840 diabetic participants and 14,684 nondiabetic participants. Compared with diabetic participants not taking a β-blocker, all-cause mortality was significantly higher in diabetic participants taking any β-blocker (HR, 1.49; 95% CI, 1.09-2.04; P=.01), taking a β1-selective β-blocker (HR, 1.60; 95% CI, 1.13-2.24; P=.007), or taking a specific β-blocker (bisoprolol, metoprolol, and carvedilol) (HR, 1.55; 95% CI, 1.09-2.21; P=.01). In addition, all-cause mortality in diabetic participants with coronary heart disease (CHD) was significantly higher in those taking beta-blockers, compared with those not taking beta-blockers (HR, 1.64; 95% CI, 1.08-2.48; P=.02), whereas that in non-diabetic participants with CHD was significantly lower in those taking beta-blockers (HR, 0.68; 95% CI, 0.50-0.94; P=.02). A propensity score-matched Cox proportional hazards model yielded similar results. CONCLUSION Use of β-blockers may be associated with an increased risk of mortality for patients with diabetes and among the subset who have CHD.
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Affiliation(s)
- Tetsuro Tsujimoto
- Department of Diabetes, Endocrinology, and Metabolism, Center Hospital, National Center for Global Health and Medicine, Tokyo National Center for Global Health and Medicine, Tokyo, Japan.
| | - Hiroshi Kajio
- Department of Diabetes, Endocrinology, and Metabolism, Center Hospital, National Center for Global Health and Medicine, Tokyo National Center for Global Health and Medicine, Tokyo, Japan
| | - Martin F Shapiro
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Takehiro Sugiyama
- Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine, Tokyo National Center for Global Health and Medicine, Tokyo, Japan; Department of Public Health/Health Policy, the Universitiy of Tokyo, Tokyo, Japan
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Affiliation(s)
- Martin F Shapiro
- Division of General Internal Medicine, Weill-Cornell Medical College, New York, NY, USA.
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Tsujimoto T, Sugiyama T, Shapiro MF, Noda M, Kajio H. Risk of Cardiovascular Events in Patients With Diabetes Mellitus on β-Blockers. Hypertension 2017; 70:103-110. [PMID: 28559400 PMCID: PMC5739105 DOI: 10.1161/hypertensionaha.117.09259] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 03/05/2017] [Accepted: 04/06/2017] [Indexed: 01/01/2023]
Abstract
Although the use of β-blockers may help in achieving maximum effects of intensive glycemic control because of a decrease in the adverse effects after severe hypoglycemia, they pose a potential risk for the occurrence of severe hypoglycemia. This study aimed to evaluate whether the use of β-blockers is effective in patients with diabetes mellitus and whether its use is associated with the occurrence of severe hypoglycemia. Using the ACCORD trial (Action to Control Cardiovascular Risk in Diabetes) data, we performed Cox proportional hazards analyses with a propensity score adjustment. The primary outcome was the first occurrence of a cardiovascular event during the study period, which included nonfatal myocardial infarction, unstable angina, nonfatal stroke, and cardiovascular death. The mean follow-up periods (±SD) were 4.6±1.6 years in patients on β-blockers (n=2527) and 4.7±1.6 years in those not on β-blockers (n=2527). The cardiovascular event rate was significantly higher in patients on β-blockers than in those not on β-blockers (hazard ratio, 1.46; 95% confidence interval, 1.24-1.72; P<0.001). In patients with coronary heart disease or heart failure, the cumulative event rate for cardiovascular events was also significantly higher in those on β-blockers than in those not on β-blockers (hazard ratio, 1.27; 95% confidence interval, 1.02-1.60; P=0.03). The incidence of severe hypoglycemia was significantly higher in patients on β-blockers than in those not on β-blockers (hazard ratio, 1.30; 95% confidence interval, 1.03-1.64; P=0.02). In conclusion, the use of β-blockers in patients with diabetes mellitus was associated with an increased risk for cardiovascular events.
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Affiliation(s)
- Tetsuro Tsujimoto
- From the Department of Diabetes, Endocrinology, and Metabolism, Center Hospital (T.T., H.K.), and Department of Clinical Study and Informatics, Center for Clinical Sciences (T.S.), National Center for Global Health and Medicine, Tokyo, Japan; Department of Public Health/Health Policy, the University of Tokyo, Japan (T.S.); Division of General Internal Medicine & Health Services Research, David Geffen School of Medicine at UCLA (M.F.S.); Department of Health Policy and Management, UCLA Fielding School of Public Health (M.F.S.); and Department of Endocrinology and Diabetes, Saitama Medical University, Japan (M.N.).
| | - Takehiro Sugiyama
- From the Department of Diabetes, Endocrinology, and Metabolism, Center Hospital (T.T., H.K.), and Department of Clinical Study and Informatics, Center for Clinical Sciences (T.S.), National Center for Global Health and Medicine, Tokyo, Japan; Department of Public Health/Health Policy, the University of Tokyo, Japan (T.S.); Division of General Internal Medicine & Health Services Research, David Geffen School of Medicine at UCLA (M.F.S.); Department of Health Policy and Management, UCLA Fielding School of Public Health (M.F.S.); and Department of Endocrinology and Diabetes, Saitama Medical University, Japan (M.N.)
| | - Martin F Shapiro
- From the Department of Diabetes, Endocrinology, and Metabolism, Center Hospital (T.T., H.K.), and Department of Clinical Study and Informatics, Center for Clinical Sciences (T.S.), National Center for Global Health and Medicine, Tokyo, Japan; Department of Public Health/Health Policy, the University of Tokyo, Japan (T.S.); Division of General Internal Medicine & Health Services Research, David Geffen School of Medicine at UCLA (M.F.S.); Department of Health Policy and Management, UCLA Fielding School of Public Health (M.F.S.); and Department of Endocrinology and Diabetes, Saitama Medical University, Japan (M.N.)
| | - Mitsuhiko Noda
- From the Department of Diabetes, Endocrinology, and Metabolism, Center Hospital (T.T., H.K.), and Department of Clinical Study and Informatics, Center for Clinical Sciences (T.S.), National Center for Global Health and Medicine, Tokyo, Japan; Department of Public Health/Health Policy, the University of Tokyo, Japan (T.S.); Division of General Internal Medicine & Health Services Research, David Geffen School of Medicine at UCLA (M.F.S.); Department of Health Policy and Management, UCLA Fielding School of Public Health (M.F.S.); and Department of Endocrinology and Diabetes, Saitama Medical University, Japan (M.N.)
| | - Hiroshi Kajio
- From the Department of Diabetes, Endocrinology, and Metabolism, Center Hospital (T.T., H.K.), and Department of Clinical Study and Informatics, Center for Clinical Sciences (T.S.), National Center for Global Health and Medicine, Tokyo, Japan; Department of Public Health/Health Policy, the University of Tokyo, Japan (T.S.); Division of General Internal Medicine & Health Services Research, David Geffen School of Medicine at UCLA (M.F.S.); Department of Health Policy and Management, UCLA Fielding School of Public Health (M.F.S.); and Department of Endocrinology and Diabetes, Saitama Medical University, Japan (M.N.)
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Abstract
BACKGROUND Falls and fall-related injuries (FRI) are common and costly occurrences among older adults living in the community, with increased risk for those with physical and cognitive limitations. Caregivers provide support for older adults with physical functioning limitations, which are associated with fall risk. DESIGN Using the 2004-2012 waves of the Health and Retirement Study, we examined whether receipt of low (0-13 weekly hours) and high levels (≥14 weekly hours) of informal care or any formal care is associated with lower risk of falls and FRIs among community-dwelling older adults. We additionally tested whether serious physical functioning (≥3 activities of daily living) or cognitive limitations moderated this relationship. RESULTS Caregiving receipt categories were jointly significant in predicting noninjurious falls (P=0.03) but not FRIs (P=0.30). High levels of informal care category (P=0.001) and formal care (P<0.001) had stronger associations with reduced fall risk relative to low levels of informal care. Among individuals with ≥3 activities of daily living, fall risks were reduced by 21% for those receiving high levels of informal care; additionally, FRIs were reduced by 42% and 58% for those receiving high levels of informal care and any formal care. High levels of informal care receipt were also associated with a 54% FRI risk reduction among the cognitively impaired. CONCLUSIONS Fall risk reductions among older adults occurred predominantly among those with significant physical and cognitive limitations. Accordingly, policy efforts involving fall prevention should target populations with increased physical functioning and cognitive limitations. They should also reduce financial barriers to informal and formal caregiving.
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Affiliation(s)
- Geoffrey J Hoffman
- *Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, MI †UCLA Division of General Internal Medicine and Health Services Research ‡Department of Community Health Sciences §Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA
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Green JB, Shapiro MF, Ettner SL, Malin J, Ang A, Wong MD. Physician variation in lung cancer treatment at the end of life. Am J Manag Care 2017; 23:216-223. [PMID: 28554208 PMCID: PMC5762116] [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: 01/01/2023]
Abstract
OBJECTIVES To determine whether a treating oncologist's characteristics are associated with variation in use of chemotherapy for patients with advanced non-small cell lung cancer (aNSCLC) at the end of life. STUDY DESIGN Retrospective cohort. METHODS Using the 2009 Surveillance, Epidemiology, and End Results-Medicare database, we studied chemotherapy receipt within 30 days of death among Medicare enrollees who were diagnosed with aNSCLC between 1999 and 2006, received chemotherapy, and died within 3 years of diagnosis. A multilevel model was constructed to assess the contribution of patient and physician characteristics and geography to receiving chemotherapy within 30 days of death. RESULTS Among 21,894 patients meeting eligibility criteria, 43.1% received chemotherapy within 30 days of death. In unadjusted bivariate analyses, female sex, Asian or black race, older age, and a greater number of comorbid diagnoses predicted lower likelihood of receiving chemotherapy at the end of life (P ≤.038 for all comparisons). Adjusting for patient and physician characteristics, physicians in small independent practices were substantially more likely than those employed in other practice models, particularly academic practices or nongovernment hospitals, to order chemotherapy for a patient in the last 30 days of life (P <.001 for all comparisons); female physicians were less likely than males to prescribe such treatment (P = .04). CONCLUSIONS Patients receiving care for aNSCLC in small independent oncology practices are more likely to receive chemotherapy in the last 30 days of life.
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Affiliation(s)
- Jonas B Green
- Cedars-Sinai Medical Care Foundation, Los Angeles, CA. E-mail:
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Hoffman GJ, Hays RD, Wallace SP, Shapiro MF, Ettner SL. Depressive symptomatology and fall risk among community-dwelling older adults. Soc Sci Med 2017; 178:206-213. [PMID: 28279573 PMCID: PMC5411980 DOI: 10.1016/j.socscimed.2017.02.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 02/03/2017] [Accepted: 02/12/2017] [Indexed: 12/15/2022]
Abstract
RATIONALE Falls are common among older adults and may be related to depressive symptoms (DS). With advancing age, there is an onset of chronic conditions, sensory impairments, and activity limitations that are associated with falls and with depressive disorders. Prior cross-sectional studies have observed significant associations between DS and subsequent falls as well as between fractures and subsequent clinical depression and DS. OBJECTIVE The directionality of these observed relationship between falls and DS is in need of elaboration given that cross-sectional study designs can yield biased estimates of the DS-falls relationship. METHODS Using 2006-2010 Health and Retirement Study data, cross-lagged panel structural equation models were used to evaluate associations between falls and DS among 7233 community-dwelling adults ages ≥65. Structural coefficients between falls and DS (in 2006→2008, 2008→2010) were estimated. RESULTS A good-fitting model was found: Controlling for baseline (2006) physical functioning, vision, chronic conditions, and social support and neighborhood social cohesion, falls were not associated with subsequent DS, but a 0.5 standard deviation increase in 2006 DS was associated with a 30% increase in fall risk two years later. This DS-falls relationship was no longer significant when use of psychiatric medications, which was positively associated with falls, was included in the model. CONCLUSION Using sophisticated methods and a large U.S. sample, we found larger magnitudes of effect in the DS-falls relationship than in prior studies-highlighting the risk of falls for older adults with DS. Medical providers might assess older individuals for DS as well as use of psychotropic medications as part of a broadened falls prevention approach. National guidelines for fall risk assessments as well as quality indicators for fall prevention should include assessment for clinical depression.
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Affiliation(s)
- Geoffrey J Hoffman
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, 400 N. Ingalls Street, Room 4352, Ann Arbor, MI 48109, United States.
| | - Ron D Hays
- Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, Department of Health Policy and Management, UCLA Fielding School of Public Health, United States
| | - Steven P Wallace
- Department of Community Health Sciences, UCLA Fielding School of Public Health, United States
| | - Martin F Shapiro
- Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, Department of Health Policy and Management, UCLA Fielding School of Public Health, United States
| | - Susan L Ettner
- Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, United States
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Chang DW, Shapiro MF. Lingering Questions Concerning Intensive Care Unit Utilization-Reply. JAMA Intern Med 2017; 177:289-290. [PMID: 28166358 DOI: 10.1001/jamainternmed.2016.8761] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Dong W Chang
- Division of Respiratory and Critical Care Physiology and Medicine, Department of Medicine, Los Angeles Biomed Research Institute at Harbor-University of California, Los Angeles Medical Center, Torrance
| | - Martin F Shapiro
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles
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Affiliation(s)
- Dong W Chang
- Division of Respiratory and Critical Care Physiology and Medicine, Los Angeles Biomed Research Institute at Harbor-University of California, Los Angeles, Medical Center, Torrance
| | - Daniel Dacosta
- Department of Medicine, Los Angeles Biomed Research Institute at Harbor-University of California, Los Angeles, Medical Center, Torrance
| | - Martin F Shapiro
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California, Los Angeles
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Laube JGR, Shapiro MF. Comparison of Patient Health History Questionnaires Used in General Internal and Family Medicine, Integrative Medicine, and Complementary and Alternative Medicine Clinics. J Altern Complement Med 2017; 23:385-393. [PMID: 28068145 DOI: 10.1089/acm.2016.0281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/12/2022] Open
Abstract
OBJECTIVES Health history questionnaires (HHQs) are a set of self-administered questions completed by patients prior to a clinical encounter. Despite widespread use, minimal research has evaluated the content of HHQs used in general internal medicine and family medicine (GIM/FM), integrative medicine, and complementary and alternative medicine (CAM; chiropractic, naturopathic, and Traditional Chinese Medicine [TCM]) clinics. Integrative medicine and CAM claim greater emphasis on well-being than does GIM/FM. This study investigated whether integrative medicine and CAM clinics' HHQs include more well-being content and otherwise differ from GIM/FM HHQs. METHODS HHQs were obtained from GIM/FM (n = 9), integrative medicine (n = 11), naturopathic medicine (n = 5), chiropractic (n = 4), and TCM (n = 7) clinics in California. HHQs were coded for presence of medical history (chief complaint, past medical history, social history, family history, surgeries, hospitalizations, medications, allergies, review of systems), health maintenance procedures (immunization, screenings), and well-being components (nutrition, exercise, stress, sleep, spirituality). RESULTS In HHQs of GIM/FM clinics, the average number of well-being components was 1.4 (standard deviation [SD], 1.4) compared with 4.0 (SD, 1.1) for integrative medicine (p < 0.01), 3.2 (SD, 2.1) for naturopathic medicine (p = 0.04), 2.0 (SD, 1.4) for chiropractic (p = 0.54), and 2.0 (SD, 1.5) for TCM (p = 0.47). In HHQs of GIM/FM clinics, the average number of medical history components was 6.4 (SD, 1.9) compared with 8.3 (SD, 1.2) for integrative medicine (p = 0.01), 9.0 (SD, 0) for naturopathic medicine (p = 0.01), 7.1 (SD, 2.8) for chiropractic (p = 0.58), and 7.1 (SD, 1.7) for TCM (p = 0.41). CONCLUSIONS Integrative and naturopathic medicine HHQs included significantly more well-being and medical history components than did GIM/FM HHQs. Further investigation is warranted to determine the optimal HHQ content to support the clinical and preventive health goals of general internal medicine, family medicine, integrative medicine, and CAM practices.
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Affiliation(s)
- Justin G R Laube
- 1 Division of General Internal Medicine and Health Service Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.,2 Center for East-West Medicine, Department of Medicine, University of California , Los Angeles, Los Angeles, CA
| | - Martin F Shapiro
- 1 Division of General Internal Medicine and Health Service Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.,3 Department of Health Policy and Management, Fielding School of Public Health, University of California , Los Angeles, Los Angeles, CA
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Sugiyama T, Horino M, Inoue K, Kobayashi Y, Shapiro MF, McCarthy WJ. Trends of Child's Weight Perception by Children, Parents, and Healthcare Professionals during the Time of Terminology Change in Childhood Obesity in the United States, 2005-2014. Child Obes 2016; 12:463-473. [PMID: 27710015 PMCID: PMC5107670 DOI: 10.1089/chi.2016.0128] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To investigate the changes on self- and parental weight perceptions and parental communication with healthcare professionals (HCPs) in the United States during the mid-2000s period when the terminology changed for classifications of childhood obesity/overweight. METHODS A repeated cross-sectional study was conducted with 6799 children aged 8-15 years with the National Health and Nutrition Examination Survey 2005-2014. BMI was calculated from objectively measured heights and weights, and children were classified as normal/underweight, overweight or obese, using the new terminology. Children reported their own weight status. Parents reported their child's weight status and reported how HCPs described their children's weight status. Logistic regressions were used to investigate changes in weight perceptions among overweight/obese children themselves and their parents and parental communication with HCPs about children's overweight/obesity status during the time of the terminology change. RESULTS The proportion of parents told by HCPs about children's weight status increased for overweight children [6.8% in 2005-2006 to 18.8% in 2013-2014, p for trend (ptrend = 0.02)], and marginally increased between 2005-2006 (37.1%) and 2007-2008 (45.4%) for obese children (p = 0.09). However, parental perceptions for obese/overweight children did not change. Also, obese children's weight perception did not change, and the proportion of overweight children who perceived their weight status accurately declined in 2005-2012 (25.9%-16.4%, ptrend = 0.02). CONCLUSIONS Although the terminology change about childhood obesity/overweight was associated with increased communication about child's weight status by HCPs, the accuracy of weight perceptions among obese/overweight children or their parents did not improve or declined.
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Affiliation(s)
- Takehiro Sugiyama
- Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
- Department of Public Health/Health Policy, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Masako Horino
- UCLA Center for Cancer Prevention and Control Research, Los Angeles, CA
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA
| | - Kaori Inoue
- Department of Endocrinology and Metabolism, the Institute for Adult Diseases, Asahi Life Foundation, Tokyo, Japan
| | - Yasuki Kobayashi
- Department of Public Health/Health Policy, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Martin F. Shapiro
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA
- Division of General Internal Medicine & Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - William J. McCarthy
- UCLA Center for Cancer Prevention and Control Research, Los Angeles, CA
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA
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Abstract
IMPORTANCE Maximizing the value of critical care services requires understanding the relationship between intensive care unit (ICU) utilization, clinical outcomes, and costs. OBJECTIVE To examine whether hospitals had consistent patterns of ICU utilization across 4 common medical conditions and the association between higher use of the ICU and hospital costs, use of invasive procedures, and mortality. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study of 156 842 hospitalizations in 94 acute-care nonfederal hospitals for diabetic ketoacidosis (DKA), pulmonary embolism (PE), upper gastrointestinal bleeding (UGIB), and congestive heart failure (CHF) in Washington state and Maryland from 2010 to 2012. Hospitalizations for DKA, PE, UGIB, and CHF were identified from the presence of compatible International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Multilevel logistic regression models were used to determine the predicted hospital-level ICU utilization during hospitalizations for the 4 study conditions. For each condition, hospitals were ranked based on the predicted ICU utilization rate to examine the variability in ICU utilization across institutions. MAIN OUTCOMES AND MEASURES The primary outcomes were associations between hospital-level ICU utilization rates and risk-adjusted hospital mortality, use of invasive procedures, and hospital costs. RESULTS The 94 hospitals and 156 842 hospitalizations included in the study represented 4.7% of total hospitalizations in this study. ICU admission rates ranged from 16.3% to 81.2% for DKA, 5.0% to 44.2% for PE, 11.5% to 51.2% for UGIB, and 3.9% to 48.8% for CHF. Spearman rank coefficients between DKA, PE, UGIB, and CHF showed significant correlations in ICU utilization for these 4 medical conditions among hospitals (ρ ≥ 0.90 for all comparisons; P < .01 for all). For each condition, hospital-level ICU utilization rate was not associated with hospital mortality. Use of invasive procedures and costs of hospitalization were greater in institutions with higher ICU utilization for all 4 conditions. CONCLUSIONS AND RELEVANCE For medical conditions where ICU care is frequently provided, but may not always be necessary, institutions that utilize ICUs more frequently are more likely to perform invasive procedures and have higher costs but have no improvement in hospital mortality. Hospitals had similar ICU utilization patterns across the 4 medical conditions, suggesting that systematic institutional factors may influence decisions to potentially overutilize ICU care. Interventions that seek to improve the value of critical care services will need to address these factors that lead clinicians to admit patients to higher levels of care when equivalent care can be delivered elsewhere in the hospital.
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Affiliation(s)
- Dong W Chang
- Division of Respiratory and Critical Care Physiology and Medicine, Los Angeles Biomed Research Institute, Harbor-University of California, Los Angeles Medical Center
| | - Martin F Shapiro
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles
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Hoffman GJ, Hays RD, Shapiro MF, Wallace SP, Ettner SL. The Costs of Fall-Related Injuries among Older Adults: Annual Per-Faller, Service Component, and Patient Out-of-Pocket Costs. Health Serv Res 2016; 52:1794-1816. [PMID: 27581952 DOI: 10.1111/1475-6773.12554] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [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: 01/03/2023] Open
Abstract
OBJECTIVE To estimate expenditures for fall-related injuries (FRIs) among older Medicare beneficiaries. DATA SOURCES The 2007-2009 Medicare claims and 2008 Health and Retirement Study (HRS) data for 5,497 (228 FRI and 5,269 non-FRI) beneficiaries. STUDY DESIGN FRIs were indicated by inpatient/outpatient ICD-9 diagnostic codes for fractures, trauma, dislocations, and by e-codes. A pre-post comparison group design was used to estimate the differential change in pre-post expenditures for the FRI relative to the non-FRI cohort (FRI expenditures). Out-of-pocket (OOP) costs, service category total annual FRI-related Medicare expenditures, expenditures related to the type of initial FRI treatment (inpatient, ED, outpatient), and the risk of persistently high expenditures (4th quartile for each post-FRI quarter) were estimated. PRINCIPAL FINDINGS Estimated FRI expenditures were $9,389 (95 percent CI: $5,969-$12,808). Inpatient, physician/outpatient, skilled nursing facility, and home health comprised 31, 18, 39, and 12 percent of the total. OOP costs were $1,363.0 (95 percent CI: $889-$1,837). Expenditures for FRIs initially treated in inpatient/ED/outpatient settings were $21,424/$6,142/$8,622. The FRI cohort had a 64 percent increased risk of persistently high expenditures. Total Medicare expenditures were $13 billion (95 percent CI: $9-$18 billion). CONCLUSIONS FRIs are associated with substantial, persistent Medicare expenditures. Cost-effectiveness of multifactorial falls prevention programs should be assessed using these expenditure estimates.
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Affiliation(s)
- Geoffrey J Hoffman
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, MI
| | - Ron D Hays
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, UCLA, Los Angeles, CA.,Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA
| | - Martin F Shapiro
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, UCLA, Los Angeles, CA.,Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA
| | - Steven P Wallace
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA
| | - Susan L Ettner
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, UCLA, Los Angeles, CA
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Abstract
The structure of health-related quality of life (HRQOL) in HIV disease is examined in 205 symptomatic HIV+ individuals receiving care at two West Coast public hospitals. A 64-item HRQOL battery, tapping aspects of HRQOL of particular relevance to individuals with HIV disease, was administered and found to yield reliable self-report data. Confirmatory factor analysis provides support for a two-factor model of HRQOL: (a) a physical health dimension defined by physical function, role function, freedom from pain, disability days, and quality of sex life, and (b) a mental health dimension defined by overall quality of life, emotional well-being, hopefulness, lack of loneliness, will to function, quality of family life, quality of friendships, and cognitive function/distress. Correlations of HRQOL measures with social support, access to care, coping, and symptom measures are reported and discussed.
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Affiliation(s)
- Ron D. Hays
- RAND Social Policy Department and UCLA Department of Medicine,
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Affiliation(s)
- Martin F Shapiro
- From the Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, and the Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles
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Mahajan AP, Kinsler JJ, Cunningham WE, James S, Makam L, Manchanda R, Shapiro MF, Sayles JN. Does the Centers for Disease Control and Prevention's Recommendation of Opt-Out HIV Screening Impact the Effect of Stigma on HIV Test Acceptance? AIDS Behav 2016; 20:107-114. [PMID: 26462670 DOI: 10.1007/s10461-015-1222-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
HIV/AIDS-related stigma is a key factor impeding patient utilization of HIV testing services. To destigmatize HIV testing, the Centers for Disease Control and Prevention recommended an 'opt-out' screening strategy aimed at all patients in all clinical settings, regardless of HIV risk. This study assessed whether opt-out screening as compared to opt-in screening was associated with increased uptake of HIV testing among patients with HIV/AIDS-related stigma concerns. This study included 374 patients attending two Los Angeles ambulatory care clinics. Stigma items were grouped into three constructs: Blame/isolation, abandonment, and contagion. Individuals endorsing the blame/isolation subscale (AOR = 0.52; 95 % CI 0.29-0.92; p\0.05) and abandonment subscale (AOR = 0.27; 95 % CI 0.13-0.59; p\0.01) were significantly less likely to accept an HIV test. Additionally, the opt-out model did not counter the negative effects of stigma on HIV test acceptance. These findings indicate that stigma remains a barrier to HIV testing, regardless of the opt-out screening approach.
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Affiliation(s)
- Takehiro Sugiyama
- Department of Clinical Study and Informatics, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan2Department of Public Health/Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Martin F Shapiro
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California Los Angeles4Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles
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40
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Wong MD, Coller KM, Dudovitz RN, Kennedy DP, Buddin R, Shapiro MF, Kataoka SH, Brown AF, Tseng CH, Bergman P, Chung PJ. Successful schools and risky behaviors among low-income adolescents. Pediatrics 2014; 134:e389-96. [PMID: 25049339 PMCID: PMC4187228 DOI: 10.1542/peds.2013-3573] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [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] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES We examined whether exposure to high-performing schools reduces the rates of risky health behaviors among low-income minority adolescents and whether this is due to better academic performance, peer influence, or other factors. METHODS By using a natural experimental study design, we used the random admissions lottery into high-performing public charter high schools in low-income Los Angeles neighborhoods to determine whether exposure to successful school environments leads to fewer risky (eg, alcohol, tobacco, drug use, unprotected sex) and very risky health behaviors (e.g., binge drinking, substance use at school, risky sex, gang participation). We surveyed 521 ninth- through twelfth-grade students who were offered admission through a random lottery (intervention group) and 409 students who were not offered admission (control group) about their health behaviors and obtained their state-standardized test scores. RESULTS The intervention and control groups had similar demographic characteristics and eighth-grade test scores. Being offered admission to a high-performing school (intervention effect) led to improved math (P < .001) and English (P = .04) standard test scores, greater school retention (91% vs. 76%; P < .001), and lower rates of engaging in ≥1 very risky behaviors (odds ratio = 0.73, P < .05) but no difference in risky behaviors, such as any recent use of alcohol, tobacco, or drugs. School retention and test scores explained 58.0% and 16.2% of the intervention effect on engagement in very risky behaviors, respectively. CONCLUSIONS Increasing performance of public schools in low-income communities may be a powerful mechanism to decrease very risky health behaviors among low-income adolescents and to decrease health disparities across the life span.
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Affiliation(s)
- Mitchell D. Wong
- University of California Los Angeles, David Geffen School of Medicine, Los Angeles, California
| | - Karen M. Coller
- University of California Los Angeles, David Geffen School of Medicine, Los Angeles, California
| | - Rebecca N. Dudovitz
- University of California Los Angeles, David Geffen School of Medicine, Los Angeles, California
| | | | | | - Martin F. Shapiro
- University of California Los Angeles, David Geffen School of Medicine, Los Angeles, California
| | - Sheryl H. Kataoka
- University of California Los Angeles, David Geffen School of Medicine, Los Angeles, California
| | - Arleen F. Brown
- University of California Los Angeles, David Geffen School of Medicine, Los Angeles, California
| | - Chi-Hong Tseng
- University of California Los Angeles, David Geffen School of Medicine, Los Angeles, California
| | - Peter Bergman
- Teachers College, Columbia University, New York, New York
| | - Paul J. Chung
- University of California Los Angeles, David Geffen School of Medicine, Los Angeles, California
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Sugiyama T, Tsugawa Y, Tseng CH, Kobayashi Y, Shapiro MF. Different time trends of caloric and fat intake between statin users and nonusers among US adults: gluttony in the time of statins? JAMA Intern Med 2014; 174:1038-45. [PMID: 24763487 PMCID: PMC4307794 DOI: 10.1001/jamainternmed.2014.1927] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
IMPORTANCE Both dietary modification and use of statins can lower blood cholesterol. The increase in caloric intake among the general population is reported to have plateaued in the last decade, but no study has examined the relationship between the time trends of caloric intake and statin use. OBJECTIVE To examine the difference in the temporal trends of caloric and fat intake between statin users and nonusers among US adults. DESIGN, SETTING, AND PARTICIPANTS A repeated cross-sectional study in a nationally representative sample of 27,886 US adults, 20 years or older, from the National Health and Nutrition Examination Survey, 1999 through 2010. EXPOSURES Statin use. MAIN OUTCOMES AND MEASURES Caloric and fat intake measured through 24-hour dietary recall. Generalized linear models with interaction term between survey cycle and statin use were constructed to investigate the time trends of dietary intake for statin users and nonusers after adjustment for possible confounders. We calculated model-adjusted caloric and fat intake using these models and examined if the time trends differed by statin use. Body mass index (BMI) changes were also compared between statin users and nonusers. RESULTS In the 1999-2000 period, the caloric intake was significantly less for statin users compared with nonusers (2000 vs 2179 kcal/d; P = .007). The difference between the groups became smaller as time went by, and there was no statistical difference after the 2005-2006 period. Among statin users, caloric intake in the 2009-2010 period was 9.6% higher (95% CI, 1.8-18.1; P = .02) than that in the 1999-2000 period. In contrast, no significant change was observed among nonusers during the same study period. Statin users also consumed significantly less fat in the 1999-2000 period (71.7 vs 81.2 g/d; P = .003). Fat intake increased 14.4% among statin users (95% CI, 3.8-26.1; P = .007) while not changing significantly among nonusers. Also, BMI increased more among statin users (+1.3) than among nonusers (+0.4) in the adjusted model (P = .02). CONCLUSIONS AND RELEVANCE Caloric and fat intake have increased among statin users over time, which was not true for nonusers. The increase in BMI was faster for statin users than for nonusers. Efforts aimed at dietary control among statin users may be becoming less intensive. The importance of dietary composition may need to be reemphasized for statin users.
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Affiliation(s)
- Takehiro Sugiyama
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California, Los Angeles2Department of Public Health/Health Policy, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan3Depa
| | - Yusuke Tsugawa
- Harvard Interfaculty Initiative in Health Policy, Cambridge, Massachusetts5Center for Clinical Epidemiology, St Luke's Life Science Institute, Tokyo, Japan
| | - Chi-Hong Tseng
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California, Los Angeles
| | - Yasuki Kobayashi
- Department of Public Health/Health Policy, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Martin F Shapiro
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California, Los Angeles6Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angele
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Hsiue PP, Gregson AL, Injean P, Vangala S, Brindis RG, Shemin RJ, Shahian DM, Miller LG, Shapiro MF, Benharash P, McKinnell JA. Variation in antibiotic prophylaxis selection for coronary artery bypass graft procedures in an era of increasing methicillin-resistant Staphylococcus aureus prevalence. Infect Control Hosp Epidemiol 2014; 35:737-40. [PMID: 24799655 DOI: 10.1086/676436] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Peter P Hsiue
- Division of Infectious Disease, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California
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43
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Bharmal N, Kaplan RM, Shapiro MF, Kagawa-Singer M, Wong MD, Mangione CM, Divan H, McCarthy WJ. The association of religiosity with overweight/obese body mass index among Asian Indian immigrants in California. Prev Med 2013; 57:315-21. [PMID: 23769898 DOI: 10.1016/j.ypmed.2013.06.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [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: 01/23/2013] [Revised: 05/31/2013] [Accepted: 06/02/2013] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The aim of this study was to examine the association between religiosity and overweight or obese body mass index among a multi-religious group of Asian Indian immigrants residing in California. METHODS We examined cross-sectional survey data obtained from in-language telephone interviews with 3228 mostly immigrant Asian Indians in the 2004 California Asian Indian Tobacco Survey using multivariate logistic regression. RESULTS High self-identified religiosity was significantly associated with higher BMI after adjusting for socio-demographic and acculturation measures. Highly religious Asian Indians had 1.53 greater odds (95% CI: 1.18, 2.00) of being overweight or obese than low religiosity immigrants, though this varied by religious affiliation. Religiosity was associated with greater odds of being overweight/obese for Hindus (OR 1.54; 95% CI: 1.08, 2.22) and Sikhs (OR 1.88; 95% CI: 1.07, 3.30), but not for Muslims (OR 0.69; 95% CI: 0.28, 1.70). CONCLUSIONS Religiosity in Hindus and Sikhs, but not immigrant Muslims, appears to be independently associated with greater body mass index among Asian Indians. If this finding is confirmed, future research should identify potentially mutable mechanisms by which religion-specific religiosity affects overweight/obesity risk.
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Affiliation(s)
- Nazleen Bharmal
- Department of Medicine, General Internal Medicine & Health Services Research, University of California, Los Angeles, CA, USA.
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44
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Khanna RR, Victor RG, Bibbins-Domingo K, Shapiro MF, Pletcher MJ. Missed Opportunities for Treatment of Uncontrolled Hypertension at Physician Office Visits in the United States, 2005 Through 2009. ACTA ACUST UNITED AC 2012; 172:1344-5. [DOI: 10.1001/archinternmed.2012.2749] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Frankel MR, McNaghten A, Shapiro MF, Sullivan PS, Berry SH, Johnson CH, Flagg EW, Morton S, Bozzette SA. A probability sample for monitoring the HIV-infected population in care in the U.S. and in selected states. Open AIDS J 2012; 6:67-76. [PMID: 23049655 PMCID: PMC3462615 DOI: 10.2174/1874613601206010067] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Revised: 08/22/2011] [Accepted: 09/14/2011] [Indexed: 11/22/2022] Open
Abstract
Epidemiologic and clinical changes in the HIV epidemic over time have presented a challenge to public health surveillance to monitor behavioral and clinical factors that affect disease progression and HIV transmission. The Medical Monitoring Project (MMP) is a supplemental surveillance project designed to provide representative, population-based data on clinical status, care, outcomes, and behaviors of HIV-infected persons receiving care at the national level. We describe a three-stage probability sampling method that provides both nationally and state-level representative estimates.In stage-I, 20 states, which included 6 separately funded cities/counties, were selected using probability proportional to size (PPS) sampling. PPS sampling was also used in stage-II to select facilities for participation in each of the 26 funded areas. In stage-III, patients were randomly selected from sampled facilities in a manner that maximized the possibility of having overall equal selection probabilities for every patient in the state or city/county. The sampling methods for MMP could be adapted to other research projects at national or sub-national levels to monitor populations of interest or evaluate outcomes and care for a range of specific diseases or conditions.
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Affiliation(s)
- Martin R Frankel
- Baruch College, The City University of New York, New York City, New York, USA
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Harris DP, Chodosh J, Vassar SD, Vickrey BG, Shapiro MF. Primary care providers' views of challenges and rewards of dementia care relative to other conditions. J Am Geriatr Soc 2009; 57:2209-16. [PMID: 19943831 DOI: 10.1111/j.1532-5415.2009.02572.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To compare primary care providers' (PCPs') perceptions about dementia and its care within their healthcare organization with perceptions of other common chronic conditions and to explore factors associated with differences. DESIGN Cross-sectional survey. SETTING Three California healthcare organizations. PARTICIPANTS One hundred sixty-four PCPs. MEASUREMENTS PCPs' views about primary care for dementia were analyzed and compared with views about care for heart disease, diabetes mellitus, and selected other conditions. Differences in views about conditions according to PCP type (internists, family physicians) were assessed. Multivariate analysis examined relationships between provider and practice characteristics and views about dementia care. RESULTS More PCPs strongly agreed that older patients with dementia are difficult to manage (23.8%) than for heart disease (5.0%) or diabetes mellitus (6.3%); PCPs can improve quality of life for heart disease (58.9%) and diabetes mellitus (61.6%) than for dementia (30.9%); older patients should be routinely screened for heart disease (63.8%) and diabetes mellitus (67.7%) than dementia (55.5%); and their organizations have expertise/referral resources to manage diabetes mellitus (49.4%) and heart disease (51.8%) than dementia (21.1%). More PCPs reported almost effortless organizational care coordination for heart disease (13.0%) or diabetes mellitus (13.7%) than for dementia (5.6%), and a great deal or many opportunities for improvement in their ability to manage dementia (50.6%) than incontinence, depression, or hypertension (7.4-34.0%; all P<.05). Internists' views regarding dementia care were less optimistic than those of family physicians, but PCP type was unrelated to views on diabetes mellitus or heart disease. CONCLUSION Improving primary care management of dementia should directly address PCP concerns about expertise and referral resources, difficulty of care provision, and PCP views about prospects for patient improvement.
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Affiliation(s)
- Dorothy P Harris
- Department of Neurology, UCLA David Geffen School of Medicine, Los Angeles, CA
| | - Joshua Chodosh
- Geriatric Research Education and Clinical Center (GRECC), VA Greater Los Angeles Healthcare System, Sepulveda, CA.,Health Services Research and Development Service (HSR&D) Sepulveda Center of Excellence, VA Greater Los Angeles Healthcare System, Sepulveda, CA.,Department of Medicine, Division of Geriatrics, UCLA David Geffen School of Medicine, Los Angeles, CA
| | - Stefanie D Vassar
- Department of Neurology, UCLA David Geffen School of Medicine, Los Angeles, CA.,Department of Neurology, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Barbara G Vickrey
- Department of Neurology, UCLA David Geffen School of Medicine, Los Angeles, CA.,Department of Neurology, VA Greater Los Angeles Healthcare System, Los Angeles, CA.,Health Services Research and Development Service (HSR&D) Sepulveda Center of Excellence, VA Greater Los Angeles Healthcare System, Sepulveda, CA
| | - Martin F Shapiro
- Division of General Internal Medicine and Health Services Research, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA.,Department of Health Services, UCLA David Geffen School of Medicine, Los Angeles, CA
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Wong MD, Ettner SL, Boscardin WJ, Shapiro MF. The contribution of cancer incidence, stage at diagnosis and survival to racial differences in years of life expectancy. J Gen Intern Med 2009; 24:475-81. [PMID: 19189193 PMCID: PMC2659154 DOI: 10.1007/s11606-009-0912-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2008] [Revised: 12/17/2008] [Accepted: 12/30/2008] [Indexed: 11/25/2022]
Abstract
BACKGROUND African Americans have higher cancer mortality rates than whites. Understanding the relative contribution of cancer incidence, stage at diagnosis and survival after diagnosis to the racial gap in life expectancy has important implications for directing future health disparity interventions toward cancer prevention, screening and treatment. OBJECTIVE We estimated the degree to which higher cancer mortality among African Americans is due to higher incidence rates, later stage at diagnosis or worse survival after diagnosis. DESIGN Stochastic model of cancer incidence and survival after diagnosis. PATIENTS Surveillance and Epidemiology End Result cancer registry and National Health Interview Survey data. MEASUREMENTS Life expectancy if African Americans had the same cancer incidence, stage and survival after diagnosis as white adults. RESULTS African-American men and women live 1.47 and 0.91 fewer years, respectively, than whites as the result of all cancers combined. Among men, racial differences in cancer incidence, stage at diagnosis and survival after diagnosis account for 1.12 (95% CI: 0.52 to 1.36), 0.17 (95% CI: -0.03 to 0.33) and 0.21 (95% CI: 0.05 to 0.34) years of the racial gap in life expectancy, respectively. Among women, incidence, stage and survival after diagnosis account for 0.41 (95% CI: -0.29 to 0.60), 0.26 (95% CI: -0.06 to 0.40) and 0.31 (95% CI: 0.05 to 0.40) years, respectively. Differences in stage had a smaller impact on the life expectancy gap compared with the impact of incidence. Differences in cancer survival after diagnosis had a significant impact for only two cancers-breast (0.14 years; 95% CI: 0.05 to 0.16) and prostate (0.05 years; 95% CI 0.01 to 0.09). CONCLUSIONS In addition to breast and colorectal cancer screening, national efforts to reduce disparities in life expectancy should also target cancer prevention, perhaps through smoking cessation, and differences in survival after diagnosis among persons with breast and prostate cancer.
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Affiliation(s)
- Mitchell D Wong
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at the University of California, Los Angeles, CA 90024, USA.
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Mahajan AP, Stemple L, Shapiro MF, King JB, Cunningham WE. Consistency of state statutes with the Centers for Disease Control and Prevention HIV testing recommendations for health care settings. Ann Intern Med 2009; 150:263-9. [PMID: 19221378 PMCID: PMC2874823 DOI: 10.7326/0003-4819-150-4-200902170-00007] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In September 2006, the Centers for Disease Control and Prevention (CDC) released the "Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-care Settings" to improve screening and diagnosis. The CDC now recommends that all patients in all health care settings be offered opt-out HIV screening without separate written consent and prevention counseling. State law on HIV testing is widely assumed to be a barrier to implementing the recommendations. To help policymakers and providers better understand their own legal context and to correct possible misunderstandings about statutory compatibility, a state-by-state review (including Washington, DC) of all statutes pertaining to HIV testing was performed and the consistency of these laws with the new recommendations was systematically assessed. Criteria were developed for classifying state statutory frameworks as consistent, neutral, or inconsistent with the new recommendations, and the implications for implementation of the CDC recommendations in these various legal contexts were examined. The statutory frameworks of 34 states and Washington, DC, were found to be either consistent with or neutral to the new CDC recommendations, which would enable full implementation. Statutory frameworks of 16 states were inconsistent with the new CDC recommendations, which would preclude implementation of 1 or more of the novel provisions without legislative change. In the 2 years since release of the recommendations, 9 states have passed new legislation to move from being inconsistent to consistent with the guidelines. State statutory laws are evolving toward greater compliance with the CDC recommendations. Policymakers, provider groups, consumer advocates, and other stakeholders should ensure that HIV screening practices comply with existing state law and work to amend inconsistent laws if they are interested in implementing the CDC recommendations.
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Affiliation(s)
- Anish P Mahajan
- David Geffen School of Medicine, University of California, Los Angeles, California 90024, USA.
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Wong MD, Chung AK, Boscardin WJ, Li M, Hsieh HJ, Ettner SL, Shapiro MF. The contribution of specific causes of death to sex differences in mortality. Public Health Rep 2007; 121:746-54. [PMID: 17278410 PMCID: PMC1781916 DOI: 10.1177/003335490612100615] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Men have higher mortality rates than women for most causes of death. This study was conducted to determine the contribution of specific causes of death to the sex difference in years of potential life lost (YPLL). METHODS The authors examined data from the National Health Interview Survey with linked mortality data through 1997. Using survival analysis estimates, a stochastic simulation model to simulate death events for cohorts of white, African American, and Latino adults was created. RESULTS YPLL from all causes were greater among men than women. Homicide, motor vehicle accidents, and suicide accounted for 33% of YPLL sex difference among whites, 36% among African Americans, and 52% among Latinos. For all three racial/ethnic groups, cardiovascular disease (principally ischemic heart disease) was the second largest contributor to the sex difference in YPLL (29% among whites, 23% among African Americans, and 25% among Latinos). Lung cancer was also important among whites and African Americans, accounting for 15% and 17% of the sex difference in YPLL from all causes, respectively. CONCLUSIONS Ischemic heart disease, lung cancer, and traumatic deaths account for as much as three-quarters of the excess YPLL among men, suggesting that a few modifiable behaviors such as the use of tobacco, alcohol.
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Affiliation(s)
- Mitchell D Wong
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, 911 Broxton Ave., Ste. 101, Los Angeles, CA 90024, USA.
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