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Wang X, Matone M, Garcia SM, Kellom KS, Marshall D, Ugarte A, Nyachogo M, Bristow S, Cronholm PF. A Social Network Analysis of a Multi-sector Service System for Intimate Partner Violence in a Large US City. J Prev (2022) 2024; 45:357-376. [PMID: 38431922 PMCID: PMC11033228 DOI: 10.1007/s10935-024-00774-2] [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] [Subscribe] [Scholar Register] [Accepted: 02/08/2024] [Indexed: 03/05/2024]
Abstract
About one in four women in the US report having experienced some form of intimate partner violence (IPV) during their lifetime and an estimated 15.5 million children live in families in which IPV occurred in the past year. Families of young children with IPV experiences often face complex needs and require well-coordinated efforts among service providers across social and health sectors. One promising partnership aims to support pregnant and parenting IPV survivors through coordination between IPV agencies and community-based maternal and early childhood home visiting programs. This study used social network analysis (SNA) to understand the interconnectedness of the system of IPV prevention and intervention for families with young children in a large US city. The SNA included 43 agencies serving this population across various service domains spanning IPV, legal, maternal and child health, and public benefit programs. An SNA survey collected data on four forms of collaboration between agencies, including formal administrative relationship, referral reciprocity, case consultation, and shared activities in community committees/organizing bodies. Density and centrality were the primary outcomes of interest. A community detection analysis was performed as a secondary analysis. The overall level of interconnectedness between the 43 responding agencies was low. Making referrals to each other was the most common form of collaboration, with a network density of 30%. IPV agencies had the highest average number of connections in the networks. There was a high level of variation in external collaborations among home visiting agencies, with several home visiting agencies having very few connections in the community but one home visiting program endorsing collaborative relationships with upwards of 38 partner agencies in the network. In serving families at risk for IPV, home visiting agencies were most likely to have referral relationships with mental health provider agencies and substance use disorder service agencies. A community detection analysis identified distinct communities within the network and demonstrated that certain agency types were more connected to one another while others were typically siloed within the network. Notably, the IPV and home visiting communities infrequently overlapped. Sensitivity analyses showed that survey participants' knowledge of their agencies' external collaborations varied by their work roles and agencies overall had low levels of consensus about their connectedness to one another. We identified a heterogeneous service system available to families of young children at-risk for or experiencing IPV. Overall inter-agency connectedness was low, with many siloed agencies and a lack of shared knowledge of community resources. Understanding current collaborations, silos, and centrality of agencies is an effective public health tool for allocating scarce resources across diverse service sectors to efficiently improve the system serving families experiencing IPV.
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Affiliation(s)
- Xi Wang
- PolicyLab, Children's Hospital of Philadelphia, 2716 South Street, 10-121, Philadelphia, PA, 19146, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Meredith Matone
- PolicyLab, Children's Hospital of Philadelphia, 2716 South Street, 10-121, Philadelphia, PA, 19146, USA.
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, PA, USA.
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
| | - Stephanie M Garcia
- PolicyLab, Children's Hospital of Philadelphia, 2716 South Street, 10-121, Philadelphia, PA, 19146, USA
| | - Katherine S Kellom
- PolicyLab, Children's Hospital of Philadelphia, 2716 South Street, 10-121, Philadelphia, PA, 19146, USA
| | - Deanna Marshall
- PolicyLab, Children's Hospital of Philadelphia, 2716 South Street, 10-121, Philadelphia, PA, 19146, USA
| | - Azucena Ugarte
- Office of Domestic Violence Strategies of the City of Philadelphia, Philadelphia, PA, USA
| | | | | | - Peter F Cronholm
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA, USA
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
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Truong OH, Wang JY, Cronholm PF. Holistic Review in Family Medicine Residency Programs: A CERA Study. Fam Med 2024. [PMID: 38652848 DOI: 10.22454/fammed.2024.515525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND AND OBJECTIVES Interest in using holistic review for residency recruitment as a strategy to improve the diversity of the physician workforce has increased. However, no data are published on the prevalence of holistic review in the selection process for family medicine residency programs. We designed this study to assess programs' knowledge, skills, and attitudes; prevalence; barriers to implementation; and program characteristics associated with the use of holistic review. METHODS Data for this study were elicited as part of a 2023 survey conducted by the Council of Academic Family Medicine Educational Research Alliance. The nationwide, web-based survey was sent to 739 family medicine residency program directors. RESULTS A total of 309 program directors completed the holistic review portion of the survey. Programs that understood and agreed with holistic review used it more in their selection process. Holistic review was more common in programs with higher rates of residents, faculty, and patients that are underrepresented in medicine. Barriers to holistic review utilization were increased number of applicants, increased resources associated with holistic review, and lack of consensus on the holistic review approach. CONCLUSIONS The holistic review process is an area of growing interest to diversify the physician workforce, especially among residencies caring for underresourced communities. Further discussions on the specific scoring rubrics of family medicine residency programs that use holistic review are needed and could help programs that are facing barriers. Widespread use of holistic review to diversify the physician workforce has the potential to improve patient care access and health.
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Affiliation(s)
- Oanh H Truong
- Baton Rouge General Family Medicine Residency Program, Baton Rouge, LA
- School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Jenny Y Wang
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA
| | - Peter F Cronholm
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA
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Gregory EF, Beidas RS, Fiks AG, Lorch SA, Levine LD, Rubin DM, Maddox AI, O'Sullivan AL, Wu KK, Cronholm PF. Acceptability of Dyad Care Management After Preterm Birth: A Qualitative Study. Matern Child Health J 2024; 28:351-361. [PMID: 37980700 DOI: 10.1007/s10995-023-03848-5] [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] [Accepted: 11/02/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVES Care management programs for medically complex infants interact with parents after complicated pregnancies, when gaps in maternal health care are well documented. These care managers may have the relationships and skills to promote postpartum and interconception health and health care access. It is unknown whether expanding these care management models to address maternal needs would be acceptable. METHODS We conducted qualitative interviews with women with a history of preterm birth and clinicians. For women with a history of preterm birth, additional inclusion criteria were Medicaid-insured infant in one health system and English proficiency. We purposively oversampled women whose infants received care management. Clinicians worked in two geographically adjacent health systems. Interviews explored priorities after preterm birth and perceived acceptability of mother-infant dyad care management. Interviews were audio recorded, transcribed, and coded following an integrated approach in which we applied a priori codes and captured emergent themes. RESULTS We interviewed 33 women (10/2018-7/2021) and 24 clinicians (3/2021-8/2021). Women were predominantly non-Hispanic Black, and 15 had infants receiving care management. Clinicians included physicians, nurses, and social workers from Pediatrics, Obstetrics, and Family Medicine. Subgroups converged thematically, finding care management acceptable. Tailoring programs to address stress and sleep, emphasizing care managers with strong interpersonal skills and shared experiences with care management users, and program flexibility would contribute to acceptability. CONCLUSIONS FOR PRACTICE Dyad care management after preterm birth is acceptable to potential program end-users and clinicians. Dyad health promotion may contribute to improved birth outcomes, infant, and parent health.
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Affiliation(s)
- Emily F Gregory
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA.
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA.
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA.
| | - Rinad S Beidas
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Alexander G Fiks
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Scott A Lorch
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Lisa D Levine
- Department of Obstetrics and Gynecology, Maternal Fetal Medicine Research Program, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - David M Rubin
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Adya I Maddox
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Ann L O'Sullivan
- University of Pennsylvania School of Nursing, Philadelphia, PA, 19104, USA
| | - Katherine K Wu
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Peter F Cronholm
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
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Wright KM, Ravenna P, Wheat S, Villarreal CM, Clements DS, Cronholm PF. Social Determinants of Health in Family Medicine Residency: A National Survey of Program Directors. Fam Med 2024; 56:102-107. [PMID: 37870799 DOI: 10.22454/fammed.2023.871989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
BACKGROUND AND OBJECTIVES Social factors account for most health outcomes, underscoring the need to address social determinants of health (SDH) to eliminate health disparities. Our objectives are (1) to describe the scope of formal SDH curricula in family medicine residency, (2) to identify residency program characteristics associated with integrated core curriculum components to teach SDH, and (3) to identify barriers to addressing SDH in residency. METHODS We distributed a cross-sectional survey to all family medicine residency program directors (PDs) accredited by the Accreditation Council for Graduate Medical Education as identified by the Association of Family Medicine Residency Directors. RESULTS Of 624 eligible program directors, 279 completed the survey (45% response rate). Overall, 41.2% of respondents reported significant formal SDH training in their program. Though a majority (93.9%) agreed that screening for social needs should be a standard of care, most (58.9%) did not use standardized screening tools. The most common barriers to addressing SDH were lack of clinical resources (eg, social workers, legal advocates), lack of community resources (eg, food banks, substance use disorder treatment), and inadequate screening instruments or integration into the electronic medical record system. Availability of referral resources was associated with PDs' increased perception of resident SDH competency. CONCLUSIONS Nearly all respondents agreed that screening for social needs should be a standard part of care; however, this vision is not yet realized. To better train the next generation of physicians to identify and meaningfully address social needs, additional research is needed. This research might include mixed-methods approaches that incorporate qualitative assessments to define best practices and patient-centered outcomes related to identifying and responding to SDH.
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Affiliation(s)
- Katherine M Wright
- Department of Family and Community Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Paul Ravenna
- Department of Family and Community Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Santina Wheat
- Department of Family and Community Medicine, Feinberg School of Medicine, Northwestern University,Chicago, IL
| | - Carla M Villarreal
- Department of Family and Community Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Deborah S Clements
- Department of Family and Community Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Peter F Cronholm
- Family Medicine and Community Health, Center for Public Health, Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Gregory EF, Johnson GT, Barreto A, Zakama AK, Maddox AI, Levine LD, Lorch SA, Fiks AG, Cronholm PF. Communication and Birth Experiences Among Black Birthing People Who Experienced Preterm Birth. Ann Fam Med 2024; 22:31-36. [PMID: 38253494 DOI: 10.1370/afm.3048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 08/10/2023] [Accepted: 09/05/2023] [Indexed: 01/24/2024] Open
Abstract
PURPOSE Physically or psychologically distressing birth experiences can influence postpartum health, parenting efficacy, and future pregnancy plans. Communication deficits contribute to negative birth experiences. This qualitative analysis explored themes related to communication and negative birth experiences among Black birthing people who experienced preterm birth. METHODS We conducted qualitative interviews with non-Hispanic Black, English language-proficient birthing people with Medicaid-insured preterm infants. Interviews were designed to explore experiences with health care access and well-being after birth. Interviews were audio recorded, transcribed, and coded following an integrated approach where we applied a priori codes and captured emergent themes from the data. RESULTS We interviewed 30 participants from October 2018 to July 2021. Median gestational age at birth was 30 weeks (range 22-36 weeks). Interviews occurred a median of 7 months postpartum (range 2-34 months). Themes emerged related to negative birth experiences and communication: (1) communication gaps during urgent or emergent intrapartum procedures contributed to negative birth experiences; (2) postpartum opportunities to share birth experiences, particularly with peers, sometimes mitigated the psychological consequences of negative birth experiences; (3) participants did not consistently discuss concerns about future pregnancy risk related to negative birth experiences with clinical teams. CONCLUSIONS Themes from this sample of Black birthing people who experienced preterm birth suggest 3 ways health systems might intervene to improve communication to mitigate the consequences of negative birth experiences. Improvement efforts in these areas may improve postpartum health, future pregnancy outcomes, and long-term health.
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Affiliation(s)
- Emily F Gregory
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | - Alejandra Barreto
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Arthurine K Zakama
- Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Adya I Maddox
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Lisa D Levine
- Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
- Maternal Fetal Medicine Research Program, Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Scott A Lorch
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Alexander G Fiks
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Peter F Cronholm
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
- Department of Family Medicine and Community Health, Center for Public Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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Gregory EF, Cronholm PF, Levine LD, Beidas RS, DeMarco MP, O'Sullivan AL, Lorch SA, Maddox AI, Wu K, Fiks AG. Integrating Care for Mother-Infant Dyads After Preterm Birth: A Qualitative Study of Clinician Perspectives on Feasibility. Womens Health Rep (New Rochelle) 2023; 4:642-650. [PMID: 38155873 PMCID: PMC10754422 DOI: 10.1089/whr.2023.0098] [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] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 12/30/2023]
Abstract
Objective There are gaps in receipt of maternal preventive services in the interconception period. Yet mother-infant dyads have frequent health care visits. Health systems have opportunities to better capitalize on existing visits to address dyad needs, but this possibility has not been fully explored. Methods In this qualitative study we conducted semistructured interviews with clinical team members involved with birthing parents or infants after preterm birth. We conducted snowball sampling from teams in pediatrics, obstetrics, and family medicine at two geographically adjacent health systems. Interviews explored perspectives on existing barriers and facilitators to integrating dyad care across adult and infant teams. Interviews were audio-recorded, professionally transcribed, and coded using an integrated approach. Results We interviewed 24 physicians, nurses, midwives, and social workers (March-November 2021). Participants identified barriers to integrated care including infrequent communication between clinical teams, which was generalizable to care of the birthing parent or infant as individuals, and additional barriers related to privacy, credentialing, and visit design that were specific to dyad care. To improve integration of dyad care, clinicians proposed adapting a variety tools and procedures currently used in their practices, including electronic health record tools for communication, dedicated roles to support communication or navigation, centralized information on resources for dyad care, referral protocols, identifying dyads for proactive outreach, and opportunities for clinicians to connect face-to-face about shared patients or families. Conclusions Clinicians believe existing health care structures and processes can be adapted to address current substantial barriers to integrated dyad care.
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Affiliation(s)
- Emily F. Gregory
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Peter F. Cronholm
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Lisa D. Levine
- Maternal Fetal Medicine Research Program, Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Rinad S. Beidas
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Mario P. DeMarco
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Ann L. O'Sullivan
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, PA
| | - Scott A. Lorch
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Adya I. Maddox
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Katherine Wu
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Alexander G. Fiks
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Goldberg DG, Soylu T, Hoffman CF, Kishton RE, Cronholm PF. "Anxiety, COVID, Burnout and Now Depression": a Qualitative Study of Primary Care Clinicians' Perceptions of Burnout. J Gen Intern Med 2023:10.1007/s11606-023-08536-2. [PMID: 38010463 DOI: 10.1007/s11606-023-08536-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/09/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Clinician burnout has become a major issue in the USA, contributing to increased mental health challenges and problems with quality of care, productivity, and retention. OBJECTIVE The objective of this study was to understand primary care clinicians' perspectives on burnout during the COVID-19 pandemic as well as their perspectives on the causes of burnout and strategies to improve clinician well-being. APPROACH This qualitative research involved in-depth interviews with 27 primary care clinicians practicing in a range of settings across the USA. Semi-structured interviews lasted between 60 and 90 min and were conducted using Zoom video conferencing software between July 2021 and February 2023. Transcripts were analyzed in NVivo software using multiple cycles of coding. KEY RESULTS Clinicians shared their experiences with burnout and mental health challenges during the COVID-19 pandemic. Contributors to burnout included high levels of documentation, inefficiencies of electronic health record (EHR) systems, high patient volume, staffing shortages, and expectations for responding to patient emails and telephone calls. The majority of participants described the need to work after clinic hours to complete documentation. Many clinicians also discussed the need for health system leaders to make sincere efforts to enhance work-life balance and create a culture of health and well-being for health professionals. Suggested strategies to address these issues included supportive leadership, accessible mental health services, and additional administrative time to complete documentation. CONCLUSIONS The results of this study provide an in-depth view of participating primary care clinicians' experiences and perceptions of burnout and other mental health challenges. These viewpoints can improve awareness of the issues and strategies to improve the health and well-being of our clinician workforce. Strategies include aligning payment models with the best approaches for delivering quality patient care, reducing administrative burden related to documentation, and redesigning EHR systems with a human factors approach.
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Affiliation(s)
- Debora Goetz Goldberg
- Department of Health Administration and Policy, College of Public Health, George Mason University, 4400 University Drive MS IJ3, Fairfax, VA, 22030, USA.
- Center for Evidence-Based Behavioral Health, George Mason University, Fairfax County, USA.
| | - Tulay Soylu
- Department of Health Services Administration and Policy, Temple University, Philadelphia, USA
| | - Carolyn Faith Hoffman
- Department of Health Administration and Policy, College of Public Health, George Mason University, 4400 University Drive MS IJ3, Fairfax, VA, 22030, USA
| | - Rachel E Kishton
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, USA
| | - Peter F Cronholm
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, USA
- Center for Public Health, University of Pennsylvania, Philadelphia, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA
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Moore DJ, Bradner MK, Strayer SM, Santen SA, Edwards C, Hayes RB, Cronholm PF. Motivational Interviewing Education in North American Family Medicine Clerkships: A CERA Study. Fam Med 2023; 55:598-606. [PMID: 37540536 PMCID: PMC10622121 DOI: 10.22454/fammed.2023.476432] [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] [Indexed: 08/05/2023]
Abstract
BACKGROUND AND OBJECTIVES Many health conditions are preventable or modifiable through behavioral changes. Motivational interviewing (MI) is an evidence-based communication technique that explores a patient's reasons for behavioral changes. This study assesses the current landscape of MI training in North American Family Medicine (FM) clerkships. METHODS We analyzed data gathered as part of the 2022 Council of Academic Family Medicine's Educational Research Alliance (CERA) survey of FM clerkship directors (CDs). The survey was distributed via email invitation to 159 US and Canadian FM CDs in June 2022. RESULTS Of the 94 responses received, 61% indicated that MI training is provided in their FM clerkship. Medical school type, class size, and location were associated with MI training priority, offerings, and duration in the clerkship, respectively. CD experience correlated with MI training duration; student MI skill training level was associated with MI training duration and priority; the rigor of student MI skills evaluation was correlated with MI teaching methods and training duration; self-reported student MI competency was associated with the length of time students spent with FM community preceptors as well as MI training priority and teaching methods; and several items emerged as predictors of student, CD, and FM faculty MI training expansion. CONCLUSIONS Opportunities exist to enhance the volume, content, and rigor of MI training in North American FM clerkships as well as to improve self-reported student MI competency within those clerkships.
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Affiliation(s)
- Denee J. Moore
- Department of Family Medicine and Population Health, Virginia Commonwealth University School of MedicineRichmond, VA
| | - Melissa K. Bradner
- Department of Family Medicine and Population Health, Virginia Commonwealth University School of MedicineRichmond, VA
| | - Scott M. Strayer
- Department of Family Medicine and Population Health, Virginia Commonwealth University School of MedicineRichmond, VA
| | - Sally A. Santen
- Office of Assessment, Evaluation, and Scholarship, Virginia Commonwealth University School of MedicineRichmond, VA
- Department of Emergency Medicine, Virginia Commonwealth University School of MedicineRichmond, VA
- Department of Emergency Medicine, University of CincinnatiCincinnati, OH
| | - Cherie Edwards
- Office of Assessment, Evaluation, and Scholarship, Virginia Commonwealth University School of MedicineRichmond, VA
| | - Rashelle B. Hayes
- Department of Psychiatry, Virginia Commonwealth University School of MedicineRichmond, VA
| | - Peter F. Cronholm
- Department of Family Medicine and Community Health, Center for Public Health Initiatives, Leonard Davis Institute of Health Economics, University of Pennsylvania School of MedicinePhiladelphia, PA
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Penwell-Waines L, Kulshreshtha A, Brennan J, Bergs K, Fazio L, Grace A, Ricker M, Romain A, Schneiderhan J, Cronholm PF. Comparing Resident and Program Director Perspectives on Wellness Curricula: A CERA Study. PRiMER 2023; 7:33. [PMID: 37791046 PMCID: PMC10544636 DOI: 10.22454/primer.2023.300982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Introduction Mitigating the stress of graduate medical education has been the focus of residency leadership in the United States. This study examined family medicine (FM) resident and program director (PD) satisfaction with current wellness curricula, including perceptions of availability of resources and emphasis on well-being. Methods The Council of Academic Family Medicine Educational Research Alliance administered online surveys to PDs accredited by the Accreditation Council for Graduate Medical Education, US-based FM residencies, and resident American Academy of Family Physicians members from April to May 2021. The present study included an assessment of wellness curriculum implementation using the Wellness Element Count (WEC), a satisfaction rating with wellness programming, and a single question assessing perceived changes in emphasis on wellness during COVID-19. Results A total of 242 residents (5% response rate) and 263 PDs (42% response rate) completed the survey. Residents reported lower WEC indicators compared to PDs (P<.001). Overall, 67.8% of resident respondents were satisfied with their program's wellness efforts, compared to 89.3% of PDs ( P<.001). Perceived emphasis on wellness curricula in the program was associated with greater resident satisfaction (OR=2.75, P<.05); less emphasis on wellness was associated with less resident satisfaction (OR=0.15, P<.001). Conclusions Residents reported overall lower perceived availability and satisfaction with program wellness efforts compared to PDs, suggesting a disparity between perspectives. Ongoing efforts should be directed at encouraging use of available wellness resources and supporting a culture of well-being.
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Affiliation(s)
| | - Ambar Kulshreshtha
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA
| | - Julie Brennan
- Department of Family Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH
| | | | - Lindsay Fazio
- NorthShore University Health System and University of Chicago Family Medicine Residency, Chicago, IL
| | - Aaron Grace
- Waukesha Family Medicine Residency at ProHealthCare Inc, Waukesha, WI | Medical College of Wisconsin, Milwaukee
| | - Mari Ricker
- Department of Family and Community Medicine, University of Arizona College of Medicine, Tucson, AZ
| | - Amy Romain
- Sparrow/Michigan State University Family Medicine Residency, Lansing, MI
| | - Jill Schneiderhan
- Department of Family Medicine, University of Michigan, Ann Arbor, MI
| | - Peter F Cronholm
- Department of Family Medicine and Community Health, Center for Public Health, Leonard Davis Institute of Health Economics, University of Pennsylvania School of Medicine, Philadelphia, PA
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10
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Ganetzky DBM, Purcell A, Truchil R, Tjaden AL, Cronholm PF. Patient-Centered Hypertension Management: Two Team-Based Models. Fam Pract Manag 2023; 30:12-16. [PMID: 37432165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
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11
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Okah E, Cronholm PF, Crow B, Persaud A, Westby A, Bonham VL. Race-Based Care and Beliefs Regarding the Etiology of Racial Differences in Health Outcomes. Am J Prev Med 2023; 64:477-482. [PMID: 36935165 PMCID: PMC10031413 DOI: 10.1016/j.amepre.2022.10.019] [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: 06/23/2022] [Revised: 10/12/2022] [Accepted: 10/28/2022] [Indexed: 02/11/2023]
Abstract
INTRODUCTION Physicians' perspectives regarding the etiology of racial health differences may be associated with their use of race in clinical practice (race-based practice). This study evaluates whether attributing racial differences in health to genetics, culture, or social conditions is associated with race-based practice. METHODS This is a cross-sectional analysis, conducted in 2022, of the Council of Academic Family Medicine Education Research Alliance 2021 general membership survey. Only actively practicing U.S. physicians were included. The survey included demographic questions; the Racial Attributes in Clinical Evaluation (RACE) scale (higher scores imply greater race-based practice); and 3 questions regarding beliefs that racial differences in genetics, culture (e.g., health beliefs), or social conditions (e.g., education) explained racial differences in health. Three multivariable linear regressions were used to evaluate the relationship between RACE scores and beliefs regarding the etiology of racial differences in health. RESULTS Of the 4,314 survey recipients, 949 (22%) responded, of whom 689 were actively practicing U.S. physicians. In multivariable regressions controlling for age, gender, race, ethnicity, and practice characteristics, a higher RACE score was associated with a greater belief that differences in genetics (β=3.57; 95% CI=3.19, 3.95) and culture (β=1.57; 95% CI=0.99, 2.16)-in but not social conditions-explained differences in health. CONCLUSIONS Physicians who believed that genetic or cultural differences between racial groups explained racial differences in health outcomes were more likely to use race in clinical care. Further research is needed to determine how race is differentially applied in clinical care on the basis of the belief in its genetic or cultural significance.
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Affiliation(s)
- Ebiere Okah
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Family Medicine and Community Health, School of Medicine, University of Minnesota, Minneapolis, Minnesota.
| | - Peter F Cronholm
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania; The Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brendan Crow
- Family Medicine Residency Program, Mountain Area Health Education Center (MAHEC), Asheville, North Carolina
| | - Anitra Persaud
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; National Human Genome Research Institute, NIH, Bethesda, Maryland
| | - Andrea Westby
- Department of Family Medicine and Community Health, School of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Vence L Bonham
- National Human Genome Research Institute, NIH, Bethesda, Maryland
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Cronholm PF, Kellum WE, MacCombie A, Nelson M, Neergaard R, Haywood O, Parido ME, Melochick J, Tarka DK, Barg FK. Engaging Stakeholders to Improve Care for Adults with Complex Health and Social Needs during a Public Health Emergency. J Health Care Poor Underserved 2023. [DOI: 10.1353/hpu.2023.0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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13
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Klusaritz H, Bilger A, Paterson E, Summers C, Barg FK, Cronholm PF, Saine ME, Sochalski J, Doubeni CA. Impact of Stigma on Clinician Training for Opioid Use Disorder Care: A Qualitative Study in a Primary Care Learning Collaborative. Ann Fam Med 2023; 21:S31-S38. [PMID: 36849482 PMCID: PMC9970664 DOI: 10.1370/afm.2920] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 08/02/2022] [Revised: 10/03/2022] [Accepted: 10/12/2022] [Indexed: 03/01/2023] Open
Abstract
PURPOSE We undertook a study to examine how stigma influences the uptake of training on medication for opioid use disorder (MOUD) in primary care academic programs. METHODS We conducted a qualitative study of 23 key stakeholders responsible for implementing MOUD training in their academic primary care training programs that were participants in a learning collaborative in 2018. We assessed barriers to and facilitators of successful program implementation and used an integrated approach to develop a codebook and analyze the data. RESULTS Participants represented the family medicine, internal medicine, and physician assistant fields, and they included trainees. Most participants described clinician and institutional attitudes, misperceptions, and biases that enabled or hindered MOUD training. Perceptions included concerns that patients with OUD are "manipulative" or "drug seeking." Elements of stigma in the origin domain (ie, beliefs by primary care clinicians or the community that OUD is a choice and not a disease), the enacted domain (eg, hospital bylaws banning MOUD and clinicians declining to obtain an X-Waiver to prescribe MOUD), and the intersectional domain (eg, inadequate attention to patient needs) were perceived as major barriers to MOUD training by most respondents. Participants described strategies that improved the uptake of training, including giving attention to clinician concerns, clarifying the biology of OUD, and ameliorating clinician fears of being ill equipped to provide care for patients. CONCLUSIONS OUD-related stigma was commonly reported in training programs and impeded the uptake of MOUD training. Potential strategies to address stigma in the training context, beyond providing content on effective evidence-based treatments, include addressing the concerns of primary care clinicians and incorporating the chronic care framework into OUD treatment.
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Affiliation(s)
- Heather Klusaritz
- The National Center for Integrated Behavioral Health in Primary Care, Rochester, Minnesota and Philadelphia, Pennsylvania.,Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Andrea Bilger
- The National Center for Integrated Behavioral Health in Primary Care, Rochester, Minnesota and Philadelphia, Pennsylvania.,Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Emily Paterson
- The National Center for Integrated Behavioral Health in Primary Care, Rochester, Minnesota and Philadelphia, Pennsylvania.,Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Courtney Summers
- The National Center for Integrated Behavioral Health in Primary Care, Rochester, Minnesota and Philadelphia, Pennsylvania.,Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Frances K Barg
- The National Center for Integrated Behavioral Health in Primary Care, Rochester, Minnesota and Philadelphia, Pennsylvania.,Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Peter F Cronholm
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania
| | - M Elle Saine
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Julie Sochalski
- The National Center for Integrated Behavioral Health in Primary Care, Rochester, Minnesota and Philadelphia, Pennsylvania.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.,School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Chyke A Doubeni
- The National Center for Integrated Behavioral Health in Primary Care, Rochester, Minnesota and Philadelphia, Pennsylvania .,Department of Family and Community Medicine, The Ohio State University, Columbus, Ohio
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14
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Gregory EF, Cronholm PF, Johnson GT, Maddox AI, Kellom K, Levine LD, Lorch SA, Fiks AG, Resnicow K. A Qualitative Study of Perspectives of Black Women on Autonomy and Motivational Interviewing. Womens Health Rep (New Rochelle) 2023; 4:94-102. [PMID: 36874236 PMCID: PMC9983129 DOI: 10.1089/whr.2022.0094] [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] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/16/2023] [Indexed: 02/24/2023]
Abstract
Purpose Motivational interviewing (MI) is an evidence-based strategy to modify health behaviors, including some risk factors for adverse birth outcomes. Black women, who have disproportionately high rates of adverse birth outcomes, have reported mixed preferences on MI. This study explored the acceptability of MI among Black women who are at high risk for adverse birth outcomes. Methods We conducted qualitative interviews with women with a history of preterm birth. Participants were English-language proficient and had Medicaid-insured infants. We purposively oversampled women whose infants had medical complexity. Interviews explored experiences with health care and health behaviors after birth. The interview guide was iteratively developed to obtain specific reactions to MI by including videos demonstrating MI-consistent and MI-inconsistent counseling. Interviews were audio recorded, transcribed, and coded following an integrated approach in which we applied a priori codes related to MI and allowed themes to emerge from the data. Results We interviewed 30 non-Hispanic Black women from October 2018 to July 2021. Eleven viewed the videos. Participants emphasized the importance of autonomy in decision-making and health behavior. Participants expressed a preference for MI-consistent clinical approaches, including autonomy support and building rapport, considering them respectful, nonjudgmental, and likely to support change. Conclusions In this sample of Black women with a history of preterm birth, participants valued an MI-consistent clinical approach. Incorporating MI into clinical care may improve the experience of health care among Black women, thus serving as one strategy to promote equity in birth outcomes.
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Affiliation(s)
- Emily F Gregory
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Peter F Cronholm
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Geminesse T Johnson
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Adya I Maddox
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Katherine Kellom
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Lisa D Levine
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Maternal Fetal Medicine Research Program, Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Scott A Lorch
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Alexander G Fiks
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kenneth Resnicow
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
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15
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Hare AJ, Honig K, Cronholm PF, Shabazz-McKlaine S, Morgan AU. Patient perspectives on technology-based approaches to social needs screening. Am J Manag Care 2023; 29:e18-e23. [PMID: 36716160 DOI: 10.37765/ajmc.2023.89309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES Social determinants have an outsized impact on health outcomes. Given the increasing awareness of this impact and the adoption of alternative payment models that incentivize addressing social needs, expectations are growing that health systems will appropriately screen for patients' social needs. However, there is limited evidence on how patients would like their health systems to engage with them around these needs. Our objective was to understand patient perspectives on completing social needs screening through technology-based modalities. STUDY DESIGN We performed a qualitative study with semistructured patient interviews from November 2021 to April 2022. METHODS Patients were eligible for our health system's standardized social needs screening survey if they had not completed it in the past year and were scheduled for a nonacute primary care visit. Patients were selected for interview if they completed the survey via portal or tablet or if they were eligible for but did not complete the survey. Interviews were analyzed using an integrated approach. Domains, subdomains, and themes were identified. RESULTS We completed interviews with 54 participants. Participants were broadly accepting of screening, and most were comfortable with portal or tablet-based screening. They were motivated to complete the screening and recognized the connection between social needs and health. Having a trusting relationship with their clinician and feeling that their information was private were noted by patients as important factors for process endorsement. CONCLUSIONS This qualitative study provides insight into patient-centered approaches for identifying patients' social needs.
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Affiliation(s)
- Allison J Hare
- Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115.
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16
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Grace A, Brennan J, Buck K, Cronholm PF, Fazio L, Kulshreshtha A, Ricker M, Romain A, Ross V, Schneiderhan J, Penwell-Waines L. Wellness in the Time of COVID: A CERA Follow-up Survey of Program Directors. Fam Med 2022; 54:713-717. [PMID: 36219428 DOI: 10.22454/fammed.2022.394088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES Residency program directors (PDs) are tasked with supporting resident well-being, and a 2018-2019 CERA survey found PDs to be generally satisfied with residency wellness curricula. However, less is known about graduate medical education wellness programming following the unprecedented social and public health stressors of 2020. This study aimed to evaluate PDs' satisfaction with wellness programming and perceived changes in wellness program implementation in the context of these factors. METHODS An online survey was administered by CERA to the program directors of all ACGME-accredited, US-based family medicine residencies. The survey replicated a 2018 CERA survey and assessed PDs' satisfaction with the wellness curriculum and which wellness curricular elements were currently implemented in the residency. RESULTS The survey was completed by 263 PDs (42% response rate). There was no difference in total number of wellness curricular elements reported in programs in 2021 (M=9.85) vs 2018 (M=9.57; P=.377). Compared to the 2018 survey, PDs reported increased assessment of resident burnout (P=.02), increased scheduled time for personal needs (P=.002), but decreased scheduled time for interpersonal connection (P=.017). Most PDs reported increased emphasis on wellness and the same or increased access to wellness resources compared to 2018 χ2 indicated no significant difference in PD satisfaction with wellness programming between the two years (P=.84). CONCLUSIONS Despite significant social and public health challenges to curriculum delivery, family medicine PDs did not perceive significant reductions in wellness programming, and in fact reported increases in some specific curricular elements and an overall increased emphasis on well-being. Future studies should explore the factors that facilitate and impede the implementation of wellness programming.
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Affiliation(s)
- Aaron Grace
- Waukesha Family Medicine Residency at ProHealthCare Inc, Waukesha, WI.,Medical College of Wisconsin, Milwaukee
| | - Julie Brennan
- Department of Family Medicine, University of Toledo Medical Center, Maumee, OH
| | - Katherine Buck
- John Peter Smith Family Medicine Residency, Ft Worth, TX
| | - Peter F Cronholm
- Department of Family Medicine and Community Health, Center for Public Health initiatives, Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Lindsay Fazio
- NorthShore University Health System and University of Chicago Family Medicine Residency, Chicago, IL
| | - Ambar Kulshreshtha
- Department of Family and Preventive Medicine, Emory University, Atlanta, GA
| | - Mari Ricker
- Department of Family and Community Medicine, University of Arizona College of Medicine, Tucson, AZ
| | - Amy Romain
- Sparrow/Michigan State University Family Medicine Residency Program, Lansing, MI.,and the Department of Family Medicine of Michigan State University College of Human Medicine, East Lansing, MI
| | - Valerie Ross
- University of Washington Family Medicine Residency Program, Seattle, WA
| | - Jill Schneiderhan
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI
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17
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Schiel K, Everard KM, Hooks-Anderson D, Cronholm PF. People, Not Programs: Improving Diversity in the Family Medicine Workforce. Fam Med 2022; 54:718-721. [PMID: 36219429 DOI: 10.22454/fammed.2022.683878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND AND OBJECTIVES Patients are best served by a health care workforce that reflects the diversity of their community. Increasing diversity of family medicine requires a long-term effort to recruit more medical students from underrepresented in medicine (URiM, defined as people of Black/African American, Hispanic/Latino, Native American or Pacific Islander heritage) backgrounds into family medicine residencies. This paper examines factors that influence URiM medical students to choose family medicine residencies. METHODS Data were collected via a Council of Academic Family Medicine Educational Research Alliance (CERA) survey of family medicine clerkship directors. Correlations examined associations between the percent URiM faculty, percent URiM preceptors, percent clerkship cases addressing health equity, and the percent of URiM students choosing family medicine residencies. t tests determined associations between clerkship director race, preclinical electives on health equity, department faculty champion for diversity, and department diversity activities; and the percentage of URiM students choosing family medicine residencies. RESULTS Survey response rate was 49%. Two factors had a positive relationship with the percentage of graduating students who were URiM choosing family medicine residencies: having a higher percentage of faculty who were URiM (r=0.33, P=.004) and having a higher percentage of preceptors who are URiM (rs=.386, P=.001). We found no such association for having cases addressing health equity, offering preclinical electives, departments with a faculty champion for diversity, clerkship director race, or a department's diversity activities. CONCLUSIONS The presence of teaching faculty and community preceptors from URiM backgrounds is correlated with the rate at which students who are URiM choose family medicine. People, rather than activities, seem to influence the career choices of students from URiM backgrounds.
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Affiliation(s)
| | - Kelly M Everard
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St Louis, MO
| | | | - Peter F Cronholm
- Department of Family Medicine and Community Health, Center for Public Health initiatives, Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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18
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Gmuca S, Weiss PF, McGill M, Xiao R, Ward M, Nelson M, Sherry DD, Cronholm PF, Gerber JS, Palermo TM, Young JF, Rosenberg AR. The Feasibility and Acceptability of Resilience Coaching for Adolescent Chronic Musculoskeletal Pain: A Single-Arm Pilot Trial. Children 2022; 9:children9101432. [PMID: 36291374 PMCID: PMC9600525 DOI: 10.3390/children9101432] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/14/2022] [Accepted: 09/16/2022] [Indexed: 11/16/2022]
Abstract
Promoting Resilience in Stress Management (PRISM) is a well-established resilience coaching program for youth with chronic illness. It is a one-on-one intervention targeting skills in stress management, goal-setting, cognitive reframing, and meaning-making. We aimed to (i) assess the feasibility and acceptability of PRISM and (ii) explore PRISM’s impact on clinical outcomes among youth with chronic musculoskeletal pain (CMP). This was a single-arm pilot trial of PRISM for youth with CMP aged 12–17 years. Patients completed patient-reported outcome measures (PROs) pre- and post- intervention; patients and caregivers provided qualitative feedback. Twenty-seven patients were enrolled (63% enrollment rate); 82% percent were female. The patients’ median age was 16 years (IQR: 13–16). The intervention completion rate was 81% (n = 22). The mean satisfaction for PRISM overall was 4.3 (SD 0.9), while the mean acceptability of the intervention measure (AIM) was 4.4 (SD 0.89). Participants reported improved resilience (2.2 [SD 5.1]), functional disability (−3.5 [IQR: −6.0, 1.0]), and psychological distress (−1.0 [−5.0, 2.0]) from baseline to immediately post-treatment; pain intensity, pain catastrophizing, and global health were similar at both time points. Feedback was positive and suggested that a group component may be helpful. PRISM is feasible and acceptable among youth with CMP. Exploratory analyses suggest improvements in clinically relevant outcomes, warranting further investigation.
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Affiliation(s)
- Sabrina Gmuca
- Department of Pediatrics, Division of Rheumatology, Children’s Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, 11-121, Philadelphia, PA 19146, USA
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA 19146, USA
- PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA 19146, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Palliative Care and Resilience Program, Seattle Children’s Research Institute, Seattle, WA 98145, USA
- Correspondence: ; Tel.: +1-(718)-614-5251 or +1-(215)-590-2547; Fax: +1-(215)-590-4750
| | - Pamela F. Weiss
- Department of Pediatrics, Division of Rheumatology, Children’s Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, 11-121, Philadelphia, PA 19146, USA
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA 19146, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Mackenzie McGill
- Department of Pediatrics, Division of Rheumatology, Children’s Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, 11-121, Philadelphia, PA 19146, USA
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA 19146, USA
- PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA 19146, USA
| | - Rui Xiao
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA 19146, USA
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Michaela Ward
- Mixed Methods Research Lab, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Maria Nelson
- Mixed Methods Research Lab, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - David D. Sherry
- Department of Pediatrics, Division of Rheumatology, Children’s Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, 11-121, Philadelphia, PA 19146, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Peter F. Cronholm
- Mixed Methods Research Lab, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Family Medicine and Community Health, Center for Public Health Initiatives, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Jeffrey S. Gerber
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA 19146, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Pediatrics, Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, PA 19146, USA
| | - Tonya M. Palermo
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Jami F. Young
- PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA 19146, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, Seattle, WA 98145, USA
- Department of Child and Adolescent Psychiatry and Behavioral Services, Children’s Hospital of Philadelphia, Philadelphia, PA 19146, USA
| | - Abby R. Rosenberg
- Palliative Care and Resilience Program, Seattle Children’s Research Institute, Seattle, WA 98145, USA
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA 98104, USA
- Department of Pediatrics, Division of Hematology/Oncology, University of Washington School of Medicine, Seattle, WA 98195, USA
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Cronholm PF, Kellum WE, Lawer JAR, Farris AM, Jacobs LM, Wood JC, Barg FK. Developing a Research Agenda for Adults with Complex Health and Social Needs. J Health Care Poor Underserved 2022; 33:1597-1611. [DOI: 10.1353/hpu.2022.0087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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20
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DuPrey KM, Char AS, Loose SR, Suffredini MV, Walpole K, Cronholm PF. Effect of Sleep-Related Symptoms on Recovery From a Sport-Related Concussion. Orthop J Sports Med 2022; 10:23259671221105256. [PMID: 35859645 PMCID: PMC9290123 DOI: 10.1177/23259671221105256] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 03/31/2022] [Indexed: 11/16/2022] Open
Abstract
Background Sleep issues are commonly reported in athletes after a sport-related concussion (SRC). Further studies are needed to evaluate screening methods for sleep disturbances and the risk of persisting symptoms after an SRC. Purpose To evaluate the association between the Sport Concussion Assessment Tool 5 (SCAT5) symptoms of trouble falling asleep, fatigue (or low energy), and drowsiness and the risk of persisting symptoms (≥28 days to recovery) in adolescent athletes. Study Design Cohort study; Level of evidence, 3. Methods A total of 519 athletes aged 13 to 18 years reported any sleep-related symptoms with an SRC, scored as none (0), mild (1-2), moderate (3-4), or severe (5-6), at their initial office visit (median, 5.4 days after an SRC). Scores were correlated with the risk of persisting symptoms. A composite "sleep cluster" score (range, 0-18) was calculated by summing the SCAT5 component items for trouble falling asleep, fatigue, and drowsiness. Results The results indicated that, compared with athletes who reported that they did not have each symptom, (1) athletes who reported mild, moderate, or severe trouble falling asleep were 3.0, 4.6, and 6.7 times more likely to have persisting symptoms, respectively; (2) athletes reporting mild, moderate, or severe fatigue (or low energy) were 2.6, 4.8, and 7.6 times more likely to have persisting symptoms, respectively; and (3) athletes reporting mild, moderate, or severe drowsiness were 1.9, 4.6, and 6.8 times more likely to have persisting symptoms, respectively (P < .001 for all). For every 1-point increase in the sleep cluster score, there was a 1.2-fold increased risk of persisting symptoms and an additional 2.4 days of recovery required (P < .001 for both). Conclusion Athletes who reported mild, moderate, or severe sleep-related symptoms on the SCAT5 were at a proportionally increased risk of persisting symptoms at the initial office visit.
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Affiliation(s)
- Kevin M DuPrey
- Department of Sports Medicine, Crozer Health, Springfield, Pennsylvania, USA
| | - Amber S Char
- Department of Sports Medicine, Crozer Health, Springfield, Pennsylvania, USA
| | - Sean R Loose
- Department of Sports Medicine, Crozer Health, Springfield, Pennsylvania, USA
| | | | - Kevin Walpole
- Department of Sports Medicine, Crozer Health, Springfield, Pennsylvania, USA
| | - Peter F Cronholm
- Department of Family Medicine and Community Health, Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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21
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Sanders M, Cronholm PF, Edgoose J, Fiscella K, Piggott C, McDaniel SH, Parker-Featherstone E, Fogarty CT. Evaluating the Uptake of Antiracism Training, Policies, and Practices in Departments of Family Medicine. J Am Board Fam Med 2022; 35:803-808. [PMID: 35896463 DOI: 10.3122/jabfm.2022.04.210471] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/15/2021] [Accepted: 02/08/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Recent attention and focus on, antiracism training in health care has potential to accelerate our path to social justice and achieve health equity on a national scale. However, theoretical frameworks and empirical data have yet to emerge that explain the uptake of antiracism trainings and their efficacy. OBJECTIVE This goal of this study was to test hypotheses regarding uptake of antiracism training in Family Medicine departments using Diffusion of Innovation Theory. METHODS In 2021, we incorporated 10 survey items in the Council of Academic Family Medicine Educational Research Alliance's national omnibus survey for Department of Family Medicine Chairs (n = 104). We used DOI (Diffusion of Innovation) attributes (ie, relative advantage, compatibility, complexity, trialability, and observability) as a guiding framework to assess perceived innovation of antiracism training. We also evaluated the mode of training (eg, didactic, experiential) and whether any subsequent policy or practice-level antiracist actions occurred. We used c2 tests to examine associations between DOI attributes and antiracist actions; and logistic regression to determine odds of association. RESULTS Ninety-two percent of respondents indicated antiracism training was happening in their department. Relative advantage, compatibility and observability were positively associated with antiracist actions, P < .05. Perceived relative advantage was associated with implementation of antiracist action (OR 1.94, 1.27-2.99). Complexity and trialability were not statistically significantly associated with action. CONCLUSION Our findings provide evidence of DOIs influence on antiracism uptake in Departments of Family Medicine. We believe our findings can facilitate the future implementation of antiracism training activities and actionable antiracist policies and practices.
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Affiliation(s)
- Mechelle Sanders
- From Department of Family Medicine, University of Rochester, Rochester, NY (MS, KF, CTF), Department of Family Medicine and Community Health, Center for Public Health Initiatives, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA (PFC), Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI (JE), Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO (CP), Department of Family Medicine, Director of Institute for the Family and Chief of Psychology, Department of Psychiatry, University of Rochester, Rochester, NY (SHM), Department of Family Medicine, University of Michigan, Ann Arbor, MI (EP).
| | - Peter F Cronholm
- From Department of Family Medicine, University of Rochester, Rochester, NY (MS, KF, CTF), Department of Family Medicine and Community Health, Center for Public Health Initiatives, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA (PFC), Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI (JE), Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO (CP), Department of Family Medicine, Director of Institute for the Family and Chief of Psychology, Department of Psychiatry, University of Rochester, Rochester, NY (SHM), Department of Family Medicine, University of Michigan, Ann Arbor, MI (EP)
| | - Jennifer Edgoose
- From Department of Family Medicine, University of Rochester, Rochester, NY (MS, KF, CTF), Department of Family Medicine and Community Health, Center for Public Health Initiatives, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA (PFC), Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI (JE), Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO (CP), Department of Family Medicine, Director of Institute for the Family and Chief of Psychology, Department of Psychiatry, University of Rochester, Rochester, NY (SHM), Department of Family Medicine, University of Michigan, Ann Arbor, MI (EP)
| | - Kevin Fiscella
- From Department of Family Medicine, University of Rochester, Rochester, NY (MS, KF, CTF), Department of Family Medicine and Community Health, Center for Public Health Initiatives, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA (PFC), Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI (JE), Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO (CP), Department of Family Medicine, Director of Institute for the Family and Chief of Psychology, Department of Psychiatry, University of Rochester, Rochester, NY (SHM), Department of Family Medicine, University of Michigan, Ann Arbor, MI (EP)
| | - Cleveland Piggott
- From Department of Family Medicine, University of Rochester, Rochester, NY (MS, KF, CTF), Department of Family Medicine and Community Health, Center for Public Health Initiatives, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA (PFC), Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI (JE), Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO (CP), Department of Family Medicine, Director of Institute for the Family and Chief of Psychology, Department of Psychiatry, University of Rochester, Rochester, NY (SHM), Department of Family Medicine, University of Michigan, Ann Arbor, MI (EP)
| | - Susan H McDaniel
- From Department of Family Medicine, University of Rochester, Rochester, NY (MS, KF, CTF), Department of Family Medicine and Community Health, Center for Public Health Initiatives, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA (PFC), Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI (JE), Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO (CP), Department of Family Medicine, Director of Institute for the Family and Chief of Psychology, Department of Psychiatry, University of Rochester, Rochester, NY (SHM), Department of Family Medicine, University of Michigan, Ann Arbor, MI (EP)
| | - Ebony Parker-Featherstone
- From Department of Family Medicine, University of Rochester, Rochester, NY (MS, KF, CTF), Department of Family Medicine and Community Health, Center for Public Health Initiatives, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA (PFC), Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI (JE), Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO (CP), Department of Family Medicine, Director of Institute for the Family and Chief of Psychology, Department of Psychiatry, University of Rochester, Rochester, NY (SHM), Department of Family Medicine, University of Michigan, Ann Arbor, MI (EP)
| | - Colleen T Fogarty
- From Department of Family Medicine, University of Rochester, Rochester, NY (MS, KF, CTF), Department of Family Medicine and Community Health, Center for Public Health Initiatives, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA (PFC), Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI (JE), Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO (CP), Department of Family Medicine, Director of Institute for the Family and Chief of Psychology, Department of Psychiatry, University of Rochester, Rochester, NY (SHM), Department of Family Medicine, University of Michigan, Ann Arbor, MI (EP)
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22
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Lombard PK, Cronholm PF, Forke CM. Practical Guidance for Using Behavioral Risk Factor Surveillance System Data: Merging States and Scoring Adverse Childhood Experiences. Am J Prev Med 2022; 62:e357-e365. [PMID: 35120769 DOI: 10.1016/j.amepre.2021.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/11/2021] [Accepted: 11/19/2021] [Indexed: 11/01/2022]
Abstract
INTRODUCTION The Behavioral Risk Factor Surveillance System is a national health-related survey with an optional adverse childhood experience (ACE) module. States use varying methodologies, question formats, and sampling frames, and little guidance exists for conducting multistate explorations of adverse childhood experiences. In this study, 6 adverse childhood experience scoring approaches are compared, and practical recommendations are offered for when and how each approach can be utilized most effectively. METHODS This study used 2015 Behavioral Risk Factor Surveillance System data from the adverse childhood experience module administered by 6 states. Data were merged and analyzed between 2018 and 2021. To understand how adverse childhood experience scoring may impact estimates of association, concordance/discordance among 6 approaches (continuous versus categorical, states that collected all adverse childhood experiences versus those that collected any adverse childhood experiences, and normalized versus standard scores) was evaluated. Using separate weighted multivariable logistic regression models controlling for confounders, the relationship between adverse childhood experiences using each approach and the presence of 10 chronic health conditions was also assessed. RESULTS Comparisons revealed discordance for categorical versus continuous approaches (30%) and all-ACEs versus any-ACEs (20%) but full concordance for standard versus normalized approaches. Discordance occurred more frequently with low-prevalence outcomes (≤7.0%) and lower-exposure samples (any-ACEs). CONCLUSIONS Results revealed general concordance across adverse childhood experience scoring approaches when outcomes commonly occurred and when the sample was limited to just states that asked the full array of adverse childhood experiences. However, on a deeper exploration of discordant findings, specific nuances were uncovered that may help guide researchers when deciding on which approach to use on the basis of the research question and conceptual model driving study objectives.
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Affiliation(s)
- Paige K Lombard
- Master of Public Health Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Barbara and Edward Netter Center for Community Partnerships, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Peter F Cronholm
- The Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christine M Forke
- Master of Public Health Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; The Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania; Center for Violence Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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23
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Morone JF, Cronholm PF, Teitelman AM, Hawkes CP, Lipman TH. Underrepresented Voices: Impacts of Social Determinants of Health on Type 1 Diabetes Family Management in Single Parent Black Families. Can J Diabetes 2022; 46:602-610.e1. [DOI: 10.1016/j.jcjd.2022.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 04/16/2022] [Accepted: 05/25/2022] [Indexed: 10/18/2022]
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24
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Ferber MF, Zubatsky M, Jacobs CK, Cronholm PF. COVID-19 Exposure Risk, Burnout, and Shifts in Family Medicine Faculty’s Efforts: A National Survey. Fam Med 2022; 54:193-199. [DOI: 10.22454/fammed.2022.449601] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background and Objectives: In response to the COVID-19 pandemic, academic family physicians had to change their clinical, teaching, research, and administrative efforts, while simultaneously balancing their home environment demands. It is unclear how the changes in effort affected physicians’ personal well-being, particularly burnout. This study sought to identify changes in faculty’s clinical, teaching, research, and administrative efforts during the COVID-19 pandemic and how effort shifts were associated with burnout. We also examined associations with important demographics and burnout.
Methods: We took data from the 2020 Council of Academic Family Medicine’s Educational Research Alliance survey of family medicine educators and practicing physicians during November 2020 through December 2020. We analyzed self-report measures of demographics, effort (clinical, teaching, research, and administrative) before and during the pandemic, COVID-19 exposure level, and rates of burnout (emotional exhaustion and depersonalization) using logistic regressions.
Results: Most participants reported no change in efforts. If changes were reported, clinical (21.6%) and administrative (24.8%) efforts tended to increase from before to during the pandemic, while teaching tended to decrease (27.7%). Increases in teaching and clinical efforts were associated with higher rates of emotional exhaustion. Higher depersonalization was associated with increased clinical efforts. Being older and working in a rural setting was associated with lower burnout, while being female was associated with higher burnout.
Conclusions: Shifts in effort across academic family physicians’ multiple roles were associated with emotional exhaustion and, to a lesser degree, depersonalization. The high rates of burnout demand additional attention from directors and administrators, especially among female physicians.
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Affiliation(s)
- Megan Ferriby Ferber
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St Louis, MO
| | - Max Zubatsky
- Department of Family and Community Medicine, Saint Louis University, St Louis, MO
| | - Christine K. Jacobs
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St Louis, MO
| | - Peter F. Cronholm
- Department of Family Medicine and Community Health, Center for Public Health initiatives, Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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25
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Jacobs CK, Ferber MF, Zubatsky M, Cronholm PF. Faculty Engagement and Productivity During the COVID-19 Pandemic. Fam Med 2022; 54:107-113. [DOI: 10.22454/fammed.2022.355977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background and Objectives: COVID-19 has had an unprecedented effect on faculty of academic family medicine departments. We sought to characterize faculty’s self-reported changes in engagement and productivity in clinical, education, and scholarly efforts during the COVID-19 pandemic, and to correlate the changes with age, gender, and level of COVID-19 exposure. We also sought to determine if differences in faculty engagement and productivity were related to departmental efforts to create virtual community, manage conflict, foster engagement with colleagues, and support faculty emotional well-being.
Methods: We surveyed family medicine department faculty nationally on the effects of the COVID-19 pandemic on their engagement and productivity in clinical care, teaching and research, and on the effect of departmental efforts on well-being.
Results: Most respondents reported decreased engagement and productivity across clinical, teaching, and research domains. Older age and male gender were associated with higher clinical engagement. Most respondents were satisfied with their departments’ virtual community but reported that social distancing had a negative impact on departmental ability to problem-solve and on personal emotional well-being. Higher engagement and productivity in all three domains of effort (clinical, teaching, and research) were associated with respondents’ well-being and with positive perceptions of their department’s efforts.
Conclusions: Clinical, teaching, and research engagement and productivity for academic family physicians decreased during the COVID-19 pandemic. Faculty well-being and departmental interventions lessened the impact of diminished productivity and research engagement.
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Affiliation(s)
- Christine K. Jacobs
- Saint Louis University Department of Family and Community Medicine, St Louis, MO
| | - Megan Ferriby Ferber
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St Louis, MO
| | - Max Zubatsky
- Department of Family and Community Medicine, Saint Louis University, St Louis, MO
| | - Peter F. Cronholm
- Department of Family Medicine and Community Health, Center for Public Health initiatives, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
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Abstract
BACKGROUND AND OBJECTIVES Preexposure prophylaxis (PrEP) reduces HIV transmission among high-risk individuals. Yet, the HIV epidemic continues to expand among marginalized populations and America's Southeastern states. Various barriers remain to PrEP uptake, namely provider knowledge and education. We sought to investigate residency training, competency, and prescribing of PrEP among population size. Additionally, we asked program directors to identify barriers to PrEP. METHODS We surveyed family medicine program directors as part of the Council of Academic Family Medicine Educational Research Alliance survey from January 2018 through February 2018. RESULTS Our survey questions had a 52.9% (276/522) response rate. No programs in rural communities less than 30,000 population (0/27) reported significant PrEP training for their residents; those in nonrural communities of at least 30,000 reported this training more frequently (41/246, 16.7%). Compared to Fischer expected values, the finding was statistically significant (P=.019); using a 75,000 population demarcation lowered significance (P=.192). We found programs that identify significant PrEP training also cite more PrEP prescribing within their practice (OR 7.27, P<.001). Programs with significant training also report their residents graduate with greater PrEP competency (OR 18.33, P<.001). The largest barriers identified were faculty expertise, not having enough high-risk patients, inadequate screening, and resident knowledge/training. CONCLUSIONS We identified natural associations between increased training in PrEP and perceived PrEP competencies. We identified a lack of significant PrEP training and associated PrEP competencies in rural residency programs. Barriers identified in this study can help inform curricular needs to improve primary care workforce capacity to lower HIV risk.
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Affiliation(s)
| | - James N Becker
- Department of Family and Community Medicine, ChristianaCare Health System, Wilmington, DE
| | - Allison Myers
- MetroHealth Department of Family Medicine, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Peter F Cronholm
- Department of Family Medicine and Community Health, Center for Public Health initiatives, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
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27
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Kishton R, Sinko L, Ortiz R, Islam MN, Fredrickson A, Sheils NE, Buresh J, Cronholm PF, Matone M. Describing the Health Status of Women Experiencing Violence or Abuse: An Observational Study Using Claims Data. J Prim Care Community Health 2022; 13:21501319221074121. [PMID: 35345928 PMCID: PMC8968984 DOI: 10.1177/21501319221074121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction: Violence against women (VAW) can result in long-term and varied sequela for survivors, making it difficult to evaluate healthcare intervention. This study seeks to improve understanding of the healthcare experiences of women survivors prior to a violence-related diagnosis, allowing healthcare systems to better design strategies to meet the needs of this population. Methods: Using population-based data from 2016 to 2019, this cross-sectional observational study presents healthcare spending, utilization, and diagnostic patterns of privately insured women, age 18 or older, in the 10-months prior to an episode of care for a documented experience of violence (DEV). Results: Of 12 624 764 women meeting enrollment criteria, 10 980 women had DEV. This group had higher general medical complexity, despite being 10 years younger than the comparison group (mean age 32.7 vs 43.5). These relationships held up when comparing participants in each cohort by age. Additional key findings including higher numbers of medical visits across clinical settings and higher total cost ($10 138-$4585). Conclusions: The study utilized population-based data, to describe specific areas of health and medical cost for women with DEV. Increased medical complexity and utilization patterns among survivors broaden the understanding of the health profiles and healthcare touchpoints of survivors to inform and optimize strategies for medical system engagement and resource allocation for this public health crisis.
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Affiliation(s)
- Rachel Kishton
- University of Pennsylvania, Philadelphia, PA, USA
- Rachel Kishton, Department of Family Medicine and Community Health, Perelman School of Medicine at the University of Pennsylvania, Penn Presbyterian Medical Center Andrew Mutch Building, Floor 7, 51 N. 39th Street Philadelphia, PA 19104, USA.
| | - Laura Sinko
- Temple University College of Public Health, Philadelphia, PA, USA
| | - Robin Ortiz
- University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | - John Buresh
- OptumLabs at United Health Group, Minnetonka, MN, USA
| | | | - Meredith Matone
- University of Pennsylvania, Philadelphia, PA, USA
- Children’s Hospital of Philadelphia, Philadelphia, PA, USA
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28
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Morone JF, Teitelman AM, Cronholm PF, Hawkes CP, Lipman TH. Influence of social determinants of health barriers to family management of type 1 diabetes in Black single parent families: A mixed methods study. Pediatr Diabetes 2021; 22:1150-1161. [PMID: 34713537 DOI: 10.1111/pedi.13276] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 10/07/2021] [Accepted: 10/23/2021] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE US disparities in pediatric type 1 diabetes treatment and outcomes are increasing disproportionately among Black youth and compounded for youth from single parent homes. Despite worsened outcomes, Black youth from single parent homes and their caregivers are underrepresented in pediatric type 1 diabetes research. The purpose of this study was to understand the social determinants of health (SDOH) barriers that may contribute to health disparities and family management in Black youth with type 1 diabetes from single parent homes. RESEARCH DESIGN AND METHODS A three-phase mixed methods study with self-identified Black single parents of youth with type 1 diabetes from an urban US pediatric diabetes center was conducted. Focus groups and interviews informed development of a parent-generated survey of SDOH barriers to diabetes management. Survey results are presented. RESULTS A resulting 71 item parent-generated survey was administered to 105 parents. Among all items, most problematic SDOH barriers included lack of social support, managing parent/child diabetes-related stress, difficulties accessing diabetes supplies, pain management, cost of food and diabetes camp, need to take time off from work, lack of skilled school staff, school absences and unsafe neighborhoods. Structural racism related to child welfare reporting, and police targeting were also notable concerns. CONCLUSIONS There is a critical need for clinical, community, and policy-related research and interventions, designed to reduce type 1 diabetes racial health disparities by addressing the impacts of SDOH as drivers of family management outcomes among Black youth from single parent families.
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Affiliation(s)
- Jennifer F Morone
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,National Clinician Scholars Program, Yale University School of Medicine, New Haven, Connecticut, USA.,VA Connecticut Healthcare System, Veterans Health Administration, New Haven, Connecticut, USA
| | - Anne M Teitelman
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Peter F Cronholm
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Colin P Hawkes
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Terri H Lipman
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Abstract
BACKGROUND AND OBJECTIVES Academic family medicine departments have traditionally promoted faculty using research and scholarship criteria augmented by teaching, clinical care, and service. Clinic-focused faculty who spend significant time in direct patient care may not have enough time to meet promotion criteria, although they are critical for training future family physicians and for rebalancing the system of academic promotion. METHODS We surveyed family medicine department chairs on the effects of protected time for scholarship, presence of promotion and tenure (P and T) committees, salary increase, and special promotion tracks on promotion of physician faculty. RESULTS Promotion rates to both associate and full professor were higher for faculty with 25% time for scholarship than for clinic-focused faculty. For clinic-focused faculty, promotion rates to associate professor were higher than they were to full professor. No differences were found for promotion to associate professor and full professor for faculty with 25% protected time for scholarship. No differences were found in promotion rates for either rank between departments that had P and T committees and those that didn't, whether promotion came with a salary increase, or if departments had a special track for physician faculty whose job is patient care. CONCLUSIONS Promotion rates are higher for faculty with protected time for scholarship than for clinic-focused faculty for promotion to both associate and full professor. Clinic demands on faculty may reduce the likelihood of engaging in scholarship or research that in many academic family medicine departments is necessary for promotion.
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Affiliation(s)
- Christine K Jacobs
- Saint Louis University Department of Family and Community Medicine, St Louis, MO
| | - Kelly M Everard
- Department of Family Medicine, Saint Louis University School of Medicine, St Louis, MO
| | - Peter F Cronholm
- Center for Public Health Initiatives, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
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30
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Kanter K, Gallagher R, Eweje F, Lee A, Gordon D, Landy S, Gasior J, Soto-Calderon H, Cronholm PF, Cocchiaro B, Weimer J, Roth A, Lankenau S, Brenner J. Willingness to use a wearable device capable of detecting and reversing overdose among people who use opioids in Philadelphia. Harm Reduct J 2021; 18:75. [PMID: 34301246 PMCID: PMC8299455 DOI: 10.1186/s12954-021-00522-3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 06/30/2021] [Indexed: 02/02/2023] Open
Abstract
Background The incidence of opioid-related overdose deaths has been rising for 30 years and has been further exacerbated amidst the COVID-19 pandemic. Naloxone can reverse opioid overdose, lower death rates, and enable a transition to medication for opioid use disorder. Though current formulations for community use of naloxone have been shown to be safe and effective public health interventions, they rely on bystander presence. We sought to understand the preferences and minimum necessary conditions for wearing a device capable of sensing and reversing opioid overdose among people who regularly use opioids. Methods We conducted a combined cross-sectional survey and semi-structured interview at a respite center, shelter, and syringe exchange drop-in program in Philadelphia, Pennsylvania, USA, during the COVID-19 pandemic in August and September 2020. The primary aim was to explore the proportion of participants who would use a wearable device to detect and reverse overdose. Preferences regarding designs and functionalities were collected via a questionnaire with items having Likert-based response options and a semi-structured interview intended to elicit feedback on prototype designs. Independent variables included demographics, opioid use habits, and previous experience with overdose. Results A total of 97 adults with an opioid use history of at least 3 months were interviewed. A majority of survey participants (76%) reported a willingness to use a device capable of detecting an overdose and automatically administering a reversal agent upon initial survey. When reflecting on the prototype, most respondents (75.5%) reported that they would wear the device always or most of the time. Respondents indicated discreetness and comfort as important factors that increased their chance of uptake. Respondents suggested that people experiencing homelessness and those with low tolerance for opioids would be in greatest need of the device. Conclusions The majority of people sampled with a history of opioid use in an urban setting were interested in having access to a device capable of detecting and reversing an opioid overdose. Participants emphasized privacy and comfort as the most important factors influencing their willingness to use such a device. Trial registration NCT04530591. Supplementary Information The online version contains supplementary material available at 10.1186/s12954-021-00522-3.
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Affiliation(s)
- Katie Kanter
- Perelman School of Medicine, University of Pennsylvania, 3450 Hamilton Walk, Stemmler Building, Office #220, Philadelphia, PA, 19104, USA.,Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Ryan Gallagher
- Perelman School of Medicine, University of Pennsylvania, 3450 Hamilton Walk, Stemmler Building, Office #220, Philadelphia, PA, 19104, USA.,Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Feyisope Eweje
- Perelman School of Medicine, University of Pennsylvania, 3450 Hamilton Walk, Stemmler Building, Office #220, Philadelphia, PA, 19104, USA.,Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Alexander Lee
- Perelman School of Medicine, University of Pennsylvania, 3450 Hamilton Walk, Stemmler Building, Office #220, Philadelphia, PA, 19104, USA.,Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - David Gordon
- Ballinger, 833 Chestnut Street, Suite 1400, Philadelphia, PA, 19107, USA
| | - Stephen Landy
- Perelman School of Medicine, University of Pennsylvania, 3450 Hamilton Walk, Stemmler Building, Office #220, Philadelphia, PA, 19104, USA.,Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Julia Gasior
- Perelman School of Medicine, University of Pennsylvania, 3450 Hamilton Walk, Stemmler Building, Office #220, Philadelphia, PA, 19104, USA.,Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Haideliza Soto-Calderon
- Penn Department of Medicine Clinical Trials Unit, Anatomy-Chemistry Building, 1st Floor, Philadelphia, PA, 19104, USA
| | - Peter F Cronholm
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Center for Public Health Initiatives, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Ben Cocchiaro
- Prevention Point Philadelphia, 2913-15 Kensington Ave, Philadelphia, PA, 19134, USA.,Penn State College of Medicine, 500 University Dr, Hershey, PA, 17033, USA
| | - James Weimer
- Department of Computer and Information Science, University of Pennsylvania, Levine Hall, 3330 Walnut St, Philadelphia, PA, USA
| | - Alexis Roth
- Dornsife School of Public Health, Drexel University, Nesbitt Hall, 3215 Market St, Philadelphia, PA, 19104, USA
| | - Stephen Lankenau
- Dornsife School of Public Health, Drexel University, Nesbitt Hall, 3215 Market St, Philadelphia, PA, 19104, USA
| | - Jacob Brenner
- Perelman School of Medicine, University of Pennsylvania, 3450 Hamilton Walk, Stemmler Building, Office #220, Philadelphia, PA, 19104, USA. .,Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA.
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Nadler LE, Ogden SN, Scheffey KL, Cronholm PF, Dichter ME. Provider Practices and Perspectives regarding Collection and Documentation of Gender Identity. J Homosex 2021; 68:901-913. [PMID: 31526306 PMCID: PMC7676221 DOI: 10.1080/00918369.2019.1667162] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Recent recommendations to include patient sexual orientation (SO) and gender identity (GI) in the electronic health record (EHR) aim to improve clinical care and address health disparities among sexual and gender minority patients. Collection and documentation of GI may be complex due to multiple clinically relevant components. This study explored provider practices in collecting and documenting GI across multiple specialties. Qualitative interviews with 25 healthcare providers were transcribed verbatim, and thematic analysis and principles of grounded theory were used to analyze the data. Without a protocol and absent dedicated locations in the EHR for collecting and documenting patient GI, provider practices were inconsistent and highlighted challenges for communication across clinical staff. Providers noted that patients' disclosure of GI was typically unprompted, or was presumed through disclosure of gender affirming treatments. Findings indicate the need for provider training and appropriate EHR fields to support GI collection and documentation.
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Affiliation(s)
- Lauren E. Nadler
- Department of Family Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Shannon N. Ogden
- Department of Family Medicine and Community Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kathryn L. Scheffey
- Department of Family Medicine and Community Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Peter F. Cronholm
- Department of Family Medicine and Community Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Melissa E. Dichter
- School of Social Work, College of Public Health, Temple University, Philadelphia, Pennsylvania, USA
- Center for Health Equity Research and Promotion, U.S. Department of Veterans Affairs, Philadelphia, Pennsylvania, USA
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Wolk CB, Locke J, Salas E, Eiraldi R, Cronholm PF, Mandell D. An examination of the factor structure of TeamSTEPPS measures in school mental health teams. J Psychol Couns Sch 2020; 30:172-184. [PMID: 33777407 PMCID: PMC7995600 DOI: 10.1017/jgc.2019.18] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS™) is a tested strategy for improving communication and climate in hospitals. It is a promising but untested tool among school-based mental health teams. We examined the psychometric properties of the TeamSTEPPS Teamwork Perceptions Questionnaire (T-TPQ) and Teamwork Attitudes Questionnaire (T-TAQ) among 167 school mental health team members. Team members worked for one of five agencies in 33 K-8 urban public schools. Exploratory factor analyses and descriptive data are presented. For both the T-TPQ and T-TAQ, a unitary factor structure best fit the data for this sample. The T-TPQ and T-TAQ were not significantly correlated with one another and total scores did not significantly differ by staff role. Agencies differed in T-TAQ results, and one agency had lower T-TAQ total scores relative to other agencies. Results suggest that the factor structures are different among school mental health teams than among other healthcare providers.
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Affiliation(s)
- Courtney Benjamin Wolk
- Center for Mental Health Policy and Services Research, Perelman School of Medicine, University of Pennsylvania. 3535 Market Street, Floor 3, Philadelphia, PA 19104
- Corresponding author Phone: 215-746-6099; Fax: 215-349-8715
| | - Jill Locke
- Department of Speech and Hearing Sciences, University of Washington. 1701 NE Columbia Road, Seattle, WA 98195
| | - Eduardo Salas
- Department of Psychology, Rice University. P.O. Box 1892, Houston, TX 77251
| | - Ricardo Eiraldi
- Division of Developmental and Behavioral Pediatrics, Perelman School of Medicine, University of Pennsylvania, 2716 South Street, 8th floor, Philadelphia, PA 19146
| | - Peter F. Cronholm
- Department of Family Medicine and Community Health, University of Pennsylvania, 51 North 39th Street, 6th Floor Mutch Bld, Philadelphia, PA 19104
| | - David Mandell
- Center for Mental Health Policy and Services Research, Perelman School of Medicine, University of Pennsylvania. 3535 Market Street, Floor 3, Philadelphia, PA 19104
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Abstract
Background and Objectives: Breastfeeding counseling is an integral skill for all family physicians, regardless of whether they ultimately practice maternal child health (MCH). Evidence on time spent in breastfeeding education and resident competence is lacking. This study aimed to identify program characteristics associated with an increase the amount of breastfeeding education and program directors’ (PDs) perceived competence of residents’ breastfeeding counseling skills.
Methods: A national survey of family medicine PDs including breastfeeding questions was conducted as part of the 2019 CERA survey. We specifically sought to identify variables that correlate with increased breastfeeding education time and perceived competence.
Results: Family medicine programs with greatest breastfeeding education time and perceived resident competence included lactation consultants, had more MCH visits in resident continuity clinic, more graduates that practice MCH, and included competency evaluations by faculty. There was more volume of breastfeeding education in programs with group prenatal care and an academic affiliation. There was greater perceived competence among programs with more hours of breastfeeding training overall.
Conclusions: This study defines associations with curricular targets for improved breastfeeding counseling competence among family medicine residents. Inclusion of lactation consultants, regular faculty observation of counseling skills, and group prenatal care may be gradually introduced in programs to strengthen resident education and skills in breastfeeding counseling. The body of evidence in this field remains lacking, and further research is needed to characterize curricular interventions that increase resident competence in this important skill.
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Affiliation(s)
- Zeynep Uzumcu
- Department of Family and Community Medicine, Jefferson University Hospital, Philadelphia, PA
| | | | - Peter F. Cronholm
- Center for Public Health Initiatives, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
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Penwell-Waines L, Cronholm PF, Brennan J, Romain A, Runyan C, Buck K, Fazio L, Grace A, Ricker M, Ross V, Schneiderhan J, Talen M. Getting It Off the Ground: Key Factors Associated With Implementation of Wellness Programs. Fam Med 2020; 52:182-188. [DOI: 10.22454/fammed.2020.317857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background and Objectives: Many residency programs are developing resident wellness curricula to improve resident well-being and to meet Accreditation Council for Graduate Medical Education guidelines. However, there is limited guidance on preferred curricular components and implementation. We sought to identify how specific driving factors (eg, having an identified wellness champion with a budget and protected time to develop wellness programs) impact implementation of essential elements of a resident wellness curriculum.
Methods: We surveyed 608 family medicine residency program directors (PDs) in 2018-2019 on available resources for wellness programs, essential wellness elements being implemented, and satisfaction with wellness programming; 251 PDs provided complete responses (42.5% response rate). Linear and logistic regressions were conducted for main analyses.
Results: Having an identified wellness champion, protected time, and dedicated budget for wellness were associated with greater implementation of wellness programs and PD satisfaction with wellness programming; of these, funding had the strongest association. Larger programs were implementing more wellness program components. Program setting had no association with implementation.
Conclusions: PDs in programs allocating money and/or faculty time can expect more wellness programming and greater satisfaction with how resident well-being is addressed.
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Affiliation(s)
| | - Peter F. Cronholm
- Department of Family Medicine and Community Health, University of Pennsylvania, and Center for Public Health Initiatives, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - Julie Brennan
- Department of Family Medicine, University of Toledo Medical Center, Maumee, OH
| | - Amy Romain
- Department of Family Medicine, Michigan State University College of Human Medicine, East Lansing, MI
| | - Christine Runyan
- Department of Family Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Katherine Buck
- John Peter Smith Family Medicine, Residency, Ft Worth, TX
| | - Lindsay Fazio
- NorthShore University Health System and University of Chicago Family Medicine Residency, Chicago, IL
| | - Aaron Grace
- Waukesha Family Medicine Residency Program, Medical College of Wisconsin, Waukesha, WI
| | - Mari Ricker
- Department of Family and Community Medicine, University of Arizona College of Medicine, Tucson, AZ
| | - Valerie Ross
- University of Washington Family Medicine Residency Program, Seattle, WA
| | - Jill Schneiderhan
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Mary Talen
- Northwestern University Family Medicine Residency, Chicago, IL
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Klusaritz H, Bilger A, Paterson E, Summers C, Barg FK, Cronholm PF, Sochalski J. Treatment for Opioid Use Disorder in Primary Care: Opportunities and Challenges for Sustainable Training Programs. J Health Care Poor Underserved 2020; 31:332-343. [DOI: 10.1353/hpu.2020.0157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Beltrán S, Lett E, Cronholm PF. Nonadherence Labeling in Primary Care: Bias by Race and Insurance Type for Adults With Type 2 Diabetes. Am J Prev Med 2019; 57:652-658. [PMID: 31564598 DOI: 10.1016/j.amepre.2019.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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] [Received: 01/17/2019] [Revised: 06/04/2019] [Accepted: 06/05/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Little is known about how provider bias can influence nonadherence labeling. Therefore, a retrospective cohort analysis was conducted to assess the risk of patients with Type 2 diabetes being labeled nonadherent by sociodemographic factors. METHODS Patients with Type 2 diabetes were identified from 4 primary care sites of the University of Pennsylvania Health System. Demographics, HbA1c, and ICD-10 codes for Type 2 diabetes and nonadherence were extracted from the electronic health record and analyzed in October 2017. Log-binomial regression models were used to estimate patients' risk of nonadherence labeling by race, age, sex, BMI, and insurance payer while controlling for HbA1c as a proxy for medication use. RESULTS This study included 3,768 adults aged 18-70 years with Type 2 diabetes who received care from 1 of 4 primary care sites at University of Pennsylvania from 2014 to 2017. An increased risk was found for black patients relative to white patients (RR=2.86, 95% CI=1.91, 4.27) and Medicaid (RR=1.8, 95% CI=1.45, 2.22) or Medicare (RR=1.69, 95% CI=1.36, 2.1) relative to private insurance to be labeled as nonadherent while adjusting for HbA1c. Though statistically insignificant, Hispanic patients also showed increased risk of nonadherence labeling. BMI, age, and sex showed no association. CONCLUSIONS Black race and nonprivate insurance status were shown to be associated with increased risk of nonadherence labeling. The findings may indicate a concerning bias among providers in their perception of patient behavior by race and insurance.
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Affiliation(s)
- Sourik Beltrán
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Elle Lett
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Peter F Cronholm
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania
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Agawu A, Fahl C, Alexis D, Diaz T, Harris D, Harris MC, Aysola J, Cronholm PF, Higginbotham EJ. The Influence of Gender and Underrepresented Minority Status on Medical Student Ranking of Residency Programs. J Natl Med Assoc 2019; 111:665-673. [PMID: 31668360 DOI: 10.1016/j.jnma.2019.09.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 12/18/2018] [Revised: 04/25/2019] [Accepted: 09/24/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Physician diversity is linked to improved quality of care of diverse patient populations. The transition from medical school to residency is an opportunity to improve and increase workforce diversity in all specialties. However, there is limited published literature on the factors contributing to the ranking of residency programs on women and underrepresented minorities (URMs). OBJECTIVE To characterize factors medical students used to rank residency programs and describe any differences based on race/ethnicity or gender. METHODS A mixed-methods study consisting of a web-based survey and semi-structured interviews with National Resident Matching Program (NRMP) participating graduates over a two-year period. The survey assessed demographics and a 6-point Likert scale rating of various factors used to rank residency programs. Unpaired student t-tests were used to compare means. A subset of students was interviewed and a modified grounded theory approach identified decision-making themes as well as the role of gender and URM status. RESULTS Out of a total of 316 invitations sent, 148 completed the survey (46.8% response rate), of which 21% of respondents self-identified as URMs. The majority of respondents graduated in 2014 (53%), and were male (51%). Participants ranked program atmosphere, reputation, location, and proximity to family the highest. URM students ranked patient population (p < 0.01), revisit opportunities (p = 0.04), gender diversity (p < 0.01), and ethnic diversity (p < 0.01) significantly higher than non-URM students. Female students ranked patient population (p < 0.01) and gender diversity (p < 0.01) significantly higher than males. Qualitative findings revealed differences in perceptions by URMs and non-URMs of patient population, revisit opportunities, gender diversity, and ethnic diversity. CONCLUSIONS While all students prioritized pragmatic factors, women and URM students assess and weigh additional factors related to culture, inclusion, and diversity more than others. By tailoring recruitment strategies to meet the expectations of women and URMs, residency programs can better meet goals in becoming more diverse and inclusive.
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Affiliation(s)
- Atu Agawu
- General Pediatrics/Emergency Department, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Corrinne Fahl
- Office of Inclusion and Diversity, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Dominique Alexis
- Office of Inclusion and Diversity, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Tomas Diaz
- Resident in Emergency Medicine at the University of California - San Francisco, San Francisco General Hospital, San Francisco, CA, USA
| | - Diana Harris
- Department of Philosophy, University of Pennsylvania, Philadelphia, PA, USA
| | - Mary C Harris
- Pediatrics and Advisory Dean, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jaya Aysola
- Department of Medicine and Pediatrics, Perelman School of Medicine, University of Pennsylvania, USA
| | - Peter F Cronholm
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA, USA
| | - Eve J Higginbotham
- Inclusion and Diversity, Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Affiliation(s)
- Peter F Cronholm
- Department of Family and Community Health, University of Pennsylvania School of Medicine, Philadelphia, PA
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Lockman JL, Yehya N, Schwartz AJ, Cronholm PF. Professionalism in pediatric anesthesiology: Affirmation of a definition based on results of a nationally administered survey of pediatric anesthesiologists. Paediatr Anaesth 2019; 29:345-352. [PMID: 30710425 PMCID: PMC7029412 DOI: 10.1111/pan.13598] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 04/30/2018] [Revised: 01/04/2019] [Accepted: 01/22/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Previously published work established the need for a specialty-specific definition of professionalism in pediatric anesthesiology. That work established a composite definition consisting of 11 domains and their component "defining themes" for professionalism in pediatric anesthesiology. As a next step toward assessing generalizability of our single-center findings, we sought to gain input from a national sample of pediatric anesthesiologists. AIMS The aim of this study was to establish the construct validity of our previously published multidimensional definition of professionalism in pediatric anesthesiology using a nationally representative sample of pediatric anesthesiologists. METHODS A survey was distributed via snowball sampling to the leaders of every pediatric anesthesiology fellowship program and pediatric anesthesia department or clinical division in the United States. Survey items were designed to validate individual component themes in the working definition. For affirmed items, the respondent was asked to rate the importance of the item. Respondents were also invited to suggest novel themes to be included in the definition. RESULTS A total of 216 pediatric anesthesiologists representing a variety of experience levels and practice settings responded to the survey. All 40 themes were strongly supported by the respondents, with the least supported theme receiving 71.6% approval. 92.8% of respondents indicated that the 11 domains previously identified formed a comprehensive list of domains for professionalism in pediatric anesthesiology. Four additional novel themes were suggested by respondents, including wellness/self-care/burnout prevention, political advocacy, justice within a practice organization, and respect for leadership/experienced partners. These are topics for future study. The survey responses also indicated a near-universal agreement that didactic lectures would be ineffective for teaching professionalism. CONCLUSION This national survey of pediatric anesthesiologists serves to confirm the construct validity of our prior working definition of professionalism in pediatric anesthesiology, and has uncovered several opportunities for further study. This definition can be used for both curriculum and policy development within the specialty.
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Affiliation(s)
- Justin L. Lockman
- Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, USA
| | - Nadir Yehya
- Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, USA
| | - Alan Jay Schwartz
- Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, USA
| | - Peter F. Cronholm
- Department of Family Medicine and Community Health, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, USA,Center for Public Health Initiatives, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, USA,Leonard Davis Institute of Health Economics, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, USA
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Tomasson G, Farrar JT, Cuthbertson D, McAlear CA, Ashdown S, Cronholm PF, Dawson J, Gebhart D, Lanier G, Luqmani RA, Milman N, Peck J, Robson JC, Shea JA, Carette S, Khalidi N, Koening CL, Langford CA, Monach PA, Moreland L, Pagnoux C, Specks U, Sreih AG, Ytterberg SR, Merkel PA. Feasibility and Construct Validation of the Patient Reported Outcomes Measurement Information System in Systemic Vasculitis. J Rheumatol 2019; 46:928-934. [PMID: 30824648 DOI: 10.3899/jrheum.171405] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The Patient Reported Outcome Measurement Information System (PROMIS) is a collection of item banks of self-reported health. This study assessed the feasibility and construct validity of using PROMIS instruments in vasculitis. METHODS Data from a multicenter longitudinal cohort of subjects with systemic vasculitis were used. Instruments from 10 PROMIS item banks were selected with direct involvement of patients. Subjects completed PROMIS instruments using computer adaptive testing (CAT). The Medical Outcomes Study Short Form-36 (SF-36) was also administered. Cross-sectional construct validity was assessed by calculating correlations of PROMIS scores with SF-36 measures and physician and patient global scores for disease activity. Longitudinal construct validity was assessed by correlations of between-visit differences in PROMIS scores with differences in other measures. RESULTS During the study period, 973 subjects came for 2306 study visits and the PROMIS collection was completed at 2276 (99%) of visits. The median time needed to complete each PROMIS instrument ranged from 40 to 55 s. PROMIS instruments correlated cross-sectionally with individual scales of the SF-36, most strongly with subscales of the SF-36 addressing the same domain as the PROMIS instrument. For example, PROMIS fatigue correlated with both the physical component score (PCS; r = -0.65) and with the mental component score (MCS; r = -0.54). PROMIS physical function correlated strongly with PCS (r = 0.81) but weakly with MCS (r = 0.29). Weaker correlations were observed longitudinally between change in PROMIS scores with change in PCS and MCS. CONCLUSION Collection of data using CAT PROMIS instruments is feasible among patients with vasculitis and has some cross-sectional and longitudinal construct validity.
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Affiliation(s)
- Gunnar Tomasson
- From the Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Department of Biostatistics, Epidemiology, and Informatics, and Division of Rheumatology, and Department of Family Medicine and Community Health, and Division of General Internal Medicine, University of Pennsylvania, Philadelphia; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Department of Rheumatology, Cleveland Clinic, Cleveland; Ohio State University Wexner Medical Center, Columbus, Ohio; Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, and Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford; Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol, Bristol, UK; Department of Rheumatology, University of Ottawa, Ottawa; Division of Rheumatology, Mount Sinai Hospital, Toronto; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada. .,G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, and Centre for Rheumatology Research, University Hospital; J.T. Farrar, MD, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Cuthbertson, MS, Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; S. Ashdown, RN, Oxfordshire; P.F. Cronholm, MD, MSCE, Department of Family Medicine and Community Health, University of Pennsylvania; J. Dawson, MA, MSc, DPhil, SRN, SCM, Nuffield Department of Population Health (HSRU), University of Oxford; D. Gebhart, MD, Ohio State University Wexner Medical Center, Columbus; G. Lanier, Patient Research Partner, Boston; R.A. Luqmani, DM, FRCP, FRCP(E), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; N. Milman, MD, MSc, FRCPC, Department of Rheumatology, University of Ottawa; J. Peck, RN, Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol; J.A. Shea, PhD, Division of General Internal Medicine, University of Pennsylvania; S. Carette, MD, Division of Rheumatology, Mount Sinai Hospital; N. Khalidi, MD, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, Division of Rheumatology, University of Utah; C.A. Langford, MD, Department of Rheumatology, Cleveland Clinic; P.A. Monach, MD, PhD, Section of Rheumatology, Boston University School of Medicine; L. Moreland, MD, Division of Rheumatology, University of Pittsburgh; C. Pagnoux, MD, MSc, MPH, Division of Rheumatology, Mount Sinai Hospital; U. Specks, MD, Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science; A.G. Sreih, MD, Division of Rheumatology, University of Pennsylvania; S.R. Ytterberg, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science; P.A. Merkel, MD, MPH, Division of Rheumatology, University of Pennsylvania.
| | - John T Farrar
- From the Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Department of Biostatistics, Epidemiology, and Informatics, and Division of Rheumatology, and Department of Family Medicine and Community Health, and Division of General Internal Medicine, University of Pennsylvania, Philadelphia; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Department of Rheumatology, Cleveland Clinic, Cleveland; Ohio State University Wexner Medical Center, Columbus, Ohio; Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, and Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford; Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol, Bristol, UK; Department of Rheumatology, University of Ottawa, Ottawa; Division of Rheumatology, Mount Sinai Hospital, Toronto; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.,G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, and Centre for Rheumatology Research, University Hospital; J.T. Farrar, MD, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Cuthbertson, MS, Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; S. Ashdown, RN, Oxfordshire; P.F. Cronholm, MD, MSCE, Department of Family Medicine and Community Health, University of Pennsylvania; J. Dawson, MA, MSc, DPhil, SRN, SCM, Nuffield Department of Population Health (HSRU), University of Oxford; D. Gebhart, MD, Ohio State University Wexner Medical Center, Columbus; G. Lanier, Patient Research Partner, Boston; R.A. Luqmani, DM, FRCP, FRCP(E), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; N. Milman, MD, MSc, FRCPC, Department of Rheumatology, University of Ottawa; J. Peck, RN, Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol; J.A. Shea, PhD, Division of General Internal Medicine, University of Pennsylvania; S. Carette, MD, Division of Rheumatology, Mount Sinai Hospital; N. Khalidi, MD, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, Division of Rheumatology, University of Utah; C.A. Langford, MD, Department of Rheumatology, Cleveland Clinic; P.A. Monach, MD, PhD, Section of Rheumatology, Boston University School of Medicine; L. Moreland, MD, Division of Rheumatology, University of Pittsburgh; C. Pagnoux, MD, MSc, MPH, Division of Rheumatology, Mount Sinai Hospital; U. Specks, MD, Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science; A.G. Sreih, MD, Division of Rheumatology, University of Pennsylvania; S.R. Ytterberg, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science; P.A. Merkel, MD, MPH, Division of Rheumatology, University of Pennsylvania
| | - David Cuthbertson
- From the Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Department of Biostatistics, Epidemiology, and Informatics, and Division of Rheumatology, and Department of Family Medicine and Community Health, and Division of General Internal Medicine, University of Pennsylvania, Philadelphia; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Department of Rheumatology, Cleveland Clinic, Cleveland; Ohio State University Wexner Medical Center, Columbus, Ohio; Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, and Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford; Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol, Bristol, UK; Department of Rheumatology, University of Ottawa, Ottawa; Division of Rheumatology, Mount Sinai Hospital, Toronto; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.,G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, and Centre for Rheumatology Research, University Hospital; J.T. Farrar, MD, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Cuthbertson, MS, Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; S. Ashdown, RN, Oxfordshire; P.F. Cronholm, MD, MSCE, Department of Family Medicine and Community Health, University of Pennsylvania; J. Dawson, MA, MSc, DPhil, SRN, SCM, Nuffield Department of Population Health (HSRU), University of Oxford; D. Gebhart, MD, Ohio State University Wexner Medical Center, Columbus; G. Lanier, Patient Research Partner, Boston; R.A. Luqmani, DM, FRCP, FRCP(E), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; N. Milman, MD, MSc, FRCPC, Department of Rheumatology, University of Ottawa; J. Peck, RN, Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol; J.A. Shea, PhD, Division of General Internal Medicine, University of Pennsylvania; S. Carette, MD, Division of Rheumatology, Mount Sinai Hospital; N. Khalidi, MD, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, Division of Rheumatology, University of Utah; C.A. Langford, MD, Department of Rheumatology, Cleveland Clinic; P.A. Monach, MD, PhD, Section of Rheumatology, Boston University School of Medicine; L. Moreland, MD, Division of Rheumatology, University of Pittsburgh; C. Pagnoux, MD, MSc, MPH, Division of Rheumatology, Mount Sinai Hospital; U. Specks, MD, Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science; A.G. Sreih, MD, Division of Rheumatology, University of Pennsylvania; S.R. Ytterberg, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science; P.A. Merkel, MD, MPH, Division of Rheumatology, University of Pennsylvania
| | - Carol A McAlear
- From the Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Department of Biostatistics, Epidemiology, and Informatics, and Division of Rheumatology, and Department of Family Medicine and Community Health, and Division of General Internal Medicine, University of Pennsylvania, Philadelphia; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Department of Rheumatology, Cleveland Clinic, Cleveland; Ohio State University Wexner Medical Center, Columbus, Ohio; Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, and Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford; Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol, Bristol, UK; Department of Rheumatology, University of Ottawa, Ottawa; Division of Rheumatology, Mount Sinai Hospital, Toronto; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.,G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, and Centre for Rheumatology Research, University Hospital; J.T. Farrar, MD, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Cuthbertson, MS, Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; S. Ashdown, RN, Oxfordshire; P.F. Cronholm, MD, MSCE, Department of Family Medicine and Community Health, University of Pennsylvania; J. Dawson, MA, MSc, DPhil, SRN, SCM, Nuffield Department of Population Health (HSRU), University of Oxford; D. Gebhart, MD, Ohio State University Wexner Medical Center, Columbus; G. Lanier, Patient Research Partner, Boston; R.A. Luqmani, DM, FRCP, FRCP(E), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; N. Milman, MD, MSc, FRCPC, Department of Rheumatology, University of Ottawa; J. Peck, RN, Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol; J.A. Shea, PhD, Division of General Internal Medicine, University of Pennsylvania; S. Carette, MD, Division of Rheumatology, Mount Sinai Hospital; N. Khalidi, MD, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, Division of Rheumatology, University of Utah; C.A. Langford, MD, Department of Rheumatology, Cleveland Clinic; P.A. Monach, MD, PhD, Section of Rheumatology, Boston University School of Medicine; L. Moreland, MD, Division of Rheumatology, University of Pittsburgh; C. Pagnoux, MD, MSc, MPH, Division of Rheumatology, Mount Sinai Hospital; U. Specks, MD, Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science; A.G. Sreih, MD, Division of Rheumatology, University of Pennsylvania; S.R. Ytterberg, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science; P.A. Merkel, MD, MPH, Division of Rheumatology, University of Pennsylvania
| | - Susan Ashdown
- From the Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Department of Biostatistics, Epidemiology, and Informatics, and Division of Rheumatology, and Department of Family Medicine and Community Health, and Division of General Internal Medicine, University of Pennsylvania, Philadelphia; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Department of Rheumatology, Cleveland Clinic, Cleveland; Ohio State University Wexner Medical Center, Columbus, Ohio; Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, and Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford; Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol, Bristol, UK; Department of Rheumatology, University of Ottawa, Ottawa; Division of Rheumatology, Mount Sinai Hospital, Toronto; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.,G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, and Centre for Rheumatology Research, University Hospital; J.T. Farrar, MD, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Cuthbertson, MS, Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; S. Ashdown, RN, Oxfordshire; P.F. Cronholm, MD, MSCE, Department of Family Medicine and Community Health, University of Pennsylvania; J. Dawson, MA, MSc, DPhil, SRN, SCM, Nuffield Department of Population Health (HSRU), University of Oxford; D. Gebhart, MD, Ohio State University Wexner Medical Center, Columbus; G. Lanier, Patient Research Partner, Boston; R.A. Luqmani, DM, FRCP, FRCP(E), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; N. Milman, MD, MSc, FRCPC, Department of Rheumatology, University of Ottawa; J. Peck, RN, Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol; J.A. Shea, PhD, Division of General Internal Medicine, University of Pennsylvania; S. Carette, MD, Division of Rheumatology, Mount Sinai Hospital; N. Khalidi, MD, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, Division of Rheumatology, University of Utah; C.A. Langford, MD, Department of Rheumatology, Cleveland Clinic; P.A. Monach, MD, PhD, Section of Rheumatology, Boston University School of Medicine; L. Moreland, MD, Division of Rheumatology, University of Pittsburgh; C. Pagnoux, MD, MSc, MPH, Division of Rheumatology, Mount Sinai Hospital; U. Specks, MD, Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science; A.G. Sreih, MD, Division of Rheumatology, University of Pennsylvania; S.R. Ytterberg, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science; P.A. Merkel, MD, MPH, Division of Rheumatology, University of Pennsylvania
| | - Peter F Cronholm
- From the Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Department of Biostatistics, Epidemiology, and Informatics, and Division of Rheumatology, and Department of Family Medicine and Community Health, and Division of General Internal Medicine, University of Pennsylvania, Philadelphia; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Department of Rheumatology, Cleveland Clinic, Cleveland; Ohio State University Wexner Medical Center, Columbus, Ohio; Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, and Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford; Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol, Bristol, UK; Department of Rheumatology, University of Ottawa, Ottawa; Division of Rheumatology, Mount Sinai Hospital, Toronto; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.,G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, and Centre for Rheumatology Research, University Hospital; J.T. Farrar, MD, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Cuthbertson, MS, Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; S. Ashdown, RN, Oxfordshire; P.F. Cronholm, MD, MSCE, Department of Family Medicine and Community Health, University of Pennsylvania; J. Dawson, MA, MSc, DPhil, SRN, SCM, Nuffield Department of Population Health (HSRU), University of Oxford; D. Gebhart, MD, Ohio State University Wexner Medical Center, Columbus; G. Lanier, Patient Research Partner, Boston; R.A. Luqmani, DM, FRCP, FRCP(E), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; N. Milman, MD, MSc, FRCPC, Department of Rheumatology, University of Ottawa; J. Peck, RN, Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol; J.A. Shea, PhD, Division of General Internal Medicine, University of Pennsylvania; S. Carette, MD, Division of Rheumatology, Mount Sinai Hospital; N. Khalidi, MD, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, Division of Rheumatology, University of Utah; C.A. Langford, MD, Department of Rheumatology, Cleveland Clinic; P.A. Monach, MD, PhD, Section of Rheumatology, Boston University School of Medicine; L. Moreland, MD, Division of Rheumatology, University of Pittsburgh; C. Pagnoux, MD, MSc, MPH, Division of Rheumatology, Mount Sinai Hospital; U. Specks, MD, Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science; A.G. Sreih, MD, Division of Rheumatology, University of Pennsylvania; S.R. Ytterberg, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science; P.A. Merkel, MD, MPH, Division of Rheumatology, University of Pennsylvania
| | - Jill Dawson
- From the Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Department of Biostatistics, Epidemiology, and Informatics, and Division of Rheumatology, and Department of Family Medicine and Community Health, and Division of General Internal Medicine, University of Pennsylvania, Philadelphia; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Department of Rheumatology, Cleveland Clinic, Cleveland; Ohio State University Wexner Medical Center, Columbus, Ohio; Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, and Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford; Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol, Bristol, UK; Department of Rheumatology, University of Ottawa, Ottawa; Division of Rheumatology, Mount Sinai Hospital, Toronto; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.,G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, and Centre for Rheumatology Research, University Hospital; J.T. Farrar, MD, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Cuthbertson, MS, Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; S. Ashdown, RN, Oxfordshire; P.F. Cronholm, MD, MSCE, Department of Family Medicine and Community Health, University of Pennsylvania; J. Dawson, MA, MSc, DPhil, SRN, SCM, Nuffield Department of Population Health (HSRU), University of Oxford; D. Gebhart, MD, Ohio State University Wexner Medical Center, Columbus; G. Lanier, Patient Research Partner, Boston; R.A. Luqmani, DM, FRCP, FRCP(E), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; N. Milman, MD, MSc, FRCPC, Department of Rheumatology, University of Ottawa; J. Peck, RN, Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol; J.A. Shea, PhD, Division of General Internal Medicine, University of Pennsylvania; S. Carette, MD, Division of Rheumatology, Mount Sinai Hospital; N. Khalidi, MD, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, Division of Rheumatology, University of Utah; C.A. Langford, MD, Department of Rheumatology, Cleveland Clinic; P.A. Monach, MD, PhD, Section of Rheumatology, Boston University School of Medicine; L. Moreland, MD, Division of Rheumatology, University of Pittsburgh; C. Pagnoux, MD, MSc, MPH, Division of Rheumatology, Mount Sinai Hospital; U. Specks, MD, Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science; A.G. Sreih, MD, Division of Rheumatology, University of Pennsylvania; S.R. Ytterberg, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science; P.A. Merkel, MD, MPH, Division of Rheumatology, University of Pennsylvania
| | - Don Gebhart
- From the Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Department of Biostatistics, Epidemiology, and Informatics, and Division of Rheumatology, and Department of Family Medicine and Community Health, and Division of General Internal Medicine, University of Pennsylvania, Philadelphia; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Department of Rheumatology, Cleveland Clinic, Cleveland; Ohio State University Wexner Medical Center, Columbus, Ohio; Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, and Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford; Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol, Bristol, UK; Department of Rheumatology, University of Ottawa, Ottawa; Division of Rheumatology, Mount Sinai Hospital, Toronto; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.,G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, and Centre for Rheumatology Research, University Hospital; J.T. Farrar, MD, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Cuthbertson, MS, Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; S. Ashdown, RN, Oxfordshire; P.F. Cronholm, MD, MSCE, Department of Family Medicine and Community Health, University of Pennsylvania; J. Dawson, MA, MSc, DPhil, SRN, SCM, Nuffield Department of Population Health (HSRU), University of Oxford; D. Gebhart, MD, Ohio State University Wexner Medical Center, Columbus; G. Lanier, Patient Research Partner, Boston; R.A. Luqmani, DM, FRCP, FRCP(E), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; N. Milman, MD, MSc, FRCPC, Department of Rheumatology, University of Ottawa; J. Peck, RN, Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol; J.A. Shea, PhD, Division of General Internal Medicine, University of Pennsylvania; S. Carette, MD, Division of Rheumatology, Mount Sinai Hospital; N. Khalidi, MD, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, Division of Rheumatology, University of Utah; C.A. Langford, MD, Department of Rheumatology, Cleveland Clinic; P.A. Monach, MD, PhD, Section of Rheumatology, Boston University School of Medicine; L. Moreland, MD, Division of Rheumatology, University of Pittsburgh; C. Pagnoux, MD, MSc, MPH, Division of Rheumatology, Mount Sinai Hospital; U. Specks, MD, Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science; A.G. Sreih, MD, Division of Rheumatology, University of Pennsylvania; S.R. Ytterberg, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science; P.A. Merkel, MD, MPH, Division of Rheumatology, University of Pennsylvania
| | - Georgia Lanier
- From the Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Department of Biostatistics, Epidemiology, and Informatics, and Division of Rheumatology, and Department of Family Medicine and Community Health, and Division of General Internal Medicine, University of Pennsylvania, Philadelphia; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Department of Rheumatology, Cleveland Clinic, Cleveland; Ohio State University Wexner Medical Center, Columbus, Ohio; Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, and Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford; Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol, Bristol, UK; Department of Rheumatology, University of Ottawa, Ottawa; Division of Rheumatology, Mount Sinai Hospital, Toronto; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.,G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, and Centre for Rheumatology Research, University Hospital; J.T. Farrar, MD, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Cuthbertson, MS, Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; S. Ashdown, RN, Oxfordshire; P.F. Cronholm, MD, MSCE, Department of Family Medicine and Community Health, University of Pennsylvania; J. Dawson, MA, MSc, DPhil, SRN, SCM, Nuffield Department of Population Health (HSRU), University of Oxford; D. Gebhart, MD, Ohio State University Wexner Medical Center, Columbus; G. Lanier, Patient Research Partner, Boston; R.A. Luqmani, DM, FRCP, FRCP(E), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; N. Milman, MD, MSc, FRCPC, Department of Rheumatology, University of Ottawa; J. Peck, RN, Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol; J.A. Shea, PhD, Division of General Internal Medicine, University of Pennsylvania; S. Carette, MD, Division of Rheumatology, Mount Sinai Hospital; N. Khalidi, MD, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, Division of Rheumatology, University of Utah; C.A. Langford, MD, Department of Rheumatology, Cleveland Clinic; P.A. Monach, MD, PhD, Section of Rheumatology, Boston University School of Medicine; L. Moreland, MD, Division of Rheumatology, University of Pittsburgh; C. Pagnoux, MD, MSc, MPH, Division of Rheumatology, Mount Sinai Hospital; U. Specks, MD, Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science; A.G. Sreih, MD, Division of Rheumatology, University of Pennsylvania; S.R. Ytterberg, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science; P.A. Merkel, MD, MPH, Division of Rheumatology, University of Pennsylvania
| | - Raashid A Luqmani
- From the Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Department of Biostatistics, Epidemiology, and Informatics, and Division of Rheumatology, and Department of Family Medicine and Community Health, and Division of General Internal Medicine, University of Pennsylvania, Philadelphia; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Department of Rheumatology, Cleveland Clinic, Cleveland; Ohio State University Wexner Medical Center, Columbus, Ohio; Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, and Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford; Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol, Bristol, UK; Department of Rheumatology, University of Ottawa, Ottawa; Division of Rheumatology, Mount Sinai Hospital, Toronto; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.,G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, and Centre for Rheumatology Research, University Hospital; J.T. Farrar, MD, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Cuthbertson, MS, Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; S. Ashdown, RN, Oxfordshire; P.F. Cronholm, MD, MSCE, Department of Family Medicine and Community Health, University of Pennsylvania; J. Dawson, MA, MSc, DPhil, SRN, SCM, Nuffield Department of Population Health (HSRU), University of Oxford; D. Gebhart, MD, Ohio State University Wexner Medical Center, Columbus; G. Lanier, Patient Research Partner, Boston; R.A. Luqmani, DM, FRCP, FRCP(E), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; N. Milman, MD, MSc, FRCPC, Department of Rheumatology, University of Ottawa; J. Peck, RN, Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol; J.A. Shea, PhD, Division of General Internal Medicine, University of Pennsylvania; S. Carette, MD, Division of Rheumatology, Mount Sinai Hospital; N. Khalidi, MD, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, Division of Rheumatology, University of Utah; C.A. Langford, MD, Department of Rheumatology, Cleveland Clinic; P.A. Monach, MD, PhD, Section of Rheumatology, Boston University School of Medicine; L. Moreland, MD, Division of Rheumatology, University of Pittsburgh; C. Pagnoux, MD, MSc, MPH, Division of Rheumatology, Mount Sinai Hospital; U. Specks, MD, Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science; A.G. Sreih, MD, Division of Rheumatology, University of Pennsylvania; S.R. Ytterberg, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science; P.A. Merkel, MD, MPH, Division of Rheumatology, University of Pennsylvania
| | - Nataliya Milman
- From the Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Department of Biostatistics, Epidemiology, and Informatics, and Division of Rheumatology, and Department of Family Medicine and Community Health, and Division of General Internal Medicine, University of Pennsylvania, Philadelphia; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Department of Rheumatology, Cleveland Clinic, Cleveland; Ohio State University Wexner Medical Center, Columbus, Ohio; Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, and Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford; Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol, Bristol, UK; Department of Rheumatology, University of Ottawa, Ottawa; Division of Rheumatology, Mount Sinai Hospital, Toronto; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.,G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, and Centre for Rheumatology Research, University Hospital; J.T. Farrar, MD, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Cuthbertson, MS, Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; S. Ashdown, RN, Oxfordshire; P.F. Cronholm, MD, MSCE, Department of Family Medicine and Community Health, University of Pennsylvania; J. Dawson, MA, MSc, DPhil, SRN, SCM, Nuffield Department of Population Health (HSRU), University of Oxford; D. Gebhart, MD, Ohio State University Wexner Medical Center, Columbus; G. Lanier, Patient Research Partner, Boston; R.A. Luqmani, DM, FRCP, FRCP(E), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; N. Milman, MD, MSc, FRCPC, Department of Rheumatology, University of Ottawa; J. Peck, RN, Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol; J.A. Shea, PhD, Division of General Internal Medicine, University of Pennsylvania; S. Carette, MD, Division of Rheumatology, Mount Sinai Hospital; N. Khalidi, MD, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, Division of Rheumatology, University of Utah; C.A. Langford, MD, Department of Rheumatology, Cleveland Clinic; P.A. Monach, MD, PhD, Section of Rheumatology, Boston University School of Medicine; L. Moreland, MD, Division of Rheumatology, University of Pittsburgh; C. Pagnoux, MD, MSc, MPH, Division of Rheumatology, Mount Sinai Hospital; U. Specks, MD, Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science; A.G. Sreih, MD, Division of Rheumatology, University of Pennsylvania; S.R. Ytterberg, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science; P.A. Merkel, MD, MPH, Division of Rheumatology, University of Pennsylvania
| | - Jacqueline Peck
- From the Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Department of Biostatistics, Epidemiology, and Informatics, and Division of Rheumatology, and Department of Family Medicine and Community Health, and Division of General Internal Medicine, University of Pennsylvania, Philadelphia; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Department of Rheumatology, Cleveland Clinic, Cleveland; Ohio State University Wexner Medical Center, Columbus, Ohio; Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, and Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford; Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol, Bristol, UK; Department of Rheumatology, University of Ottawa, Ottawa; Division of Rheumatology, Mount Sinai Hospital, Toronto; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.,G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, and Centre for Rheumatology Research, University Hospital; J.T. Farrar, MD, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Cuthbertson, MS, Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; S. Ashdown, RN, Oxfordshire; P.F. Cronholm, MD, MSCE, Department of Family Medicine and Community Health, University of Pennsylvania; J. Dawson, MA, MSc, DPhil, SRN, SCM, Nuffield Department of Population Health (HSRU), University of Oxford; D. Gebhart, MD, Ohio State University Wexner Medical Center, Columbus; G. Lanier, Patient Research Partner, Boston; R.A. Luqmani, DM, FRCP, FRCP(E), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; N. Milman, MD, MSc, FRCPC, Department of Rheumatology, University of Ottawa; J. Peck, RN, Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol; J.A. Shea, PhD, Division of General Internal Medicine, University of Pennsylvania; S. Carette, MD, Division of Rheumatology, Mount Sinai Hospital; N. Khalidi, MD, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, Division of Rheumatology, University of Utah; C.A. Langford, MD, Department of Rheumatology, Cleveland Clinic; P.A. Monach, MD, PhD, Section of Rheumatology, Boston University School of Medicine; L. Moreland, MD, Division of Rheumatology, University of Pittsburgh; C. Pagnoux, MD, MSc, MPH, Division of Rheumatology, Mount Sinai Hospital; U. Specks, MD, Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science; A.G. Sreih, MD, Division of Rheumatology, University of Pennsylvania; S.R. Ytterberg, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science; P.A. Merkel, MD, MPH, Division of Rheumatology, University of Pennsylvania
| | - Joanna C Robson
- From the Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Department of Biostatistics, Epidemiology, and Informatics, and Division of Rheumatology, and Department of Family Medicine and Community Health, and Division of General Internal Medicine, University of Pennsylvania, Philadelphia; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Department of Rheumatology, Cleveland Clinic, Cleveland; Ohio State University Wexner Medical Center, Columbus, Ohio; Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, and Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford; Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol, Bristol, UK; Department of Rheumatology, University of Ottawa, Ottawa; Division of Rheumatology, Mount Sinai Hospital, Toronto; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.,G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, and Centre for Rheumatology Research, University Hospital; J.T. Farrar, MD, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Cuthbertson, MS, Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; S. Ashdown, RN, Oxfordshire; P.F. Cronholm, MD, MSCE, Department of Family Medicine and Community Health, University of Pennsylvania; J. Dawson, MA, MSc, DPhil, SRN, SCM, Nuffield Department of Population Health (HSRU), University of Oxford; D. Gebhart, MD, Ohio State University Wexner Medical Center, Columbus; G. Lanier, Patient Research Partner, Boston; R.A. Luqmani, DM, FRCP, FRCP(E), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; N. Milman, MD, MSc, FRCPC, Department of Rheumatology, University of Ottawa; J. Peck, RN, Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol; J.A. Shea, PhD, Division of General Internal Medicine, University of Pennsylvania; S. Carette, MD, Division of Rheumatology, Mount Sinai Hospital; N. Khalidi, MD, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, Division of Rheumatology, University of Utah; C.A. Langford, MD, Department of Rheumatology, Cleveland Clinic; P.A. Monach, MD, PhD, Section of Rheumatology, Boston University School of Medicine; L. Moreland, MD, Division of Rheumatology, University of Pittsburgh; C. Pagnoux, MD, MSc, MPH, Division of Rheumatology, Mount Sinai Hospital; U. Specks, MD, Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science; A.G. Sreih, MD, Division of Rheumatology, University of Pennsylvania; S.R. Ytterberg, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science; P.A. Merkel, MD, MPH, Division of Rheumatology, University of Pennsylvania
| | - Judy A Shea
- From the Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Department of Biostatistics, Epidemiology, and Informatics, and Division of Rheumatology, and Department of Family Medicine and Community Health, and Division of General Internal Medicine, University of Pennsylvania, Philadelphia; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Department of Rheumatology, Cleveland Clinic, Cleveland; Ohio State University Wexner Medical Center, Columbus, Ohio; Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, and Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford; Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol, Bristol, UK; Department of Rheumatology, University of Ottawa, Ottawa; Division of Rheumatology, Mount Sinai Hospital, Toronto; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.,G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, and Centre for Rheumatology Research, University Hospital; J.T. Farrar, MD, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Cuthbertson, MS, Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; S. Ashdown, RN, Oxfordshire; P.F. Cronholm, MD, MSCE, Department of Family Medicine and Community Health, University of Pennsylvania; J. Dawson, MA, MSc, DPhil, SRN, SCM, Nuffield Department of Population Health (HSRU), University of Oxford; D. Gebhart, MD, Ohio State University Wexner Medical Center, Columbus; G. Lanier, Patient Research Partner, Boston; R.A. Luqmani, DM, FRCP, FRCP(E), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; N. Milman, MD, MSc, FRCPC, Department of Rheumatology, University of Ottawa; J. Peck, RN, Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol; J.A. Shea, PhD, Division of General Internal Medicine, University of Pennsylvania; S. Carette, MD, Division of Rheumatology, Mount Sinai Hospital; N. Khalidi, MD, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, Division of Rheumatology, University of Utah; C.A. Langford, MD, Department of Rheumatology, Cleveland Clinic; P.A. Monach, MD, PhD, Section of Rheumatology, Boston University School of Medicine; L. Moreland, MD, Division of Rheumatology, University of Pittsburgh; C. Pagnoux, MD, MSc, MPH, Division of Rheumatology, Mount Sinai Hospital; U. Specks, MD, Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science; A.G. Sreih, MD, Division of Rheumatology, University of Pennsylvania; S.R. Ytterberg, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science; P.A. Merkel, MD, MPH, Division of Rheumatology, University of Pennsylvania
| | - Simon Carette
- From the Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Department of Biostatistics, Epidemiology, and Informatics, and Division of Rheumatology, and Department of Family Medicine and Community Health, and Division of General Internal Medicine, University of Pennsylvania, Philadelphia; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Department of Rheumatology, Cleveland Clinic, Cleveland; Ohio State University Wexner Medical Center, Columbus, Ohio; Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, and Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford; Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol, Bristol, UK; Department of Rheumatology, University of Ottawa, Ottawa; Division of Rheumatology, Mount Sinai Hospital, Toronto; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.,G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, and Centre for Rheumatology Research, University Hospital; J.T. Farrar, MD, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Cuthbertson, MS, Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; S. Ashdown, RN, Oxfordshire; P.F. Cronholm, MD, MSCE, Department of Family Medicine and Community Health, University of Pennsylvania; J. Dawson, MA, MSc, DPhil, SRN, SCM, Nuffield Department of Population Health (HSRU), University of Oxford; D. Gebhart, MD, Ohio State University Wexner Medical Center, Columbus; G. Lanier, Patient Research Partner, Boston; R.A. Luqmani, DM, FRCP, FRCP(E), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; N. Milman, MD, MSc, FRCPC, Department of Rheumatology, University of Ottawa; J. Peck, RN, Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol; J.A. Shea, PhD, Division of General Internal Medicine, University of Pennsylvania; S. Carette, MD, Division of Rheumatology, Mount Sinai Hospital; N. Khalidi, MD, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, Division of Rheumatology, University of Utah; C.A. Langford, MD, Department of Rheumatology, Cleveland Clinic; P.A. Monach, MD, PhD, Section of Rheumatology, Boston University School of Medicine; L. Moreland, MD, Division of Rheumatology, University of Pittsburgh; C. Pagnoux, MD, MSc, MPH, Division of Rheumatology, Mount Sinai Hospital; U. Specks, MD, Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science; A.G. Sreih, MD, Division of Rheumatology, University of Pennsylvania; S.R. Ytterberg, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science; P.A. Merkel, MD, MPH, Division of Rheumatology, University of Pennsylvania
| | - Nader Khalidi
- From the Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Department of Biostatistics, Epidemiology, and Informatics, and Division of Rheumatology, and Department of Family Medicine and Community Health, and Division of General Internal Medicine, University of Pennsylvania, Philadelphia; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Department of Rheumatology, Cleveland Clinic, Cleveland; Ohio State University Wexner Medical Center, Columbus, Ohio; Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, and Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford; Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol, Bristol, UK; Department of Rheumatology, University of Ottawa, Ottawa; Division of Rheumatology, Mount Sinai Hospital, Toronto; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.,G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, and Centre for Rheumatology Research, University Hospital; J.T. Farrar, MD, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Cuthbertson, MS, Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; S. Ashdown, RN, Oxfordshire; P.F. Cronholm, MD, MSCE, Department of Family Medicine and Community Health, University of Pennsylvania; J. Dawson, MA, MSc, DPhil, SRN, SCM, Nuffield Department of Population Health (HSRU), University of Oxford; D. Gebhart, MD, Ohio State University Wexner Medical Center, Columbus; G. Lanier, Patient Research Partner, Boston; R.A. Luqmani, DM, FRCP, FRCP(E), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; N. Milman, MD, MSc, FRCPC, Department of Rheumatology, University of Ottawa; J. Peck, RN, Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol; J.A. Shea, PhD, Division of General Internal Medicine, University of Pennsylvania; S. Carette, MD, Division of Rheumatology, Mount Sinai Hospital; N. Khalidi, MD, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, Division of Rheumatology, University of Utah; C.A. Langford, MD, Department of Rheumatology, Cleveland Clinic; P.A. Monach, MD, PhD, Section of Rheumatology, Boston University School of Medicine; L. Moreland, MD, Division of Rheumatology, University of Pittsburgh; C. Pagnoux, MD, MSc, MPH, Division of Rheumatology, Mount Sinai Hospital; U. Specks, MD, Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science; A.G. Sreih, MD, Division of Rheumatology, University of Pennsylvania; S.R. Ytterberg, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science; P.A. Merkel, MD, MPH, Division of Rheumatology, University of Pennsylvania
| | - Curry L Koening
- From the Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Department of Biostatistics, Epidemiology, and Informatics, and Division of Rheumatology, and Department of Family Medicine and Community Health, and Division of General Internal Medicine, University of Pennsylvania, Philadelphia; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Department of Rheumatology, Cleveland Clinic, Cleveland; Ohio State University Wexner Medical Center, Columbus, Ohio; Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, and Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford; Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol, Bristol, UK; Department of Rheumatology, University of Ottawa, Ottawa; Division of Rheumatology, Mount Sinai Hospital, Toronto; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.,G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, and Centre for Rheumatology Research, University Hospital; J.T. Farrar, MD, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Cuthbertson, MS, Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; S. Ashdown, RN, Oxfordshire; P.F. Cronholm, MD, MSCE, Department of Family Medicine and Community Health, University of Pennsylvania; J. Dawson, MA, MSc, DPhil, SRN, SCM, Nuffield Department of Population Health (HSRU), University of Oxford; D. Gebhart, MD, Ohio State University Wexner Medical Center, Columbus; G. Lanier, Patient Research Partner, Boston; R.A. Luqmani, DM, FRCP, FRCP(E), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; N. Milman, MD, MSc, FRCPC, Department of Rheumatology, University of Ottawa; J. Peck, RN, Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol; J.A. Shea, PhD, Division of General Internal Medicine, University of Pennsylvania; S. Carette, MD, Division of Rheumatology, Mount Sinai Hospital; N. Khalidi, MD, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, Division of Rheumatology, University of Utah; C.A. Langford, MD, Department of Rheumatology, Cleveland Clinic; P.A. Monach, MD, PhD, Section of Rheumatology, Boston University School of Medicine; L. Moreland, MD, Division of Rheumatology, University of Pittsburgh; C. Pagnoux, MD, MSc, MPH, Division of Rheumatology, Mount Sinai Hospital; U. Specks, MD, Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science; A.G. Sreih, MD, Division of Rheumatology, University of Pennsylvania; S.R. Ytterberg, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science; P.A. Merkel, MD, MPH, Division of Rheumatology, University of Pennsylvania
| | - Carol A Langford
- From the Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Department of Biostatistics, Epidemiology, and Informatics, and Division of Rheumatology, and Department of Family Medicine and Community Health, and Division of General Internal Medicine, University of Pennsylvania, Philadelphia; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Department of Rheumatology, Cleveland Clinic, Cleveland; Ohio State University Wexner Medical Center, Columbus, Ohio; Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, and Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford; Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol, Bristol, UK; Department of Rheumatology, University of Ottawa, Ottawa; Division of Rheumatology, Mount Sinai Hospital, Toronto; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.,G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, and Centre for Rheumatology Research, University Hospital; J.T. Farrar, MD, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Cuthbertson, MS, Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; S. Ashdown, RN, Oxfordshire; P.F. Cronholm, MD, MSCE, Department of Family Medicine and Community Health, University of Pennsylvania; J. Dawson, MA, MSc, DPhil, SRN, SCM, Nuffield Department of Population Health (HSRU), University of Oxford; D. Gebhart, MD, Ohio State University Wexner Medical Center, Columbus; G. Lanier, Patient Research Partner, Boston; R.A. Luqmani, DM, FRCP, FRCP(E), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; N. Milman, MD, MSc, FRCPC, Department of Rheumatology, University of Ottawa; J. Peck, RN, Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol; J.A. Shea, PhD, Division of General Internal Medicine, University of Pennsylvania; S. Carette, MD, Division of Rheumatology, Mount Sinai Hospital; N. Khalidi, MD, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, Division of Rheumatology, University of Utah; C.A. Langford, MD, Department of Rheumatology, Cleveland Clinic; P.A. Monach, MD, PhD, Section of Rheumatology, Boston University School of Medicine; L. Moreland, MD, Division of Rheumatology, University of Pittsburgh; C. Pagnoux, MD, MSc, MPH, Division of Rheumatology, Mount Sinai Hospital; U. Specks, MD, Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science; A.G. Sreih, MD, Division of Rheumatology, University of Pennsylvania; S.R. Ytterberg, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science; P.A. Merkel, MD, MPH, Division of Rheumatology, University of Pennsylvania
| | - Paul A Monach
- From the Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Department of Biostatistics, Epidemiology, and Informatics, and Division of Rheumatology, and Department of Family Medicine and Community Health, and Division of General Internal Medicine, University of Pennsylvania, Philadelphia; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Department of Rheumatology, Cleveland Clinic, Cleveland; Ohio State University Wexner Medical Center, Columbus, Ohio; Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, and Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford; Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol, Bristol, UK; Department of Rheumatology, University of Ottawa, Ottawa; Division of Rheumatology, Mount Sinai Hospital, Toronto; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.,G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, and Centre for Rheumatology Research, University Hospital; J.T. Farrar, MD, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Cuthbertson, MS, Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; S. Ashdown, RN, Oxfordshire; P.F. Cronholm, MD, MSCE, Department of Family Medicine and Community Health, University of Pennsylvania; J. Dawson, MA, MSc, DPhil, SRN, SCM, Nuffield Department of Population Health (HSRU), University of Oxford; D. Gebhart, MD, Ohio State University Wexner Medical Center, Columbus; G. Lanier, Patient Research Partner, Boston; R.A. Luqmani, DM, FRCP, FRCP(E), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; N. Milman, MD, MSc, FRCPC, Department of Rheumatology, University of Ottawa; J. Peck, RN, Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol; J.A. Shea, PhD, Division of General Internal Medicine, University of Pennsylvania; S. Carette, MD, Division of Rheumatology, Mount Sinai Hospital; N. Khalidi, MD, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, Division of Rheumatology, University of Utah; C.A. Langford, MD, Department of Rheumatology, Cleveland Clinic; P.A. Monach, MD, PhD, Section of Rheumatology, Boston University School of Medicine; L. Moreland, MD, Division of Rheumatology, University of Pittsburgh; C. Pagnoux, MD, MSc, MPH, Division of Rheumatology, Mount Sinai Hospital; U. Specks, MD, Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science; A.G. Sreih, MD, Division of Rheumatology, University of Pennsylvania; S.R. Ytterberg, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science; P.A. Merkel, MD, MPH, Division of Rheumatology, University of Pennsylvania
| | - Larry Moreland
- From the Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Department of Biostatistics, Epidemiology, and Informatics, and Division of Rheumatology, and Department of Family Medicine and Community Health, and Division of General Internal Medicine, University of Pennsylvania, Philadelphia; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Department of Rheumatology, Cleveland Clinic, Cleveland; Ohio State University Wexner Medical Center, Columbus, Ohio; Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, and Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford; Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol, Bristol, UK; Department of Rheumatology, University of Ottawa, Ottawa; Division of Rheumatology, Mount Sinai Hospital, Toronto; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.,G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, and Centre for Rheumatology Research, University Hospital; J.T. Farrar, MD, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Cuthbertson, MS, Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; S. Ashdown, RN, Oxfordshire; P.F. Cronholm, MD, MSCE, Department of Family Medicine and Community Health, University of Pennsylvania; J. Dawson, MA, MSc, DPhil, SRN, SCM, Nuffield Department of Population Health (HSRU), University of Oxford; D. Gebhart, MD, Ohio State University Wexner Medical Center, Columbus; G. Lanier, Patient Research Partner, Boston; R.A. Luqmani, DM, FRCP, FRCP(E), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; N. Milman, MD, MSc, FRCPC, Department of Rheumatology, University of Ottawa; J. Peck, RN, Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol; J.A. Shea, PhD, Division of General Internal Medicine, University of Pennsylvania; S. Carette, MD, Division of Rheumatology, Mount Sinai Hospital; N. Khalidi, MD, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, Division of Rheumatology, University of Utah; C.A. Langford, MD, Department of Rheumatology, Cleveland Clinic; P.A. Monach, MD, PhD, Section of Rheumatology, Boston University School of Medicine; L. Moreland, MD, Division of Rheumatology, University of Pittsburgh; C. Pagnoux, MD, MSc, MPH, Division of Rheumatology, Mount Sinai Hospital; U. Specks, MD, Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science; A.G. Sreih, MD, Division of Rheumatology, University of Pennsylvania; S.R. Ytterberg, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science; P.A. Merkel, MD, MPH, Division of Rheumatology, University of Pennsylvania
| | - Christian Pagnoux
- From the Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Department of Biostatistics, Epidemiology, and Informatics, and Division of Rheumatology, and Department of Family Medicine and Community Health, and Division of General Internal Medicine, University of Pennsylvania, Philadelphia; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Department of Rheumatology, Cleveland Clinic, Cleveland; Ohio State University Wexner Medical Center, Columbus, Ohio; Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, and Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford; Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol, Bristol, UK; Department of Rheumatology, University of Ottawa, Ottawa; Division of Rheumatology, Mount Sinai Hospital, Toronto; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.,G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, and Centre for Rheumatology Research, University Hospital; J.T. Farrar, MD, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Cuthbertson, MS, Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; S. Ashdown, RN, Oxfordshire; P.F. Cronholm, MD, MSCE, Department of Family Medicine and Community Health, University of Pennsylvania; J. Dawson, MA, MSc, DPhil, SRN, SCM, Nuffield Department of Population Health (HSRU), University of Oxford; D. Gebhart, MD, Ohio State University Wexner Medical Center, Columbus; G. Lanier, Patient Research Partner, Boston; R.A. Luqmani, DM, FRCP, FRCP(E), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; N. Milman, MD, MSc, FRCPC, Department of Rheumatology, University of Ottawa; J. Peck, RN, Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol; J.A. Shea, PhD, Division of General Internal Medicine, University of Pennsylvania; S. Carette, MD, Division of Rheumatology, Mount Sinai Hospital; N. Khalidi, MD, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, Division of Rheumatology, University of Utah; C.A. Langford, MD, Department of Rheumatology, Cleveland Clinic; P.A. Monach, MD, PhD, Section of Rheumatology, Boston University School of Medicine; L. Moreland, MD, Division of Rheumatology, University of Pittsburgh; C. Pagnoux, MD, MSc, MPH, Division of Rheumatology, Mount Sinai Hospital; U. Specks, MD, Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science; A.G. Sreih, MD, Division of Rheumatology, University of Pennsylvania; S.R. Ytterberg, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science; P.A. Merkel, MD, MPH, Division of Rheumatology, University of Pennsylvania
| | - Ulrich Specks
- From the Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Department of Biostatistics, Epidemiology, and Informatics, and Division of Rheumatology, and Department of Family Medicine and Community Health, and Division of General Internal Medicine, University of Pennsylvania, Philadelphia; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Department of Rheumatology, Cleveland Clinic, Cleveland; Ohio State University Wexner Medical Center, Columbus, Ohio; Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, and Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford; Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol, Bristol, UK; Department of Rheumatology, University of Ottawa, Ottawa; Division of Rheumatology, Mount Sinai Hospital, Toronto; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.,G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, and Centre for Rheumatology Research, University Hospital; J.T. Farrar, MD, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Cuthbertson, MS, Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; S. Ashdown, RN, Oxfordshire; P.F. Cronholm, MD, MSCE, Department of Family Medicine and Community Health, University of Pennsylvania; J. Dawson, MA, MSc, DPhil, SRN, SCM, Nuffield Department of Population Health (HSRU), University of Oxford; D. Gebhart, MD, Ohio State University Wexner Medical Center, Columbus; G. Lanier, Patient Research Partner, Boston; R.A. Luqmani, DM, FRCP, FRCP(E), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; N. Milman, MD, MSc, FRCPC, Department of Rheumatology, University of Ottawa; J. Peck, RN, Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol; J.A. Shea, PhD, Division of General Internal Medicine, University of Pennsylvania; S. Carette, MD, Division of Rheumatology, Mount Sinai Hospital; N. Khalidi, MD, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, Division of Rheumatology, University of Utah; C.A. Langford, MD, Department of Rheumatology, Cleveland Clinic; P.A. Monach, MD, PhD, Section of Rheumatology, Boston University School of Medicine; L. Moreland, MD, Division of Rheumatology, University of Pittsburgh; C. Pagnoux, MD, MSc, MPH, Division of Rheumatology, Mount Sinai Hospital; U. Specks, MD, Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science; A.G. Sreih, MD, Division of Rheumatology, University of Pennsylvania; S.R. Ytterberg, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science; P.A. Merkel, MD, MPH, Division of Rheumatology, University of Pennsylvania
| | - Antoine G Sreih
- From the Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Department of Biostatistics, Epidemiology, and Informatics, and Division of Rheumatology, and Department of Family Medicine and Community Health, and Division of General Internal Medicine, University of Pennsylvania, Philadelphia; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Department of Rheumatology, Cleveland Clinic, Cleveland; Ohio State University Wexner Medical Center, Columbus, Ohio; Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, and Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford; Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol, Bristol, UK; Department of Rheumatology, University of Ottawa, Ottawa; Division of Rheumatology, Mount Sinai Hospital, Toronto; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.,G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, and Centre for Rheumatology Research, University Hospital; J.T. Farrar, MD, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Cuthbertson, MS, Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; S. Ashdown, RN, Oxfordshire; P.F. Cronholm, MD, MSCE, Department of Family Medicine and Community Health, University of Pennsylvania; J. Dawson, MA, MSc, DPhil, SRN, SCM, Nuffield Department of Population Health (HSRU), University of Oxford; D. Gebhart, MD, Ohio State University Wexner Medical Center, Columbus; G. Lanier, Patient Research Partner, Boston; R.A. Luqmani, DM, FRCP, FRCP(E), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; N. Milman, MD, MSc, FRCPC, Department of Rheumatology, University of Ottawa; J. Peck, RN, Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol; J.A. Shea, PhD, Division of General Internal Medicine, University of Pennsylvania; S. Carette, MD, Division of Rheumatology, Mount Sinai Hospital; N. Khalidi, MD, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, Division of Rheumatology, University of Utah; C.A. Langford, MD, Department of Rheumatology, Cleveland Clinic; P.A. Monach, MD, PhD, Section of Rheumatology, Boston University School of Medicine; L. Moreland, MD, Division of Rheumatology, University of Pittsburgh; C. Pagnoux, MD, MSc, MPH, Division of Rheumatology, Mount Sinai Hospital; U. Specks, MD, Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science; A.G. Sreih, MD, Division of Rheumatology, University of Pennsylvania; S.R. Ytterberg, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science; P.A. Merkel, MD, MPH, Division of Rheumatology, University of Pennsylvania
| | - Steven R Ytterberg
- From the Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Department of Biostatistics, Epidemiology, and Informatics, and Division of Rheumatology, and Department of Family Medicine and Community Health, and Division of General Internal Medicine, University of Pennsylvania, Philadelphia; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Department of Rheumatology, Cleveland Clinic, Cleveland; Ohio State University Wexner Medical Center, Columbus, Ohio; Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, and Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford; Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol, Bristol, UK; Department of Rheumatology, University of Ottawa, Ottawa; Division of Rheumatology, Mount Sinai Hospital, Toronto; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.,G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, and Centre for Rheumatology Research, University Hospital; J.T. Farrar, MD, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Cuthbertson, MS, Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; S. Ashdown, RN, Oxfordshire; P.F. Cronholm, MD, MSCE, Department of Family Medicine and Community Health, University of Pennsylvania; J. Dawson, MA, MSc, DPhil, SRN, SCM, Nuffield Department of Population Health (HSRU), University of Oxford; D. Gebhart, MD, Ohio State University Wexner Medical Center, Columbus; G. Lanier, Patient Research Partner, Boston; R.A. Luqmani, DM, FRCP, FRCP(E), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; N. Milman, MD, MSc, FRCPC, Department of Rheumatology, University of Ottawa; J. Peck, RN, Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol; J.A. Shea, PhD, Division of General Internal Medicine, University of Pennsylvania; S. Carette, MD, Division of Rheumatology, Mount Sinai Hospital; N. Khalidi, MD, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, Division of Rheumatology, University of Utah; C.A. Langford, MD, Department of Rheumatology, Cleveland Clinic; P.A. Monach, MD, PhD, Section of Rheumatology, Boston University School of Medicine; L. Moreland, MD, Division of Rheumatology, University of Pittsburgh; C. Pagnoux, MD, MSc, MPH, Division of Rheumatology, Mount Sinai Hospital; U. Specks, MD, Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science; A.G. Sreih, MD, Division of Rheumatology, University of Pennsylvania; S.R. Ytterberg, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science; P.A. Merkel, MD, MPH, Division of Rheumatology, University of Pennsylvania
| | - Peter A Merkel
- From the Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Department of Biostatistics, Epidemiology, and Informatics, and Division of Rheumatology, and Department of Family Medicine and Community Health, and Division of General Internal Medicine, University of Pennsylvania, Philadelphia; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, Florida; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Department of Rheumatology, Cleveland Clinic, Cleveland; Ohio State University Wexner Medical Center, Columbus, Ohio; Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, and Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford; Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol, Bristol, UK; Department of Rheumatology, University of Ottawa, Ottawa; Division of Rheumatology, Mount Sinai Hospital, Toronto; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.,G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, and Centre for Rheumatology Research, University Hospital; J.T. Farrar, MD, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; D. Cuthbertson, MS, Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida; C.A. McAlear, MA, Division of Rheumatology, University of Pennsylvania; S. Ashdown, RN, Oxfordshire; P.F. Cronholm, MD, MSCE, Department of Family Medicine and Community Health, University of Pennsylvania; J. Dawson, MA, MSc, DPhil, SRN, SCM, Nuffield Department of Population Health (HSRU), University of Oxford; D. Gebhart, MD, Ohio State University Wexner Medical Center, Columbus; G. Lanier, Patient Research Partner, Boston; R.A. Luqmani, DM, FRCP, FRCP(E), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; N. Milman, MD, MSc, FRCPC, Department of Rheumatology, University of Ottawa; J. Peck, RN, Faculty of Health and Applied Sciences, University of the West of England, Bristol and School of Clinical Sciences, University of Bristol; J.A. Shea, PhD, Division of General Internal Medicine, University of Pennsylvania; S. Carette, MD, Division of Rheumatology, Mount Sinai Hospital; N. Khalidi, MD, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, Division of Rheumatology, University of Utah; C.A. Langford, MD, Department of Rheumatology, Cleveland Clinic; P.A. Monach, MD, PhD, Section of Rheumatology, Boston University School of Medicine; L. Moreland, MD, Division of Rheumatology, University of Pittsburgh; C. Pagnoux, MD, MSc, MPH, Division of Rheumatology, Mount Sinai Hospital; U. Specks, MD, Division of Pulmonology and Critical Care Medicine, Mayo Clinic College of Medicine and Science; A.G. Sreih, MD, Division of Rheumatology, University of Pennsylvania; S.R. Ytterberg, MD, Division of Rheumatology, Mayo Clinic College of Medicine and Science; P.A. Merkel, MD, MPH, Division of Rheumatology, University of Pennsylvania
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Milman N, McConville E, Robson JC, Boonen A, Tugwell P, Wells GA, Chaudhuri D, Dawson J, Tomasson G, Ashdown S, Gebhart D, Lanier G, Peck J, McAlear CA, Kellom KS, Cronholm PF, Merkel PA. Updating OMERACT Core Set of Domains for ANCA-associated Vasculitis: Patient Perspective Using the International Classification of Function, Disability, and Health. J Rheumatol 2019; 46:1415-1420. [PMID: 30709951 DOI: 10.3899/jrheum.181073] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Aspects of antineutrophil cytoplasmic antibodies-associated vasculitis (AAV) prioritized by patients with AAV were described using the International Classification of Function, Disability, and Health (ICF). METHODS Items identified during 14 individual interviews were incorporated into an ICF-based questionnaire administered to participants of 2 vasculitis patient symposia: 36 in the United Kingdom and 63 in the United States. RESULTS Categories identified as at least "moderately relevant" by ≥ 5% of subjects included 44 body functions, 14 body structures, 35 activities and participation, 31 environmental factors, and 38 personal factors. CONCLUSION Identified categories differ from those identified by the current Outcome Measures in Rheumatology (OMERACT) core set and those prioritized by vasculitis experts.
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Affiliation(s)
- Nataliya Milman
- From the Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program, Ottawa Hospital Research Institute; School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Faculty of Health and Applied Science, University of the West of England; School of Clinical Science, University of Bristol, Bristol; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre; Caphri Research Institute, Maastricht University, Maastricht, the Netherlands; Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Vasculitis Clinical Research Consortium, and Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, and Department of Family Medicine and Community Health, University of Pennsylvania; PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA. .,The Vasculitis Clinical Research Consortium (VCRC) Outcome Measures in Rheumatology Vasculitis Working Group was supported by the Vasculitis Clinical Research Consortium, which received support from the US National Institute of Arthritis and Musculoskeletal and Skin Diseases (grants U54-AR-057319 and U01-AR-51874 04), the National Center for Research Resources (grant U54-RR-019497), the National Center for Advancing Translational Science, and the Office of Rare Diseases Research, each part of the US National Institutes of Health (NIH). The VCRC is a member of the NIH Rare Diseases Clinical Research Network. The VCRC also received a Pilot award from the Patient-Centered Outcomes Research Institute. Dr. Milman's work was supported by a postgraduate Rheumatology Fellowship award given jointly by UCB Pharma, the Canadian Rheumatology Association, and The Arthritis Society, and a Fellowship from the Ottawa Hospital Department of Medicine. This work was further supported by a Vasculitis Foundation Research Grant. .,N. Milman, MD, MSc, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; E. McConville, MD, Resident, Department of Medicine, University of Ottawa; J.C. Robson, MBBS, PhD, MRCP, Consultant Senior Lecturer in Rheumatology, Faculty of Health and Applied Science, University of the West of England, and School of Clinical Science, University of Bristol; A. Boonen, MD, PhD, Professor, Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre, and Caphri Research Institute, Maastricht University; P. Tugwell, MD, FRCPC, Professor, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa; G.A. Wells, PhD, Professor, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa Heart Institute; D. Chaudhuri, MD, Resident, Department of Medicine, University of Ottawa; J. Dawson, MA, MSc, DPhil, Visiting Academic Researcher, Nuffield Department of Population Health (HSRU), University of Oxford; G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, University Hospital, and Centre for Rheumatology Research, University Hospital; S. Ashdown, Patient Partner, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; D. Gebhart, Patient Partner, Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; G. Lanier, Patient Partner, Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; J. Peck, Patient Partner, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; C.A. McAlear, MA, Project Manager, Vasculitis Clinical Research Consortium, and Division of Rheumatology, Department of Medicine, University of Pennsylvania; K.S. Kellom, BA, PolicyLab, Children's Hospital of Philadelphia; P.F. Cronholm, MD, MSCE, Associate Professor, Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania; P.A. Merkel, MD, MPH, Professor, Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania.
| | - Eilish McConville
- From the Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program, Ottawa Hospital Research Institute; School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Faculty of Health and Applied Science, University of the West of England; School of Clinical Science, University of Bristol, Bristol; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre; Caphri Research Institute, Maastricht University, Maastricht, the Netherlands; Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Vasculitis Clinical Research Consortium, and Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, and Department of Family Medicine and Community Health, University of Pennsylvania; PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,The Vasculitis Clinical Research Consortium (VCRC) Outcome Measures in Rheumatology Vasculitis Working Group was supported by the Vasculitis Clinical Research Consortium, which received support from the US National Institute of Arthritis and Musculoskeletal and Skin Diseases (grants U54-AR-057319 and U01-AR-51874 04), the National Center for Research Resources (grant U54-RR-019497), the National Center for Advancing Translational Science, and the Office of Rare Diseases Research, each part of the US National Institutes of Health (NIH). The VCRC is a member of the NIH Rare Diseases Clinical Research Network. The VCRC also received a Pilot award from the Patient-Centered Outcomes Research Institute. Dr. Milman's work was supported by a postgraduate Rheumatology Fellowship award given jointly by UCB Pharma, the Canadian Rheumatology Association, and The Arthritis Society, and a Fellowship from the Ottawa Hospital Department of Medicine. This work was further supported by a Vasculitis Foundation Research Grant.,N. Milman, MD, MSc, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; E. McConville, MD, Resident, Department of Medicine, University of Ottawa; J.C. Robson, MBBS, PhD, MRCP, Consultant Senior Lecturer in Rheumatology, Faculty of Health and Applied Science, University of the West of England, and School of Clinical Science, University of Bristol; A. Boonen, MD, PhD, Professor, Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre, and Caphri Research Institute, Maastricht University; P. Tugwell, MD, FRCPC, Professor, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa; G.A. Wells, PhD, Professor, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa Heart Institute; D. Chaudhuri, MD, Resident, Department of Medicine, University of Ottawa; J. Dawson, MA, MSc, DPhil, Visiting Academic Researcher, Nuffield Department of Population Health (HSRU), University of Oxford; G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, University Hospital, and Centre for Rheumatology Research, University Hospital; S. Ashdown, Patient Partner, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; D. Gebhart, Patient Partner, Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; G. Lanier, Patient Partner, Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; J. Peck, Patient Partner, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; C.A. McAlear, MA, Project Manager, Vasculitis Clinical Research Consortium, and Division of Rheumatology, Department of Medicine, University of Pennsylvania; K.S. Kellom, BA, PolicyLab, Children's Hospital of Philadelphia; P.F. Cronholm, MD, MSCE, Associate Professor, Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania; P.A. Merkel, MD, MPH, Professor, Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania
| | - Joanna C Robson
- From the Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program, Ottawa Hospital Research Institute; School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Faculty of Health and Applied Science, University of the West of England; School of Clinical Science, University of Bristol, Bristol; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre; Caphri Research Institute, Maastricht University, Maastricht, the Netherlands; Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Vasculitis Clinical Research Consortium, and Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, and Department of Family Medicine and Community Health, University of Pennsylvania; PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,The Vasculitis Clinical Research Consortium (VCRC) Outcome Measures in Rheumatology Vasculitis Working Group was supported by the Vasculitis Clinical Research Consortium, which received support from the US National Institute of Arthritis and Musculoskeletal and Skin Diseases (grants U54-AR-057319 and U01-AR-51874 04), the National Center for Research Resources (grant U54-RR-019497), the National Center for Advancing Translational Science, and the Office of Rare Diseases Research, each part of the US National Institutes of Health (NIH). The VCRC is a member of the NIH Rare Diseases Clinical Research Network. The VCRC also received a Pilot award from the Patient-Centered Outcomes Research Institute. Dr. Milman's work was supported by a postgraduate Rheumatology Fellowship award given jointly by UCB Pharma, the Canadian Rheumatology Association, and The Arthritis Society, and a Fellowship from the Ottawa Hospital Department of Medicine. This work was further supported by a Vasculitis Foundation Research Grant.,N. Milman, MD, MSc, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; E. McConville, MD, Resident, Department of Medicine, University of Ottawa; J.C. Robson, MBBS, PhD, MRCP, Consultant Senior Lecturer in Rheumatology, Faculty of Health and Applied Science, University of the West of England, and School of Clinical Science, University of Bristol; A. Boonen, MD, PhD, Professor, Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre, and Caphri Research Institute, Maastricht University; P. Tugwell, MD, FRCPC, Professor, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa; G.A. Wells, PhD, Professor, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa Heart Institute; D. Chaudhuri, MD, Resident, Department of Medicine, University of Ottawa; J. Dawson, MA, MSc, DPhil, Visiting Academic Researcher, Nuffield Department of Population Health (HSRU), University of Oxford; G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, University Hospital, and Centre for Rheumatology Research, University Hospital; S. Ashdown, Patient Partner, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; D. Gebhart, Patient Partner, Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; G. Lanier, Patient Partner, Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; J. Peck, Patient Partner, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; C.A. McAlear, MA, Project Manager, Vasculitis Clinical Research Consortium, and Division of Rheumatology, Department of Medicine, University of Pennsylvania; K.S. Kellom, BA, PolicyLab, Children's Hospital of Philadelphia; P.F. Cronholm, MD, MSCE, Associate Professor, Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania; P.A. Merkel, MD, MPH, Professor, Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania
| | - Annelies Boonen
- From the Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program, Ottawa Hospital Research Institute; School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Faculty of Health and Applied Science, University of the West of England; School of Clinical Science, University of Bristol, Bristol; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre; Caphri Research Institute, Maastricht University, Maastricht, the Netherlands; Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Vasculitis Clinical Research Consortium, and Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, and Department of Family Medicine and Community Health, University of Pennsylvania; PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,The Vasculitis Clinical Research Consortium (VCRC) Outcome Measures in Rheumatology Vasculitis Working Group was supported by the Vasculitis Clinical Research Consortium, which received support from the US National Institute of Arthritis and Musculoskeletal and Skin Diseases (grants U54-AR-057319 and U01-AR-51874 04), the National Center for Research Resources (grant U54-RR-019497), the National Center for Advancing Translational Science, and the Office of Rare Diseases Research, each part of the US National Institutes of Health (NIH). The VCRC is a member of the NIH Rare Diseases Clinical Research Network. The VCRC also received a Pilot award from the Patient-Centered Outcomes Research Institute. Dr. Milman's work was supported by a postgraduate Rheumatology Fellowship award given jointly by UCB Pharma, the Canadian Rheumatology Association, and The Arthritis Society, and a Fellowship from the Ottawa Hospital Department of Medicine. This work was further supported by a Vasculitis Foundation Research Grant.,N. Milman, MD, MSc, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; E. McConville, MD, Resident, Department of Medicine, University of Ottawa; J.C. Robson, MBBS, PhD, MRCP, Consultant Senior Lecturer in Rheumatology, Faculty of Health and Applied Science, University of the West of England, and School of Clinical Science, University of Bristol; A. Boonen, MD, PhD, Professor, Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre, and Caphri Research Institute, Maastricht University; P. Tugwell, MD, FRCPC, Professor, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa; G.A. Wells, PhD, Professor, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa Heart Institute; D. Chaudhuri, MD, Resident, Department of Medicine, University of Ottawa; J. Dawson, MA, MSc, DPhil, Visiting Academic Researcher, Nuffield Department of Population Health (HSRU), University of Oxford; G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, University Hospital, and Centre for Rheumatology Research, University Hospital; S. Ashdown, Patient Partner, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; D. Gebhart, Patient Partner, Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; G. Lanier, Patient Partner, Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; J. Peck, Patient Partner, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; C.A. McAlear, MA, Project Manager, Vasculitis Clinical Research Consortium, and Division of Rheumatology, Department of Medicine, University of Pennsylvania; K.S. Kellom, BA, PolicyLab, Children's Hospital of Philadelphia; P.F. Cronholm, MD, MSCE, Associate Professor, Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania; P.A. Merkel, MD, MPH, Professor, Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania
| | - Peter Tugwell
- From the Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program, Ottawa Hospital Research Institute; School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Faculty of Health and Applied Science, University of the West of England; School of Clinical Science, University of Bristol, Bristol; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre; Caphri Research Institute, Maastricht University, Maastricht, the Netherlands; Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Vasculitis Clinical Research Consortium, and Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, and Department of Family Medicine and Community Health, University of Pennsylvania; PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,The Vasculitis Clinical Research Consortium (VCRC) Outcome Measures in Rheumatology Vasculitis Working Group was supported by the Vasculitis Clinical Research Consortium, which received support from the US National Institute of Arthritis and Musculoskeletal and Skin Diseases (grants U54-AR-057319 and U01-AR-51874 04), the National Center for Research Resources (grant U54-RR-019497), the National Center for Advancing Translational Science, and the Office of Rare Diseases Research, each part of the US National Institutes of Health (NIH). The VCRC is a member of the NIH Rare Diseases Clinical Research Network. The VCRC also received a Pilot award from the Patient-Centered Outcomes Research Institute. Dr. Milman's work was supported by a postgraduate Rheumatology Fellowship award given jointly by UCB Pharma, the Canadian Rheumatology Association, and The Arthritis Society, and a Fellowship from the Ottawa Hospital Department of Medicine. This work was further supported by a Vasculitis Foundation Research Grant.,N. Milman, MD, MSc, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; E. McConville, MD, Resident, Department of Medicine, University of Ottawa; J.C. Robson, MBBS, PhD, MRCP, Consultant Senior Lecturer in Rheumatology, Faculty of Health and Applied Science, University of the West of England, and School of Clinical Science, University of Bristol; A. Boonen, MD, PhD, Professor, Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre, and Caphri Research Institute, Maastricht University; P. Tugwell, MD, FRCPC, Professor, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa; G.A. Wells, PhD, Professor, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa Heart Institute; D. Chaudhuri, MD, Resident, Department of Medicine, University of Ottawa; J. Dawson, MA, MSc, DPhil, Visiting Academic Researcher, Nuffield Department of Population Health (HSRU), University of Oxford; G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, University Hospital, and Centre for Rheumatology Research, University Hospital; S. Ashdown, Patient Partner, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; D. Gebhart, Patient Partner, Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; G. Lanier, Patient Partner, Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; J. Peck, Patient Partner, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; C.A. McAlear, MA, Project Manager, Vasculitis Clinical Research Consortium, and Division of Rheumatology, Department of Medicine, University of Pennsylvania; K.S. Kellom, BA, PolicyLab, Children's Hospital of Philadelphia; P.F. Cronholm, MD, MSCE, Associate Professor, Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania; P.A. Merkel, MD, MPH, Professor, Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania
| | - George A Wells
- From the Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program, Ottawa Hospital Research Institute; School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Faculty of Health and Applied Science, University of the West of England; School of Clinical Science, University of Bristol, Bristol; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre; Caphri Research Institute, Maastricht University, Maastricht, the Netherlands; Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Vasculitis Clinical Research Consortium, and Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, and Department of Family Medicine and Community Health, University of Pennsylvania; PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,The Vasculitis Clinical Research Consortium (VCRC) Outcome Measures in Rheumatology Vasculitis Working Group was supported by the Vasculitis Clinical Research Consortium, which received support from the US National Institute of Arthritis and Musculoskeletal and Skin Diseases (grants U54-AR-057319 and U01-AR-51874 04), the National Center for Research Resources (grant U54-RR-019497), the National Center for Advancing Translational Science, and the Office of Rare Diseases Research, each part of the US National Institutes of Health (NIH). The VCRC is a member of the NIH Rare Diseases Clinical Research Network. The VCRC also received a Pilot award from the Patient-Centered Outcomes Research Institute. Dr. Milman's work was supported by a postgraduate Rheumatology Fellowship award given jointly by UCB Pharma, the Canadian Rheumatology Association, and The Arthritis Society, and a Fellowship from the Ottawa Hospital Department of Medicine. This work was further supported by a Vasculitis Foundation Research Grant.,N. Milman, MD, MSc, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; E. McConville, MD, Resident, Department of Medicine, University of Ottawa; J.C. Robson, MBBS, PhD, MRCP, Consultant Senior Lecturer in Rheumatology, Faculty of Health and Applied Science, University of the West of England, and School of Clinical Science, University of Bristol; A. Boonen, MD, PhD, Professor, Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre, and Caphri Research Institute, Maastricht University; P. Tugwell, MD, FRCPC, Professor, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa; G.A. Wells, PhD, Professor, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa Heart Institute; D. Chaudhuri, MD, Resident, Department of Medicine, University of Ottawa; J. Dawson, MA, MSc, DPhil, Visiting Academic Researcher, Nuffield Department of Population Health (HSRU), University of Oxford; G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, University Hospital, and Centre for Rheumatology Research, University Hospital; S. Ashdown, Patient Partner, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; D. Gebhart, Patient Partner, Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; G. Lanier, Patient Partner, Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; J. Peck, Patient Partner, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; C.A. McAlear, MA, Project Manager, Vasculitis Clinical Research Consortium, and Division of Rheumatology, Department of Medicine, University of Pennsylvania; K.S. Kellom, BA, PolicyLab, Children's Hospital of Philadelphia; P.F. Cronholm, MD, MSCE, Associate Professor, Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania; P.A. Merkel, MD, MPH, Professor, Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania
| | - Dipayan Chaudhuri
- From the Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program, Ottawa Hospital Research Institute; School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Faculty of Health and Applied Science, University of the West of England; School of Clinical Science, University of Bristol, Bristol; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre; Caphri Research Institute, Maastricht University, Maastricht, the Netherlands; Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Vasculitis Clinical Research Consortium, and Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, and Department of Family Medicine and Community Health, University of Pennsylvania; PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,The Vasculitis Clinical Research Consortium (VCRC) Outcome Measures in Rheumatology Vasculitis Working Group was supported by the Vasculitis Clinical Research Consortium, which received support from the US National Institute of Arthritis and Musculoskeletal and Skin Diseases (grants U54-AR-057319 and U01-AR-51874 04), the National Center for Research Resources (grant U54-RR-019497), the National Center for Advancing Translational Science, and the Office of Rare Diseases Research, each part of the US National Institutes of Health (NIH). The VCRC is a member of the NIH Rare Diseases Clinical Research Network. The VCRC also received a Pilot award from the Patient-Centered Outcomes Research Institute. Dr. Milman's work was supported by a postgraduate Rheumatology Fellowship award given jointly by UCB Pharma, the Canadian Rheumatology Association, and The Arthritis Society, and a Fellowship from the Ottawa Hospital Department of Medicine. This work was further supported by a Vasculitis Foundation Research Grant.,N. Milman, MD, MSc, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; E. McConville, MD, Resident, Department of Medicine, University of Ottawa; J.C. Robson, MBBS, PhD, MRCP, Consultant Senior Lecturer in Rheumatology, Faculty of Health and Applied Science, University of the West of England, and School of Clinical Science, University of Bristol; A. Boonen, MD, PhD, Professor, Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre, and Caphri Research Institute, Maastricht University; P. Tugwell, MD, FRCPC, Professor, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa; G.A. Wells, PhD, Professor, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa Heart Institute; D. Chaudhuri, MD, Resident, Department of Medicine, University of Ottawa; J. Dawson, MA, MSc, DPhil, Visiting Academic Researcher, Nuffield Department of Population Health (HSRU), University of Oxford; G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, University Hospital, and Centre for Rheumatology Research, University Hospital; S. Ashdown, Patient Partner, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; D. Gebhart, Patient Partner, Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; G. Lanier, Patient Partner, Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; J. Peck, Patient Partner, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; C.A. McAlear, MA, Project Manager, Vasculitis Clinical Research Consortium, and Division of Rheumatology, Department of Medicine, University of Pennsylvania; K.S. Kellom, BA, PolicyLab, Children's Hospital of Philadelphia; P.F. Cronholm, MD, MSCE, Associate Professor, Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania; P.A. Merkel, MD, MPH, Professor, Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania
| | - Jill Dawson
- From the Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program, Ottawa Hospital Research Institute; School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Faculty of Health and Applied Science, University of the West of England; School of Clinical Science, University of Bristol, Bristol; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre; Caphri Research Institute, Maastricht University, Maastricht, the Netherlands; Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Vasculitis Clinical Research Consortium, and Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, and Department of Family Medicine and Community Health, University of Pennsylvania; PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,The Vasculitis Clinical Research Consortium (VCRC) Outcome Measures in Rheumatology Vasculitis Working Group was supported by the Vasculitis Clinical Research Consortium, which received support from the US National Institute of Arthritis and Musculoskeletal and Skin Diseases (grants U54-AR-057319 and U01-AR-51874 04), the National Center for Research Resources (grant U54-RR-019497), the National Center for Advancing Translational Science, and the Office of Rare Diseases Research, each part of the US National Institutes of Health (NIH). The VCRC is a member of the NIH Rare Diseases Clinical Research Network. The VCRC also received a Pilot award from the Patient-Centered Outcomes Research Institute. Dr. Milman's work was supported by a postgraduate Rheumatology Fellowship award given jointly by UCB Pharma, the Canadian Rheumatology Association, and The Arthritis Society, and a Fellowship from the Ottawa Hospital Department of Medicine. This work was further supported by a Vasculitis Foundation Research Grant.,N. Milman, MD, MSc, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; E. McConville, MD, Resident, Department of Medicine, University of Ottawa; J.C. Robson, MBBS, PhD, MRCP, Consultant Senior Lecturer in Rheumatology, Faculty of Health and Applied Science, University of the West of England, and School of Clinical Science, University of Bristol; A. Boonen, MD, PhD, Professor, Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre, and Caphri Research Institute, Maastricht University; P. Tugwell, MD, FRCPC, Professor, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa; G.A. Wells, PhD, Professor, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa Heart Institute; D. Chaudhuri, MD, Resident, Department of Medicine, University of Ottawa; J. Dawson, MA, MSc, DPhil, Visiting Academic Researcher, Nuffield Department of Population Health (HSRU), University of Oxford; G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, University Hospital, and Centre for Rheumatology Research, University Hospital; S. Ashdown, Patient Partner, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; D. Gebhart, Patient Partner, Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; G. Lanier, Patient Partner, Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; J. Peck, Patient Partner, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; C.A. McAlear, MA, Project Manager, Vasculitis Clinical Research Consortium, and Division of Rheumatology, Department of Medicine, University of Pennsylvania; K.S. Kellom, BA, PolicyLab, Children's Hospital of Philadelphia; P.F. Cronholm, MD, MSCE, Associate Professor, Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania; P.A. Merkel, MD, MPH, Professor, Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania
| | - Gunnar Tomasson
- From the Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program, Ottawa Hospital Research Institute; School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Faculty of Health and Applied Science, University of the West of England; School of Clinical Science, University of Bristol, Bristol; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre; Caphri Research Institute, Maastricht University, Maastricht, the Netherlands; Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Vasculitis Clinical Research Consortium, and Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, and Department of Family Medicine and Community Health, University of Pennsylvania; PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,The Vasculitis Clinical Research Consortium (VCRC) Outcome Measures in Rheumatology Vasculitis Working Group was supported by the Vasculitis Clinical Research Consortium, which received support from the US National Institute of Arthritis and Musculoskeletal and Skin Diseases (grants U54-AR-057319 and U01-AR-51874 04), the National Center for Research Resources (grant U54-RR-019497), the National Center for Advancing Translational Science, and the Office of Rare Diseases Research, each part of the US National Institutes of Health (NIH). The VCRC is a member of the NIH Rare Diseases Clinical Research Network. The VCRC also received a Pilot award from the Patient-Centered Outcomes Research Institute. Dr. Milman's work was supported by a postgraduate Rheumatology Fellowship award given jointly by UCB Pharma, the Canadian Rheumatology Association, and The Arthritis Society, and a Fellowship from the Ottawa Hospital Department of Medicine. This work was further supported by a Vasculitis Foundation Research Grant.,N. Milman, MD, MSc, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; E. McConville, MD, Resident, Department of Medicine, University of Ottawa; J.C. Robson, MBBS, PhD, MRCP, Consultant Senior Lecturer in Rheumatology, Faculty of Health and Applied Science, University of the West of England, and School of Clinical Science, University of Bristol; A. Boonen, MD, PhD, Professor, Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre, and Caphri Research Institute, Maastricht University; P. Tugwell, MD, FRCPC, Professor, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa; G.A. Wells, PhD, Professor, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa Heart Institute; D. Chaudhuri, MD, Resident, Department of Medicine, University of Ottawa; J. Dawson, MA, MSc, DPhil, Visiting Academic Researcher, Nuffield Department of Population Health (HSRU), University of Oxford; G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, University Hospital, and Centre for Rheumatology Research, University Hospital; S. Ashdown, Patient Partner, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; D. Gebhart, Patient Partner, Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; G. Lanier, Patient Partner, Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; J. Peck, Patient Partner, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; C.A. McAlear, MA, Project Manager, Vasculitis Clinical Research Consortium, and Division of Rheumatology, Department of Medicine, University of Pennsylvania; K.S. Kellom, BA, PolicyLab, Children's Hospital of Philadelphia; P.F. Cronholm, MD, MSCE, Associate Professor, Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania; P.A. Merkel, MD, MPH, Professor, Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania
| | - Susan Ashdown
- From the Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program, Ottawa Hospital Research Institute; School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Faculty of Health and Applied Science, University of the West of England; School of Clinical Science, University of Bristol, Bristol; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre; Caphri Research Institute, Maastricht University, Maastricht, the Netherlands; Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Vasculitis Clinical Research Consortium, and Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, and Department of Family Medicine and Community Health, University of Pennsylvania; PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,The Vasculitis Clinical Research Consortium (VCRC) Outcome Measures in Rheumatology Vasculitis Working Group was supported by the Vasculitis Clinical Research Consortium, which received support from the US National Institute of Arthritis and Musculoskeletal and Skin Diseases (grants U54-AR-057319 and U01-AR-51874 04), the National Center for Research Resources (grant U54-RR-019497), the National Center for Advancing Translational Science, and the Office of Rare Diseases Research, each part of the US National Institutes of Health (NIH). The VCRC is a member of the NIH Rare Diseases Clinical Research Network. The VCRC also received a Pilot award from the Patient-Centered Outcomes Research Institute. Dr. Milman's work was supported by a postgraduate Rheumatology Fellowship award given jointly by UCB Pharma, the Canadian Rheumatology Association, and The Arthritis Society, and a Fellowship from the Ottawa Hospital Department of Medicine. This work was further supported by a Vasculitis Foundation Research Grant.,N. Milman, MD, MSc, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; E. McConville, MD, Resident, Department of Medicine, University of Ottawa; J.C. Robson, MBBS, PhD, MRCP, Consultant Senior Lecturer in Rheumatology, Faculty of Health and Applied Science, University of the West of England, and School of Clinical Science, University of Bristol; A. Boonen, MD, PhD, Professor, Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre, and Caphri Research Institute, Maastricht University; P. Tugwell, MD, FRCPC, Professor, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa; G.A. Wells, PhD, Professor, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa Heart Institute; D. Chaudhuri, MD, Resident, Department of Medicine, University of Ottawa; J. Dawson, MA, MSc, DPhil, Visiting Academic Researcher, Nuffield Department of Population Health (HSRU), University of Oxford; G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, University Hospital, and Centre for Rheumatology Research, University Hospital; S. Ashdown, Patient Partner, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; D. Gebhart, Patient Partner, Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; G. Lanier, Patient Partner, Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; J. Peck, Patient Partner, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; C.A. McAlear, MA, Project Manager, Vasculitis Clinical Research Consortium, and Division of Rheumatology, Department of Medicine, University of Pennsylvania; K.S. Kellom, BA, PolicyLab, Children's Hospital of Philadelphia; P.F. Cronholm, MD, MSCE, Associate Professor, Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania; P.A. Merkel, MD, MPH, Professor, Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania
| | - Don Gebhart
- From the Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program, Ottawa Hospital Research Institute; School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Faculty of Health and Applied Science, University of the West of England; School of Clinical Science, University of Bristol, Bristol; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre; Caphri Research Institute, Maastricht University, Maastricht, the Netherlands; Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Vasculitis Clinical Research Consortium, and Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, and Department of Family Medicine and Community Health, University of Pennsylvania; PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,The Vasculitis Clinical Research Consortium (VCRC) Outcome Measures in Rheumatology Vasculitis Working Group was supported by the Vasculitis Clinical Research Consortium, which received support from the US National Institute of Arthritis and Musculoskeletal and Skin Diseases (grants U54-AR-057319 and U01-AR-51874 04), the National Center for Research Resources (grant U54-RR-019497), the National Center for Advancing Translational Science, and the Office of Rare Diseases Research, each part of the US National Institutes of Health (NIH). The VCRC is a member of the NIH Rare Diseases Clinical Research Network. The VCRC also received a Pilot award from the Patient-Centered Outcomes Research Institute. Dr. Milman's work was supported by a postgraduate Rheumatology Fellowship award given jointly by UCB Pharma, the Canadian Rheumatology Association, and The Arthritis Society, and a Fellowship from the Ottawa Hospital Department of Medicine. This work was further supported by a Vasculitis Foundation Research Grant.,N. Milman, MD, MSc, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; E. McConville, MD, Resident, Department of Medicine, University of Ottawa; J.C. Robson, MBBS, PhD, MRCP, Consultant Senior Lecturer in Rheumatology, Faculty of Health and Applied Science, University of the West of England, and School of Clinical Science, University of Bristol; A. Boonen, MD, PhD, Professor, Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre, and Caphri Research Institute, Maastricht University; P. Tugwell, MD, FRCPC, Professor, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa; G.A. Wells, PhD, Professor, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa Heart Institute; D. Chaudhuri, MD, Resident, Department of Medicine, University of Ottawa; J. Dawson, MA, MSc, DPhil, Visiting Academic Researcher, Nuffield Department of Population Health (HSRU), University of Oxford; G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, University Hospital, and Centre for Rheumatology Research, University Hospital; S. Ashdown, Patient Partner, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; D. Gebhart, Patient Partner, Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; G. Lanier, Patient Partner, Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; J. Peck, Patient Partner, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; C.A. McAlear, MA, Project Manager, Vasculitis Clinical Research Consortium, and Division of Rheumatology, Department of Medicine, University of Pennsylvania; K.S. Kellom, BA, PolicyLab, Children's Hospital of Philadelphia; P.F. Cronholm, MD, MSCE, Associate Professor, Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania; P.A. Merkel, MD, MPH, Professor, Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania
| | - Georgia Lanier
- From the Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program, Ottawa Hospital Research Institute; School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Faculty of Health and Applied Science, University of the West of England; School of Clinical Science, University of Bristol, Bristol; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre; Caphri Research Institute, Maastricht University, Maastricht, the Netherlands; Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Vasculitis Clinical Research Consortium, and Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, and Department of Family Medicine and Community Health, University of Pennsylvania; PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,The Vasculitis Clinical Research Consortium (VCRC) Outcome Measures in Rheumatology Vasculitis Working Group was supported by the Vasculitis Clinical Research Consortium, which received support from the US National Institute of Arthritis and Musculoskeletal and Skin Diseases (grants U54-AR-057319 and U01-AR-51874 04), the National Center for Research Resources (grant U54-RR-019497), the National Center for Advancing Translational Science, and the Office of Rare Diseases Research, each part of the US National Institutes of Health (NIH). The VCRC is a member of the NIH Rare Diseases Clinical Research Network. The VCRC also received a Pilot award from the Patient-Centered Outcomes Research Institute. Dr. Milman's work was supported by a postgraduate Rheumatology Fellowship award given jointly by UCB Pharma, the Canadian Rheumatology Association, and The Arthritis Society, and a Fellowship from the Ottawa Hospital Department of Medicine. This work was further supported by a Vasculitis Foundation Research Grant.,N. Milman, MD, MSc, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; E. McConville, MD, Resident, Department of Medicine, University of Ottawa; J.C. Robson, MBBS, PhD, MRCP, Consultant Senior Lecturer in Rheumatology, Faculty of Health and Applied Science, University of the West of England, and School of Clinical Science, University of Bristol; A. Boonen, MD, PhD, Professor, Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre, and Caphri Research Institute, Maastricht University; P. Tugwell, MD, FRCPC, Professor, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa; G.A. Wells, PhD, Professor, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa Heart Institute; D. Chaudhuri, MD, Resident, Department of Medicine, University of Ottawa; J. Dawson, MA, MSc, DPhil, Visiting Academic Researcher, Nuffield Department of Population Health (HSRU), University of Oxford; G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, University Hospital, and Centre for Rheumatology Research, University Hospital; S. Ashdown, Patient Partner, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; D. Gebhart, Patient Partner, Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; G. Lanier, Patient Partner, Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; J. Peck, Patient Partner, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; C.A. McAlear, MA, Project Manager, Vasculitis Clinical Research Consortium, and Division of Rheumatology, Department of Medicine, University of Pennsylvania; K.S. Kellom, BA, PolicyLab, Children's Hospital of Philadelphia; P.F. Cronholm, MD, MSCE, Associate Professor, Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania; P.A. Merkel, MD, MPH, Professor, Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania
| | - Jacqueline Peck
- From the Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program, Ottawa Hospital Research Institute; School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Faculty of Health and Applied Science, University of the West of England; School of Clinical Science, University of Bristol, Bristol; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre; Caphri Research Institute, Maastricht University, Maastricht, the Netherlands; Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Vasculitis Clinical Research Consortium, and Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, and Department of Family Medicine and Community Health, University of Pennsylvania; PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,The Vasculitis Clinical Research Consortium (VCRC) Outcome Measures in Rheumatology Vasculitis Working Group was supported by the Vasculitis Clinical Research Consortium, which received support from the US National Institute of Arthritis and Musculoskeletal and Skin Diseases (grants U54-AR-057319 and U01-AR-51874 04), the National Center for Research Resources (grant U54-RR-019497), the National Center for Advancing Translational Science, and the Office of Rare Diseases Research, each part of the US National Institutes of Health (NIH). The VCRC is a member of the NIH Rare Diseases Clinical Research Network. The VCRC also received a Pilot award from the Patient-Centered Outcomes Research Institute. Dr. Milman's work was supported by a postgraduate Rheumatology Fellowship award given jointly by UCB Pharma, the Canadian Rheumatology Association, and The Arthritis Society, and a Fellowship from the Ottawa Hospital Department of Medicine. This work was further supported by a Vasculitis Foundation Research Grant.,N. Milman, MD, MSc, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; E. McConville, MD, Resident, Department of Medicine, University of Ottawa; J.C. Robson, MBBS, PhD, MRCP, Consultant Senior Lecturer in Rheumatology, Faculty of Health and Applied Science, University of the West of England, and School of Clinical Science, University of Bristol; A. Boonen, MD, PhD, Professor, Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre, and Caphri Research Institute, Maastricht University; P. Tugwell, MD, FRCPC, Professor, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa; G.A. Wells, PhD, Professor, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa Heart Institute; D. Chaudhuri, MD, Resident, Department of Medicine, University of Ottawa; J. Dawson, MA, MSc, DPhil, Visiting Academic Researcher, Nuffield Department of Population Health (HSRU), University of Oxford; G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, University Hospital, and Centre for Rheumatology Research, University Hospital; S. Ashdown, Patient Partner, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; D. Gebhart, Patient Partner, Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; G. Lanier, Patient Partner, Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; J. Peck, Patient Partner, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; C.A. McAlear, MA, Project Manager, Vasculitis Clinical Research Consortium, and Division of Rheumatology, Department of Medicine, University of Pennsylvania; K.S. Kellom, BA, PolicyLab, Children's Hospital of Philadelphia; P.F. Cronholm, MD, MSCE, Associate Professor, Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania; P.A. Merkel, MD, MPH, Professor, Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania
| | - Carol A McAlear
- From the Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program, Ottawa Hospital Research Institute; School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Faculty of Health and Applied Science, University of the West of England; School of Clinical Science, University of Bristol, Bristol; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre; Caphri Research Institute, Maastricht University, Maastricht, the Netherlands; Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Vasculitis Clinical Research Consortium, and Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, and Department of Family Medicine and Community Health, University of Pennsylvania; PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,The Vasculitis Clinical Research Consortium (VCRC) Outcome Measures in Rheumatology Vasculitis Working Group was supported by the Vasculitis Clinical Research Consortium, which received support from the US National Institute of Arthritis and Musculoskeletal and Skin Diseases (grants U54-AR-057319 and U01-AR-51874 04), the National Center for Research Resources (grant U54-RR-019497), the National Center for Advancing Translational Science, and the Office of Rare Diseases Research, each part of the US National Institutes of Health (NIH). The VCRC is a member of the NIH Rare Diseases Clinical Research Network. The VCRC also received a Pilot award from the Patient-Centered Outcomes Research Institute. Dr. Milman's work was supported by a postgraduate Rheumatology Fellowship award given jointly by UCB Pharma, the Canadian Rheumatology Association, and The Arthritis Society, and a Fellowship from the Ottawa Hospital Department of Medicine. This work was further supported by a Vasculitis Foundation Research Grant.,N. Milman, MD, MSc, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; E. McConville, MD, Resident, Department of Medicine, University of Ottawa; J.C. Robson, MBBS, PhD, MRCP, Consultant Senior Lecturer in Rheumatology, Faculty of Health and Applied Science, University of the West of England, and School of Clinical Science, University of Bristol; A. Boonen, MD, PhD, Professor, Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre, and Caphri Research Institute, Maastricht University; P. Tugwell, MD, FRCPC, Professor, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa; G.A. Wells, PhD, Professor, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa Heart Institute; D. Chaudhuri, MD, Resident, Department of Medicine, University of Ottawa; J. Dawson, MA, MSc, DPhil, Visiting Academic Researcher, Nuffield Department of Population Health (HSRU), University of Oxford; G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, University Hospital, and Centre for Rheumatology Research, University Hospital; S. Ashdown, Patient Partner, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; D. Gebhart, Patient Partner, Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; G. Lanier, Patient Partner, Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; J. Peck, Patient Partner, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; C.A. McAlear, MA, Project Manager, Vasculitis Clinical Research Consortium, and Division of Rheumatology, Department of Medicine, University of Pennsylvania; K.S. Kellom, BA, PolicyLab, Children's Hospital of Philadelphia; P.F. Cronholm, MD, MSCE, Associate Professor, Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania; P.A. Merkel, MD, MPH, Professor, Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania
| | - Katherine S Kellom
- From the Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program, Ottawa Hospital Research Institute; School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Faculty of Health and Applied Science, University of the West of England; School of Clinical Science, University of Bristol, Bristol; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre; Caphri Research Institute, Maastricht University, Maastricht, the Netherlands; Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Vasculitis Clinical Research Consortium, and Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, and Department of Family Medicine and Community Health, University of Pennsylvania; PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,The Vasculitis Clinical Research Consortium (VCRC) Outcome Measures in Rheumatology Vasculitis Working Group was supported by the Vasculitis Clinical Research Consortium, which received support from the US National Institute of Arthritis and Musculoskeletal and Skin Diseases (grants U54-AR-057319 and U01-AR-51874 04), the National Center for Research Resources (grant U54-RR-019497), the National Center for Advancing Translational Science, and the Office of Rare Diseases Research, each part of the US National Institutes of Health (NIH). The VCRC is a member of the NIH Rare Diseases Clinical Research Network. The VCRC also received a Pilot award from the Patient-Centered Outcomes Research Institute. Dr. Milman's work was supported by a postgraduate Rheumatology Fellowship award given jointly by UCB Pharma, the Canadian Rheumatology Association, and The Arthritis Society, and a Fellowship from the Ottawa Hospital Department of Medicine. This work was further supported by a Vasculitis Foundation Research Grant.,N. Milman, MD, MSc, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; E. McConville, MD, Resident, Department of Medicine, University of Ottawa; J.C. Robson, MBBS, PhD, MRCP, Consultant Senior Lecturer in Rheumatology, Faculty of Health and Applied Science, University of the West of England, and School of Clinical Science, University of Bristol; A. Boonen, MD, PhD, Professor, Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre, and Caphri Research Institute, Maastricht University; P. Tugwell, MD, FRCPC, Professor, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa; G.A. Wells, PhD, Professor, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa Heart Institute; D. Chaudhuri, MD, Resident, Department of Medicine, University of Ottawa; J. Dawson, MA, MSc, DPhil, Visiting Academic Researcher, Nuffield Department of Population Health (HSRU), University of Oxford; G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, University Hospital, and Centre for Rheumatology Research, University Hospital; S. Ashdown, Patient Partner, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; D. Gebhart, Patient Partner, Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; G. Lanier, Patient Partner, Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; J. Peck, Patient Partner, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; C.A. McAlear, MA, Project Manager, Vasculitis Clinical Research Consortium, and Division of Rheumatology, Department of Medicine, University of Pennsylvania; K.S. Kellom, BA, PolicyLab, Children's Hospital of Philadelphia; P.F. Cronholm, MD, MSCE, Associate Professor, Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania; P.A. Merkel, MD, MPH, Professor, Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania
| | - Peter F Cronholm
- From the Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program, Ottawa Hospital Research Institute; School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Faculty of Health and Applied Science, University of the West of England; School of Clinical Science, University of Bristol, Bristol; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre; Caphri Research Institute, Maastricht University, Maastricht, the Netherlands; Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Vasculitis Clinical Research Consortium, and Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, and Department of Family Medicine and Community Health, University of Pennsylvania; PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,The Vasculitis Clinical Research Consortium (VCRC) Outcome Measures in Rheumatology Vasculitis Working Group was supported by the Vasculitis Clinical Research Consortium, which received support from the US National Institute of Arthritis and Musculoskeletal and Skin Diseases (grants U54-AR-057319 and U01-AR-51874 04), the National Center for Research Resources (grant U54-RR-019497), the National Center for Advancing Translational Science, and the Office of Rare Diseases Research, each part of the US National Institutes of Health (NIH). The VCRC is a member of the NIH Rare Diseases Clinical Research Network. The VCRC also received a Pilot award from the Patient-Centered Outcomes Research Institute. Dr. Milman's work was supported by a postgraduate Rheumatology Fellowship award given jointly by UCB Pharma, the Canadian Rheumatology Association, and The Arthritis Society, and a Fellowship from the Ottawa Hospital Department of Medicine. This work was further supported by a Vasculitis Foundation Research Grant.,N. Milman, MD, MSc, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; E. McConville, MD, Resident, Department of Medicine, University of Ottawa; J.C. Robson, MBBS, PhD, MRCP, Consultant Senior Lecturer in Rheumatology, Faculty of Health and Applied Science, University of the West of England, and School of Clinical Science, University of Bristol; A. Boonen, MD, PhD, Professor, Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre, and Caphri Research Institute, Maastricht University; P. Tugwell, MD, FRCPC, Professor, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa; G.A. Wells, PhD, Professor, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa Heart Institute; D. Chaudhuri, MD, Resident, Department of Medicine, University of Ottawa; J. Dawson, MA, MSc, DPhil, Visiting Academic Researcher, Nuffield Department of Population Health (HSRU), University of Oxford; G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, University Hospital, and Centre for Rheumatology Research, University Hospital; S. Ashdown, Patient Partner, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; D. Gebhart, Patient Partner, Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; G. Lanier, Patient Partner, Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; J. Peck, Patient Partner, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; C.A. McAlear, MA, Project Manager, Vasculitis Clinical Research Consortium, and Division of Rheumatology, Department of Medicine, University of Pennsylvania; K.S. Kellom, BA, PolicyLab, Children's Hospital of Philadelphia; P.F. Cronholm, MD, MSCE, Associate Professor, Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania; P.A. Merkel, MD, MPH, Professor, Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania
| | - Peter A Merkel
- From the Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program, Ottawa Hospital Research Institute; School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Faculty of Health and Applied Science, University of the West of England; School of Clinical Science, University of Bristol, Bristol; Nuffield Department of Population Health, Health Services Research Unit (HSRU), and Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre; Caphri Research Institute, Maastricht University, Maastricht, the Netherlands; Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland; Department of Rheumatology, and Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland; Vasculitis Clinical Research Consortium, and Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, and Department of Family Medicine and Community Health, University of Pennsylvania; PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,The Vasculitis Clinical Research Consortium (VCRC) Outcome Measures in Rheumatology Vasculitis Working Group was supported by the Vasculitis Clinical Research Consortium, which received support from the US National Institute of Arthritis and Musculoskeletal and Skin Diseases (grants U54-AR-057319 and U01-AR-51874 04), the National Center for Research Resources (grant U54-RR-019497), the National Center for Advancing Translational Science, and the Office of Rare Diseases Research, each part of the US National Institutes of Health (NIH). The VCRC is a member of the NIH Rare Diseases Clinical Research Network. The VCRC also received a Pilot award from the Patient-Centered Outcomes Research Institute. Dr. Milman's work was supported by a postgraduate Rheumatology Fellowship award given jointly by UCB Pharma, the Canadian Rheumatology Association, and The Arthritis Society, and a Fellowship from the Ottawa Hospital Department of Medicine. This work was further supported by a Vasculitis Foundation Research Grant.,N. Milman, MD, MSc, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute; E. McConville, MD, Resident, Department of Medicine, University of Ottawa; J.C. Robson, MBBS, PhD, MRCP, Consultant Senior Lecturer in Rheumatology, Faculty of Health and Applied Science, University of the West of England, and School of Clinical Science, University of Bristol; A. Boonen, MD, PhD, Professor, Department of Medicine, Division of Rheumatology, Maastricht University Medical Centre, and Caphri Research Institute, Maastricht University; P. Tugwell, MD, FRCPC, Professor, Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa; G.A. Wells, PhD, Professor, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa Heart Institute; D. Chaudhuri, MD, Resident, Department of Medicine, University of Ottawa; J. Dawson, MA, MSc, DPhil, Visiting Academic Researcher, Nuffield Department of Population Health (HSRU), University of Oxford; G. Tomasson, MD, PhD, Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, and Department of Rheumatology, University Hospital, and Centre for Rheumatology Research, University Hospital; S. Ashdown, Patient Partner, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; D. Gebhart, Patient Partner, Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; G. Lanier, Patient Partner, Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; J. Peck, Patient Partner, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; C.A. McAlear, MA, Project Manager, Vasculitis Clinical Research Consortium, and Division of Rheumatology, Department of Medicine, University of Pennsylvania; K.S. Kellom, BA, PolicyLab, Children's Hospital of Philadelphia; P.F. Cronholm, MD, MSCE, Associate Professor, Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania; P.A. Merkel, MD, MPH, Professor, Division of Rheumatology, Department of Medicine, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania
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Abstract
BACKGROUND AND OBJECTIVES The national opioid crisis requires medical education to develop a proactive response centering on prevention and treatment. Primary care providers (PCPs)-many of whom are family medicine physicians-commonly treat patients on opiates, and write nearly 50% of opioid prescriptions. Despite linkages between PCP opioid prescribing patterns and the associated potential for overdose, little is known about how family medicine clerkship students are trained to prevent opioid overdose, including training on the use of naloxone. This study describes the presence of opioid overdose education at the national level and barriers to inclusion. It also discusses implementation strategies along with instructional methodology and learner evaluation. METHODS Data were collected as part of a cross-sectional survey administered electronically by the Council of Academic Family Medicine Educational Research Alliance to 139 family medicine clerkship directors. RESULTS A total of 99 clerkship directors (71.2% response rate) responded to the survey. A large majority (86.4%) agreed that it is important to offer opioid overdose prevention education in the clerkship, yet only 25.8% include this topic. Of these, only 50.0% address naloxone use. The most common barriers to including opioid overdose prevention education were prioritization of educational topics (82.1%) followed by lack of available faculty with sufficient experience/expertise (67.7%). CONCLUSIONS Findings point to a disparity between perceived importance of opioid overdose prevention education and inclusion of this topic in family medicine clerkship-level medical education. Innovative use of online education and partnering with community resources may address barriers related to curricular prioritization while supporting interprofessional education principles.
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Affiliation(s)
- Laura Gano
- Department of Family Medicine, Indiana University, Indianapolis, IN
| | - Scott E Renshaw
- Department of Family Medicine, Indiana University, Indianapolis, IN
| | | | - Peter F Cronholm
- Department of Family and Community Health, University of Pennsylvania School of Medicine, Philadelphia, PA
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DuPrey KM, Webner D, Lyons A, Kucuk CH, Ellis J, Cronholm PF. Procedural Shortcomings With Near Point of Convergence Assessment May Lead to Inappropriate Prognosis of Concussion Injury in Athletes: Response. Am J Sports Med 2018; 46:NP66-NP68. [PMID: 30280935 DOI: 10.1177/0363546518800701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Dichter ME, Teitelman A, Klusaritz H, Maurer DM, Cronholm PF, Doubeni CA. Trauma-Informed Care Training in Family Medicine Residency Programs Results From a CERA Survey. Fam Med 2018; 50:617-622. [PMID: 30215822 DOI: 10.22454/fammed.2018.505481] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Experiences of psychological trauma are common among primary care patient populations, and adversely affect patients' health and health care utilization. Trauma-informed care (TIC) is a framework for identifying and responding to patients' experiences of psychological trauma to avoid retraumatization. The purpose of this study was to evaluate the current state of TIC training in family medicine residency programs in the United States in order to identify opportunities for and barriers to TIC training. METHODS Items addressing the four core domains of TIC were incorporated into the 2017 Council of Academy Family Medicine Educational Research Alliance (CERA) survey of program directors. The items assessed the presence, content, and sufficiency of TIC curriculum, as well as barriers to further integration of TIC training. RESULTS Approximately 50% of programs responded to the survey. Of 263 respondents, 71 (27%) reported TIC training in their curriculum, but the majority devoted less than 5 hours annually to core content. The content most commonly addressed recognizing signs of trauma, most frequently using didactic formats. Overall, just over one-half of the programs reported that their curriculum met patients' TIC needs "somewhat" (48.5%) or "a great deal" (4.6%). Lack of a champion followed by lack of time were the most commonly cited barriers to integrating TIC training. CONCLUSIONS Despite the acknowledged importance of effects of trauma in health care, this study identified insufficient exposure to training in the core TIC domains in family medicine residency programs, underscoring a need for greater integration of TIC training during residency.
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Affiliation(s)
- Melissa E Dichter
- University of Pennsylvania Perelman School of Medicine, Department of Family and Community Medicine
| | | | - Heather Klusaritz
- University of Pennsylvania Perelman School of Medicine, Department of Family and Community Medicine
| | | | - Peter F Cronholm
- Department of Family and Community Health, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Chyke A Doubeni
- University of Pennsylvania Perelman School of Medicine, Department of Family and Community Medicine
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Abstract
Purpose The Patient-Centered Medical Home (PCMH) has become a dominant model of primary care re-design. This transformation presents a challenge to many care delivery organizations. The purpose of this paper is to describe attributes shaping successful and unsuccessful practice transformation within four medical practice groups. Design/methodology/approach As part of a larger study of 25 practices transitioning into a PCMH, the current study focused on diabetes care and identified high- and low-improvement medical practices in terms of quantitative patient measures of glycosylated hemoglobin and qualitative assessments of practice performance. A subset of the top two high-improvement and bottom two low-improvement practices were identified as comparison groups. Semi-structured interviews were conducted with diverse personnel at these practices to investigate their experiences with practice transformation and data were analyzed using analytic induction. Findings Results show a variety of key attributes facilitating more successful PCMH transformation, such as empanelment, shared goals and regular meetings, and a clear understanding of PCMH transformation purposes, goals, and benefits, providing care/case management services, and facilitating patient reminders. Several barriers also exist to successful transformation, such as low levels of resources to handle financial expense, lack of understanding PCMH transformation purposes, goals, and benefits, inadequate training and management of technology, and low team cohesion. Originality/value Few studies qualitatively compare and contrast high and low performing practices to illuminate the experience of practice transformation. These findings highlight the experience of organizational members and their challenges in practice transformation while providing quality diabetes care.
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Affiliation(s)
- Michelle Miller-Day
- Department of Health and Strategic Communication, Chapman University , Orange, California, USA
| | - Janelle Applequist
- The Zimmerman School of Advertising, University of South Florida , Tampa, Florida, USA
| | | | - Alexandra Dalton
- Department of Clinical Research and Leadership, George Washington University , Washington, District of Columbia, USA
| | - Katherine Kellom
- Department of Family Medicine and Community Health, Center for Public Health Initiatives, Leonard Davis Institute of Health Economics, University of Pennsylvania , Philadelphia, Pennsylvania, USA
| | - Robert Gabbay
- Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Peter F Cronholm
- Department of Family Medicine and Community Health, Center for Public Health Initiatives, Leonard Davis Institute of Health Economics, University of Pennsylvania , Philadelphia, Pennsylvania, USA
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Cronholm PF, Dichter ME. The Need for Systems of Care and a Trauma-Informed Approach to Intimate Partner Violence. Am Fam Physician 2018; 97:Online. [PMID: 30215942] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Abstract
BACKGROUND AND OBJECTIVES Behavioral health integration (BHI) in primary care settings is critical to mental health care in the United States. Family medicine resident experience in BHI in family medicine residency (FMR) continuity clinics is essential preparation for practice. We surveyed FMR program directors to characterize the status of BHI in FMR training. METHODS Using the Council of Academic Family Medicine Educational Research Alliance (CERA) 2017 survey, FMR program directors (n=478, 261 respondents, 54.6% response rate) were queried regarding the stage of BHI within the residency family medicine center (FMC), integration activities at the FMC, and the professions of the BH faculty. BHI was characterized by Substance Abuse and Mental Health Services Agency (SAMHSA) designations within FMRs, and chi-square or ANOVA with Tukey honest significant difference (HSD) post hoc testing was used to assess differences in reported BHI attributes. RESULTS Program directors reported a high level of BHI in their FMCs (44.1% full integration, 33.7% colocated). Higher levels of BHI were associated with increased use of warm handoffs, same day consultation, shared health records, and the use of behavioral health (BH) professionals for both mental health and medical issues. Family physicians, psychiatrists, and psychologists were most likely to be training residents in BHI. CONCLUSIONS Almost half of FMR programs have colocated BH care or fully integrated BH as defined by SAMHSA. Highly integrated FMRs use a diversity of behavioral professionals and activities. Residencies currently at the collaboration stage could increase BH provider types and BHI practices to better prepare residents for practice. Residencies with full BHI may consider focusing on supporting BHI-trained residents transitioning into practice, or disseminating the model in the general primary care community.
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Affiliation(s)
- Christine Jacobs
- Saint Louis University Department of Family and Community Medicine, St Louis, MO
| | - Jay A Brieler
- Saint Louis University Department of Family and Community Medicine, St Louis, MO
| | - Joanne Salas
- Saint Louis University Department of Family and Community Medicine, St Louis, MO
| | - Renée M Betancourt
- Department of Family Medicine and Community Health, University of Pennsylvania
| | - Peter F Cronholm
- Department of Family and Community Health, University of Pennsylvania School of Medicine, Philadelphia, PA
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Robson JC, Dawson J, Doll H, Cronholm PF, Milman N, Kellom K, Ashdown S, Easley E, Gebhart D, Lanier G, Mills J, Peck J, Luqmani RA, Shea J, Tomasson G, Merkel PA. Validation of the ANCA-associated vasculitis patient-reported outcomes (AAV-PRO) questionnaire. Ann Rheum Dis 2018; 77:1157-1164. [PMID: 29695498 DOI: 10.1136/annrheumdis-2017-212713] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 11/17/2017] [Revised: 03/29/2018] [Accepted: 04/03/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To finalise and validate a disease-specific patient-reported outcome (PRO) measure: the ANCA-associated vasculitis patient-reported outcome (AAV-PRO) questionnaire. Using a 35-item candidate questionnaire developed following 50 qualitative interviews in the UK, USA and Canada, a longitudinal survey was conducted to determine the final scale structure and validate the AAV-PRO. METHODS Participants were recruited via Vasculitis UK and the Vasculitis Patient-Powered Research Network. The 35-item candidate questionnaire was completed at baseline and 3 months; UK participants completed the EuroQol-5D-5L (EQ-5D-5L), while US participants completed a test-retest exercise, 3-5 days after baseline. Scale structure was defined using exploratory factor analysis (EFA) and Rasch analysis. Convergent and known groups validity, test-retest reliability and longitudinal construct validity were assessed. RESULTS There were 626 participants with AAV; >25% reporting 'active disease'. EFA and Rasch analysis supported a 29-item profile measure comprising six domains: 'organ-specific symptoms', 'systemic symptoms', 'treatment side effects', 'social and emotional impact', 'concerns about the future' and 'physical function'. Mean domain scores were higher for participants with 'active disease' versus 'remission' (p<0.001). Construct validity was demonstrated by correlations between domain scores and the EQ-5D-5L (range r=-0.55 to 0.78), all p<0.0001. In participants reporting 'no change' (n=97) during the test-retest, intraclass correlation coefficient values were high (range 0.89-0.96) for each domain. CONCLUSIONS The AAV-PRO, a new disease-specific PRO measure for AAV, has good face and construct validity, is reliable, feasible and discriminates among disease states.
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Affiliation(s)
- Joanna C Robson
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK.,University of Bristol School of Clinical Science, Bristol, UK
| | - Jill Dawson
- University of Oxford, Nuffield Department of Population Health (HSRU), Oxford, UK
| | | | - Peter F Cronholm
- University of Pennsylvania Perelman School of Medicine, Department of Family Medicine and Community Health, Philadelphia, Pennsylvania, USA
| | - Nataliya Milman
- Division of Rheumatology, Department of Medicine in Ottawa, Ottawa, Ontario, Canada
| | - Katherine Kellom
- Children's Hospital of Philadelphia, PolicyLab, Philadelphia, Pennsylvania, USA
| | | | - Ebony Easley
- University of Pennsylvania, Department of Family Medicine and Community Health, Philadelphia, USA
| | | | | | - John Mills
- West Bank House, Vasculitis UK, Matlock, UK
| | | | - Raashid Ahmed Luqmani
- Nuffield Department of Orthopaedicx, Rheumatology and Musculoskeletal Science (NDORMs), University of Oxford, Oxford, UK
| | - Judy Shea
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Peter A Merkel
- Department of Rheumatology, University of Pennsylvania, Philadelphia, Massachusetts, USA
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Kellom KS, Matone M, Adejare A, Barg FK, Rubin DM, Cronholm PF. A Qualitative Exploration of Co-location as an Intervention to Strengthen Home Visiting Implementation in Addressing Maternal Child Health. Matern Child Health J 2018; 22:883-892. [PMID: 29429135 DOI: 10.1007/s10995-018-2463-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objectives The aim of this paper is to explore the process and impact of co-locating evidence-based maternal and child service models to inform future implementation efforts. Methods As part of a state-wide evaluation of maternal and child home visiting programs, we conducted semi-structured interviews with administrators and home visitors from home visiting agencies across Pennsylvania. We collected 33 interviews from 4 co-located agencies. We used the Consolidated Framework for Implementation Research (CFIR) to describe the key elements mitigating implementation of multiple home visiting models. Results A primary advantage of co-location described by participants was the ability to increase the agency's base of eligible clients through the implementation of a model with different program eligibility (e.g. income, child age) than the existing agency offering. Model differences related to curriculum (e.g. content or intensity/meeting frequency) enabled programs to more selectively match clients to models. To recruit eligible clients, new models were able to build upon the existing service networks of the initial program. Co-location provided organizational opportunities for shared trainings, enabling administrative efficiencies and collaborative staff learning. Programs implemented strategies to build synergies with complementary model features, for instance using the additional program option to serve waitlisted clients and to transition services after one model is completed. Conclusions for Practice Considerable benefits are experienced when home visiting models co-locate. This research builds on literature encouraging collaboration among community agencies and provides insight on a specific facilitative approach. This implementation strategy informs policy across the social services spectrum and competitive funding contexts.
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Affiliation(s)
- Katherine S Kellom
- PolicyLab, Children's Hospital of Philadelphia, 2716 South St, Philadelphia, PA, 19146, USA
| | - Meredith Matone
- PolicyLab, Children's Hospital of Philadelphia, 2716 South St, Philadelphia, PA, 19146, USA.,Division of General Pediatrics, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Aderinola Adejare
- The Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH, 43210, USA
| | - Frances K Barg
- Mixed Methods Research Lab, University of Pennsylvania, 51 N. 39th St., Philadelphia, PA, 19104, USA.,Department of Family Medicine and Community Health, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, 19104, USA.,Center for Public Health Initiatives, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, 19104, USA.,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - David M Rubin
- PolicyLab, Children's Hospital of Philadelphia, 2716 South St, Philadelphia, PA, 19146, USA.,Division of General Pediatrics, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.,Department of Pediatrics, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - Peter F Cronholm
- Mixed Methods Research Lab, University of Pennsylvania, 51 N. 39th St., Philadelphia, PA, 19104, USA. .,Department of Family Medicine and Community Health, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, 19104, USA. .,Center for Public Health Initiatives, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, 19104, USA. .,Leonard Davis Institute of Health Economics, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, 19104, USA.
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Robson JC, Dawson J, Cronholm PF, Milman N, Kellom KS, Ashdown S, Easley E, Farrar JT, Gebhart D, Lanier G, McAlear CA, Peck J, Luqmani RA, Shea JA, Tomasson G, Merkel PA. Health-related quality of life in ANCA-associated vasculitis and item generation for a disease-specific patient-reported outcome measure. Patient Relat Outcome Meas 2018; 9:17-34. [PMID: 29379322 PMCID: PMC5759851 DOI: 10.2147/prom.s144992] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Objective The antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAVs) are multisystem diseases of the small blood vessels. Patients experience irreversible damage and psychological effects from AAV and its treatment. An international collaboration was created to investigate the impact of AAV on health-related quality of life (HRQoL), and develop a disease-specific patient-reported outcome measure to assess outcomes of importance to patients. Methods Patients with AAV from the UK, USA, and Canada were interviewed to identify salient aspects of HRQoL affected by AAV. The study was overseen by a steering committee including four patient research partners. Purposive sampling of interviewees ensured representation of a range of disease manifestations and demographics. Inductive analysis was used to identify themes of importance to patients; these were further confirmed by a free-listing exercise in the US. Individual themes were recast into candidate items, which were scrutinized by patients, piloted through cognitive interviews and received a linguistic and translatability evaluation. Results Fifty interviews, conducted to saturation, with patients from the UK, USA, and Canada, identified 55 individual themes of interest within seven broad domains: general health perceptions, impact on function, psychological perceptions, social perceptions, social contact, social role, and symptoms. Individual themes were constructed into >100 candidate questionnaire items, which were then reduced and refined to 35 candidate items. Conclusion This is the largest international qualitative analysis of HRQoL in AAV to date, and the results have underpinned the development of 35 candidate items for a disease-specific, patient-reported outcome questionnaire.
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Affiliation(s)
- Joanna C Robson
- Department of Rheumatology, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK.,School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Jill Dawson
- Department of Population Health (HSRU), University of Oxford, Oxford, UK
| | - Peter F Cronholm
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA, USA
| | - Nataliya Milman
- Division of Rheumatology, Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | - Susan Ashdown
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Ebony Easley
- Department of Family Medicine and Community Health, Mixed Methods Research Laboratory, University of Pennsylvania, Philadelphia, PA, USA
| | - John T Farrar
- Biostatistics and Epidemiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Don Gebhart
- Division of Rheumatology, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Biostatistics and Clinical Epidemiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Georgia Lanier
- Division of Rheumatology, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Biostatistics and Clinical Epidemiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Carol A McAlear
- Vasculitis Research, University of Pennsylvania, Philadelphia, PA, USA
| | - Jacqueline Peck
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Raashid A Luqmani
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Judy A Shea
- School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Gunnar Tomasson
- Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Peter A Merkel
- Division of Rheumatology, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Biostatistics and Clinical Epidemiology, University of Pennsylvania, Philadelphia, PA, USA
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