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Ball SL, Kim B, Cutrona SL, Molloy-Paolillo BK, Ahlness E, Moldestad M, Sayre G, Rinne ST. Clinician and staff experiences with frustrated patients during an electronic health record transition: a qualitative case study. BMC Health Serv Res 2024; 24:535. [PMID: 38671473 PMCID: PMC11046755 DOI: 10.1186/s12913-024-10974-5] [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] [Received: 08/29/2023] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Electronic health record (EHR) transitions are known to be highly disruptive, can drastically impact clinician and staff experiences, and may influence patients' experiences using the electronic patient portal. Clinicians and staff can gain insights into patient experiences and be influenced by what they see and hear from patients. Through the lens of an emergency preparedness framework, we examined clinician and staff reactions to and perceptions of their patients' experiences with the portal during an EHR transition at the Department of Veterans Affairs (VA). METHODS This qualitative case study was situated within a larger multi-methods evaluation of the EHR transition. We conducted a total of 122 interviews with 30 clinicians and staff across disciplines at the initial VA EHR transition site before, immediately after, and up to 12 months after go-live (September 2020-November 2021). Interview transcripts were coded using a priori and emergent codes. The coded text segments relevant to patient experience and clinician interactions with patients were extracted and analyzed to identify themes. For each theme, recommendations were defined based on each stage of an emergency preparedness framework (mitigate, prepare, respond, recover). RESULTS In post-go-live interviews participants expressed concerns about the reliability of communicating with their patients via secure messaging within the new EHR portal. Participants felt ill-equipped to field patients' questions and frustrations navigating the new portal. Participants learned that patients experienced difficulties learning to use and accessing the portal; when unsuccessful, some had difficulties obtaining medication refills via the portal and used the call center as an alternative. However, long telephone wait times provoked patients to walk into the clinic for care, often frustrated and without an appointment. Patients needing increased in-person attention heightened participants' daily workload and their concern for patients' well-being. Recommendations for each theme fit within a stage of the emergency preparedness framework. CONCLUSIONS Application of an emergency preparedness framework to EHR transitions could help address the concerns raised by the participants, (1) mitigating disruptions by identifying at-risk patients before the transition, (2) preparing end-users by disseminating patient-centered informational resources, (3) responding by building capacity for disrupted services, and (4) recovering by monitoring integrity of the new portal function.
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Affiliation(s)
- Sherry L Ball
- VA Northeast Ohio Healthcare System, 10701 East Blvd., Research Service 151, 44106, Cleveland, OH, USA.
| | - Bo Kim
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Sarah L Cutrona
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
- Division of Health Informatics & Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Brianne K Molloy-Paolillo
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
| | - Ellen Ahlness
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VHA Puget Sound Health Care System, Seattle, WA, USA
| | - Megan Moldestad
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VHA Puget Sound Health Care System, Seattle, WA, USA
| | - George Sayre
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VHA Puget Sound Health Care System, Seattle, WA, USA
- University of Washington School of Public Health, Seattle, WA, USA
| | - Seppo T Rinne
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA
- Geisel School of Medicine at Dartmouth, Hannover, NH, USA
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Palakshappa JA, Hale ER, Brown JD, Kittel CA, Dressler E, Rosenthal GE, Cutrona SL, Foley KL, Haines ER, Houston Ii TK. Longitudinal Monitoring of Clinician-Patient Video Visits During the Peak of the COVID-19 Pandemic: Adoption and Sustained Challenges in an Integrated Health Care Delivery System. J Med Internet Res 2024; 26:e54008. [PMID: 38587889 PMCID: PMC11036186 DOI: 10.2196/54008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/24/2024] [Accepted: 03/09/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND Numerous prior opinion papers, administrative electronic health record data studies, and cross-sectional surveys of telehealth during the pandemic have been published, but none have combined assessments of video visit success monitoring with longitudinal assessments of perceived challenges to the rapid adoption of video visits during the pandemic. OBJECTIVE This study aims to quantify (1) the use of video visits (compared with in-person and telephone visits) over time during the pandemic, (2) video visit successful connection rates, and (3) changes in perceived video visit challenges. METHODS A web-based survey was developed for the dual purpose of monitoring and improving video visit implementation in our health care system during the COVID-19 pandemic. The survey included questions regarding rates of in-person, telephone, and video visits for clinician-patient encounters; the rate of successful connection for video visits; and perceived challenges to video visits (eg, software, hardware, bandwidth, and technology literacy). The survey was distributed via email to physicians, advanced practice professionals, and clinicians in May 2020. The survey was repeated in March 2021. Differences between the 2020 and 2021 responses were adjusted for within-respondent correlation across surveys and tested using generalized estimating equations. RESULTS A total of 1126 surveys were completed (511 surveys in 2020 and 615 surveys in 2021). In 2020, only 21.7% (73/336) of clinicians reported no difficulty connecting with patients during video visits and 28.6% (93/325) of clinicians reported no difficulty in 2021. The distribution of the percentage of successfully connected video visits ("Over the past two weeks of scheduled visits, what percentage did you successfully connect with patients by video?") was not significantly different between 2020 and 2021 (P=.74). Challenges in conducting video visits persisted over time. Poor connectivity was the most common challenge reported by clinicians. This response increased over time, with 30.5% (156/511) selecting it as a challenge in 2020 and 37.1% (228/615) in 2021 (P=.01). Patients not having access to their electronic health record portals was also a commonly reported challenge (109/511, 21.3% in 2020 and 137/615, 22.3% in 2021, P=.73). CONCLUSIONS During the pandemic, our health care delivery system rapidly adopted synchronous patient-clinician communication using video visits. As experience with video visits increased, the reported failure rate did not significantly decline, and clinicians continued to report challenges related to general network connectivity and patient access to technology.
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Affiliation(s)
- Jessica A Palakshappa
- Atrium Health Wake Forest Baptist, Winston Salem, NC, United States
- Wake Forest University School of Medicine, Winston Salem, NC, United States
| | - Erica R Hale
- Atrium Health Wake Forest Baptist, Winston Salem, NC, United States
- Wake Forest University School of Medicine, Winston Salem, NC, United States
| | - Joshua D Brown
- Atrium Health Wake Forest Baptist, Winston Salem, NC, United States
| | - Carol A Kittel
- Wake Forest University School of Medicine, Winston Salem, NC, United States
| | - Emily Dressler
- Wake Forest University School of Medicine, Winston Salem, NC, United States
| | - Gary E Rosenthal
- Atrium Health Wake Forest Baptist, Winston Salem, NC, United States
- Wake Forest University School of Medicine, Winston Salem, NC, United States
| | - Sarah L Cutrona
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
- Center for Healthcare Organization and Implementation Research, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States
| | - Kristie L Foley
- Wake Forest University School of Medicine, Winston Salem, NC, United States
| | - Emily R Haines
- Wake Forest University School of Medicine, Winston Salem, NC, United States
| | - Thomas K Houston Ii
- Atrium Health Wake Forest Baptist, Winston Salem, NC, United States
- Wake Forest University School of Medicine, Winston Salem, NC, United States
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Jackson GL, Fix GM, White BS, Cutrona SL, Reardon CM, Damschroder LJ, Burns M, DeLaughter K, Opra Widerquist MA, Arasim M, Lindquist J, Gifford AL, King HA, Kaitz J, Jasuja GK, Hogan TP, Lopez JCF, Henderson B, Fitzgerald BA, Goetschius A, Hagan D, McCoy C, Seelig A, Nevedal A. Diffusion of excellence: evaluating a system to identify, replicate, and spread promising innovative practices across the Veterans health administration. Front Health Serv 2024; 3:1223277. [PMID: 38420338 PMCID: PMC10900518 DOI: 10.3389/frhs.2023.1223277] [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] [Received: 05/15/2023] [Accepted: 11/20/2023] [Indexed: 03/02/2024]
Abstract
Introduction The Veterans Health Administration (VHA) Diffusion of Excellence (DoE) program provides a system to identify, replicate, and spread promising practices across the largest integrated healthcare system in the United States. DoE identifies innovations that have been successfully implemented in the VHA through a Shark Tank style competition. VHA facility and regional directors bid resources needed to replicate promising practices. Winning facilities/regions receive external facilitation to aid in replication/implementation over the course of a year. DoE staff then support diffusion of successful practices across the nationwide VHA. Methods Organized around the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) Framework, we summarize results of an ongoing long-term mixed-methods implementation evaluation of DoE. Data sources include: Shark Tank application and bid details, tracking practice adoptions through a Diffusion Marketplace, characteristics of VHA facilities, focus groups with Shark Tank bidders, structured observations of DoE events, surveys of DoE program participants, and semi-structured interviews of national VHA program office leaders, VHA healthcare system/facility executives, practice developers, implementation teams and facilitators. Results In the first eight Shark Tanks (2016-2022), 3,280 Shark Tank applications were submitted; 88 were designated DoE Promising Practices (i.e., practices receive facilitated replication). DoE has effectively spread practices across the VHA, with 1,440 documented instances of adoption/replication of practices across the VHA. This includes 180 adoptions/replications in facilities located in rural areas. Leadership decisions to adopt innovations are often based on big picture considerations such as constituency support and linkage to organizational goals. DoE Promising Practices that have the greatest national spread have been successfully replicated at new sites during the facilitated replication process, have close partnerships with VHA national program offices, and tend to be less expensive to implement. Two indicators of sustainment indicate that 56 of the 88 Promising Practices are still being diffused across the VHA; 56% of facilities originally replicating the practices have sustained them, even up to 6 years after the first Shark Tank. Conclusion DoE has developed a sustainable process for the identification, replication, and spread of promising practices as part of a learning health system committed to providing equitable access to high quality care.
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Affiliation(s)
- George L. Jackson
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs (VA) Health Care System, Durham, NC, United States
- Advancing Implementation and Improvement Science Program, Peter O’Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Gemmae M. Fix
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VA Medical Centers, Bedford and Boston, MA, United States
- Section of General Internal Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, United States
- Department of Health Law, Policy & Management, Boston University, Boston, MA, United States
| | - Brandolyn S. White
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs (VA) Health Care System, Durham, NC, United States
| | - Sarah L. Cutrona
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VA Medical Centers, Bedford and Boston, MA, United States
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Caitlin M. Reardon
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Laura J. Damschroder
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Madison Burns
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs (VA) Health Care System, Durham, NC, United States
| | - Kathryn DeLaughter
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VA Medical Centers, Bedford and Boston, MA, United States
| | | | - Maria Arasim
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Jennifer Lindquist
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs (VA) Health Care System, Durham, NC, United States
| | - Allen L. Gifford
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VA Medical Centers, Bedford and Boston, MA, United States
- Section of General Internal Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, United States
- Department of Health Law, Policy & Management, Boston University, Boston, MA, United States
| | - Heather A. King
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs (VA) Health Care System, Durham, NC, United States
- Department of Population Health Sciences, Duke University, Durham, NC, United States
- Division of General Internal Medicine, Duke University, Durham, NC, United States
| | - Jenesse Kaitz
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VA Medical Centers, Bedford and Boston, MA, United States
| | - Guneet K. Jasuja
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VA Medical Centers, Bedford and Boston, MA, United States
- Section of General Internal Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, United States
- Department of Health Law, Policy & Management, Boston University, Boston, MA, United States
| | - Timothy P. Hogan
- Advancing Implementation and Improvement Science Program, Peter O’Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, United States
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VA Medical Centers, Bedford and Boston, MA, United States
| | - Jaifred Christian F. Lopez
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs (VA) Health Care System, Durham, NC, United States
- Department of Population Health Sciences, Duke University, Durham, NC, United States
| | - Blake Henderson
- VHA Innovation Ecosystem, Office of Healthcare Innovation and Learning, United States Veterans Health Administration, Washington, DC, United States
| | - Blaine A. Fitzgerald
- VHA Innovation Ecosystem, Office of Healthcare Innovation and Learning, United States Veterans Health Administration, Washington, DC, United States
| | - Amber Goetschius
- VHA Innovation Ecosystem, Office of Healthcare Innovation and Learning, United States Veterans Health Administration, Washington, DC, United States
| | - Danielle Hagan
- VHA Innovation Ecosystem, Office of Healthcare Innovation and Learning, United States Veterans Health Administration, Washington, DC, United States
| | - Carl McCoy
- VHA Innovation Ecosystem, Office of Healthcare Innovation and Learning, United States Veterans Health Administration, Washington, DC, United States
| | - Alex Seelig
- Agile Six Applications, Inc., San Diego, CA, United States
| | - Andrea Nevedal
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States
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Haderlein TP, Guzman-Clark J, Dardashti NS, McMahon N, Duran EL, Haun JN, Robinson SA, Blok AC, Cutrona SL, Lindsay JA, Armstrong CM, Nazi KM, Shimada SL, Wilck NR, Reilly E, Kuhn E, Hogan TP. Improving Veteran Engagement with Virtual Care Technologies: a Veterans Health Administration State of the Art Conference Research Agenda. J Gen Intern Med 2024; 39:21-28. [PMID: 38252243 PMCID: PMC10937853 DOI: 10.1007/s11606-023-08488-7] [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: 04/27/2023] [Accepted: 10/13/2023] [Indexed: 01/23/2024]
Abstract
Although the availability of virtual care technologies in the Veterans Health Administration (VHA) continues to expand, ensuring engagement with these technologies among Veterans remains a challenge. VHA Health Services Research & Development convened a Virtual Care State of The Art (SOTA) conference in May 2022 to create a research agenda for improving virtual care access, engagement, and outcomes. This article reports findings from the Virtual Care SOTA engagement workgroup, which comprised fourteen VHA subject matter experts representing VHA clinical care, research, administration, and operations. Workgroup members reviewed current evidence on factors and strategies that may affect Veteran engagement with virtual care technologies and generated key questions to address evidence gaps. The workgroup agreed that although extensive literature exists on factors that affect Veteran engagement, more work is needed to identify effective strategies to increase and sustain engagement. Workgroup members identified key priorities for research on Veteran engagement with virtual care technologies through a series of breakout discussion groups and ranking exercises. The top three priorities were to (1) understand the Veteran journey from active service to VHA enrollment and beyond, and when and how virtual care technologies can best be introduced along that journey to maximize engagement and promote seamless care; (2) utilize the meaningful relationships in a Veteran's life, including family, friends, peers, and other informal or formal caregivers, to support Veteran adoption and sustained use of virtual care technologies; and (3) test promising strategies in meaningful combinations to promote Veteran adoption and/or sustained use of virtual care technologies. Research in these priority areas has the potential to help VHA refine strategies to improve virtual care user engagement, and by extension, outcomes.
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Affiliation(s)
- Taona P Haderlein
- VHA HSR&D Center for the Study of Healthcare Innovation, Implementation, & Policy, Los Angeles, CA, USA.
- Department of Veterans Affairs, Veterans Emergency Management Evaluation Center, Sepulveda, CA, USA.
| | | | - Navid S Dardashti
- NYU Grossman School of Medicine, New York, NY, USA
- VA New York Harbor Healthcare System, New York, NY, USA
| | - Nicholas McMahon
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
| | | | - Jolie N Haun
- Research and Development Service, James A. Haley Veterans Hospital, Tampa, FL, USA
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Stephanie A Robinson
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA
| | - Amanda C Blok
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, United States Department of Veterans Affairs, Ann Arbor, MI, USA
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Sarah L Cutrona
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Jan A Lindsay
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- South Central Mental Illness Research, Education and Clinical Center (A Virtual Center), Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
- Rice University's Baker Institute for Public Policy, Houston, TX, USA
| | - Christina M Armstrong
- Connected Health Implementation Strategies, Office of Connected Care, Veterans Health Administration, Washington, DC, USA
| | - Kim M Nazi
- Trilogy Federal, LLC, Arlington, VA, USA
- KMN Consulting Services, LTD, Coxsackie, NY, USA
| | - Stephanie L Shimada
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Nancy R Wilck
- Connected Health Implementation Strategies, Office of Connected Care, Veterans Health Administration, Washington, DC, USA
| | - Erin Reilly
- VISN 1 Mental Illness Research, Education, and Clinical Center (MIRECC), VA Bedford Healthcare System, Bedford, MA, USA
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Eric Kuhn
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Healthcare System, Menlo Park, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Timothy P Hogan
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
- Peter O'Donnell School of Public Health, UT Southwestern Medical Center, Dallas, TX, USA
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Robinson SA, Shimada SL, Zocchi MS, Etingen B, Smith B, McMahon N, Cutrona SL, Harmon JS, Wilck NR, Hogan TP. Factors Associated with Veteran Self-Reported Use of Digital Health Devices. J Gen Intern Med 2024; 39:79-86. [PMID: 38252248 PMCID: PMC10937849 DOI: 10.1007/s11606-023-08479-8] [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: 04/20/2023] [Accepted: 10/12/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Digital health devices (DHDs), technologies designed to gather, monitor, and sometimes share data about health-related behaviors or symptoms, can support the prevention or management of chronic conditions. DHDs range in complexity and utility, from tracking lifestyle behaviors (e.g., pedometer) to more sophisticated biometric data collection for disease self-management (e.g., glucometers). Despite these positive health benefits, supporting adoption and sustained use of DHDs remains a challenge. OBJECTIVE This analysis examined the prevalence of, and factors associated with, DHD use within the Veterans Health Administration (VHA). DESIGN National survey. PARTICIPANTS Veterans who receive VHA care and are active secure messaging users. MAIN MEASURES Demographics, access to technology, perceptions of using health technologies, and use of lifestyle monitoring and self-management DHDs. RESULTS Among respondents, 87% were current or past users of at least one DHD, and 58% were provided a DHD by VHA. Respondents 65 + years were less likely to use a lifestyle monitoring device (AOR 0.57, 95% CI [0.39, 0.81], P = .002), but more likely to use a self-management device (AOR 1.69, 95% [1.10, 2.59], P = .016). Smartphone owners were more likely to use a lifestyle monitoring device (AOR 2.60, 95% CI [1.42, 4.75], P = .002) and a self-management device (AOR 1.83, 95% CI [1.04, 3.23], P = .037). CONCLUSIONS The current analysis describes the types of DHDs that are being adopted by Veterans and factors associated with their adoption. Results suggest that various factors influence adoption, including age, access to technology, and health status, and that these relationships may differ based on the functionalities of the device. VHA provision of devices was frequent among device users. Providing Veterans with DHDs and the training needed to use them may be important factors in facilitating device adoption. Taken together, this knowledge can inform future implementation efforts, and next steps to support patient-team decision making about DHD use.
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Affiliation(s)
- Stephanie A Robinson
- eHealth Partnered Evaluation Initiative, Veterans Affairs Bedford Healthcare System, 200 Springs Rd., Bldg. 70 Room 263, Bedford, MA, 01730, USA.
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA.
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA.
| | - Stephanie L Shimada
- eHealth Partnered Evaluation Initiative, Veterans Affairs Bedford Healthcare System, 200 Springs Rd., Bldg. 70 Room 263, Bedford, MA, 01730, USA
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
- Department of Health Law, Policy, & Management, Boston University School of Public Health, Boston, MA, USA
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Mark S Zocchi
- eHealth Partnered Evaluation Initiative, Veterans Affairs Bedford Healthcare System, 200 Springs Rd., Bldg. 70 Room 263, Bedford, MA, 01730, USA
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Bella Etingen
- eHealth Partnered Evaluation Initiative, Veterans Affairs Bedford Healthcare System, 200 Springs Rd., Bldg. 70 Room 263, Bedford, MA, 01730, USA
- Center of Innovation for Complex Chronic Healthcare, Hines Veterans Affairs Hospital, Hines, IL, USA
| | - Bridget Smith
- eHealth Partnered Evaluation Initiative, Veterans Affairs Bedford Healthcare System, 200 Springs Rd., Bldg. 70 Room 263, Bedford, MA, 01730, USA
- Center of Innovation for Complex Chronic Healthcare, Hines Veterans Affairs Hospital, Hines, IL, USA
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nicholas McMahon
- eHealth Partnered Evaluation Initiative, Veterans Affairs Bedford Healthcare System, 200 Springs Rd., Bldg. 70 Room 263, Bedford, MA, 01730, USA
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
| | - Sarah L Cutrona
- eHealth Partnered Evaluation Initiative, Veterans Affairs Bedford Healthcare System, 200 Springs Rd., Bldg. 70 Room 263, Bedford, MA, 01730, USA
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Julie S Harmon
- eHealth Partnered Evaluation Initiative, Veterans Affairs Bedford Healthcare System, 200 Springs Rd., Bldg. 70 Room 263, Bedford, MA, 01730, USA
- Office of Connected Care, Veterans Health Administration, US Department of Veterans Affairs, Washington, DC, USA
| | - Nancy R Wilck
- eHealth Partnered Evaluation Initiative, Veterans Affairs Bedford Healthcare System, 200 Springs Rd., Bldg. 70 Room 263, Bedford, MA, 01730, USA
- Office of Connected Care, Veterans Health Administration, US Department of Veterans Affairs, Washington, DC, USA
| | - Timothy P Hogan
- eHealth Partnered Evaluation Initiative, Veterans Affairs Bedford Healthcare System, 200 Springs Rd., Bldg. 70 Room 263, Bedford, MA, 01730, USA
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
- Peter O'Donnell Jr School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Anderson E, Krones A, Vimalananda VG, Cutrona SL, Orlander JD, Strymish JL, Rinne ST. Understanding suboptimal e-consult requests: lessons from the VA. Am J Manag Care 2023; 29:e378-e385. [PMID: 38170529 DOI: 10.37765/ajmc.2023.89472] [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] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
OBJECTIVES Electronic consultations, or e-consults, which are requests for specialist advice without direct patient interaction, are becoming increasingly common across health systems. We sought to identify clinicians' perspectives on the quality of e-consult requests that they send and receive. STUDY DESIGN A qualitative research study at the US Department of Veterans Affairs (VA) New England Healthcare System. METHODS We interviewed a total of 73 clinicians, including 38 specialists across 3 specialties (cardiology, neurology, pulmonology) and 35 primary care clinicians (PCCs), between March and June 2019. The interviews were analyzed using thematic analysis. RESULTS VA specialists and PCCs generally agreed that e-consult requests should be focused and precise, not require lengthy chart review, and include adequate preliminary workup results. At the same time, specialists expressed frustration with what they perceived as suboptimal e-consult requests. Interviewees attributed this gap to 3 factors: limitations of the electronic health record user interface, divergence between PCCs and specialists in the areas of expertise, and organizational pressures on the 2 groups. CONCLUSIONS VA clinicians' perspectives on suboptimal requests contain lessons that are broadly applicable to other health systems that seek to maximize the potential of e-consults to facilitate clinician collaboration and care coordination.
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Affiliation(s)
- Ekaterina Anderson
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, 200 Springs Rd, Bedford, MA 01730.
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Ahlness EA, Orlander J, Brunner J, Cutrona SL, Kim B, Molloy-Paolillo BK, Rinne ST, Rucci J, Sayre G, Anderson E. "Everything's so Role-Specific": VA Employee Perspectives' on Electronic Health Record (EHR) Transition Implications for Roles and Responsibilities. J Gen Intern Med 2023; 38:991-998. [PMID: 37798577 PMCID: PMC10593626 DOI: 10.1007/s11606-023-08282-5] [Citation(s) in RCA: 1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 06/13/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Electronic health record (EHR) transitions are increasingly widespread and often highly disruptive. It is imperative we learn from past experiences to anticipate and mitigate such disruptions. Veterans Affairs (VA) is undergoing a large-scale transition from its homegrown EHR (CPRS/Vista) to a commercial EHR (Cerner), creating a unique opportunity of shedding light on large-scale EHR-to-EHR transition challenges. OBJECTIVE To explore one facet of the organizational impact of VA's EHR transition: its implications for employees' roles and responsibilities at the first VA site to implement Cerner Millennium EHR. DESIGN As part of a formative evaluation of frontline staff experiences with VA's EHR transition, we conducted brief (~ 15 min) and full-length interviews (~ 60 min) with clinicians and staff at Mann-Grandstaff VA Medical Center in Spokane, WA, before, during, and after transition (July 2020-November 2021). PARTICIPANTS We conducted 111 interviews with 26 Spokane clinicians and staff, recruited via snowball sampling. APPROACH We conducted audio interviews using a semi-structured guide with grounded prompts. We coded interview transcripts using a priori and emergent codes, followed by qualitative content analysis. KEY RESULTS Unlike VA's previous EHR, Cerner imposes additional restrictions on access to its EHR functionality based upon "roles" assigned to users. Participants described a mismatch between established institutional duties and their EHR permissions, unanticipated changes in scope of duties brought upon by the transition, as well as impediments to communication and collaboration due to different role-based views. CONCLUSIONS Health systems should anticipate substantive impacts on professional workflows when EHR role settings do not reflect prior workflows. Such changes may increase user error, dissatisfaction, and patient care disruptions. To mitigate employee dissatisfaction and safety risks, health systems should proactively plan for and communicate about expected modifications and monitor for unintended role-related consequences of EHR transitions, while vendors should ensure accurate role configuration and assignment.
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Affiliation(s)
- Ellen A Ahlness
- Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle VA Medical Center, Seattle, WA, USA.
| | - Jay Orlander
- Medical Service, VA Boston Healthcare System, Boston, MA, USA
- Section of General Internal Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Julian Brunner
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Health Care, Los Angeles, CA, USA
| | - Sarah L Cutrona
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
- Division of Health Informatics & Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Bo Kim
- Center for Healthcare Organization and Implementation Research, VA Boston Health Care System, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Brianne K Molloy-Paolillo
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
| | - Seppo T Rinne
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Justin Rucci
- Center for Healthcare Organization and Implementation Research, VA Boston Health Care System, Boston, MA, USA
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - George Sayre
- Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle VA Medical Center, Seattle, WA, USA
- University of Washington School of Public Health, Seattle, WA, USA
| | - Ekaterina Anderson
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
- Division of Health Informatics & Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
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Molloy-Paolillo B, Mohr D, Levy DR, Cutrona SL, Anderson E, Rucci J, Helfrich C, Sayre G, Rinne ST. Assessing Electronic Health Record (EHR) Use during a Major EHR Transition: An Innovative Mixed Methods Approach. J Gen Intern Med 2023; 38:999-1006. [PMID: 37798584 PMCID: PMC10593729 DOI: 10.1007/s11606-023-08318-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 07/03/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Electronic health record (EHR) transitions are inherently disruptive to healthcare workers who must rapidly learn a new EHR and adapt to altered clinical workflows. Healthcare workers' perceptions of EHR usability and their EHR use patterns following transitions are poorly understood. The Department of Veterans Affairs (VA) is currently replacing its homegrown EHR with a commercial Cerner EHR, presenting a unique opportunity to examine EHR use trends and usability perceptions. OBJECTIVE To assess EHR usability and uptake up to 1-year post-transition at the first VA EHR transition site using a novel longitudinal, mixed methods approach. DESIGN A concurrent mixed methods strategy using EHR use metrics and qualitative interview data. PARTICIPANTS 141 clinicians with data from select EHR use metrics in Cerner Lights On Network®. Interviews with 25 healthcare workers in various clinical and administrative roles. APPROACH We assessed changes in total EHR time, documentation time, and order time per patient post-transition. Interview transcripts (n = 90) were coded and analyzed for content specific to EHR usability. KEY RESULTS Total EHR time, documentation time, and order time all decreased precipitously within the first four months after go-live and demonstrated gradual improvements over 12 months. Interview participants expressed ongoing concerns with the EHR's usability and functionality up to a year after go-live such as tasks taking longer than the old system and inefficiencies related to inadequate training and inherent features of the new system. These sentiments did not seem to reflect the observed improvements in EHR use metrics. CONCLUSIONS The integration of quantitative and qualitative data yielded a complex picture of EHR usability. Participants described persistent challenges with EHR usability 1 year after go-live contrasting with observed improvements in EHR use metrics. Combining findings across methods can provide a clearer, contextualized understanding of EHR adoption and use patterns during EHR transitions.
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Affiliation(s)
- Brianne Molloy-Paolillo
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA.
| | - David Mohr
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA
- Boston University School of Public Health, Boston, MA, USA
| | - Deborah R Levy
- Center of Innovation for Pain Research, Informatics, Multimorbidities, and Education (PRIME), VA Connecticut Health Care, West Haven, CT, USA
- Yale University School of Medicine, New Haven, CT, USA
| | - Sarah L Cutrona
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
- Department of Population and Quantitative Health Sciences/Division of Health Informatics and Implementation Science, UMass Chan Medical School, Worcester, MA, USA
| | - Ekaterina Anderson
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
- Department of Population and Quantitative Health Sciences/Division of Health Informatics and Implementation Science, UMass Chan Medical School, Worcester, MA, USA
| | - Justin Rucci
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA
- Division of Pulmonary Critical Care, Boston University, Boston, MA, USA
| | - Christian Helfrich
- Seattle-Denver Center of Innovation, VA Puget Sound Health Care System, Seattle, WA, USA
- Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA
| | - George Sayre
- Seattle-Denver Center of Innovation, VA Puget Sound Health Care System, Seattle, WA, USA
- Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA
| | - Seppo T Rinne
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
- Pulmonary & Critical Care Medicine, School of Medicine, Boston University, Boston, MA, USA
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Rucci JM, Ball S, Brunner J, Moldestad M, Cutrona SL, Sayre G, Rinne S. "Like One Long Battle:" Employee Perspectives of the Simultaneous Impact of COVID-19 and an Electronic Health Record Transition. J Gen Intern Med 2023; 38:1040-1048. [PMID: 37798583 PMCID: PMC10593661 DOI: 10.1007/s11606-023-08284-3] [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: 12/01/2022] [Accepted: 06/13/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Healthcare organizations regularly manage external stressors that threaten patient care, but experiences handling concurrent stressors are not well characterized. OBJECTIVE To evaluate the experience of Veterans Affairs (VA) clinicians and staff navigating simultaneous organizational stressors-an electronic health record (EHR) transition and the COVID-19 pandemic-and identify potential strategies to optimize management of co-occurring stressors. DESIGN Qualitative case study describing employee experiences at VA's initial EHR transition site. PARTICIPANTS Clinicians, nurses, allied health professionals, and local leaders at VA's initial EHR transition site. APPROACH We collected longitudinal qualitative interview data between July 2020 and November 2021 once before and 2-4 times after the date on which the health system transitioned; this timing corresponded with local surges of COVID-19 cases. Interviewers conducted coding and analysis of interview transcripts. For this study, we focused on quotes related to COVID-19 and performed content analysis to describe recurring themes describing the simultaneous impact of COVID-19 and an EHR transition. KEY RESULTS We identified five themes related to participants' experiences: (1) efforts to mitigate COVID-19 transmission led to insufficient access to EHR training and support, (2) clinical practice changes in response to the pandemic impacted EHR workflows in unexpected ways, (3) lack of clear communication and inconsistent enforcement of COVID-19 policies intensified pre-existing frustrations with the EHR, (4) managing concurrent organizational stressors increased work dissatisfaction and feelings of burnout, and (5) participants had limited bandwidth to manage competing demands that arose from concurrent organizational stressors. CONCLUSION The expected challenges of an EHR transition were compounded by co-occurrence of the COVID-19 pandemic, which had negative impacts on clinician experience and patient care. During simultaneous organizational stressors, health care facilities should be prepared to address the complex interplay of two stressors on employee experience.
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Affiliation(s)
- Justin M Rucci
- Center for Healthcare Organization and Implementation Research, Boston, VA, USA.
- The Pulmonary Center, Department of Medicine, Boston University, Boston, MA, USA.
| | - Sherry Ball
- VA Northeast Ohio Healthcare System, Cleveland, OH, USA
| | - Julian Brunner
- Center for the Study of Healthcare Innovation Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Megan Moldestad
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VHA Puget Sound Health Care System, Seattle, WA, USA
| | - Sarah L Cutrona
- Center for Healthcare Organization and Implementation Research, Bedford, VA, USA
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, USA
| | - George Sayre
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VHA Puget Sound Health Care System, Seattle, WA, USA
- University of Washington School of Public Health, Seattle, Washington, USA
| | - Seppo Rinne
- The Pulmonary Center, Department of Medicine, Boston University, Boston, MA, USA
- Center for Healthcare Organization and Implementation Research, Bedford, VA, USA
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Ahlness EA, Molloy-Paolillo BK, Brunner J, Cutrona SL, Kim B, Matteau E, Rinne ST, Walton E, Wong E, Sayre G. Impacts of an Electronic Health Record Transition on Veterans Health Administration Health Professions Trainee Experience. J Gen Intern Med 2023; 38:1031-1039. [PMID: 37798576 PMCID: PMC10593679 DOI: 10.1007/s11606-023-08283-4] [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: 12/01/2022] [Accepted: 06/13/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Adoption of electronic health care records (EHRs) has proliferated since 2000. While EHR transitions are widely understood to be disruptive, little attention has been paid to their effect on health professions trainees' (HPTs) ability to learn and conduct work. Veterans Health Administration's (VA) massive transition from its homegrown EHR (CPRS/Vista) to the commercial Oracle Cerner presents an unparalleled-in-scope opportunity to gain insight on trainee work functions and their ability to obtain requisite experience during transitions. OBJECTIVE To identify how an organizational EHR transition affected HPT work and learning at the third VA go-live site. DESIGN A formative mixed-method evaluation of HPT experiences with VHA's EHR transition including interviews with HPTs and supervisors at Chalmers P. Wylie VA Outpatient Clinic in Columbus, OH, before (~60 min), during (15-30 min), and after (~60 min) go-live (December 2021-July 2022). We also conducted pre- (March 2022-April 2022) and post-go live (May 2022-June 2022) HPT and employee surveys. PARTICIPANTS We conducted 24 interviews with HPTs (n=4), site leaders (n=2), and academic affiliates (n=2) using snowball sampling. We recruited HPTs in pre- (n=13) and post-go-live (n=10) surveys and employees in pre- (n=408) and post-go-live (n=458) surveys. APPROACH We conducted interviews using a semi-structured guide and grounded prompts. We coded interviews and survey free text data using a priori and emergent codes, subsequently conducting thematic analysis. We conducted descriptive statistical analysis of survey responses and merged interview and survey data streams. KEY RESULTS Our preliminary findings indicate that the EHR transition comprehensively affected HPT experiences, disrupting processes from onboarding and training to clinical care contributions and training-to-career retention. CONCLUSIONS Understanding HPTs' challenges during EHR transitions is critical to effective training. Mitigating the identified barriers to HPT training and providing patient care may lessen their dissatisfaction and ensure quality patient care during EHR transitions.
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Affiliation(s)
- Ellen A Ahlness
- Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle. VA Medical Center, Seattle, WA, USA.
| | - Brianne K Molloy-Paolillo
- Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, MA, USA
| | - Julian Brunner
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Health Care, Los Angeles, CA, USA
| | - Sarah L Cutrona
- Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, MA, USA
- Division of Health Informatics & Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Bo Kim
- Center for Healthcare Organization and Implementation Research, VA Boston Health Care System, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Erin Matteau
- VA Office of Academic Affiliations, Washington, DC, USA
| | - Seppo T Rinne
- Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, MA, USA
- The Pulmonary Center, Department of Medicine, Boston University, Boston, MA, USA
| | - Edward Walton
- VA Office of Academic Affiliations, Washington, DC, USA
| | - Edwin Wong
- Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle. VA Medical Center, Seattle, WA, USA
- University of Washington School of Public Health, Seattle, WA, USA
| | - George Sayre
- Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle. VA Medical Center, Seattle, WA, USA
- University of Washington School of Public Health, Seattle, WA, USA
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11
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Cutrona SL, White L, Miano D, Damschroder LJ, Hogan TP, Gifford AL, White B, King HA, Opra Widerquist MA, Orvek E, DeLaughter K, Nevedal AL, Reardon CM, Henderson B, Vega R, Jackson GL. Supporting Veteran's Administration Medical Center Directors' Decisions When Adopting Innovative Practices: Development and Implementation of the "QuickView" and "WishList" Tools. Perm J 2023; 27:79-91. [PMID: 37545198 PMCID: PMC10502382 DOI: 10.7812/tpp/23.008] [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] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Background Since 2015, the Veterans Health Administration (VHA) Diffusion of Excellence Program has supported spread of practices developed by frontline employees. Shark Tank-style competitions encourage "Sharks" nationwide (VHA medical center/regional directors) to bid for the opportunity to implement practices at their institutions. Methods The authors evaluated bidding strategies (2016-2020), developing the "QuickView" practice comparator to promote informed bidding. Program leaders distributed QuickView and revised versions in subsequent competitions. Our team utilized in-person observation, online chats after the competition, bidder interviews, and bid analysis to evaluate QuickView use. Bids were ranked based on demonstrated understanding of resources required for practice implementation. Results Sharks stated that QuickView supported preparation before the competition and suggested improvements. Our revised tool reported necessary staff time and incorporated a "WishList" from practice finalists detailing minimum requirements for successful implementation. Bids from later years reflected increased review of facilities' current states before the competition and increased understanding of the resources needed for implementation. Percentage of bids describing local need for the practice rose from 2016 to 2020: 4.7% (6/127); 62.1% (54/87); 78.3% (36/46); 80.6% (29/36); 89.7% (26/29). Percentage of bids committing specific resources rose following QuickView introduction: 81.1% (103/127) in 2016, 69.0% (60/87) in 2017, then 73.9% (34/46) in 2018, 88.9% (32/36) in 2019, and 89.7% (26/29) in 2020. Discussion In the years following QuickView/WishList implementation, bids reflected increased assessment before the competition of both local needs and available resources. Conclusion Selection of a new practice for implementation requires an understanding of local need, necessary resources, and fit. QuickView and WishList appear to support these determinations.
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Affiliation(s)
- Sarah L Cutrona
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VA Medical Centers, Bedford, MA, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Lindsay White
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VA Medical Centers, Bedford, MA, USA
| | - Danielle Miano
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VA Medical Centers, Bedford, MA, USA
| | - Laura J Damschroder
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Timothy P Hogan
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VA Medical Centers, Bedford, MA, USA
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX, USA
| | - Allen L Gifford
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VA Medical Centers, Bedford, MA, USA
- Section of General Internal Medicine, Department of Health Law, Policy & Management, Boston University, Boston, MA, USA
| | - Brandolyn White
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, NC, USA
| | - Heather A King
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, NC, USA
- Department of Population Health Sciences, Division of General Internal Medicine, and Department of Family Medicine and Community Health, Duke University, Durham, NC, USA
| | | | - Elizabeth Orvek
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VA Medical Centers, Bedford, MA, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Kathryn DeLaughter
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VA Medical Centers, Bedford, MA, USA
| | - Andrea L Nevedal
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Caitlin M Reardon
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Blake Henderson
- Diffusion of Excellence, Office of Discovery, Education and Affiliate Networks, VHA, Washington, DC, USA
| | - Ryan Vega
- Office of Discovery, Education and Affiliate Networks, VHA, Bedford, MA, USA
| | - George L Jackson
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, NC, USA
- Department of Population Health Sciences, Division of General Internal Medicine, and Department of Family Medicine and Community Health, Duke University, Durham, NC, USA
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Sohl SJ, Sadasivam RS, Kittel C, Dressler EV, Wentworth S, Balakrishnan K, Weaver KE, Dellinger RA, Puccinelli-Ortega N, Cutrona SL, Foley KL, Houston T. Pilot study of implementing the Shared Healthcare Actions & Reflections Electronic systems in Survivorship (SHARE-S) program in coordination with clinical care. Cancer Med 2023. [PMID: 37096778 DOI: 10.1002/cam4.5965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/30/2023] [Accepted: 04/06/2023] [Indexed: 04/26/2023] Open
Abstract
INTRODUCTION Initial cancer survivorship care planning efforts focused on information sharing demonstrated limited impact on patient health outcomes. We designed the Shared Healthcare Actions & Reflections Electronic Systems in survivorship (SHARE-S) program to enhance survivorship guideline implementation by transitioning some effort from clinicians to technology and patients through supporting health self-management (e.g., healthy lifestyles). METHODS We conducted a single-group hybrid implementation-effectiveness pilot study. SHARE-S incorporated three strategies: (1) e-referral from the clinical team for patient engagement, (2) three health self-management coach calls, and (3) text messages to enhance coaching. Our primary implementation measure was the proportion of patients e-referred who enrolled (target >30%). Secondary implementation measures assessed patient engagement. We also measured effectiveness by describing changes in patient health outcomes. RESULTS Of the 118 cancer survivor patients e-referred, 40 engaged in SHARE-S (proportion enrolled = 34%). Participants had a mean age of 57.4 years (SD = 15.7), 73% were female, 23% were Black/African American, and 5 (12.5%) were from a rural location. Patient-level adherence to coach calls was >90%. Changes from baseline to follow-up showed at least a small effect (Cohen's d = 0.2) for improvements in: mindful attention, alcohol use, physical activity, fruit and vegetable intake, days of mindfulness practice, depressive symptoms, ability to participate in social roles and activities, cancer-specific quality of life, benefits of having cancer, and positive feelings. CONCLUSION The SHARE-S program successfully engaged cancer survivor patients. Once enrolled, patients showed promising improvements in health outcomes. Supporting patient self-management is an important component of optimizing delivery of cancer survivorship care.
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Affiliation(s)
- Stephanie J Sohl
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, North Carolina, USA
| | - Rajani S Sadasivam
- University of Massachusetts T.H. Chan Medical School, Worcester, Massachusetts, USA
| | - Carol Kittel
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, North Carolina, USA
| | - Emily V Dressler
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, North Carolina, USA
| | - Stacy Wentworth
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, North Carolina, USA
| | - Kavitha Balakrishnan
- University of Massachusetts T.H. Chan Medical School, Worcester, Massachusetts, USA
| | - Kathryn E Weaver
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, North Carolina, USA
| | | | | | - Sarah L Cutrona
- University of Massachusetts T.H. Chan Medical School, Worcester, Massachusetts, USA
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA
| | - Kristie L Foley
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, North Carolina, USA
| | - Thomas Houston
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, North Carolina, USA
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Kaitz J, DeLaughter K, Deeney C, Cutrona SL, Hogan TP, Gifford AL, Jackson GL, White B, King H, Reardon C, Nevedal A, Henderson B, Fix GM. Leveraging Organizational Conditions for Innovation: A Typology of Facility Engagement in the Veterans Health Administration Shark Tank-Style Competition. Perm J 2023:1-8. [PMID: 36946078 DOI: 10.7812/tpp/22.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Introduction The development and spread of innovation are known challenges in health care. The US Veterans Health Administration (VHA) created a "Shark Tank"-style competition directed at frontline employees. In this annual, systemwide competition, employees submit innovations to the competition, and winning innovations receive support for implementation in other facilities. Method A multiple case study design was used to understand facility engagement in the competition, and the relationship between engagement and organizational conditions. The authors created a typology to describe the relationship between facility engagement in the competition and organizational conditions for innovation. Results Overall, there was high participation in the VHA's competition across all 130 facilities. The authors identified 7 mutually exclusive types of facility engagement. Discussion As expected, facilities with the most established conditions for innovation were the most engaged in the competition. Additionally, other facilities had various ways to be involved. Consequently, there may be benefit to the VHA tailoring how they work with facilities, based on organizational conditions. Larger facilities with ongoing research and more resources may be more suited to develop innovations, whereas smaller facilities could benefit from a focus on adoption. Conclusion These insights are valuable to the VHA and can be used by other health care systems to tailor innovation programs and allocate resources based on diverse needs across a vast health care system.
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Affiliation(s)
- Jenesse Kaitz
- Center for Healthcare Organization and Implementation Research, VA Bedford and Boston Healthcare Systems, Bedford and Boston, MA, USA
| | - Kathryn DeLaughter
- Center for Healthcare Organization and Implementation Research, VA Bedford and Boston Healthcare Systems, Bedford and Boston, MA, USA
| | - Christine Deeney
- Center for Healthcare Organization and Implementation Research, VA Bedford and Boston Healthcare Systems, Bedford and Boston, MA, USA
| | - Sarah L Cutrona
- Center for Healthcare Organization and Implementation Research, VA Bedford and Boston Healthcare Systems, Bedford and Boston, MA, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Timothy P Hogan
- Center for Healthcare Organization and Implementation Research, VA Bedford and Boston Healthcare Systems, Bedford and Boston, MA, USA
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Allen L Gifford
- Center for Healthcare Organization and Implementation Research, VA Bedford and Boston Healthcare Systems, Bedford and Boston, MA, USA
- Boston University Chobanian & Avedisian School of Medicine, Section of General Internal Medicine, Boston, MA, USA
- Boston University School of Public Health, Boston, MA, USA
| | - George L Jackson
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, USA
- Department of Population Health Sciences and Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Brandolyn White
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, USA
| | - Heather King
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, USA
- Department of Population Health Sciences and Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Caitlin Reardon
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Andrea Nevedal
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Blake Henderson
- Department of Veterans Affairs, VHA Innovation Ecosystem/Diffusion of Excellence, Washington, DC, USA
| | - Gemmae M Fix
- Center for Healthcare Organization and Implementation Research, VA Bedford and Boston Healthcare Systems, Bedford and Boston, MA, USA
- Boston University Chobanian & Avedisian School of Medicine, Section of General Internal Medicine, Boston, MA, USA
- Boston University School of Public Health, Boston, MA, USA
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Chen J, Cutrona SL, Dharod A, Bunch SC, Foley KL, Ostasiewski B, Hale ER, Bridges A, Moses A, Donny EC, Sutfin EL, Houston TK. Monitoring the Implementation of Tobacco Cessation Support Tools: Using Novel Electronic Health Record Activity Metrics. JMIR Med Inform 2023; 11:e43097. [PMID: 36862466 PMCID: PMC10020903 DOI: 10.2196/43097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/21/2022] [Accepted: 01/18/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Clinical decision support (CDS) tools in electronic health records (EHRs) are often used as core strategies to support quality improvement programs in the clinical setting. Monitoring the impact (intended and unintended) of these tools is crucial for program evaluation and adaptation. Existing approaches for monitoring typically rely on health care providers' self-reports or direct observation of clinical workflows, which require substantial data collection efforts and are prone to reporting bias. OBJECTIVE This study aims to develop a novel monitoring method leveraging EHR activity data and demonstrate its use in monitoring the CDS tools implemented by a tobacco cessation program sponsored by the National Cancer Institute's Cancer Center Cessation Initiative (C3I). METHODS We developed EHR-based metrics to monitor the implementation of two CDS tools: (1) a screening alert reminding clinic staff to complete the smoking assessment and (2) a support alert prompting health care providers to discuss support and treatment options, including referral to a cessation clinic. Using EHR activity data, we measured the completion (encounter-level alert completion rate) and burden (the number of times an alert was fired before completion and time spent handling the alert) of the CDS tools. We report metrics tracked for 12 months post implementation, comparing 7 cancer clinics (2 clinics implemented the screening alert and 5 implemented both alerts) within a C3I center, and identify areas to improve alert design and adoption. RESULTS The screening alert fired in 5121 encounters during the 12 months post implementation. The encounter-level alert completion rate (clinic staff acknowledged completion of screening in EHR: 0.55; clinic staff completed EHR documentation of screening results: 0.32) remained stable over time but varied considerably across clinics. The support alert fired in 1074 encounters during the 12 months. Providers acted upon (ie, not postponed) the support alert in 87.3% (n=938) of encounters, identified a patient ready to quit in 12% (n=129) of encounters, and ordered a referral to the cessation clinic in 2% (n=22) of encounters. With respect to alert burden, on average, both alerts fired over 2 times (screening alert: 2.7; support alert: 2.1) before completion; time spent postponing the screening alert was similar to completing (52 vs 53 seconds) the alert, and time spent postponing the support alert was more than completing (67 vs 50 seconds) the alert per encounter. These findings inform four areas where the alert design and use can be improved: (1) improving alert adoption and completion through local adaptation, (2) improving support alert efficacy by additional strategies including training in provider-patient communication, (3) improving the accuracy of tracking for alert completion, and (4) balancing alert efficacy with the burden. CONCLUSIONS EHR activity metrics were able to monitor the success and burden of tobacco cessation alerts, allowing for a more nuanced understanding of potential trade-offs associated with alert implementation. These metrics can be used to guide implementation adaptation and are scalable across diverse settings.
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Affiliation(s)
- Jinying Chen
- iDAPT Implementation Science Center for Cancer Control, Wake Forest University School of Medicine, Winston-Salem, NC, United States
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, United States
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
- Department of Preventive Medicine and Epidemiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Sarah L Cutrona
- iDAPT Implementation Science Center for Cancer Control, Wake Forest University School of Medicine, Winston-Salem, NC, United States
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Ajay Dharod
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, United States
- Department of Implementation Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, United States
- Wake Forest Center for Healthcare Innovation, Winston-Salem, NC, United States
- Wake Forest Center for Biomedical Informatics, Winston-Salem, NC, United States
| | - Stephanie C Bunch
- Center for Health Analytics, Media, and Policy, RTI International, Research Triangle Park, NC, United States
| | - Kristie L Foley
- iDAPT Implementation Science Center for Cancer Control, Wake Forest University School of Medicine, Winston-Salem, NC, United States
- Department of Implementation Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Brian Ostasiewski
- Clinical & Translational Science Institute, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Erica R Hale
- iDAPT Implementation Science Center for Cancer Control, Wake Forest University School of Medicine, Winston-Salem, NC, United States
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Aaron Bridges
- Clinical & Translational Science Institute, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Adam Moses
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Eric C Donny
- Department of Physiology and Pharmacology, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Erin L Sutfin
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Thomas K Houston
- iDAPT Implementation Science Center for Cancer Control, Wake Forest University School of Medicine, Winston-Salem, NC, United States
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, United States
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15
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Reardon CM, Damschroder L, Opra Widerquist MA, Arasim M, Jackson GL, White B, Cutrona SL, Fix GM, Gifford AL, DeLaughter K, King HA, Henderson B, Vega R, Nevedal AL. Sustainment of diverse evidence-informed practices disseminated in the Veterans Health Administration (VHA): initial development and piloting of a pragmatic survey tool. Implement Sci Commun 2023; 4:6. [PMID: 36647162 PMCID: PMC9842210 DOI: 10.1186/s43058-022-00386-z] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 12/18/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND There are challenges associated with measuring sustainment of evidence-informed practices (EIPs). First, the terms sustainability and sustainment are often falsely conflated: sustainability assesses the likelihood of an EIP being in use in the future while sustainment assesses the extent to which an EIP is (or is not) in use. Second, grant funding often ends before sustainment can be assessed. The Veterans Health Administration (VHA) Diffusion of Excellence (DoE) program is one of few large-scale models of diffusion; it seeks to identify and disseminate practices across the VHA system. The DoE sponsors "Shark Tank" competitions, in which leaders bid on the opportunity to implement a practice with approximately 6 months of implementation support. As part of an ongoing evaluation of the DoE, we sought to develop and pilot a pragmatic survey tool to assess sustainment of DoE practices. METHODS In June 2020, surveys were sent to 64 facilities that were part of the DoE evaluation. We began analysis by comparing alignment of quantitative and qualitative responses; some facility representatives reported in the open-text box of the survey that their practice was on a temporary hold due to COVID-19 but answered the primary outcome question differently. As a result, the team reclassified the primary outcome of these facilities to Sustained: Temporary COVID-Hold. Following this reclassification, the number and percent of facilities in each category was calculated. We used directed content analysis, guided by the Consolidated Framework for Implementation Research (CFIR), to analyze open-text box responses. RESULTS A representative from forty-one facilities (64%) completed the survey. Among responding facilities, 29/41 sustained their practice, 1/41 partially sustained their practice, 8/41 had not sustained their practice, and 3/41 had never implemented their practice. Sustainment rates increased between Cohorts 1-4. CONCLUSIONS The initial development and piloting of our pragmatic survey allowed us to assess sustainment of DoE practices. Planned updates to the survey will enable flexibility in assessing sustainment and its determinants at any phase after adoption. This assessment approach can flex with the longitudinal and dynamic nature of sustainment, including capturing nuances in outcomes when practices are on a temporary hold. If additional piloting illustrates the survey is useful, we plan to assess the reliability and validity of this measure for broader use in the field.
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Affiliation(s)
- Caitlin M. Reardon
- grid.413800.e0000 0004 0419 7525Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, USA
| | - Laura Damschroder
- grid.413800.e0000 0004 0419 7525Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, USA
| | - Marilla A. Opra Widerquist
- grid.413800.e0000 0004 0419 7525Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, USA
| | - Maria Arasim
- grid.413800.e0000 0004 0419 7525Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, USA
| | - George L. Jackson
- grid.512153.1Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, USA ,grid.26009.3d0000 0004 1936 7961Department of Population Health Sciences, Duke University, Durham, USA ,grid.26009.3d0000 0004 1936 7961Division of General Internal Medicine, Duke University, Durham, USA ,grid.26009.3d0000 0004 1936 7961Department of Family Medicine & Community Health, Duke University, Durham, USA
| | - Brandolyn White
- grid.512153.1Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, USA
| | - Sarah L. Cutrona
- Center for Healthcare Organization & Implementation Research (CHOIR), Bedford & Boston VA Medical Centers, Bedford, USA ,Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, USA ,grid.168645.80000 0001 0742 0364Division of General Internal Medicine, University of Massachusetts Medical School, Worcester, USA
| | - Gemmae M. Fix
- Center for Healthcare Organization & Implementation Research (CHOIR), Bedford & Boston VA Medical Centers, Bedford, USA ,grid.189504.10000 0004 1936 7558Section of General Internal Medicine, Boston University School of Medicine, Boston, USA
| | - Allen L. Gifford
- Center for Healthcare Organization & Implementation Research (CHOIR), Bedford & Boston VA Medical Centers, Bedford, USA ,grid.189504.10000 0004 1936 7558Section of General Internal Medicine, Boston University School of Medicine, Boston, USA ,grid.189504.10000 0004 1936 7558Department of Health Law, Policy & Management, Boston University, Boston, USA
| | - Kathryn DeLaughter
- Center for Healthcare Organization & Implementation Research (CHOIR), Bedford & Boston VA Medical Centers, Bedford, USA ,Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, USA
| | - Heather A. King
- grid.512153.1Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, USA ,grid.26009.3d0000 0004 1936 7961Department of Population Health Sciences, Duke University, Durham, USA ,grid.26009.3d0000 0004 1936 7961Division of General Internal Medicine, Duke University, Durham, USA
| | - Blake Henderson
- grid.239186.70000 0004 0481 9574Innovation Ecosystem, United States Veterans Health Administration, Washington, D.C., USA
| | - Ryan Vega
- grid.239186.70000 0004 0481 9574Innovation Ecosystem, United States Veterans Health Administration, Washington, D.C., USA
| | - Andrea L. Nevedal
- grid.413800.e0000 0004 0419 7525Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, USA
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16
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Nagawa CS, Ito Fukunaga M, Faro JM, Liu F, Anderson E, Kamberi A, Orvek EA, Davis M, Pbert L, Cutrona SL, Houston TK, Sadasivam RS. Characterizing Pandemic-Related Changes in Smoking Over Time in a Cohort of Current and Former Smokers. Nicotine Tob Res 2023; 25:203-210. [PMID: 35137213 PMCID: PMC9383439 DOI: 10.1093/ntr/ntac033] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 11/17/2021] [Accepted: 01/31/2022] [Indexed: 01/13/2023]
Abstract
INTRODUCTION We used a longitudinal cohort of US adults who were current or former smokers to explore how three participant-reported factors-general stress, coronavirus disease of 2019 (COVID-19) distress, and perceived risk of complications from COVID-19 related to smoking-were associated with changes in smoking status. METHODS Smoking status was assessed at three time points. Timepoint 1 status was assessed at a prior study completion (2018-2020). Timepoint 2 (start of the pandemic), and Timepoint 3 (early phase of the pandemic) statuses were assessed using an additional survey in 2020. After classifying participants into eight groups per these time points, we compared the means of participant-reported factors and used a linear regression model to adjust for covariates. RESULTS Participants (n = 392) were mostly female (73.9%) and non-Hispanic White (70.1%). Between Timepoints 2 and 3, abstinence rates decreased by 11%, and 40% of participants reported a smoking status change. Among those reporting a change and the highest general stress levels, newly abstinent participants had higher perceived risk of complications from COVID-19 related to smoking than those who relapsed during pandemic (mean (SD): 14.2 (3.3) vs. 12.6 (3.8)). Compared to participants who sustained smoking, those who sustained abstinence, on average, scored 1.94 less on the general stress scale (βeta Coefficient (β): -1.94, p-value < .01) and 1.37 more on the perceived risk of complications from COVID-19 related to smoking scale (β: 1.37, p-value .02). CONCLUSIONS Decreased abstinence rates are concerning. Patterns of reported factors were as expected for individuals who sustained their smoking behavior but not for those who changed. IMPLICATIONS We observed an increase in smoking rates during the COVID-19 pandemic. In exploring how combinations of general stress levels, COVID-19 distress levels, and perceived risk of complications from COVID-19 related to smoking were associated with changes in smoking, we observed expected patterns of these factors among individuals who sustained abstinence or smoking. Among individuals who changed smoking status and reported high stress levels, those who reported a higher perceived risk of complications from COVID-19 related to smoking abstained from smoking. In contrast, those who reported a lower perceived risk of complications from COVID-19 related to smoking, started smoking. An intersectional perspective may be needed to understand smokers' pandemic-related behavior changes.
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Affiliation(s)
- Catherine S Nagawa
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Mayuko Ito Fukunaga
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
- Meyers Primary Care Institute, Worcester, MA, USA
| | - Jamie M Faro
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Feifan Liu
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Ekaterina Anderson
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
| | - Ariana Kamberi
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Elizabeth A Orvek
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Maryann Davis
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Lori Pbert
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Sarah L Cutrona
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
- Meyers Primary Care Institute, Worcester, MA, USA
| | - Thomas K Houston
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Rajani S Sadasivam
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
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17
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Emidio OM, Cutrona SL, Person SD, Mazor KM, Frisard C, Lemon SC. Association of neighborhood-level social determinants of health with psychosocial distress in patients newly diagnosed with lung cancer. Cancer Rep (Hoboken) 2022; 5:e1734. [PMID: 36250328 PMCID: PMC9675366 DOI: 10.1002/cnr2.1734] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 09/24/2022] [Accepted: 09/28/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND AND AIM Patients with lung cancer experience high rates of psychosocial distress. They are also more likely to have unresolved, unmet social needs which may contribute to psychosocial distress. Despite this, neighborhood-level social determinants of health (SDOH) in relation to psychosocial distress have not been adequately investigated in patients with lung cancer. The goal of this study is to examine the association between neighborhood-level SDOH and psychosocial distress among a sample of newly diagnosed patients with lung cancer. METHODS This cross-sectional study included newly diagnosed, adult lung cancer patients from an accredited cancer center. Psychosocial distress was measured with the Distress Thermometer. Neighborhood-level SDOH indicators for income and education were used to create a composite SDOH variable categorized into low, medium, and high deprivation levels. Covariates were age, gender, race/ethnicity, comorbidity index, cancer stage, and insurance status. Using multivariate logistic regression modeling, the association of psychosocial distress with the neighborhood-level SDOH was examined. RESULTS The prevalence of psychosocial distress in the sample was 58.4%. Neighborhood-level SDOH indicators were not significantly associated with psychosocial distress. Higher odds of psychosocial distress were significantly associated with being female and having distant or regional cancer versus localized cancer. The age group 66-75 years was significantly associated with lower distress compared with those aged <65 years. CONCLUSIONS Psychosocial distress was consistently high across all the SDOH deprivation categories; but these neighborhood-level SDOH indicators do not appear to be predictive of psychosocial distress at the time of diagnosis of lung cancer.
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Affiliation(s)
- Oluwabunmi M Emidio
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Sarah L Cutrona
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Sharina D Person
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Kathleen M Mazor
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Christine Frisard
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Stephenie C Lemon
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
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18
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Nagawa CS, Wang B, Davis M, Pbert L, Cutrona SL, Lemon SC, Sadasivam RS. Examining pathways between family or peer factors and smoking cessation in a nationally representative US sample of adults with mental health conditions who smoke: a structural equation analysis. BMC Public Health 2022; 22:1566. [PMID: 35978318 PMCID: PMC9382825 DOI: 10.1186/s12889-022-13979-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background Supportive family or peer behaviors positively impact smoking cessation in people with mental health problems who smoke. However, the limited understanding of the pathways through which family or peer factors impact quitting limits the development of effective support interventions. This study examined pathways through which family or peer views on tobacco use, family or peer smoking status, and rules against smoking in the home influenced quitting in adults with mental health problems who smoke. Methods We used data from the Population Assessment of Tobacco and Health Study, a national longitudinal survey. Baseline data were collected in 2015, and follow-up data in 2016. We included adults’ current smokers who had experienced two or more mental health symptoms in the past year (unweighted n = 4201). Structural equation modeling was used to test the relationships between family and peer factors, mediating factors, and smoking cessation. Results We found that having family or peers with negative views on tobacco use had a positive indirect effect on smoking cessation, mediated through the individual’s intention to quit (regression coefficient: 0.19) and the use of evidence-based approaches during their past year quit attempt (regression coefficient: 0.32). Having rules against smoking in the home (regression coefficient: 0.33) and having non-smoking family members or peers (regression coefficient: 0.11) had a positive indirect effect on smoking cessation, mediated through smoking behaviors (regression coefficient: 0.36). All paths were statistically significant (p < 0.01). The model explained 20% of the variability in smoking outcomes. Conclusion Family or peer-based cessation interventions that systematically increase intentions to quit and monitor smoking behavior may be able to assess the efficacy of family and peer support on quitting in people with mental health problems who smoke. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13979-z.
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Affiliation(s)
- Catherine S Nagawa
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA.
| | - Bo Wang
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Maryann Davis
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
| | - Lori Pbert
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Sarah L Cutrona
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA.,Health Services Research & Development, Center of Innovation Edith Nurse Rogers Memorial Hospital Veterans Health Administration, Bedford, USA
| | - Stephenie C Lemon
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Rajani S Sadasivam
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA.,Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
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19
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Nagawa CS, Pbert L, Wang B, Cutrona SL, Davis M, Lemon SC, Sadasivam RS. Association between family or peer views towards tobacco use and past 30-day smoking cessation among adults with mental health problems. Prev Med Rep 2022; 28:101886. [PMID: 35855923 PMCID: PMC9287352 DOI: 10.1016/j.pmedr.2022.101886] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 05/16/2022] [Accepted: 07/01/2022] [Indexed: 11/17/2022] Open
Abstract
Adults with mental health problems have a higher prevalence of cigarette smoking. Our findings suggest that neutral or positive family or peer views towards tobacco use may deter cessation efforts. Efforts to modify views family or peers are needed to improve quit rates in this population.
Adults with mental health problems have a higher prevalence of cigarette smoking. We examined the association between family or peer views towards tobacco use and past 30-day cessation among adult with mental health conditions who smoke. We used nationally representative data from the Population Assessment of Tobacco and Health Study. We included individuals who currently smoked and reported mental health symptoms over the past year (n = 4201). We used the Global Appraisal of Individual Needs Short Screener questionnaire to assess mental health conditions. Logistic regression models were used to estimate the odds ratios (OR) and 95% confidence intervals (95%CI) in the association between family and peer views towards tobacco use and past 30-day smoking cessation. Compared to participants who had family or peers with negative views towards tobacco use, those with family or peers with neutral or positive views were 32% less likely (adjusted OR: 0.68, 95%CI: 0.51 – 0.93) to report past 30-day smoking cessation. The association between family/peer views towards tobacco use and smoking cessation was statisitcally significant for individuals with symptoms on the both internalizing and externalizing sub-scales (adjusted OR: 0.62, 95%CI: 0.42 – 0.92), but not for those reporting symptoms on a single sub scale. Our findings suggest that having family members or peers who hold neutral or positive views towards tobacco use may deter cessation efforts of people with mental health conditions who smoke. Efforts to modify these views are needed to improve quit rates in people with mental health conditions who smoke.
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Affiliation(s)
- Catherine S. Nagawa
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
- Corresponding author at: University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA 01605, USA.
| | - Lori Pbert
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Bo Wang
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Sarah L. Cutrona
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
| | - Maryann Davis
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
- Center of Innovation, Edith Nurse Rogers Memorial Hospital Veterans Health Administration, USA
| | - Stephenie C. Lemon
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Rajani S. Sadasivam
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
- Center of Innovation, Edith Nurse Rogers Memorial Hospital Veterans Health Administration, USA
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20
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Faro JM, Cutrona SL. Extending a Lifeline to Nonhospitalized Patients With COVID-19 Through Automated Text Messaging. Ann Intern Med 2022; 175:291-292. [PMID: 34781713 PMCID: PMC8593887 DOI: 10.7326/m21-4273] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In their article, Delgado and colleagues reported observed outcomes of an automated, text message–based monitoring program with 24/7 clinical support, implemented to monitor nonhospitalized patients with COVID-19. The editorialists discuss the findings and note factors that contributed to the intervention's success.
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Affiliation(s)
- Jamie M Faro
- University of Massachusetts Medical School, Worcester, Massachusetts
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21
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DeLaughter KL, Fix GM, McDannold SE, Pope C, Bokhour BG, Shimada SL, Calloway R, Gordon HS, Long JA, Miano DA, Cutrona SL. Incorporating African American Veterans' Success Stories for Hypertension Management: Developing a Behavioral Support Texting Protocol. JMIR Res Protoc 2021; 10:e29423. [PMID: 34855617 PMCID: PMC8686408 DOI: 10.2196/29423] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 08/24/2021] [Accepted: 09/13/2021] [Indexed: 11/29/2022] Open
Abstract
Background Peer narratives engage listeners through personally relevant content and have been shown to promote lifestyle change and effective self-management among patients with hypertension. Incorporating key quotations from these stories into follow-up text messages is a novel way to continue the conversation, providing reinforcement of health behaviors in the patients’ daily lives. Objective In our previous work, we developed and tested videos in which African American Veterans shared stories of challenges and success strategies related to hypertension self-management. This study aims to describe our process for developing a text-messaging protocol intended for use after viewing videos that incorporate the voices of these Veterans. Methods We used a multistep process, transforming video-recorded story excerpts from 5 Veterans into 160-character texts. We then integrated these into comprehensive 6-month texting protocols. We began with an iterative review of story transcripts to identify vernacular features and key self-management concepts emphasized by each storyteller. We worked with 2 Veteran consultants who guided our narrative text message development in substantive ways, as we sought to craft culturally sensitive content for texts. Informed by Veteran input on timing and integration, supplementary educational and 2-way interactive assessment text messages were also developed. Results Within the Veterans Affairs texting system Annie, we programmed five 6-month text-messaging protocols that included cycles of 3 text message types: narrative messages, nonnarrative educational messages, and 2-way interactive messages assessing self-efficacy and behavior related to hypertension self-management. Each protocol corresponds to a single Veteran storyteller, allowing Veterans to choose the story that most resonates with their own life experiences. Conclusions We crafted a culturally sensitive text-messaging protocol using narrative content referenced in Veteran stories to support effective hypertension self-management. Integrating narrative content into a mobile health texting intervention provides a low-cost way to support longitudinal behavior change. A randomized trial is underway to test its impact on the lifestyle changes and blood pressure of African American Veterans. Trial Registration ClinicalTrials.gov NCT03970590; https://clinicaltrials.gov/ct2/show/NCT03970590 International Registered Report Identifier (IRRID) DERR1-10.2196/29423
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Affiliation(s)
- Kathryn L DeLaughter
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States
| | - Gemmae M Fix
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States.,Boston University School of Medicine, Boston, MA, United States
| | - Sarah E McDannold
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States
| | - Charlene Pope
- Nursing, Ralph H Johnson VA Medical Center, Charleston, SC, United States.,College of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Barbara G Bokhour
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States.,Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Stephanie L Shimada
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States.,Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States.,Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, United States
| | - Rodney Calloway
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States
| | - Howard S Gordon
- Jesse Brown Veterans Affairs Medical Center and VA Center of Innovation for Complex Chronic Healthcare, Chicago, IL, United States.,Section of Academic Internal Medicine, Department of Medicine, University of Illinois at Chicago, Chicago, IL, United States.,Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, United States
| | - Judith A Long
- Corporal Michael J Crescenz VA Medical Center, VA Center for Health Equity Research and Promotion (CHERP), Philadelphia, PA, United States.,Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Danielle A Miano
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States
| | - Sarah L Cutrona
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States.,Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
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22
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Jackson GL, Damschroder LJ, White BS, Henderson B, Vega RJ, Kilbourne AM, Cutrona SL. Balancing reality in embedded research and evaluation: Low vs high embeddedness. Learn Health Syst 2021; 6:e10294. [PMID: 35434356 PMCID: PMC9006533 DOI: 10.1002/lrh2.10294] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/30/2021] [Accepted: 10/07/2021] [Indexed: 11/09/2022] Open
Abstract
Embedding research and evaluation into organizations is one way to generate “practice‐based” evidence needed to accelerate implementation of evidence‐based innovations within learning health systems. Organizations and researchers/evaluators vary greatly in how they structure and operationalize these collaborations. One key aspect is the degree of embeddedness: from low embeddedness where researchers/evaluators are located outside organizations (eg, outside evaluation consultants) to high embeddedness where researchers/evaluators are employed by organizations and thus more deeply involved in program evolution and operations. Pros and cons related to the degree of embeddedness (low vs high) must be balanced when developing these relationships. We reflect on this process within the context of an embedded, mixed‐methods evaluation of the Veterans Health Administration (VHA) Diffusion of Excellence (DoE) program. Considerations that must be balanced include: (a) low vs high alignment of goals; (b) low vs high involvement in strategic planning; (c) observing what is happening vs being integrally involved with programmatic activities; (d) reporting findings at the project's end vs providing iterative findings and recommendations that contribute to program evolution; and (e) adhering to predetermined aims vs adapting aims in response to evolving partner needs.
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Affiliation(s)
- George L. Jackson
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) Durham VA Health Care System Durham North Carolina USA
- Department of Population Health Sciences Duke University Durham North Carolina USA
- Division of General Internal Medicine, Department of Medicine Duke University Durham North Carolina USA
- Department of Family Medicine and Community Health Duke University Durham North Carolina USA
| | - Laura J. Damschroder
- Center for Clinical Management Research VA Ann Arbor Healthcare System Ann Arbor Michigan USA
| | - Brandolyn S. White
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) Durham VA Health Care System Durham North Carolina USA
| | - Blake Henderson
- Office of Healthcare Innovation and Learning United States Veterans Health Administration Washington District of Columbia USA
| | - Ryan J. Vega
- Office of Healthcare Innovation and Learning United States Veterans Health Administration Washington District of Columbia USA
| | - Amy M. Kilbourne
- Quality Enhancement Research Initiative (QUERI) United States Veterans Health Administration Washington District of Columbia USA
- Department of Learning Health Sciences University of Michigan Ann Arbor Michigan USA
| | - Sarah L. Cutrona
- Center for Healthcare Organization & Implementation Research Bedford & Boston VA Medical Centers Bedford Massachusetts USA
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences University of Massachusetts Medical School Worcester Massachusetts USA
- Division of General Internal Medicine, Department of Medicine University of Massachusetts Medical School Worcester Massachusetts USA
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23
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Martinez RN, Smith BM, Etingen B, Houston TK, Shimada SL, Amante DJ, Patterson A, Richardson LM, Vandenberg G, Cutrona SL, Quintiliani LM, Frisbee KL, Hogan TP. Health-Related Goal Setting and Achievement Among Veterans with High Technology Adoption. J Gen Intern Med 2021; 36:3337-3345. [PMID: 33963510 PMCID: PMC8606471 DOI: 10.1007/s11606-021-06779-5] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 03/30/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is increasing recognition of the importance of supporting patients in their health-related goals. Patient-provider discussions and health-related mobile applications (apps) can support patients to pursue health goals; however, their impact on patient goal setting and achievement is not well understood. OBJECTIVE To examine the relationships between the following: (1) patient demographics, patient-provider discussions, and health-related goal setting and achievement, and (2) patient mobile health app use and goal achievement. DESIGN Cross-sectional survey. PARTICIPANTS Veterans who receive Veterans Health Administration (VA) healthcare and are users of VA patient-facing technology. MAIN MEASURES Veteran demographics, goal-related behaviors, and goal achievement. METHODS Veterans were invited to participate in a telephone survey. VA administrative data were linked to survey data for additional health and demographic information. Logistic regression models were run to identify factors that predict health-related goal setting and achievement. KEY RESULTS Among respondents (n=2552), 75% of patients indicated having set health goals in the preceding 6 months and approximately 42% reported achieving their goal. Men (vs. women) had lower odds of setting goals (OR: 0.71; CI95: 0.53-0.97), as did individuals with worse (vs. better) health (OR: 0.18; CI95: 0.04-0.88). Individuals with advanced education-some college/college degrees, and post-college degrees (vs. no college education)-demonstrated higher odds of setting goals (OR: 1.35; CI95: 1.01-1.79; OR: 1.71; CI95: 1.28-2.28, respectively). Those who reported having discussed their goals with their providers were more likely to set goals (OR: 3.60; CI95: 2.97-4.35). Patient mobile health app use was not statistically associated with goal achievement. CONCLUSIONS Efforts to further promote patient-led goal setting should leverage the influence of patient-provider conversations. Use of patient-facing technologies, specifically mobile health apps, may facilitate goal-oriented care, but further work is needed to examine the potential benefits of apps to support patient goals, particularly if providers discuss and endorse use of those apps with patients.
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Affiliation(s)
- Rachael N Martinez
- eHealth Partnered Evaluation Initiative, VA Bedford Healthcare System, Bedford, MA, USA
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Hines VA Hospital, Hines, IL, USA
| | - Bridget M Smith
- eHealth Partnered Evaluation Initiative, VA Bedford Healthcare System, Bedford, MA, USA
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Hines VA Hospital, Hines, IL, USA
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Bella Etingen
- eHealth Partnered Evaluation Initiative, VA Bedford Healthcare System, Bedford, MA, USA
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Hines VA Hospital, Hines, IL, USA
| | - Thomas K Houston
- eHealth Partnered Evaluation Initiative, VA Bedford Healthcare System, Bedford, MA, USA
- Learning Health Systems, Department of Medicine, Wake Forest University, Winston-Salem, NC, USA
| | - Stephanie L Shimada
- eHealth Partnered Evaluation Initiative, VA Bedford Healthcare System, Bedford, MA, USA
- Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, VA Bedford Healthcare System, Bedford, MA, USA
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, USA
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Daniel J Amante
- eHealth Partnered Evaluation Initiative, VA Bedford Healthcare System, Bedford, MA, USA
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Angela Patterson
- eHealth Partnered Evaluation Initiative, VA Bedford Healthcare System, Bedford, MA, USA
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Lorilei M Richardson
- eHealth Partnered Evaluation Initiative, VA Bedford Healthcare System, Bedford, MA, USA
- Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, VA Bedford Healthcare System, Bedford, MA, USA
| | - Gerrit Vandenberg
- eHealth Partnered Evaluation Initiative, VA Bedford Healthcare System, Bedford, MA, USA
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, USA
| | - Sarah L Cutrona
- eHealth Partnered Evaluation Initiative, VA Bedford Healthcare System, Bedford, MA, USA
- Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, VA Bedford Healthcare System, Bedford, MA, USA
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Lisa M Quintiliani
- eHealth Partnered Evaluation Initiative, VA Bedford Healthcare System, Bedford, MA, USA
- Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Kathleen L Frisbee
- eHealth Partnered Evaluation Initiative, VA Bedford Healthcare System, Bedford, MA, USA
- Office of Connected Care, Veterans Health Administration, U.S. Department of Veterans Affairs, Washington, DC, USA
| | - Timothy P Hogan
- eHealth Partnered Evaluation Initiative, VA Bedford Healthcare System, Bedford, MA, USA.
- Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, VA Bedford Healthcare System, Bedford, MA, USA.
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX, USA.
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24
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Chen J, Wijesundara JG, Patterson A, Cutrona SL, Aiello S, McManus DD, McKee MD, Wang B, Houston TK. Facilitators and barriers to post-discharge pain assessment and triage: a qualitative study of nurses' and patients' perspectives. BMC Health Serv Res 2021; 21:1021. [PMID: 34583702 PMCID: PMC8480104 DOI: 10.1186/s12913-021-07031-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 09/11/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND After hospital discharge, patients can experience symptoms prompting them to seek acute medical attention. Early evaluation of patients' post-discharge symptoms by healthcare providers may improve appropriate healthcare utilization and patient safety. Post-discharge follow-up phone calls, which are used for routine transitional care in U.S. hospitals, serve as an important channel for provider-patient communication about symptoms. This study aimed to assess the facilitators and barriers to evaluating and triaging pain symptoms in cardiovascular patients through follow-up phone calls after their discharge from a large healthcare system in Central Massachusetts. We also discuss strategies that may help address the identified barriers. METHODS Guided by the Practical, Robust, Implementation and Sustainability Model (PRISM), we completed semi-structured interviews with 7 nurses and 16 patients in 2020. Selected nurses conducted (or supervised) post-discharge follow-up calls on behalf of 5 clinical teams (2 primary care; 3 cardiology). We used thematic analysis to identify themes from interviews and mapped them to the domains of the PRISM model. RESULTS Participants described common facilitators and barriers related to the four domains of PRISM: Intervention (I), Recipients (R), Implementation and Sustainability Infrastructure (ISI), and External Environment (EE). Facilitators include: (1) patients being willing to receive provider follow-up (R); (2) nurses experienced in symptom assessment (R); (3) good care coordination within individual clinical teams (R); (4) electronic health record system and call templates to support follow-up calls (ISI); and (5) national and institutional policies to support post-discharge follow-up (EE). Barriers include: (1) limitations of conducting symptom assessment by provider-initiated follow-up calls (I); (2) difficulty connecting patients and providers in a timely manner (R); (3) suboptimal coordination for transitional care among primary care and cardiology providers (R); and (4) lack of emphasis on post-discharge follow-up call reimbursement among cardiology clinics (EE). Specific barriers for pain assessment include: (1) concerns with pain medication misuse (R); and (2) no standardized pain assessment and triage protocol (ISI). CONCLUSIONS Strategies to empower patients, facilitate timely patient-provider communication, and support care coordination regarding pain evaluation and treatment may reduce the barriers and improve processes and outcomes of pain assessment and triage.
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Affiliation(s)
- Jinying Chen
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 368 Plantation Street, Worcester, MA, 01605, USA.
| | - Jessica G Wijesundara
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Angela Patterson
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Sarah L Cutrona
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | | | - David D McManus
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - M Diane McKee
- Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Bo Wang
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Thomas K Houston
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
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25
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Anderson E, Vimalananda VG, Orlander JD, Cutrona SL, Strymish JL, Bokhour BG, Rinne ST. Implications of Electronic Consultations for Clinician Communication and Relationships: A Qualitative Study. Med Care 2021; 59:808-815. [PMID: 34116530 PMCID: PMC8360667 DOI: 10.1097/mlr.0000000000001575] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Strong relationships and effective communication between clinicians support care coordination and contribute to care quality. As a new mechanism of clinician communication, electronic consultations (e-consults) may have downstream effects on care provision and coordination. OBJECTIVE The objective of this study was to understand primary care providers' and specialists' perspectives on how e-consults affect communication and relationships between clinicians. RESEARCH DESIGN Qualitative study using thematic analysis of semistructured interviews. SUBJECTS Six of 8 sites in the VISN 1 (Veterans Integrated Service Network) in New England were chosen, based on variation in organization and received e-consult volume. Seventy-three respondents, including 60 clinicians in primary care and 3 high-volume specialties (cardiology, pulmonology, and neurology) and 13 clinical leaders at the site and VISN level, were recruited. MEASURES Participants' perspectives on the role and impact of e-consults on communication and relationships between clinicians. RESULTS Clinicians identified 3 types of e-consults' social affordances: (1) e-consults were praised for allowing specialist advice to be more grounded in patient data and well-documented, but concerns about potential legal liability and increased transparency of communication to patients and others were also noted; (2) e-consults were perceived as an imperfect modality for iterative communication, especially for complex conversations requiring shared deliberation; (3) e-consults were understood as a factor influencing clinician relationships, but clinicians disagreed on whether e-consults promote or undermine relationship building. CONCLUSIONS Clinicians have diverse concerns about the implications of e-consults for communication and relationships. Our findings may inform efforts to expand and improve the use of e-consults in diverse health care settings.
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Affiliation(s)
- Ekaterina Anderson
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford
- Department of Population and Quantitative Health Sciences, Division of Health Informatics and Implementation Science, University of Massachusetts Medical School, Worcester
| | - Varsha G. Vimalananda
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford
- Section of Endocrinology, Diabetes, and Metabolism, Boston University School of Medicine
| | - Jay D. Orlander
- Medical Service, VA Boston Healthcare System
- Evans Department of Medicine, Boston University School of Medicine
| | - Sarah L. Cutrona
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford
- Department of Population and Quantitative Health Sciences, Division of Health Informatics and Implementation Science, University of Massachusetts Medical School, Worcester
| | - Judith L. Strymish
- Medical Service and Section of Infectious Diseases, VA Boston Healthcare System, Boston
- Harvard Medical School, Cambridge
| | - Barbara G. Bokhour
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford
- Department of Population and Quantitative Health Sciences, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester
| | - Seppo T. Rinne
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford
- Section of Pulmonary, Allergy, Sleep, and Critical Care Medicine, Boston University School of Medicine, Boston, MA
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26
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Anderson E, Rinne ST, Orlander JD, Cutrona SL, Strymish JL, Vimalananda VG. Electronic consultations and economies of scale: a qualitative study of clinician perspectives on scaling up e-consult delivery. J Am Med Inform Assoc 2021; 28:2165-2175. [PMID: 34338797 DOI: 10.1093/jamia/ocab139] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/18/2021] [Accepted: 06/21/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To explore Veterans Health Administration clinicians' perspectives on the idea of redesigning electronic consultation (e-consult) delivery in line with a hub-and-spoke (centralized) model. MATERIALS AND METHODS We conducted a qualitative study in VA New England Healthcare System (VISN 1). Semi-structured phone interviews were conducted with 35 primary care providers and 38 specialty care providers, including 13 clinical leaders, at 6 VISN 1 sites varying in size, specialist availability, and e-consult volume. Interviews included exploration of the hub-and-spoke (centralized) e-consult model as a system redesign option. Qualitative content analysis procedures were applied to identify and describe salient categories. RESULTS Participants saw several potential benefits to scaling up e-consult delivery from a decentralized model to a hub-and-spoke model, including expanded access to specialist expertise and increased timeliness of e-consult responses. Concerns included differences in resource availability and management styles between sites, anticipated disruption to working relationships, lack of incentives for central e-consultants, dedicated staff's burnout and fatigue, technological challenges, and lack of motivation for change. DISCUSSION Based on a case study from one of the largest integrated healthcare systems in the United States, our work identifies novel concerns and offers insights for healthcare organizations contemplating a scale-up of their e-consult systems. CONCLUSIONS Scaling up e-consults in line with the hub-and-spoke model may help pave the way for a centralized and efficient approach to care delivery, but the success of this transformation will depend on healthcare systems' ability to evaluate and address barriers to leveraging economies of scale for e-consults.
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Affiliation(s)
- Ekaterina Anderson
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA.,Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Seppo T Rinne
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA.,Section of Pulmonary, Allergy, Sleep, and Critical Care Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jay D Orlander
- Medical Service, VA Boston Healthcare System, Boston, Massachusetts, USA.,Evans Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Sarah L Cutrona
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA.,Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Judith L Strymish
- Medical Service and Section of Infectious Diseases, VA Boston Healthcare System, Boston, Massachusetts, USA.,Harvard Medical School, Cambridge, Massachusetts, USA
| | - Varsha G Vimalananda
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA.,Section of Endocrinology, Diabetes, and Metabolism, Boston University School of Medicine, Boston, Massachusetts, USA
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27
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Nevedal AL, Reardon CM, Opra Widerquist MA, Jackson GL, Cutrona SL, White BS, Damschroder LJ. Rapid versus traditional qualitative analysis using the Consolidated Framework for Implementation Research (CFIR). Implement Sci 2021; 16:67. [PMID: 34215286 PMCID: PMC8252308 DOI: 10.1186/s13012-021-01111-5] [Citation(s) in RCA: 123] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 04/05/2021] [Indexed: 12/14/2022] Open
Abstract
Background Qualitative approaches, alone or in mixed methods, are prominent within implementation science. However, traditional qualitative approaches are resource intensive, which has led to the development of rapid qualitative approaches. Published rapid approaches are often inductive in nature and rely on transcripts of interviews. We describe a deductive rapid analysis approach using the Consolidated Framework for Implementation Research (CFIR) that uses notes and audio recordings. This paper compares our rapid versus traditional deductive CFIR approach. Methods Semi-structured interviews were conducted for two cohorts of the Veterans Health Administration (VHA) Diffusion of Excellence (DoE). The CFIR guided data collection and analysis. In cohort A, we used our traditional CFIR-based deductive analysis approach (directed content analysis), where two analysts completed independent in-depth manual coding of interview transcripts using qualitative software. In cohort B, we used our new rapid CFIR-based deductive analysis approach (directed content analysis), where the primary analyst wrote detailed notes during interviews and immediately “coded” notes into a MS Excel CFIR construct by facility matrix; a secondary analyst then listened to audio recordings and edited the matrix. We tracked time for our traditional and rapid deductive CFIR approaches using a spreadsheet and captured transcription costs from invoices. We retrospectively compared our approaches in terms of effectiveness and rigor. Results Cohorts A and B were similar in terms of the amount of data collected. However, our rapid deductive CFIR approach required 409.5 analyst hours compared to 683 h during the traditional deductive CFIR approach. The rapid deductive approach eliminated $7250 in transcription costs. The facility-level analysis phase provided the greatest savings: 14 h/facility for the traditional analysis versus 3.92 h/facility for the rapid analysis. Data interpretation required the same number of hours for both approaches. Conclusion Our rapid deductive CFIR approach was less time intensive and eliminated transcription costs, yet effective in meeting evaluation objectives and establishing rigor. Researchers should consider the following when employing our approach: (1) team expertise in the CFIR and qualitative methods, (2) level of detail needed to meet project aims, (3) mode of data to analyze, and (4) advantages and disadvantages of using the CFIR. Supplementary Information The online version contains supplementary material available at 10.1186/s13012-021-01111-5.
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Affiliation(s)
- Andrea L Nevedal
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System (152-MPD), 795 Willow Road, Building 324, Menlo Park, CA, 94025, USA.
| | - Caitlin M Reardon
- Veterans Affairs (VA) Center for Clinical Management Research, Ann Arbor Healthcare System, 2215 Fuller Rd. (152), Ann Arbor, MI, 48105, USA
| | - Marilla A Opra Widerquist
- Veterans Affairs (VA) Center for Clinical Management Research, Ann Arbor Healthcare System, 2215 Fuller Rd. (152), Ann Arbor, MI, 48105, USA
| | - George L Jackson
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, USA.,Department of Population Health Science, Duke University, Durham, USA.,Division of General Internal Medicine, Duke University, Durham, USA.,Department of Family Medicine and Community Health, Duke University, Durham, USA
| | - Sarah L Cutrona
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VA Medical Centers, Boston, USA.,Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, USA.,Division of General Internal Medicine, University of Massachusetts Medical School, Worcester, USA
| | - Brandolyn S White
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, USA
| | - Laura J Damschroder
- Veterans Affairs (VA) Center for Clinical Management Research, Ann Arbor Healthcare System, 2215 Fuller Rd. (152), Ann Arbor, MI, 48105, USA
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28
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Vashi AA, Orvek EA, Tuepker A, Jackson GL, Amrhein A, Cole B, Asch SM, Gifford AL, Lindquist J, Marshall NJ, Newell S, Smigelsky MA, White BS, White LK, Cutrona SL. The Veterans Health Administration (VHA) Innovators Network: Evaluation design, methods and lessons learned through an embedded research approach. Healthc (Amst) 2021; 8 Suppl 1:100477. [PMID: 34175094 DOI: 10.1016/j.hjdsi.2020.100477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 08/14/2020] [Accepted: 09/22/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Collaboration between researchers, implementers and policymakers improves uptake of health systems research. In 2018, researchers and VHA Innovators Network (iNET) leadership used an embedded research model to conduct an evaluation of iNET. We describe our evaluation design, early results, and lessons learned. METHODS This mixed-methods evaluation incorporated primary data collection via electronic survey, descriptive analysis using existing VA datasets (examining associations between facility characteristics and iNET participation), and qualitative interviews to support real-time program implementation and to probe perceived impacts, benefits and challenges of participation. RESULTS We developed reporting tools and collected data regarding site participation, providing iNET leadership rapid access to needed information on projects (e.g., target populations reached, milestones achieved, and barriers encountered). Secondary data analyses indicated iNET membership was greater among larger, more complex VA facilities. Of the 37 iNET member sites, over half (n = 22) did not have any of the six major types of VA research centers; thus iNET is supporting VA sites not traditionally served by research innovation pathways. Qualitative findings highlighted enhanced engagement and perceived value of social and informational networks. CONCLUSIONS Working alongside our iNET partners, we supported and influenced iNET's development through our embedded evaluation's preliminary findings. We also provided training and guidance aimed at building capacity among iNET participants. IMPLICATIONS Embedded research can yield successful collaborative efforts between researchers and partners. An embedded research team can help programs pivot to ensure effective use of limited resources. Such models inform program development and expansion, supporting strategic planning and demonstrating value.
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Affiliation(s)
- Anita A Vashi
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA; Department of Emergency Medicine, University of California, San Francisco, San Francisco, CA, USA; Department of Emergency Medicine (Affiliated), Stanford University, Stanford, CA, USA.
| | - Elizabeth A Orvek
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA; Quantitative Methods Core, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Anaïs Tuepker
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, USA; Department of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland, OR, USA
| | - George L Jackson
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, USA; Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA; Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Allison Amrhein
- Department of Veterans Affairs, Veterans Health Administration Innovators Network, USA
| | - Brynn Cole
- Department of Veterans Affairs, Veterans Health Administration Innovators Network, USA
| | - Steven M Asch
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA; Division of Primary Care and Population Health, Stanford University, Stanford, CA, USA
| | - Allen L Gifford
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA; Boston University, Boston, MA, USA
| | - Jennifer Lindquist
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, USA
| | - Nell J Marshall
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Summer Newell
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, USA
| | - Melissa A Smigelsky
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, USA; Veterans Integrated Service Network (VISN) 6 Mental Illness Research, Education and Clinical Center (MIRECC), Durham VA Health Care System, Durham, NC, USA
| | - Brandolyn S White
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, USA
| | - Lindsay K White
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA
| | - Sarah L Cutrona
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA; Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
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Gurwitz JH, Kapoor A, Garber L, Mazor KM, Wagner J, Cutrona SL, Singh S, Kanaan AO, Donovan JL, Crawford S, Anzuoni K, Konola TJ, Zhou Y, Field TS. Effect of a Multifaceted Clinical Pharmacist Intervention on Medication Safety After Hospitalization in Persons Prescribed High-risk Medications: A Randomized Clinical Trial. JAMA Intern Med 2021; 181:610-618. [PMID: 33646267 PMCID: PMC7922235 DOI: 10.1001/jamainternmed.2020.9285] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [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] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The National Action Plan for Adverse Drug Event (ADE) Prevention identified 3 high-priority, high-risk drug classes as targets for reducing the risk of drug-related injuries: anticoagulants, diabetes agents, and opioids. OBJECTIVE To determine whether a multifaceted clinical pharmacist intervention improves medication safety for patients who are discharged from the hospital and prescribed medications within 1 or more of these high-risk drug classes. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial was conducted at a large multidisciplinary group practice in Massachusetts and included patients 50 years or older who were discharged from the hospital and prescribed at least 1 high-risk medication. Participants were enrolled into the trial from June 2016 through September 2018. INTERVENTIONS The pharmacist-directed intervention included an in-home assessment by a clinical pharmacist, evidence-based educational resources, communication with the primary care team, and telephone follow-up. Participants in the control group were provided educational materials via mail. MAIN OUTCOMES AND MEASURES The study assessed 2 outcomes over a 45-day posthospital discharge period: (1) adverse drug-related incidents and (2) a subset defined as clinically important medication errors, which included preventable or ameliorable ADEs and potential ADEs (ie, medication-related errors that may not yet have caused injury to a patient, but have the potential to cause future harm if not addressed). Clinically important medication errors were the primary study outcome. RESULTS There were 361 participants (mean [SD] age, 68.7 [9.3] years; 177 women [49.0%]; 319 White [88.4%] and 8 Black individuals [2.2%]). Of these, 180 (49.9%) were randomly assigned to the intervention group and 181 (50.1%) to the control group. Among all participants, 100 (27.7%) experienced 1 or more adverse drug-related incidents, and 65 (18%) experienced 1 or more clinically important medication errors. There were 81 adverse drug-related incidents identified in the intervention group and 72 in the control group. There were 44 clinically important medication errors in the intervention group and 45 in the control group. The intervention did not significantly alter the per-patient rate of adverse drug-related incidents (unadjusted incidence rate ratio, 1.13; 95% CI, 0.83-1.56) or clinically important medication errors (unadjusted incidence rate ratio, 0.99; 95% CI, 0.65-1.49). CONCLUSIONS AND RELEVANCE In this randomized clinical trial, there was not an observed lower rate of adverse drug-related incidents or clinically important medication errors during the posthospitalization period that was associated with a clinical pharmacist intervention. However, there were study recruitment challenges and lower than expected numbers of events among the study population. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02781662.
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Affiliation(s)
- Jerry H Gurwitz
- Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester.,Department of Medicine, University of Massachusetts Medical School, Worcester.,Reliant Medical Group, Worcester, Massachusetts
| | - Alok Kapoor
- Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester.,Department of Medicine, University of Massachusetts Medical School, Worcester
| | - Lawrence Garber
- Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester.,Reliant Medical Group, Worcester, Massachusetts
| | - Kathleen M Mazor
- Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester.,Department of Medicine, University of Massachusetts Medical School, Worcester
| | - Joann Wagner
- Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester
| | - Sarah L Cutrona
- Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester.,Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, Massachusetts.,Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | - Sonal Singh
- Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester.,Department of Medicine, University of Massachusetts Medical School, Worcester
| | - Abir O Kanaan
- Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester.,Massachusetts College of Pharmacy and Health Sciences, Worcester
| | - Jennifer L Donovan
- Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester
| | - Sybil Crawford
- Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester.,Department of Medicine, University of Massachusetts Medical School, Worcester
| | - Kathryn Anzuoni
- Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester
| | - Timothy J Konola
- Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester
| | - Yanhua Zhou
- Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester
| | - Terry S Field
- Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester.,Department of Medicine, University of Massachusetts Medical School, Worcester
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Fuller JM, Ho YX, Morse R, Fix G, Cutrona SL, Gaziano T, Connolly SL, Hass R, Jackson J, McInnes DK. A Mobile Health Tool for Peer Support of Individuals Reentering Communities After Incarceration. J Health Care Poor Underserved 2021; 32:148-165. [PMID: 35574220 PMCID: PMC9097827 DOI: 10.1353/hpu.2021.0055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Individuals just released from prison, or returning citizens (RCs), face high mortality rates during the reentry period, with cardiovascular disease (CVD) being a leading cause. Peer mentors can support RCs' health, but they traditionally work in person, which may not always be feasible, particularly during pandemic outbreaks such as COVID-19. We used human-centered design to build a prototype of RCPeer, a web/mobile application (app) to support peer-led reentry efforts through CVD risk screening, action planning, linkage to resources addressing reintegration needs (e.g., housing, transportation), and goal-setting. We assessed feasibility, acceptability, and usability of RCPeer using mixed-methods. System Usability Scale (SUS) scores were 68 for peers and 66 for RCs, indicating good usability. Qualitative data suggests that RCPeer can support reentry tasks through RCs and peers sharing data, strengthen RC-peer relationships, and facilitate RCs meeting their goals. Future work is needed to enhance usability for RCs with limited technology experience.
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Affiliation(s)
| | | | | | - Gemmae Fix
- Center for Health Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA
| | - Sarah L Cutrona
- Center for Health Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA
| | - Thomas Gaziano
- Department of Cardiovascular Medicine, Brigham & Women's Hospital, Boston, MA
| | - Samantha L Connolly
- Center for Health Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Boston, MA
| | | | | | - D Keith McInnes
- Center for Health Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA
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31
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Nagawa CS, Faro JM, Menon AJ, Ito Fukunaga M, Williams JH, Mourao D, Emidio OM, Davis M, Pbert L, Cutrona SL, Houston TK, Sadasivam RS. Written Advice Given by African American Smokers to Their Peers: Qualitative Study of Motivational Messages. JMIR Form Res 2021; 5:e21481. [PMID: 33929332 PMCID: PMC8128361 DOI: 10.2196/21481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 10/16/2020] [Accepted: 04/13/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although African Americans have the lowest rates of smoking onset and progression to daily smoking, they are less likely to achieve long-term cessation. Interventions tailored to promote use of cessation resources in African American individuals who smoke are needed. In our past work, we demonstrated the effectiveness of a technology-assisted peer-written message intervention for increasing smoking cessation in non-Hispanic White smokers. In this formative study, we have adapted this intervention to be specific for African American smokers. OBJECTIVE We aimed to report on the qualitative analysis of messages written by African American current and former smokers for their peers in response to hypothetical scenarios of smokers facing cessation challenges. METHODS We recruited African American adult current and former smokers (n=41) via ResearchMatch between April 2017 and November 2017. We asked participants to write motivational messages for their peers in response to smoking-related hypothetical scenarios. We also collected data on sociodemographic factors and smoking characteristics. Thematic analysis was conducted to identify cessation strategies suggested by the study participants. RESULTS Among the study participants, 60% (25/41) were female. Additionally, more than half (23/41, 56%) were thinking about quitting, 29% (12/41) had set a quit date, and 27% (11/41) had used electronic cigarettes in the past 30 days. Themes derived from the qualitative analysis of peer-written messages were (1) behavioral strategies, (2) seeking help, (3) improvements in quality of life, (4) attitudes and expectations, and (5) mindfulness/religious or spiritual practices. Under the behavioral strategies theme, distraction strategies were the most frequently suggested strategies (referenced 84 times in the 318 messages), followed by use of evidence-based treatments/cessation strategies. Within the seeking help theme, subthemes included seeking help or support from family/friends or close social networks (referenced 56 times) and health care professionals (referenced 22 times). The most frequent subthemes that emerged from improvements in the quality of life theme included improving one's health (referenced 22 times) and quality of life (referenced 21 times). Subthemes that emerged from the attitude and expectations theme included practicing positive self-talk (referenced 27 times), autonomy/independence from the smoking habit (referenced six times), and financial cost of smoking (referenced five times). The two subthemes that emerged from the mindfulness/religious or spiritual practices theme were use of self-awareness techniques (referenced 36 times) and religious or spiritual practices to cope (referenced 13 times). CONCLUSIONS Our approach to adapt a prior peer-message intervention to African American smokers yielded a set of evidence-based messages that may be suitable for smokers at all phases of motivation to quit (ready to quit or not ready to quit). In future research, we plan to assess the impact of texting these messages to African American smokers in a smoking cessation trial.
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Affiliation(s)
- Catherine S Nagawa
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Jamie M Faro
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Anitha J Menon
- Department of Psychology, University of Zambia, Lusaka, Zambia
| | - Mayuko Ito Fukunaga
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States.,Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States.,Meyers Primary Care Institute, Worcester, MA, United States
| | | | - Dalton Mourao
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Oluwabunmi M Emidio
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Maryann Davis
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, United States
| | - Lori Pbert
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Sarah L Cutrona
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States.,Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States
| | - Thomas K Houston
- Section of General Internal Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Rajani S Sadasivam
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
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Faro JM, Mattocks KM, Mourao D, Nagawa CS, Lemon SC, Wang B, Cutrona SL, Sadasivam RS. Experiences and perceptions of referrals to a community-based physical activity program for cancer survivors: a qualitative exploration. BMC Health Serv Res 2021; 21:358. [PMID: 33865384 PMCID: PMC8052851 DOI: 10.1186/s12913-021-06365-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 04/08/2021] [Indexed: 01/15/2023] Open
Abstract
Background Physical activity rates in cancer survivors continue to be low despite the known benefits and availability of evidence-based programs. LIVESTRONG at the Y is a national community-based physical activity program offered cost-free to cancer survivors, though is underutilized. We explored perceptions and experiences of staff and participating survivors to better understand program awareness, referrals and participation. Methods LIVESTRONG at the Y program staff [directors (n = 16), instructors (n = 4)] and survivors (n = 8) from 8 United States YMCAs took part in 30-min semi-structured phone interviews between March–May 2019. Interviews were digitally recorded, transcribed, and evaluated using a thematic analysis approach. Results Program staff themes included: 1) Program awareness should be further developed for both the general public and medical providers; 2) Strong relationships with medical providers increased program referrals; 3) Electronic referral systems between providers and LIVESTRONG would help to streamline the referral process; and 4) Bi-directional communication between program staff and medical providers is key to providing patient progress updates. Survivor themes included: 1) Survivors trust their medical team and the information they provide about physical activity; 2) Providers need to incorporate an action plan and referrals for survivors to be active once treatments are completed; and 3) Personal experiences of those who participated in LIVESTRONG resonate with survivors and increase participation. Conclusions LIVESTRONG staff reported the need for an integrated electronic referral system and bi-directional communication with providers about participant progress. Survivors want physical activity education, electronic referrals and follow-up from their healthcare team, coupled with peer support from other survivors. Cancer care provider knowledge and electronic referrals during and after treatment may expedite and increase participation in this community-based program.
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Affiliation(s)
- Jamie M Faro
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, 368 Plantation Street, Worcester, MA, 0160, USA.
| | - Kristin M Mattocks
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, 368 Plantation Street, Worcester, MA, 0160, USA.,VA Central Western Massachusetts Healthcare System, Leeds, MA, USA
| | - Dalton Mourao
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, 368 Plantation Street, Worcester, MA, 0160, USA
| | - Catherine S Nagawa
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, 368 Plantation Street, Worcester, MA, 0160, USA
| | - Stephenie C Lemon
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, 368 Plantation Street, Worcester, MA, 0160, USA
| | - Bo Wang
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, 368 Plantation Street, Worcester, MA, 0160, USA
| | - Sarah L Cutrona
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, 368 Plantation Street, Worcester, MA, 0160, USA.,Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA
| | - Rajani S Sadasivam
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, 368 Plantation Street, Worcester, MA, 0160, USA
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Faro JM, Mattocks KM, Nagawa CS, Lemon SC, Wang B, Cutrona SL, Sadasivam RS. Physical Activity, Mental Health, and Technology Preferences to Support Cancer Survivors During the COVID-19 Pandemic: Cross-sectional Study. JMIR Cancer 2021; 7:e25317. [PMID: 33471776 PMCID: PMC7860926 DOI: 10.2196/25317] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/31/2020] [Accepted: 01/16/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND COVID-19 has had significant health-related and behavioral impacts worldwide. Cancer survivors (hereafter referred to as "survivors") are particularly prone to behavioral changes and are encouraged to be more vigilant and observe stricter social distancing measures. OBJECTIVE We explored (1) changes in physical activity and sedentary behaviors since the onset of COVID-19, along with changes in mental health status, and (2) alternative strategies to support survivors' physical activity and social health during and after COVID-19, along with the role of digital health in such strategies. METHODS A questionnaire was distributed among survivors participating (currently or previously) in the community-based physical activity program LIVESTRONG at the Young Men's Christian Association (YMCA), from 3 sites outside an urban area in Massachusetts. Questions addressed pre-COVID-19 vs current changes in physical activity and sedentary behavior. Anxiety and depression were assessed using the 2-item Generalized Anxiety Disorder scale (GAD-2) and 2-item Patient Health Questionnaire (PHQ-2), and scores ≥3 indicated a clinical diagnosis of anxiety or depression, respectively. Digital health preferences were assessed through closed-ended questions. Open-ended responses addressing other preferences for physical activity programs and social support were analyzed, coded, and categorized into themes. RESULTS Among 61 participants (mean age 62 [SD 10.4] years; females: 51/61 [83.6%]), 67.2% (n=41) reported decreased physical activity and 67.2% (n=41) reported prolonged sitting times since the onset of COVID-19. Further, 24.6% (n=15) and 26.2% (n=16) met the GAD-2 and PHQ-2 criteria for clinical anxiety and depression, respectively. All participants owned a cellphone; 90% (n=54) owned a smartphone. Preferences for physical activity programs (n=28) included three themes: (1) use of digital or remote platforms (Zoom, other online platforms, and video platforms), (2) specific activities and locations (eg, outdoor activities, walking, gardening, biking, and physical activities at the YMCA and at senior centers), and (3) importance of social support regardless of activity type (eg, time spent with family, friends, peers, or coaches). The survey revealed a mean score of 71.8 (SD 21.4; scale 0-100) for the importance of social support during physical activity programs. Social support preferences (n=15) revealed three themes: (1) support through remote platforms (eg, texting, Zoom, phone calls, emails, and Facebook), (2) tangible in-person support (YMCA and senior centers), and (3) social support with no specific platform (eg, small gatherings and family or friend visits). CONCLUSIONS Physical activity and mental health are critical factors for the quality of life of survivors, and interventions tailored to their activity preferences are necessary. Digital or remote physical activity programs with added social support may help address the ongoing needs of survivors during and after the pandemic.
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Affiliation(s)
- Jamie M Faro
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Kristin M Mattocks
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
- VA Central Western Massachusetts Healthcare System, Northampton, MA, United States
| | - Catherine S Nagawa
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Stephenie C Lemon
- Division of Preventive Behavioral Medicine, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Bo Wang
- Biostatistics and Health Services Research, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Sarah L Cutrona
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States
| | - Rajani S Sadasivam
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
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Vimalananda VG, Orlander JD, Afable MK, Fincke BG, Solch AK, Rinne ST, Kim EJ, Cutrona SL, Thomas DD, Strymish JL, Simon SR. Electronic consultations (E-consults) and their outcomes: a systematic review. J Am Med Inform Assoc 2021; 27:471-479. [PMID: 31621847 DOI: 10.1093/jamia/ocz185] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 08/06/2019] [Accepted: 09/30/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Electronic consultations (e-consults) are clinician-to-clinician communications that may obviate face-to-face specialist visits. E-consult programs have spread within the US and internationally despite limited data on outcomes. We conducted a systematic review of the recent peer-reviewed literature on the effect of e-consults on access, cost, quality, and patient and clinician experience and identified the gaps in existing research on these outcomes. MATERIALS AND METHODS We searched 4 databases for empirical studies published between 1/1/2015 and 2/28/2019 that reported on one or more outcomes of interest. Two investigators reviewed titles and abstracts. One investigator abstracted information from each relevant article, and another confirmed the abstraction. We applied the GRADE criteria for the strength of evidence for each outcome. RESULTS We found only modest empirical evidence for effectiveness of e-consults on important outcomes. Most studies are observational and within a single health care system, and comprehensive assessments are lacking. For those outcomes that have been reported, findings are generally positive, with mixed results for clinician experience. These findings reassure but also raise concern for publication bias. CONCLUSION Despite stakeholder enthusiasm and encouraging results in the literature to date, more rigorous study designs applied across all outcomes are needed. Policy makers need to know what benefits may be expected in what contexts, so they can define appropriate measures of success and determine how to achieve them.
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Affiliation(s)
- Varsha G Vimalananda
- Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, Massachusetts, USA.,Section of Endocrinology, Diabetes, and Metabolism, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jay D Orlander
- Department of General Medicine, VA Boston Healthcare System, Boston, Massachusetts, USA.,Evans Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Melissa K Afable
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Quality, Safety and Value, Partners Healthcare System, Boston, Massachusetts, USA
| | - B Graeme Fincke
- Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, Massachusetts, USA.,Section of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Amanda K Solch
- Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, Massachusetts, USA
| | - Seppo T Rinne
- Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, Massachusetts, USA.,Section of Pulmonary, Allergy, Sleep, and Critical Care Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Eun Ji Kim
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA.,Division of General Internal Medicine, Zucker School of Medicine, Hofstra Northwell, Manhasset, New York, USA
| | - Sarah L Cutrona
- Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, Massachusetts, USA.,Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Dylan D Thomas
- Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, Massachusetts, USA.,Section of Endocrinology, Diabetes, and Metabolism, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Judith L Strymish
- Department of Medicine, Harvard Medical School, Cambridge, Massachusetts, USA.,Department of Medicine and Infectious Diseases, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Steven R Simon
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Cambridge, Massachusetts, USA.,Geriatrics and Extended Care Service, VA Boston Healthcare System, Boston, Massachusetts, USA
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Jackson GL, Cutrona SL, White BS, Reardon CM, Orvek E, Nevedal AL, Lindquist J, Gifford AL, White L, King HA, DeLaughter K, Houston TK, Henderson B, Vega R, Kilbourne AM, Damschroder LJ. Merging Implementation Practice and Science to Scale Up Promising Practices: The Veterans Health Administration (VHA) Diffusion of Excellence (DoE) Program. Jt Comm J Qual Patient Saf 2020; 47:217-227. [PMID: 33549485 DOI: 10.1016/j.jcjq.2020.11.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 11/23/2020] [Accepted: 11/23/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The Veterans Health Administration (VHA) Diffusion of Excellence (DoE) program developed and manages a framework for identification, replication, and diffusion of promising practices throughout the nation's largest integrated health care system. DoE identifies promising practices through a "Shark Tank" competition with winning bidders receiving external implementation facilitation. DoE further supports diffusion of successful practices across the VHA. METHODS This article presents results of a mixed methods implementation evaluation of DoE, focusing on program reach, program participation and decisions to adopt innovative practices, implementation processes, and practice sustainment. Data sources include practice adoption metrics, focus groups with bidders (two focus groups), observations of DoE events (seven events), surveys of stakeholders (five separate surveys), and semistructured interviews of facility directors, practice developers, implementation teams, and facilitators (133 participants). RESULTS In the first four Shark Tank cohorts (2016-2018), 1,676 practices were submitted; 47 were designated Gold Status Practices (practices with facilitated implementation). Motivation for participation varied. Generally, staff led projects targeting problems they felt passionate about, facility directors focused on big-picture quality metrics and getting middle manager support, and frontline staff displayed variable motivation to implement new projects. Approximately half of facilitated implementation efforts were successful; barriers included insufficient infrastructure, staff, and resources. At the facility level, 73.3% of facilities originating or receiving facilitated implementation support have maintained the practice. VHA-wide, 834 decisions to adopt these practices were made. CONCLUSION DoE has resulted in the identification of many candidate practices, promoted adoption of promising practices by facility directors, and supported practice implementation and diffusion across the VHA.
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Dryden EM, Hyde JK, Wormwood JB, Wu J, Calloway R, Cutrona SL, Elwyn G, Fix GM, Orner MB, Shimada SL, Bokhour BG. Assessing Patients' Perceptions of Clinician Communication: Acceptability of Brief Point-of-Care Surveys in Primary Care. J Gen Intern Med 2020; 35:2990-2999. [PMID: 32748346 PMCID: PMC7572926 DOI: 10.1007/s11606-020-06062-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 07/15/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Improving patient-centered (PC) communication is a priority in many healthcare organizations. Most PC communication metrics are distal to the care encounter and lack clear attribution, thereby reducing relevance for leaders and clinicians. OBJECTIVE We assessed the acceptability of measuring PC communication at the point-of-care. DESIGN A brief patient survey was conducted immediately post-primary care appointments at one Veterans Affairs Medical Center. Audit-feedback reports were created for clinicians and discussed in qualitative interviews. PARTICIPANTS A total of 485 patients completed the survey. Thirteen interviews were conducted with clinicians and hospital leaders. MAIN MEASURE(S) Measures included collaboRATE (a 3-item tool measuring PC communication), a question about how well needs were met, and overall visit satisfaction. Data were analyzed using descriptive statistics to characterize the mean and distribution of collaboRATE scores and determine the proportion of patients giving clinicians a "top score" on each item. Associations among responses were examined. Interviews focused on the value of measuring PC communication and were analyzed using a framework approach. KEY RESULTS The proportion of patients giving PC communication "top scores" ranged from 41 to 92% for 16 clinicians who had ≥ 25 completed surveys. Among patients who gave "top scores" for PC communication, the odds of reporting that needs were "completely met" were 10.8 times higher (p < .001) and the odds of reporting being "very satisfied" with their care were 13.3 times higher (p < .001) compared with patients who did not give "top scores." Interviewees found clinician-specific feedback useful; concerns included prioritizing this data when other measures are used to evaluate clinicians' performance. Difficulties improving PC communication given organizational structures were noted. Recommendations for interventions included peer-to-peer education and mentoring by top-scoring clinicians. CONCLUSIONS Assessing provider communication at the point-of-care is acceptable and useful to clinicians. Challenges remain to properly incentivize and support the use of this data for improving PC communication.
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Affiliation(s)
- Eileen M Dryden
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA.
| | - Justeen K Hyde
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA.,Boston University School of Medicine, Boston, MA, USA
| | - Jolie B Wormwood
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA.,Department of Psychology, University of New Hampshire, Durham, NH, USA
| | - Juliet Wu
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA
| | - Rodney Calloway
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA
| | - Sarah L Cutrona
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA.,Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Gemmae M Fix
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA.,Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Michelle B Orner
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA
| | - Stephanie L Shimada
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA.,Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA.,Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Barbara G Bokhour
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA.,Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
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Wijesundara JG, Ito Fukunaga M, Ogarek J, Barton B, Fisher L, Preusse P, Sundaresan D, Garber L, Mazor KM, Cutrona SL. Electronic Health Record Portal Messages and Interactive Voice Response Calls to Improve Rates of Early Season Influenza Vaccination: Randomized Controlled Trial. J Med Internet Res 2020; 22:e16373. [PMID: 32975529 PMCID: PMC7547389 DOI: 10.2196/16373] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 06/24/2020] [Accepted: 08/03/2020] [Indexed: 01/30/2023] Open
Abstract
Background Patient reminders for influenza vaccination, delivered via an electronic health record patient portal and interactive voice response calls, offer an innovative approach to engaging patients and improving patient care. Objective The goal of this study was to test the effectiveness of portal and interactive voice response outreach in improving rates of influenza vaccination by targeting patients in early September, shortly after vaccinations became available. Methods Using electronic health record portal messages and interactive voice response calls promoting influenza vaccination, outreach was conducted in September 2015. Participants included adult patients within a large multispecialty group practice in central Massachusetts. Our main outcome was electronic health record–documented early influenza vaccination during the 2015-2016 influenza season, measured in November 2015. We randomly assigned all active portal users to 1 of 2 groups: (1) receiving a portal message promoting influenza vaccinations, listing upcoming clinics, and offering online scheduling of vaccination appointments (n=19,506) or (2) receiving usual care (n=19,505). We randomly assigned all portal nonusers to 1 of 2 groups: (1) receiving interactive voice response call (n=15,000) or (2) receiving usual care (n=43,596). The intervention also solicited patient self-reports on influenza vaccinations completed outside the clinic. Self-reported influenza vaccination data were uploaded into the electronic health records to increase the accuracy of existing provider-directed electronic health record clinical decision support (vaccination alerts) but were excluded from main analyses. Results Among portal users, 28.4% (5549/19,506) of those randomized to receive messages and 27.1% (5294/19,505) of the usual care group had influenza vaccinations documented by November 2015 (P=.004). In multivariate analysis of portal users, message recipients were slightly more likely to have documented vaccinations when compared to the usual care group (OR 1.07, 95% CI 1.02-1.12). Among portal nonusers, 8.4% (1262/15,000) of those randomized to receive calls and 8.2% (3586/43,596) of usual care had documented vaccinations (P=.47), and multivariate analysis showed nonsignificant differences. Over half of portal messages sent were opened (10,112/19,479; 51.9%), and over half of interactive voice response calls placed (7599/14,984; 50.7%) reached their intended target, thus we attained similar levels of exposure to the messaging for both interventions. Among portal message recipients, 25.4% of message openers (2570/10,112) responded to a subsequent question on receipt of influenza vaccination; among interactive voice response recipients, 72.5% of those reached (5513/7599) responded to a similar question. Conclusions Portal message outreach to a general primary care population achieved a small but statistically significant improvement in rates of influenza vaccination (OR 1.07, 95% CI 1.02-1.12). Interactive voice response calls did not significantly improve vaccination rates among portal nonusers (OR 1.03, 95% CI 0.96-1.10). Rates of patient engagement with both modalities were favorable. Trial Registration ClinicalTrials.gov NCT02266277; https://clinicaltrials.gov/ct2/show/NCT02266277
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Affiliation(s)
- Jessica G Wijesundara
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Mayuko Ito Fukunaga
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States.,Meyers Primary Care Institute, Worcester, MA, United States.,Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Jessica Ogarek
- Center for Gerontology and Healthcare Research, Brown University, Providence, MA, United States
| | - Bruce Barton
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Lloyd Fisher
- Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, United States.,Reliant Medical Group, Worcester, MA, United States
| | | | | | - Lawrence Garber
- Meyers Primary Care Institute, Worcester, MA, United States.,Reliant Medical Group, Worcester, MA, United States
| | - Kathleen M Mazor
- Meyers Primary Care Institute, Worcester, MA, United States.,Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Sarah L Cutrona
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States.,Health Services Research & Development, Center of Innovation, Edith Nourse Rogers Memorial Hospital, Veterans Health Administration, Bedford, MA, United States
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Peng C, He M, Cutrona SL, Kiefe CI, Liu F, Wang Z. Theme Trends and Knowledge Structure on Mobile Health Apps: Bibliometric Analysis. JMIR Mhealth Uhealth 2020; 8:e18212. [PMID: 32716312 PMCID: PMC7418015 DOI: 10.2196/18212] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/20/2020] [Accepted: 04/26/2020] [Indexed: 12/15/2022] Open
Abstract
Background Due to the widespread and unprecedented popularity of mobile phones, the use of digital medicine and mobile health apps has seen significant growth. Mobile health apps have tremendous potential for monitoring and treating diseases, improving patient care, and promoting health. Objective This paper aims to explore research trends, coauthorship networks, and the research hot spots of mobile health app research. Methods Publications related to mobile health apps were retrieved and extracted from the Web of Science database with no language restrictions. Bibliographic Item Co-Occurrence Matrix Builder was employed to extract bibliographic information (publication year and journal source) and perform a descriptive analysis. We then used the VOSviewer (Leiden University) tool to construct and visualize the co-occurrence networks of researchers, research institutions, countries/regions, citations, and keywords. Results We retrieved 2802 research papers on mobile health apps published from 2000 to 2019. The number of annual publications increased over the past 19 years. JMIR mHealth and uHealth (323/2802, 11.53%), Journal of Medical Internet Research (106/2802, 3.78%), and JMIR Research Protocols (82/2802, 2.93%) were the most common journals for these publications. The United States (1186/2802, 42.33%), England (235/2802, 8.39%), Australia (215/2802, 7.67%), and Canada (112/2802, 4.00%) were the most productive countries of origin. The University of California San Francisco, the University of Washington, and the University of Toronto were the most productive institutions. As for the authors’ contributions, Schnall R, Kuhn E, Lopez-Coronado M, and Kim J were the most active researchers. The co-occurrence cluster analysis of the top 100 keywords forms 5 clusters: (1) the technology and system development of mobile health apps; (2) mobile health apps for mental health; (3) mobile health apps in telemedicine, chronic disease, and medication adherence management; (4) mobile health apps in health behavior and health promotion; and (5) mobile health apps in disease prevention via the internet. Conclusions We summarize the recent advances in mobile health app research and shed light on their research frontier, trends, and hot topics through bibliometric analysis and network visualization. These findings may provide valuable guidance on future research directions and perspectives in this rapidly developing field.
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Affiliation(s)
- Cheng Peng
- Department of Ophthalmology, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Miao He
- Department of Information Center, The First Hospital of China Medical University, Shenyang, China
| | - Sarah L Cutrona
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States.,Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States
| | - Catarina I Kiefe
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Feifan Liu
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Zhongqing Wang
- Department of Information Center, The First Hospital of China Medical University, Shenyang, China.,Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
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Nagawa CS, Emidio OM, Lapane KL, Houston TK, Barton BA, Faro JM, Blok AC, Orvek EA, Cutrona SL, Smith BM, Allison JJ, Sadasivam RS. Teamwork for smoking cessation: which smoker was willing to engage their partner? Results from a cross-sectional study. BMC Res Notes 2020; 13:344. [PMID: 32690076 PMCID: PMC7372767 DOI: 10.1186/s13104-020-05183-2] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 07/14/2020] [Indexed: 12/05/2022] Open
Abstract
Objective Smokers are greatly influenced by those living with them, but strategies that increase partner support for smoking cessation are lacking. Using a cross-sectional study design, we explored factors associated with willingness to engage a partner in smoking cessation in smokers registered on a web-assisted tobacco intervention trial. Results Study participants (n = 983) were recruited between July 2018 and March 2019. About 28% of smokers were willing to engage their partner in cessation efforts. The odds of willingness to engage a partner were more than two-fold for smokers reporting presence of other smokers in the immediate family (adjusted odds ratio (aOR): 2.18; 95% confidence interval (CI) 1.51–3.15 for 1–3 smokers; aOR, 3.12; 95% CI 1.95–4.98 for ≥ 4 smokers) compared to those with no smokers in the immediate family. Women had lower odds of willingness to engage (aOR; 0.82; 95% CI 0.58–1.16) than men, but this was not statistically significant. Use of e-cigarettes and visitation to a smoking cessation website prior to the intervention were both positively associated with willingness to engage partners in cessation. Future research should assess whether interventions tailored to smokers willing to engage partners or spouses could increase effectiveness of partner support during cessation.
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Affiliation(s)
- Catherine S Nagawa
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA.
| | - Oluwabunmi M Emidio
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Kate L Lapane
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Thomas K Houston
- Learning Health Systems, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Bruce A Barton
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Jamie M Faro
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Amanda C Blok
- Veterans Affairs Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, United States Department of Veterans Affairs, Ann Arbor, MI, USA.,Systems, Populations and Leadership Department, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Elizabeth A Orvek
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Sarah L Cutrona
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA.,Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, MA, USA
| | - Bridget M Smith
- Center of Innovation for Complex Chronic Healthcare, Spinal Cord Injury Quality Enhancement Research Initiative, Hines VA Medical Center, Chicago, IL, USA.,Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Evanston, IL, USA
| | - Jeroan J Allison
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Rajani S Sadasivam
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
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Nevedal AL, Reardon CM, Jackson GL, Cutrona SL, White B, Gifford AL, Orvek E, DeLaughter K, White L, King HA, Henderson B, Vega R, Damschroder L. Implementation and sustainment of diverse practices in a large integrated health system: a mixed methods study. Implement Sci Commun 2020; 1:61. [PMID: 32885216 PMCID: PMC7427879 DOI: 10.1186/s43058-020-00053-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 06/18/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND One goal of health systems seeking to evolve into learning health systems is to accelerate the implementation and sustainment of evidence-based practices (EBPs). As part of this evolution, the Veterans Health Administration (VHA) developed the Innovation Ecosystem, which includes the Diffusion of Excellence (DoE), a program that identifies and diffuses Gold Status Practices (GSPs) across facilities. The DoE hosts an annual "Shark Tank" competition in which leaders bid on the opportunity to implement a GSP with 6 months of implementation support. Over 750 diverse practices were submitted in cohorts 2 and 3 of Shark Tank; 23 were designated GSPs and were implemented in 31 VA networks or facilities. As part of a national evaluation of the DoE, we identified factors contributing to GSP implementation and sustainment. METHODS Our sequential mixed methods evaluation of cohorts 2 and 3 of Shark Tank included semi-structured interviews with at least one representative from 30/31 implementing teams (N = 78/105 people invited) and survey responses from 29/31 teams (N = 39/47 invited). Interviews focused on factors influencing implementation and future sustainment. Surveys focused on sustainment 1.5-2 years after implementation. The Consolidated Framework for Implementation Research (CFIR) informed data collection and directed content analysis. Ordinal scales were developed inductively to rank implementation and sustainment outcomes. RESULTS Over 50% of teams (17/30) successfully implemented their GSP within the 6-month implementation period. Despite extensive implementation support, significant barriers related to centralized decision-making, staffing, and resources led to partial (n = 6) or no (n = 7) implementation for the remaining teams. While 12/17 initially successful implementation teams reported sustained use of their GSP, over half of the initially unsuccessful teams (n = 7/13) also reported sustained GSP use 1.5 years after the initial implementation period. When asked at 6 months, 18/27 teams with complete data accurately anticipated their future sustainability based on reported sustainment an average of 1.5 years later. CONCLUSIONS Most teams implemented within 6 months and/or sustained their GSP 1.5 years later. High levels of implementation and sustainment across diverse practices and teams suggest that VHA's DoE is a successful large-scale model of diffusion. Team predictions about sustainability after the first 6 months of implementation provide a promising early assessment and point of intervention to increase sustainability.
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Affiliation(s)
- Andrea L. Nevedal
- Center for Innovation to Implementation, VHA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA 94025 USA
| | - Caitlin M. Reardon
- Center for Clinical Management Research, VHA Ann Arbor Healthcare System, 2215 Fuller Rd., 152, Ann Arbor, MI 48105 USA
| | - George L. Jackson
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VHA Health Care System, HSR&D (152) Suite 600, 411 West Chapel Hill Street, Durham, NC 27701 USA
- Department of Population Health Sciences and Division of General Internal Medicine, Duke University School of Medicine, 215 Morris Street, Durham, NC 27701 USA
| | - Sarah L. Cutrona
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VHA Medical Centers, 200 Springs Road (152), Building 70, Bedford, MA 01730 USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, The Albert Sherman Center, Worcester, MA 01605 USA
| | - Brandolyn White
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VHA Health Care System, HSR&D (152) Suite 600, 411 West Chapel Hill Street, Durham, NC 27701 USA
| | - Allen L. Gifford
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VHA Medical Centers, 200 Springs Road (152), Building 70, Bedford, MA 01730 USA
- Section of General Internal Medicine & Department of Health Law, Policy & Management, Boston University, 715 Albany St., Talbot Building, T2W, Boston, MA 02118 USA
| | - Elizabeth Orvek
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VHA Medical Centers, 200 Springs Road (152), Building 70, Bedford, MA 01730 USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, The Albert Sherman Center, Worcester, MA 01605 USA
| | - Kathryn DeLaughter
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VHA Medical Centers, 200 Springs Road (152), Building 70, Bedford, MA 01730 USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, The Albert Sherman Center, Worcester, MA 01605 USA
| | - Lindsay White
- Center for Healthcare Organization & Implementation Research, Bedford & Boston VHA Medical Centers, 200 Springs Road (152), Building 70, Bedford, MA 01730 USA
| | - Heather A. King
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VHA Health Care System, HSR&D (152) Suite 600, 411 West Chapel Hill Street, Durham, NC 27701 USA
- Department of Population Health Sciences and Division of General Internal Medicine, Duke University School of Medicine, 215 Morris Street, Durham, NC 27701 USA
| | - Blake Henderson
- Diffusion of Excellence, VHA Innovation Ecosystem, 810 Vermont Avenue NW, Washington, DC, 20420 USA
| | - Ryan Vega
- VHA Office of Discovery, Education and Affiliate Networks, 810 Vermont Avenue NW, Washington, DC, 20420 USA
| | - Laura Damschroder
- Center for Clinical Management Research, VHA Ann Arbor Healthcare System, 2215 Fuller Rd., 152, Ann Arbor, MI 48105 USA
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Sadasivam RS, Kamberi A, DeLaughter K, Phillips B, Williams JH, Cutrona SL, Ray MN, Gilbert GH, Houston TK. Secure Asynchronous Communication Between Smokers and Tobacco Treatment Specialists: Secondary Analysis of a Web-Assisted Tobacco Intervention in the QUIT-PRIMO and National Dental PBRN Networks. J Med Internet Res 2020; 22:e13289. [PMID: 32374266 PMCID: PMC7240437 DOI: 10.2196/13289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 05/24/2019] [Accepted: 01/28/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Within a web-assisted tobacco intervention, we provided a function for smokers to asynchronously communicate with a trained tobacco treatment specialist (TTS). Previous studies have not attempted to isolate the effect of asynchronous counseling on smoking cessation. OBJECTIVE This study aimed to conduct a semiquantitative analysis of TTS-smoker communication and evaluate its association with smoking cessation. METHODS We conducted a secondary analysis of data on secure asynchronous communication between trained TTSs and a cohort of smokers during a 6-month period. Smokers were able to select their preferred TTS and message them using a secure web-based form. To evaluate whether the TTS used evidence-based practices, we coded messages using the Motivational Interviewing Self-Evaluation Checklist and Smoking Cessation Counseling (SCC) Scale. We assessed the content of messages initiated by the smokers by creating topical content codes. At 6 months, we assessed the association between smoking cessation and the amount of TTS use and created a multivariable model adjusting for demographic characteristics and smoking characteristics at baseline. RESULTS Of the 725 smokers offered asynchronous counseling support, 33.8% (245/725) messaged the TTS at least once. A total of 1082 messages (TTSs: 565; smokers 517) were exchanged between the smokers and TTSs. The majority of motivational interviewing codes were those that supported client strengths (280/517, 54.1%) and promoted engagement (280/517, 54.1%). SCC code analysis showed that the TTS provided assistance to smokers if they were willing to quit (247/517, 47.8%) and helped smokers prepare to quit (206/517, 39.8%) and anticipate barriers (197/517, 38.1%). The majority of smokers' messages discussed motivations to quit (234/565, 41.4%) and current and past treatments (talking about their previous use of nicotine replacement therapy and medications; 201/565, 35.6%). The majority of TTS messages used behavioral strategies (233/517, 45.1%), offered advice on treatments (189/517, 36.5%), and highlighted motivations to quit (171/517, 33.1%). There was no association between the amount of TTS use and cessation. In the multivariable model, after adjusting for gender, age, race, education, readiness at baseline, number of cigarettes smoked per day at baseline, and the selected TTS, smokers messaging the TTS one or two times had a smoking cessation odds ratio (OR) of 0.8 (95% CI 0.4-1.4), and those that messaged the TTS more than two times had a smoking cessation OR of 1.0 (95% CI 0.4-2.3). CONCLUSIONS Our study demonstrated the feasibility of using asynchronous counseling to deliver evidence-based counseling. Low participant engagement or a lack of power could be potential explanations for the nonassociation with smoking cessation. Future trials should explore approaches to increase participant engagement and test asynchronous counseling in combination with other approaches for improving the rates of smoking cessation.
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Affiliation(s)
| | - Ariana Kamberi
- University of Massachusetts Medical School, Worcester, MA, United States
| | - Kathryn DeLaughter
- Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States
| | - Barrett Phillips
- Veterans Affairs Central Western Massachusetts Healthcare System, Leeds, MA, United States
| | | | - Sarah L Cutrona
- University of Massachusetts Medical School, Worcester, MA, United States
| | - Midge N Ray
- University of Alabama at Birmingham, Birmingham, AL, United States
| | - Gregg H Gilbert
- University of Alabama at Birmingham, Birmingham, AL, United States
| | - Thomas K Houston
- University of Massachusetts Medical School, Worcester, MA, United States
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Vega R, Jackson GL, Henderson B, Clancy C, McPhail J, Cutrona SL, Damschroder LJ, Bhatnagar S. Diffusion of Excellence: Accelerating the Spread of Clinical Innovation and Best Practices across the Nation's Largest Health System. Perm J 2019; 23:18.309. [PMID: 31634112 DOI: 10.7812/tpp/18.309] [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] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The time it takes for clinical innovation and evidence-based practices to reach patients remains a major challenge for the health care sector. In 2015, the Veterans Health Administration (VHA) launched the Diffusion of Excellence Initiative aimed at aligning organizational resources with early-stage to midstage promising practices and innovations to replicate, scale, and eventually spread those with greatest potential for impact and positive outcomes. Using a 5-step systematic approach refined over time, frontline VHA staff have submitted more than 1676 practices since the initiative's inception, 47 of which have been selected as high-impact, Gold Status practices. These Gold Status practices have been replicated more than 412 times in Veterans Affairs hospitals across the country, improving care for more than 100,000 veterans and approximately $22.6 million in cost avoidance for the VHA. More importantly, practices such as Project HAPPEN (Hospital-Acquired Pneumonia Prevention by Engaging Nurses to complete oral care) and rapid availability of intranasal naloxone have saved veterans' lives. Several practices are now being implemented across the country, and the Diffusion of Excellence Initiative is playing a pivotal role as the VHA works to modernize its health care system. This initiative serves as a promising model for other health care systems seeking to accelerate the spread and adoption of clinical innovation and evidence-based practices.
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Affiliation(s)
- Ryan Vega
- Office of Discovery, Education, and Affiliate Networks, Veterans Health Administration, Richmond, VA
| | - George L Jackson
- Durham Veterans Administration Medical Center, Veterans Health Administration, NC
| | - Blake Henderson
- Office of Discovery, Education, and Affiliate Networks, Veterans Health Administration, Washington, DC
| | - Carolyn Clancy
- Office of Discovery, Education, and Affiliate Networks, Veterans Health Administration, Washington, DC
| | - Jennifer McPhail
- Diffusion of Excellence Team, Atlas Research, LLC, Washington, DC
| | - Sarah L Cutrona
- Edith Nourse Rogers Memorial Veterans Hospital, Veterans Health Administration, Bedford, MA
| | - Laura J Damschroder
- Ann Arbor Veterans Administration Medical Center, Veterans Health Administration, MI
| | - Saurabha Bhatnagar
- Office of Quality, Safety, and Value, Veterans Health Administration, Washington, DC
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Amroze A, Field TS, Fouayzi H, Sundaresan D, Burns L, Garber L, Sadasivam RS, Mazor KM, Gurwitz JH, Cutrona SL. Use of Electronic Health Record Access and Audit Logs to Identify Physician Actions Following Noninterruptive Alert Opening: Descriptive Study. JMIR Med Inform 2019; 7:e12650. [PMID: 30730293 PMCID: PMC6383113 DOI: 10.2196/12650] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/14/2019] [Accepted: 01/20/2019] [Indexed: 01/22/2023] Open
Abstract
Background Electronic health record (EHR) access and audit logs record behaviors of providers as they navigate the EHR. These data can be used to better understand provider responses to EHR–based clinical decision support (CDS), shedding light on whether and why CDS is effective. Objective This study aimed to determine the feasibility of using EHR access and audit logs to track primary care physicians’ (PCPs’) opening of and response to noninterruptive alerts delivered to EHR InBaskets. Methods We conducted a descriptive study to assess the use of EHR log data to track provider behavior. We analyzed data recorded following opening of 799 noninterruptive alerts sent to 75 PCPs’ InBaskets through a prior randomized controlled trial. Three types of alerts highlighted new medication concerns for older patients’ posthospital discharge: information only (n=593), medication recommendations (n=37), and test recommendations (n=169). We sought log data to identify the person opening the alert and the timing and type of PCPs’ follow-up EHR actions (immediate vs by the end of the following day). We performed multivariate analyses examining associations between alert type, patient characteristics, provider characteristics, and contextual factors and likelihood of immediate or subsequent PCP action (general, medication-specific, or laboratory-specific actions). We describe challenges and strategies for log data use. Results We successfully identified the required data in EHR access and audit logs. More than three-quarters of alerts (78.5%, 627/799) were opened by the PCP to whom they were directed, allowing us to assess immediate PCP action; of these, 208 alerts were followed by immediate action. Expanding on our analyses to include alerts opened by staff or covering physicians, we found that an additional 330 of the 799 alerts demonstrated PCP action by the end of the following day. The remaining 261 alerts showed no PCP action. Compared to information-only alerts, the odds ratio (OR) of immediate action was 4.03 (95% CI 1.67-9.72) for medication-recommendation and 2.14 (95% CI 1.38-3.32) for test-recommendation alerts. Compared to information-only alerts, ORs of medication-specific action by end of the following day were significantly greater for medication recommendations (5.59; 95% CI 2.42-12.94) and test recommendations (1.71; 95% CI 1.09-2.68). We found a similar pattern for OR of laboratory-specific action. We encountered 2 main challenges: (1) Capturing a historical snapshot of EHR status (number of InBasket messages at time of alert delivery) required incorporation of data generated many months prior with longitudinal follow-up. (2) Accurately interpreting data elements required iterative work by a physician/data manager team taking action within the EHR and then examining audit logs to identify corresponding documentation. Conclusions EHR log data could inform future efforts and provide valuable information during development and refinement of CDS interventions. To address challenges, use of these data should be planned before implementing an EHR–based study.
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Affiliation(s)
- Azraa Amroze
- Meyers Primary Care Institute, Worcester, MA, United States
| | - Terry S Field
- Meyers Primary Care Institute, Worcester, MA, United States.,University of Massachusetts Medical School, Worcester, MA, United States
| | - Hassan Fouayzi
- Meyers Primary Care Institute, Worcester, MA, United States.,University of Massachusetts Medical School, Worcester, MA, United States
| | - Devi Sundaresan
- Meyers Primary Care Institute, Worcester, MA, United States.,Reliant Medical Group, Worcester, MA, United States
| | - Laura Burns
- University of Massachusetts Memorial Health Care, Worcester, MA, United States
| | - Lawrence Garber
- Meyers Primary Care Institute, Worcester, MA, United States.,Reliant Medical Group, Worcester, MA, United States
| | - Rajani S Sadasivam
- University of Massachusetts Medical School, Worcester, MA, United States
| | - Kathleen M Mazor
- Meyers Primary Care Institute, Worcester, MA, United States.,University of Massachusetts Medical School, Worcester, MA, United States
| | - Jerry H Gurwitz
- Meyers Primary Care Institute, Worcester, MA, United States.,University of Massachusetts Medical School, Worcester, MA, United States.,Reliant Medical Group, Worcester, MA, United States
| | - Sarah L Cutrona
- Meyers Primary Care Institute, Worcester, MA, United States.,University of Massachusetts Medical School, Worcester, MA, United States.,Edith Nourse Rogers Memorial Veterans Hospital, Veterans Health Administration, Bedford, MA, United States
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Affiliation(s)
- Barbara G Bokhour
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Veterans Affairs Medical Center, Bedford, MA, USA. .,Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA.
| | - Sarah L Cutrona
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Veterans Affairs Medical Center, Bedford, MA, USA.,Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
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Kim EJ, Orlander JD, Afable M, Pawar S, Cutrona SL, Simon SR, Strymish J, Vimalananda VG. Cardiology electronic consultation (e-consult) use by primary care providers at VA medical centres in New England. J Telemed Telecare 2018; 25:370-377. [PMID: 29754562 DOI: 10.1177/1357633x18774468] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION E-consultations (e-consults) were implemented at VA medical centers to improve access to specialty care. Cardiology e-consults are among the most commonly requested, but little is known about how primary care providers (PCPs) use cardiology e-consults to access specialty care. METHODS This is a retrospective analysis of 750 patients' medical charts with cardiology e-consults requested by medical providers (October 2013-September 2015) in the VA New England Healthcare System. We described the patients and referring provider characteristics, and e-consult questions. We reviewed cardiologists' responses and examined their recommendations. RESULTS Among the 424 e-consults requested from PCPs, 92.7% were used to request answers to clinical questions, while 7.3% were used for administrative purposes. Among the 393 e-consults with clinical questions, 60 e-consults were regarding preoperative management; these questions most commonly addressed general risk assessment (n = 44), anti-coagulation/anti-platelet management (n = 33), and EKG interpretation (n = 20). Cardiologists provided answers for the majority (89.6%) of clinical questions. Among the e-consults in which cardiologists did not provide answers or clinical guidance (n = 41), the reasons included missing or insufficient clinical information (n = 18), medical complexity (n = 6), and deferment to the patient's non-VA primary cardiologist (n = 7). Cardiologists recommended that the patients be seen as face-to-face consults for 7.9% of e-consults. DISCUSSION Primary care providers are the most frequent requesters of cardiology e-consults, using them primarily to obtain input on clinical questions. Cardiologists did not provide answers for one in ten, owing principally to insufficient available clinical information. Educating PCPs and standardizing the template for requesting e-consultation may help to reduce the number of unanswered e-consults.
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Affiliation(s)
- Eun Ji Kim
- 1 Division of General Internal Medicine, Zucker School of Medicine at Hofstra/Northwell, USA
| | - Jay D Orlander
- 2 Medical Service, VA Boston Healthcare System, USA.,3 Evans Department of Medicine, Boston University School of Medicine, USA
| | - Melissa Afable
- 4 Center for Healthcare Organization and Implementation Research, Partners Healthcare, USA
| | - Sumeet Pawar
- 5 Department of Cardiology, Yale School of Medicine, USA
| | - Sarah L Cutrona
- 6 Center for Healthcare Organization and Implementation Research (CHOIR), Bedford VA Medical Center, USA.,7 Department of Quantitative Health Science, University of Massachusetts Medical School, USA
| | - Steven R Simon
- 8 Geriatrics and Extended Care Service, VA Boston Healthcare System, Boston, MA, USA.,9 Harvard Medical School, USA
| | - Judith Strymish
- 2 Medical Service, VA Boston Healthcare System, USA.,9 Harvard Medical School, USA
| | - Varsha G Vimalananda
- 3 Evans Department of Medicine, Boston University School of Medicine, USA.,6 Center for Healthcare Organization and Implementation Research (CHOIR), Bedford VA Medical Center, USA
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Sadasivam RS, Cutrona SL, Luger TM, Volz E, Kinney R, Rao SR, Allison JJ, Houston TK. Share2Quit: Online Social Network Peer Marketing of Tobacco Cessation Systems. Nicotine Tob Res 2017; 19:314-323. [PMID: 27613918 DOI: 10.1093/ntr/ntw187] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 07/18/2016] [Indexed: 11/13/2022]
Abstract
Introduction Although technology-assisted tobacco interventions (TATIs) are effective, they are underused due to recruitment challenges. We tested whether we could successfully recruit smokers to a TATI using peer marketing through a social network (Facebook). Methods We recruited smokers on Facebook using online advertisements. These recruited smokers (seeds) and subsequent waves of smokers (peer recruits) were provided the Share2Quit peer recruitment Facebook app and other tools. Smokers were incentivized for up to seven successful peer recruitments and had 30 days to recruit from date of registration. Successful peer recruitment was defined as a peer recruited smoker completing the registration on the TATI following a referral. Our primary questions were (1) whether smokers would recruit other smokers and (2) whether peer recruitment would extend the reach of the intervention to harder-to-reach groups, including those not ready to quit and minority smokers. Results Overall, 759 smokers were recruited (seeds: 190; peer recruits: 569). Fifteen percent (n = 117) of smokers successfully recruited their peers (seeds: 24.7%; peer recruits: 7.7%) leading to four recruitment waves. Compared to seeds, peer recruits were less likely to be ready to quit (peer recruits 74.2% vs. seeds 95.1%), more likely to be male (67.1% vs. 32.9%), and more likely to be African American (23.8% vs. 10.8%) (p < .01 for all comparisons). Conclusions Peer marketing quadrupled our engaged smokers and enriched the sample with not-ready-to-quit and African American smokers. Peer recruitment is promising, and our study uncovered several important challenges for future research. Implications This study demonstrates the successful recruitment of smokers to a TATI using a Facebook-based peer marketing strategy. Smokers on Facebook were willing and able to recruit other smokers to a TATI, yielding a large and diverse population of smokers.
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Affiliation(s)
- Rajani S Sadasivam
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Sarah L Cutrona
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA.,Meyers Primary Care Institute, Worcester, MA
| | - Tana M Luger
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA.,Center for Healthcare Organization and Implementation Research, Department of Veterans Affairs, Bedford, MA
| | | | - Rebecca Kinney
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Sowmya R Rao
- Department of Surgery, Boston University, Boston, MA
| | - Jeroan J Allison
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Thomas K Houston
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA.,Center for Healthcare Organization and Implementation Research, Department of Veterans Affairs, Bedford, MA
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Torres Stone RA, Waring ME, Cutrona SL, Kiefe CI, Allison J, Doubeni CA. The association of dietary quality with colorectal cancer among normal weight, overweight and obese men and women: a prospective longitudinal study in the USA. BMJ Open 2017; 7:e015619. [PMID: 28679675 PMCID: PMC5734399 DOI: 10.1136/bmjopen-2016-015619] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Lower body mass index (BMI) and higher dietary quality reduce the risk of colorectal cancer (CRC). A full understanding of how these associations vary by sex and weight is lacking. METHODS We used data from the National Institutes of Health - American Association of Retired Persons (NIH)-AARP) Diet and Health Study for 398 458 persons who were 50-71 years old in 1995-1996 and followed through 2006. Exposures were dietary quality as reflected by the Mediterranean Diet, the Healthy Eating Index-2010 and the Dietary Approaches to Stop Hypertension score, stratified by BMI category. The outcome was CRC diagnosis from cancer registry data. Cox regression models were adjusted for disease risk factors. RESULTS Over a mean duration of 123 months of follow-up, there were 6515 new diagnoses of CRC (1953 among the normal weight, 2924 among the overweight and 1638 among the obese; 4483 among men and 2032 among women). For normal weight and overweight men, we found a strong dose-response pattern for the association of increasing quintile of dietary quality with decreasing risk of CRC; this pattern was observed for obese men as well, but less consistently across the three measures of dietary quality. The findings were of smaller magnitude and less consistent for women but still suggesting associations of similar direction. CONCLUSION We observed that increased dietary quality was associated with lower risk of incident CRC up to 10 years later for men regardless of baseline weight category.
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Affiliation(s)
- Rosalie A Torres Stone
- Department of Sociology, Clark University, Worcester, Massachusetts, USA
- Department of Psychiatry, Systems and Psychosocial Advances Research Center (SPARC), University of Massachusetts Medical School, Shrewsbury, Massachusetts, USA
| | - Molly E Waring
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Sarah L Cutrona
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Catarina I Kiefe
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Jeroan Allison
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Chyke A Doubeni
- Department of Family Medicine and Community Health, and the Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Saver BG, Mazor KM, Luckmann R, Cutrona SL, Hayes M, Gorodetsky T, Esparza N, Bacigalupe G. Persuasive Interventions for Controversial Cancer Screening Recommendations: Testing a Novel Approach to Help Patients Make Evidence-Based Decisions. Ann Fam Med 2017; 15:48-55. [PMID: 28376460 PMCID: PMC5217843 DOI: 10.1370/afm.1996] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 03/17/2016] [Revised: 07/19/2016] [Accepted: 08/09/2016] [Indexed: 11/09/2022] Open
Abstract
PURPOSE We wanted to evaluate novel decision aids designed to help patients trust and accept the controversial, evidence-based, US Preventive Services Task Force recommendations about prostate cancer screening (from 2012) and mammography screening for women aged 40 to 49 years (from 2009). METHODS We created recorded vignettes of physician-patient discussions about prostate cancer screening and mammography, accompanied by illustrative slides, based on principles derived from preceding qualitative work and behavioral science literature. We conducted a randomized crossover study with repeated measures with 27 men aged 50 to 74 years and 35 women aged 40 to 49 years. All participants saw a video intervention and a more traditional, paper-based decision aid intervention in random order. At entry and after seeing each intervention, they were surveyed about screening intentions, perceptions of benefits and harm, and decisional conflict. RESULTS Changes in screening intentions were analyzed without regard to order of intervention after an initial analyses showed no evidence of an order effect. At baseline, 69% of men and 86% of women reported wanting screening, with 31% and 6%, respectively, unsure. Mean change on a 3-point, yes, unsure, no scale was -0.93 (P = <.001) for men and -0.50 (P = <.001) for women after seeing the video interventions vs 0.0 and -0.06 (P = .75) after seeing the print interventions. At the study end, 33% of men and 49% of women wanted screening, and 11% and 20%, respectively, were unsure. CONCLUSIONS Our novel, persuasive video interventions significantly changed the screening intentions of substantial proportions of viewers. Our approach needs further testing but may provide a model for helping patients to consider and accept evidence-based, counterintuitive recommendations.
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Affiliation(s)
- Barry G Saver
- University of Massachusetts Medical School, Worcester, Massachusetts
- Meyers Primary Care Research Institute, Worcester, Massachusetts
- Swedish Family Medicine Residency Cherry Hill, Seattle, Washington
| | - Kathleen M Mazor
- University of Massachusetts Medical School, Worcester, Massachusetts
- Meyers Primary Care Research Institute, Worcester, Massachusetts
| | - Roger Luckmann
- University of Massachusetts Medical School, Worcester, Massachusetts
| | - Sarah L Cutrona
- University of Massachusetts Medical School, Worcester, Massachusetts
- Meyers Primary Care Research Institute, Worcester, Massachusetts
- Veterans Health Administration, HSRD COIN Edith Nourse Rogers Memorial Hospitalo, Bedford, Massachusetts
| | - Marcela Hayes
- University of Massachusetts Medical School, Worcester, Massachusetts
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Cutrona SL, Sadasivam RS, DeLaughter K, Kamberi A, Volkman JE, Cobb N, Gilbert GH, Ray MN, Houston TK. Online tobacco websites and online communities-who uses them and do users quit smoking? The quit-primo and national dental practice-based research network Hi-Quit studies. Transl Behav Med 2016; 6:546-557. [PMID: 27379777 PMCID: PMC5110489 DOI: 10.1007/s13142-015-0373-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Online tobacco cessation communities are beneficial but underused. Our study examined whether, among smokers participating in a web-assisted tobacco intervention (Decide2quit.org), specific characteristics were associated with navigating to BecomeAnEx.org, an online cessation community, and with subsequent quit rates. Among smokers (N = 759) registered with Decide2quit.org, we identified visitors to BecomeAnEx.org, examining associations between smoker characteristics and likelihood of visiting. We then tested for associations between visits and 6-month cessation (point prevalence). We also tested for an interaction between use of other online support-seeking (Decide2quit.org tobacco cessation coaches), visiting, and 6-month cessation. One quarter (26.0 %; n = 197) of the smokers visited BecomeAnEx.org; less than one tenth (7.5 %; n = 57) registered to participate in the online forum. Visitors were more likely to be female (73.0 vs. 62.6 % of non-visitors, P < 0.01) to have visited a cessation website before (33.0 vs. 17.4 %, P < 0.01) and to report quit attempts in the previous year (62.0 vs. 53.0 %, P = 0.03). In analyses of all participants, BecomeAnEx.org visiting was not associated with 6-month quit completion. Among participants who communicated with a coach, BecomeAnEx.org visiting also lacked a significant association with 6 month quit completion, although a non-significant trend toward quit completion in visitors was noted (OR 2.21, 95 % CI 0.81-3.1). Online cessation communities attract smokers with previous cessation website experience and recent quit attempts. Community visiting was not associated with quit rates in our study, but low use may have limited our power to detect differences. Further research should explore whether an additive effect can be achieved by offering community visitors support via online coaches.
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Affiliation(s)
- Sarah L Cutrona
- UMass Medical School, 365 Plantation St, Biotech 1, Suite 100, Worcester, MA, 01605, USA.
| | - Rajani S Sadasivam
- UMass Medical School, 365 Plantation St, Biotech 1, Suite 100, Worcester, MA, 01605, USA
| | - Kathryn DeLaughter
- UMass Medical School, 365 Plantation St, Biotech 1, Suite 100, Worcester, MA, 01605, USA
| | - Ariana Kamberi
- UMass Medical School, 365 Plantation St, Biotech 1, Suite 100, Worcester, MA, 01605, USA
| | - Julie E Volkman
- UMass Medical School, 365 Plantation St, Biotech 1, Suite 100, Worcester, MA, 01605, USA
- VA eHealth QUERI and CHOIR, Bedford, MA, USA
| | - Nathan Cobb
- Division of Pulmonary and Critical Care, Georgetown University Medical Center, Washington, DC, USA
- MeYou Health, Boston, MA, USA
| | - Gregg H Gilbert
- Department of Clinical & Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Midge N Ray
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Thomas K Houston
- UMass Medical School, 365 Plantation St, Biotech 1, Suite 100, Worcester, MA, 01605, USA
- VA eHealth QUERI and CHOIR, Bedford, MA, USA
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Cutrona SL, Mazor KM, Agunwamba AA, Valluri S, Wilson PM, Sadasivam RS, Finney Rutten LJ. Health Information Brokers in the General Population: An Analysis of the Health Information National Trends Survey 2013-2014. J Med Internet Res 2016; 18:e123. [PMID: 27260952 PMCID: PMC4912679 DOI: 10.2196/jmir.5447] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 02/25/2016] [Accepted: 02/26/2016] [Indexed: 11/26/2022] Open
Abstract
Background Health information exchanged between friends or family members can influence decision making, both for routine health questions and for serious health issues. A health information broker is a person to whom friends and family turn for advice or information on health-related topics. Characteristics and online behaviors of health information brokers have not previously been studied in a national population. Objective The objective of this study was to examine sociodemographic characteristics, health information seeking behaviors, and other online behaviors among health information brokers. Methods Data from the Health Information National Trends Survey (2013-2014; n=3142) were used to compare brokers with nonbrokers. Modified Poisson regression was used to examine the relationship between broker status and sociodemographics and online information seeking. Results Over half (54.8%) of the respondents were consulted by family or friends for advice or information on health topics (ie, they acted as health information brokers). Brokers represented 54.1% of respondents earning <$20,000 yearly and 56.5% of respondents born outside the United States. Women were more likely to be brokers (PR 1.34, 95% CI 1.23-1.47) as were those with education past high school (PR 1.42, CI 1.22-1.65). People aged ≥75 were less likely to be brokers as compared to respondents aged 35-49 (PR 0.81, CI 0.67-0.99). Brokers used the Internet more frequently for a variety of online behaviors such as seeking health information, creating and sharing online content, and downloading health information onto a mobile device; and also reported greater confidence in obtaining health information online. Conclusions More than 50% of adults who responded to this national survey, including those with low income and those born abroad, were providing health information or advice to friends and family. These individuals may prove to be effective targets for initiatives supporting patient engagement and disease management, and may also be well-positioned within their respective social networks to propagate health messages.
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Affiliation(s)
- Sarah L Cutrona
- University of Massachusetts Medical School, Department of Medicine, Worcester, MA, United States.
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