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MacEwan SR, Rahurkar S, Tarver WL, Gaughan AA, Rush LJ, Schamess A, McAlearney AS. COVID-19 vaccination perspectives among patients with Long COVID: A qualitative study. Hum Vaccin Immunother 2024; 20:2327663. [PMID: 38532547 PMCID: PMC10978020 DOI: 10.1080/21645515.2024.2327663] [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: 12/20/2023] [Accepted: 03/04/2024] [Indexed: 03/28/2024] Open
Abstract
Individuals who have Long COVID may have unique perspectives about COVID-19 vaccination due to the significant impact that COVID-19 has had on their lives. However, little is known about the specific vaccination perspectives among this patient population. The goal of our study was to improve our understanding of perspectives about COVID-19 vaccines among individuals with Long COVID. Interviews were conducted with patients receiving care at a post-COVID recovery clinic. Deductive thematic analysis was used to characterize participant perspectives according to the vaccine acceptance continuum framework, which recognizes a spectrum from vaccine acceptance to refusal. From interviews with 21 patients, we identified perspectives across the continuum of vaccine acceptance. These perspectives included acceptance of vaccines to prevent future illness, concerns about vaccine side effects on Long COVID symptoms, and refusal of vaccines due to perceived natural immunity. A limitation of our study is that these perspectives are specific to individuals receiving care at one post-COVID recovery clinic. In conclusion, our study demonstrates that some patients with Long COVID are uncertain about COVID-19 vaccines and boosters but may also be amenable to conversations that impact future vaccination acceptance. Patient perspectives should be considered when communicating recommendations for COVID-19 vaccinations to this population.
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Affiliation(s)
- Sarah R. MacEwan
- Division of General Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), The Ohio State University, Columbus, OH, USA
| | - Saurabh Rahurkar
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), The Ohio State University, Columbus, OH, USA
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Willi L. Tarver
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), The Ohio State University, Columbus, OH, USA
- Division of Cancer Prevention and Control, The Ohio State University, Columbus, OH, USA
| | - Alice A. Gaughan
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), The Ohio State University, Columbus, OH, USA
| | - Laura J. Rush
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), The Ohio State University, Columbus, OH, USA
| | - Andrew Schamess
- Division of General Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Ann Scheck McAlearney
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), The Ohio State University, Columbus, OH, USA
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
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MacEwan SR, Rahurkar S, Tarver WL, Forward C, Eramo JL, Teuschler L, Gaughan AA, Rush LJ, Stanwick S, McConnell E, Schamess A, McAlearney AS. Patient Experiences Navigating Care Coordination For Long COVID: A Qualitative Study. J Gen Intern Med 2024:10.1007/s11606-024-08622-z. [PMID: 38308155 DOI: 10.1007/s11606-024-08622-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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 01/09/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND Little is known about how to best evaluate, diagnose, and treat long COVID, which presents challenges for patients as they seek care. OBJECTIVE Understand experiences of patients as they navigate care for long COVID. DESIGN Qualitative study involving interviews with patients about topics related to seeking and receiving care for long COVID. PARTICIPANTS Eligible patients were at least 18 years of age, spoke English, self-identified as functioning well prior to COVID infection, and reported long COVID symptoms continued to impact their lives at 3 months or more after a COVID infection. APPROACH Patients were recruited from a post-COVID recovery clinic at an academic medical center from August to September 2022. Interviews were audio-recorded, transcribed, and analyzed using thematic analysis. KEY RESULTS Participants (n=21) reported experiences related to elements of care coordination: access to care, evaluation, treatment, and ongoing care concerns. Some patients noted access to care was facilitated by having providers that listened to and validated their symptoms; other patients reported feeling their access to care was hindered by providers who did not believe or understand their symptoms. Patients reported confusion around how to communicate their symptoms when being evaluated for long COVID, and they expressed frustration with receiving test results that were normal or diagnoses that were not directly attributed to long COVID. Patients acknowledged that clinicians are still learning how to treat long COVID, and they voiced appreciation for providers who are willing to try new treatment approaches. Patients expressed ongoing care concerns, including feeling there is nothing more that can be done, and questioned long-term impacts on their aging and life expectancy. CONCLUSIONS Our findings shed light on challenges faced by patients with long COVID as they seek care. Healthcare systems and providers should consider these challenges when developing strategies to improve care coordination for patients with long COVID.
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Affiliation(s)
- Sarah R MacEwan
- Division of General Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA.
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA.
| | - Saurabh Rahurkar
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Willi L Tarver
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
- Division of Cancer Prevention and Control, The Ohio State University, Columbus, OH, USA
| | - Cortney Forward
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Jennifer L Eramo
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Lauren Teuschler
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Alice A Gaughan
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Laura J Rush
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Stacy Stanwick
- Division of General Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Erin McConnell
- Division of General Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Andrew Schamess
- Division of General Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Ann Scheck McAlearney
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
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3
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Gregory ME, Cao W, Rahurkar S, Jonnalagadda P, Stock JC, Ghazi SM, Reid E, Berk AL, Hebert C, Li L, Addison D. Exploring the Incorporation of a Novel Cardiotoxicity Mobile Health App Into Care of Patients With Cancer: Qualitative Study of Patient and Provider Perspectives. JMIR Cancer 2023; 9:e46481. [PMID: 38085565 PMCID: PMC10751627 DOI: 10.2196/46481] [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: 02/13/2023] [Revised: 09/05/2023] [Accepted: 11/08/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND Cardiotoxicity is a limitation of several cancer therapies and early recognition improves outcomes. Symptom-tracking mobile health (mHealth) apps are feasible and beneficial, but key elements for mHealth symptom-tracking to indicate early signs of cardiotoxicity are unknown. OBJECTIVE We explored considerations for the design of, and implementation into a large academic medical center, an mHealth symptom-tracking tool for early recognition of cardiotoxicity in patients with cancer after cancer therapy initiation. METHODS We conducted semistructured interviews of >50% of the providers (oncologists, cardio-oncologists, and radiation oncologists) who manage cancer treatment-related cardiotoxicity in the participating institution (n=11), and either interviews or co-design or both with 6 patients. Data were coded and analyzed using thematic analysis. RESULTS Providers indicated that there was no existing process to enable early recognition of cardiotoxicity and felt the app could reduce delays in diagnosis and lead to better patient outcomes. Signs and symptoms providers recommended for tracking included chest pain or tightness, shortness of breath, heart racing or palpitations, syncope, lightheadedness, edema, and excessive fatigue. Implementation barriers included determining who would receive symptom reports, ensuring all members of the patient's care team (eg, oncologist, cardiologist, and primary care) were informed of the symptom reports and could collaborate on care plans, and how to best integrate the app data into the electronic health record. Patients (n=6, 100%) agreed that the app would be useful for enhanced symptom capture and education and indicated willingness to use it. CONCLUSIONS Providers and patients agree that a patient-facing, cancer treatment-related cardiotoxicity symptom-tracking mHealth app would be beneficial. Additional studies evaluating the role of mHealth as a potential strategy for targeted early cardioprotective therapy initiation are needed.
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Affiliation(s)
- Megan E Gregory
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, Univeristy of Florida, Gainesville, FL, United States
| | - Weidan Cao
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, United States
| | - Saurabh Rahurkar
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, United States
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Pallavi Jonnalagadda
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, United States
| | - James C Stock
- Cardio-Oncology Program, Division of Cardiovascular Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States
- Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Sanam M Ghazi
- Cardio-Oncology Program, Division of Cardiovascular Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Endia Reid
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, United States
| | - Abigail L Berk
- Biomedical Sciences Program, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Courtney Hebert
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, United States
| | - Lang Li
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, United States
| | - Daniel Addison
- Cardio-Oncology Program, Division of Cardiovascular Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States
- Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States
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Obeng-Gyasi S, Handley D, Elsaid MI, Rahurkar S, Andersen BL, Jonnalagadda P, Chen JC, Owusu-Brackett N, Carson WE, Stover DG. Low Hospital Volume Is Associated with Higher All-Cause Mortality in Black Women with Triple Negative Breast Cancer. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01788-y. [PMID: 38038902 DOI: 10.1007/s40615-023-01788-y] [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: 07/18/2023] [Revised: 08/20/2023] [Accepted: 09/01/2023] [Indexed: 12/02/2023]
Abstract
INTRODUCTION This study examines the association between hospital volume and all-cause mortality in Black women with triple negative breast cancer (TNBC) who received surgery and chemotherapy. METHODS Black women ages 18+ with stage I-III TNBC who received both surgery and chemotherapy were identified in the National Cancer Database (NCDB). Hospital volume was determined using the number of annual breast cancer cases divided by the number of years the hospital participated in the NCDB. Hospital annual volume quartiles ranged from Q1 (lowest) to Q4 (highest). Univariable analysis and multivariable logistic regression modeling with restricted cubic splines examined the effect of hospital volume on all-cause mortality. RESULTS Sixteen thousand five hundred fifty-six patients met the study criteria. All-cause mortality incidence was lower at higher volume compared to lower volume hospitals Q1 24.1% (95% CI: 22.8 to 25.4), Q2 21.8% (95% CI: 20.5 to 23.1), Q3 20.9% (95% CI: 19.6 to 22.1), Q4 19.0% (95% CI: 17.7 to 20.1), p<0.001. On multivariable analysis, treatment at the highest hospital volume quartile was associated with a 21% reduction in the odds of death compared to the lowest quartile [Q4 Vs. Q1, OR=0.79 (95% CI: 0.67 to 0.92)]. For every 100-patient increase in annual volume, all-cause mortality was reduced by 4% [OR=0.96 (95% CI: 0.94 to 0.98)]. There was a significant linear dose-dependent relationship between increasing hospital volume and all-cause mortality. CONCLUSION Black women treated at high-volume hospitals have lower all-cause mortality than those at low-volume hospitals. Future studies should examine the characteristics of high-volume hospitals associated with improved outcomes.
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Affiliation(s)
- Samilia Obeng-Gyasi
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, N924 Doan Hall, 410 West 10th Avenue, Columbus, OH, 43210, USA.
| | - Demond Handley
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Mohamed I Elsaid
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Saurabh Rahurkar
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | | | - Pallavi Jonnalagadda
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - J C Chen
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, N924 Doan Hall, 410 West 10th Avenue, Columbus, OH, 43210, USA
| | - Nicci Owusu-Brackett
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, N924 Doan Hall, 410 West 10th Avenue, Columbus, OH, 43210, USA
| | - William E Carson
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, N924 Doan Hall, 410 West 10th Avenue, Columbus, OH, 43210, USA
| | - Daniel G Stover
- Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
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Paskett ED, Kruse-Diehr AJ, Oliveri JM, Vanderpool RC, Gray DM, Pennell ML, Huang B, Young GS, Fickle D, Cromo M, Katz ML, Reiter PL, Rogers M, Gross DA, Fairchild V, Xu W, Carman A, Walunis JM, McAlearney AS, Huerta TR, Rahurkar S, Biederman E, Dignan M. Accelerating Colorectal Cancer Screening and Follow-up through Implementation Science (ACCSIS) in Appalachia: protocol for a group randomized, delayed intervention trial. Transl Behav Med 2023; 13:748-756. [PMID: 37202831 PMCID: PMC10538475 DOI: 10.1093/tbm/ibad017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
Appalachian regions of Kentucky and Ohio are hotspots for colorectal cancer (CRC) mortality in the USA. Screening reduces CRC incidence and mortality; however, screening uptake is needed, especially in these underserved geographic areas. Implementation science offers strategies to address this challenge. The aim of the current study was to conduct multi-site, transdisciplinary research to evaluate and improve CRC screening processes using implementation science strategies. The study consists of two phases (Planning and Implementation). In the Planning Phase, a multilevel assessment of 12 health centers (HC) (one HC from each of the 12 Appalachian counties) was conducted by interviewing key informants, creating community profiles, identifying HC and community champions, and performing HC data inventories. Two designated pilot HCs chose CRC evidence-based interventions to adapt and implement at each level (i.e., patient, provider, HC, and community) with evaluation relative to two matched control HCs. During the Implementation Phase, study staff will repeat the rollout process in HC and community settings in a randomized, staggered fashion in the remaining eight counties/HCs. Evaluation will include analyses of electronic health record data and provider and county surveys. Rural HCs have been reluctant to participate in research because of concerns about capacity; however, this project should demonstrate that research does not need to be burdensome and can adapt to local needs and HC abilities. If effective, this approach could be disseminated to HC and community partners throughout Appalachia to encourage the uptake of effective interventions to reduce the burden of CRC.
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Affiliation(s)
- Electra D Paskett
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University College of Medicine, Department of Internal Medicine, Columbus, OH, USA
| | - Aaron J Kruse-Diehr
- University of Kentucky College of Medicine, Department of Family and Community Medicine, Lexington, KY, USA
- University of Kentucky Markey Cancer Center, Cancer Prevention and Control Research Program, Lexington, KY, USA
| | - Jill M Oliveri
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Robin C Vanderpool
- University of Kentucky College of Public Health, Department of Health, Behavior and Society, Lexington, KY, USA
| | - Darrell M Gray
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University College of Medicine, Department of Internal Medicine, Columbus, OH, USA
| | - Michael L Pennell
- The Ohio State University College of Public Health, Division of Biostatistics, Columbus, OH, USA
| | - Bin Huang
- University of Kentucky Markey Cancer Center, Division of Biostatistics, Biostatistics and Bioinformatics Shared Resource Facility, Lexington, KY, USA
| | | | - Darla Fickle
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Mark Cromo
- University of Kentucky College of Medicine, Department of Internal Medicine, Lexington, KY, USA
| | - Mira L Katz
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University College of Public Health, Division of Health Behavior and Health Promotion, Columbus, OH, USA
| | - Paul L Reiter
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University College of Public Health, Division of Health Behavior and Health Promotion, Columbus, OH, USA
| | - Melinda Rogers
- University of Kentucky Markey Cancer Center, Community Impact Office, Lexington, KY, USA
| | - David A Gross
- Northeast Kentucky Area Health Education Center, Morehead, KY, USA
| | - Vickie Fairchild
- Northeast Kentucky Area Health Education Center, Morehead, KY, USA
| | - Wendy Xu
- The Ohio State University College of Public Health, Division of Health Services Management and Policy, Columbus, OH, USA
| | - Angela Carman
- University of Kentucky Markey Cancer Center, Cancer Prevention and Control Research Program, Lexington, KY, USA
| | - Jean M Walunis
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Ann Scheck McAlearney
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University College of Public Health, Division of Health Services Management and Policy, Columbus, OH, USA
- The Ohio State University College of Medicine, Department of Family and Community Medicine, Columbus, OH, USA
| | - Timothy R Huerta
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University College of Public Health, Division of Health Services Management and Policy, Columbus, OH, USA
- The Ohio State University College of Medicine, Department of Family and Community Medicine, Columbus, OH, USA
| | | | - Erika Biederman
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Mark Dignan
- University of Kentucky College of Medicine, Department of Internal Medicine, Lexington, KY, USA
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6
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MacEwan SR, Gaughan AA, Dixon GN, Olvera RG, Tarver WL, Rahurkar S, Rush LJ, Schenk AD, Stevens J, McAlearney AS. Understanding Concerns about COVID-19 and Vaccination: Perspectives from Kidney Transplant Recipients. Vaccines (Basel) 2023; 11:1134. [PMID: 37514950 PMCID: PMC10386736 DOI: 10.3390/vaccines11071134] [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: 05/08/2023] [Revised: 06/08/2023] [Accepted: 06/16/2023] [Indexed: 07/30/2023] Open
Abstract
The COVID-19 pandemic poses a significant risk for immunosuppressed groups such as transplant patients. The purpose of this study was to improve our understanding of the impact of the COVID-19 pandemic on kidney transplant recipients, including their views on COVID-19 vaccination. Semi-structured interviews were conducted from December 2021 to August 2022 with 38 kidney transplant recipients who had an appointment with their transplant care team within the previous 6 months. We used qualitative thematic analysis to characterize the perspectives of interviewees. Regardless of COVID-19 vaccination status, most interviewees reported utilizing public health measures such as masking, hand washing, and avoiding crowds to protect themselves against COVID-19. Vaccinated interviewees (n = 31) noted that they chose to receive a COVID-19 vaccine because of their increased risk due to their immunocompromised state. For unvaccinated interviewees (n = 7), reasons for not receiving a COVID-19 vaccine included concerns about the safety and efficacy of the vaccine. Both vaccinated and unvaccinated interviewees expressed concerns about the lack of adequate testing of the vaccine in transplant patients and questioned if the vaccine might have unknown side effects for transplant recipients. Regardless of the vaccination status, most interviewees noted having trust in their healthcare team. Interviewees also described interpersonal tensions that arose during the pandemic, many of which surrounded vaccination and other preventive measures that were important to participants to protect their health. Together, these data demonstrate differing concerns and experiences related to the COVID-19 pandemic for vaccinated and unvaccinated transplant recipients. These findings highlight the unique needs of transplant recipients and reveal opportunities to support this vulnerable patient population in efforts to protect their health as the COVID-19 pandemic evolves.
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Affiliation(s)
- Sarah R MacEwan
- Division of General Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Alice A Gaughan
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Graham N Dixon
- School of Communications, College of Arts and Sciences, The Ohio State University, Columbus, OH 43210, USA
| | - Ramona G Olvera
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Willi L Tarver
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Division of Cancer Prevention and Control, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, OH 43210, USA
| | - Saurabh Rahurkar
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Laura J Rush
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Austin D Schenk
- Division of Transplantation, Department of Surgery, The Ohio State University, Columbus, OH 43210, USA
| | - Jack Stevens
- Department of Pediatrics, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Ann Scheck McAlearney
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH 43210, USA
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7
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Walker DM, Tarver WL, Jonnalagadda P, Ranbom L, Ford EW, Rahurkar S. Perspectives on Challenges and Opportunities for Interoperability: Findings From Key Informant Interviews With Stakeholders in Ohio. JMIR Med Inform 2023; 11:e43848. [PMID: 36826979 PMCID: PMC10007006 DOI: 10.2196/43848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 01/11/2023] [Accepted: 01/19/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Interoperability-the exchange and integration of data across the health care system-remains a challenge despite ongoing policy efforts aimed at promoting interoperability. OBJECTIVE This study aimed to identify current challenges and opportunities to advancing interoperability across stakeholders. METHODS Primary data were collected through qualitative, semistructured interviews with stakeholders (n=24) in Ohio from July to October 2021. Interviewees were sampled using a stratified purposive sample of key informants from 4 representative groups as follows: acute care and children's hospital leaders, primary care providers, behavioral health providers, and regional health information exchange networks. Interviews focused on key informant perspectives on electronic health record implementation, the alignment of public policy with organizational strategy, interoperability implementation challenges, and opportunities for health information technology. The interviews were transcribed verbatim followed by rigorous qualitative analysis using directed content analysis. RESULTS The findings illuminate themes related to challenges and opportunities for interoperability that align with technological (ie, implementation challenges, mismatches in interoperability capabilities across stakeholders, and opportunities to leverage new technology and integrate social determinants of health data), organizational (ie, facilitators of interoperability and strategic alignment of participation in value-based payment programs with interoperability), and environmental (ie, policy) domains. CONCLUSIONS Interoperability, although technically feasible for most providers, remains challenging for technological, organizational, and environmental reasons. Our findings suggest that the incorporation of end user considerations into health information technology development, implementation, policy, and standard deployment may support interoperability advancement.
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Affiliation(s)
- Daniel M Walker
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States.,The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Willi L Tarver
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, United States.,Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Pallavi Jonnalagadda
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Lorin Ranbom
- Government Resource Center, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Eric W Ford
- Department of Healthcare Organization and Policy, School of Public Health, University of Alabama, Birmingham, AL, United States
| | - Saurabh Rahurkar
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, United States.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, United States
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8
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Rahurkar S, Vest JR, Finnell JT, Dixon BE. Trends in user-initiated health information exchange in the inpatient, outpatient, and emergency settings. J Am Med Inform Assoc 2021; 28:622-627. [PMID: 33067617 DOI: 10.1093/jamia/ocaa226] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/25/2020] [Accepted: 09/02/2020] [Indexed: 11/12/2022] Open
Abstract
Prior research on health information exchange (HIE) typically measured provider usage through surveys or they summarized the availability of HIE services in a healthcare organization. Few studies utilized user log files. Using HIE access log files, we measured HIE use in real-world clinical settings over a 7-year period (2011-2017). Use of HIE increased in inpatient, outpatient, and emergency department (ED) settings. Further, while extant literature has generally viewed the ED as the most relevant setting for HIE, the greatest change in HIE use was observed in the inpatient setting, followed by the ED setting and then the outpatient setting. Our findings suggest that in addition to federal incentives, the implementation of features that address barriers to access (eg, Single Sign On), as well as value-added services (eg, interoperability with external data sources), may be related to the growth in user-initiated HIE.
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Affiliation(s)
- Saurabh Rahurkar
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, USA.,Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), The Ohio State University, Columbus, Ohio, USA
| | - Joshua R Vest
- Department of Health Policy and Management, IU Richard M. Fairbanks School of Public Health, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA.,Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA
| | - John T Finnell
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA.,Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Brian E Dixon
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA.,Department of Epidemiology, IU Richard M. Fairbanks School of Public Health, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
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9
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Kruse-Diehr AJ, Oliveri JM, Vanderpool RC, Katz ML, Reiter PL, Gray DM, Pennell ML, Young GS, Huang B, Fickle D, Cromo M, Rogers M, Gross D, Gibson A, Jellison J, Sarap MD, Bivens TA, McGuire TD, McAlearney AS, Huerta TR, Rahurkar S, Paskett ED, Dignan M. Development of a multilevel intervention to increase colorectal cancer screening in Appalachia. Implement Sci Commun 2021; 2:51. [PMID: 34011410 PMCID: PMC8136225 DOI: 10.1186/s43058-021-00151-8] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 04/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Colorectal cancer (CRC) screening rates are lower in Appalachian regions of the United States than in non-Appalachian regions. Given the availability of various screening modalities, there is critical need for culturally relevant interventions addressing multiple socioecological levels to reduce the regional CRC burden. In this report, we describe the development and baseline findings from year 1 of "Accelerating Colorectal Cancer Screening through Implementation Science (ACCSIS) in Appalachia," a 5-year, National Cancer Institute Cancer MoonshotSM-funded multilevel intervention (MLI) project to increase screening in Appalachian Kentucky and Ohio primary care clinics. METHODS Project development was theory-driven and included the establishment of both an external Scientific Advisory Board and a Community Advisory Board to provide guidance in conducting formative activities in two Appalachian counties: one in Kentucky and one in Ohio. Activities included identifying and describing the study communities and primary care clinics, selecting appropriate evidence-based interventions (EBIs), and conducting a pilot test of MLI strategies addressing patient, provider, clinic, and community needs. RESULTS Key informant interviews identified multiple barriers to CRC screening, including fear of screening, test results, and financial concerns (patient level); lack of time and competing priorities (provider level); lack of reminder or tracking systems and staff burden (clinic level); and cultural issues, societal norms, and transportation (community level). With this information, investigators then offered clinics a menu of EBIs and strategies to address barriers at each level. Clinics selected individually tailored MLIs, including improvement of patient education materials, provision of provider education (resulting in increased knowledge, p = .003), enhancement of electronic health record (EHR) systems and development of clinic screening protocols, and implementation of community CRC awareness events, all of which promoted stool-based screening (i.e., FIT or FIT-DNA). Variability among clinics, including differences in EHR systems, was the most salient barrier to EBI implementation, particularly in terms of tracking follow-up of positive screening results, whereas the development of clinic-wide screening protocols was found to promote fidelity to EBI components. CONCLUSIONS Lessons learned from year 1 included increased recognition of variability among the clinics and how they function, appreciation for clinic staff and provider workload, and development of strategies to utilize EHR systems. These findings necessitated a modification of study design for subsequent years. TRIAL REGISTRATION Trial NCT04427527 is registered at https://clinicaltrials.gov and was registered on June 11, 2020.
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Affiliation(s)
- Aaron J Kruse-Diehr
- University of Kentucky College of Public Health, Lexington, KY, USA.
- University of Kentucky Markey Cancer Center, Lexington, KY, USA.
| | - Jill M Oliveri
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | | | - Mira L Katz
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University College of Public Health, Columbus, OH, USA
| | - Paul L Reiter
- The Ohio State University College of Public Health, Columbus, OH, USA
| | - Darrell M Gray
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Michael L Pennell
- The Ohio State University College of Public Health, Columbus, OH, USA
| | - Gregory S Young
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Bin Huang
- University of Kentucky Markey Cancer Center, Lexington, KY, USA
| | - Darla Fickle
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Mark Cromo
- University of Kentucky Markey Cancer Center, Lexington, KY, USA
| | - Melinda Rogers
- University of Kentucky Markey Cancer Center, Lexington, KY, USA
| | - David Gross
- Northeast Kentucky Area Health Education Center, Morehead, KY, USA
| | - Ashley Gibson
- Northeast Kentucky Area Health Education Center, Morehead, KY, USA
| | | | | | - Tonia A Bivens
- Lewis County Primary Care Center, Inc. dba PrimaryPlus, Vanceburg, KY, USA
| | - Tracy D McGuire
- Lewis County Primary Care Center, Inc. dba PrimaryPlus, Vanceburg, KY, USA
| | - Ann Scheck McAlearney
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University College of Public Health, Columbus, OH, USA
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Timothy R Huerta
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University College of Public Health, Columbus, OH, USA
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Saurabh Rahurkar
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Electra D Paskett
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University College of Public Health, Columbus, OH, USA
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Mark Dignan
- University of Kentucky Markey Cancer Center, Lexington, KY, USA
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10
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Ho YA, Rahurkar S, Tao G, Patel CG, Arno JN, Wang J, Broyles AA, Dixon BE. Validation of International Classification of Diseases, Tenth Revision, Clinical Modification Codes for Identifying Cases of Chlamydia and Gonorrhea. Sex Transm Dis 2021; 48:335-340. [PMID: 32740450 PMCID: PMC7855200 DOI: 10.1097/olq.0000000000001257] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND While researchers seek to use administrative health data to examine outcomes for individuals with sexually transmitted infections (STIs), the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes used to identify persons with chlamydia and gonorrhea have not been validated. Objectives were to determine the validity of using ICD-10-CM codes to identify individuals with chlamydia and gonorrhea. METHODS We used data from electronic health records gathered from public and private health systems from October 1, 2015, to December 31, 2016. Patients were included if they were aged 13 to 44 years and received either (1) laboratory testing for chlamydia or gonorrhea or (2) an ICD-10-CM diagnosis of chlamydia, gonorrhea, or an unspecified STI. To validate ICD-10-CM codes, we calculated positive and negative predictive values, sensitivity, and specificity based on the presence of a laboratory test result. We further examined the timing of clinical diagnosis relative to laboratory testing. RESULTS The positive predictive values for chlamydia, gonorrhea, and unspecified STI ICD-10-CM codes were 87.6%, 85.0%, and 32.0%, respectively. Negative predictive values were high (>92%). Sensitivity for chlamydia diagnostic codes was 10.6%, and gonorrhea was 9.7%. Specificity was 99.9% for both chlamydia and gonorrhea. The date of diagnosis occurred on or after the date of the laboratory result for 84.8% of persons with chlamydia, 91.9% for gonorrhea, and 23.5% for unspecified STI. CONCLUSIONS Disease-specific ICD-10-CM codes accurately identify persons with chlamydia and gonorrhea. However, low sensitivities suggest that most individuals could not be identified in administrative data alone without laboratory test results.
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Affiliation(s)
- Yenling Andrew Ho
- From the Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN
| | | | - Guoyu Tao
- Centers for Disease Control and Prevention, Atlanta, GA
| | | | | | - Jane Wang
- Regenstrief Institute, Indianapolis, IN
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11
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Obeng-Gyasi S, Asad S, Fisher JL, Rahurkar S, Stover DG. Socioeconomic and Surgical Disparities are Associated with Rapid Relapse in Patients with Triple-Negative Breast Cancer. Ann Surg Oncol 2021; 28:6500-6509. [PMID: 33586064 DOI: 10.1245/s10434-021-09688-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 01/19/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND A subset of triple-negative breast cancer (TNBC) is characterized by aggressive disease, rapid relapse, and mortality within 24 months of diagnosis, termed "rapid relapse" TNBC (rrTNBC). The objective of this study is to define the association between sociodemographic variables and surgical management among rrTNBC patients in the Surveillance, Epidemiology and End Results (SEER) Program. METHODS TNBC patients diagnosed from January 1, 2010 to December 31, 2014 with local or regional disease were identified in SEER. Patients were stratified as rrTNBC, defined as disease specific mortality ≤ 24 months after diagnosis, and non-rrTNBC. Chi-squared tests, t tests, and multivariable logistic regression were used to assess the association of rapid relapse with sociodemographic variables and surgical management. RESULTS The cohort included 8% (1378/17,369) rrTNBCs. A higher proportion of rrTNBC patients had no surgery (11.7%) compared with non-rrTNBC (2.6%). Omission of axillary staging among patients who had surgery was 6.2% rrTNBC versus 4.5% non-rrTNBC. Black race (odds ratio [OR] 1.22, 95% confidence interval [CI] 1.05-1.43; p = 0.01; white ref), Medicaid or no insurance (Medicaid OR 1.53, 95% CI 1.31-1.79; p < 0.001; no insurance OR 1.74, 95% CI 1.31-2.32; p < 0.001; private ref), single status (OR 1.19, 95% CI 1.01-1.39; p = 0.03; married ref), no breast (OR 2.35, 95% CI 1.77-3.11; p < 0.001; mastectomy ref), and no axillary surgery (OR 1.44, 95% CI 1.13-1.83; p = 0.003 axillary surgery ref) were associated with rapid relapse. CONCLUSIONS Medicaid or no insurance, single status, black race, and no surgery are associated with higher odds of rrTNBC in SEER. These results indicate an interplay between socioeconomic factors, clinical and genomic variables may be disproportionately contributing to worse outcomes among a subset of TNBC patients.
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Affiliation(s)
- Samilia Obeng-Gyasi
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA. .,The Ohio State University College of Medicine, Columbus, OH, USA. .,Stefanie Spielman Comprehensive Breast Center, Columbus, OH, USA.
| | - Sarah Asad
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - James L Fisher
- The Ohio State University College of Medicine, Columbus, OH, USA.,James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - Saurabh Rahurkar
- Department of Biomedical Informatics, Lincoln Tower, The Ohio State University, Columbus, OH, USA
| | - Daniel G Stover
- The Ohio State University College of Medicine, Columbus, OH, USA.,Stefanie Spielman Comprehensive Breast Center, Columbus, OH, USA.,James Cancer Hospital and Solove Research Institute, Columbus, OH, USA.,Division of Medical Oncology, Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
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12
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Abstract
Clinicians frequently stress the importance of maintaining good oral health for multiple reasons, including its link to systemic health. Because periodontal treatment reduces inflammation in oral tissues, some hypothesize it may positively affect systemic outcomes by reducing inflammation in the body. A significant number of systematic reviews (SRs) and meta-analyses (MAs) have evaluated the effect of periodontal treatment on systemic outcomes. However, inconsistent findings and questionable methodological rigor make drawing conclusions difficult. We conducted a systematic review of reviews that studied the effect of nonsurgical periodontal treatment on systemic disease outcomes. We report on outcomes evaluated, categorizing them as biomarkers, and surrogate or clinical endpoints. In addition, we used A MeaSurement Tool to Access systematic Reviews 2 (AMSTAR 2) to evaluate the methodological quality of the reviews. Of the 52 studies included in our review, 21 focused on diabetes, 15 on adverse birth outcomes, 8 on cardiovascular disease, 3 each on obesity and rheumatoid arthritis, and 2 on chronic kidney disease. Across all studies, surrogate endpoints predominated as outcomes, followed by biomarkers and, rarely, actual disease endpoints. Ninety-two percent of studies had "low" or "critically low" AMSTAR 2 confidence ratings. Criteria not met most frequently included advance registration of the protocol, justification for excluding individual studies, risk of bias from individual studies being included in the review, and appropriateness of meta-analytical methods. There is a dearth of robust evidence on whether nonsurgical periodontal treatment improves systemic disease outcomes. Future reviews should adhere more closely to methodological guidelines for conducting and reporting SRs/MAs than has been the case to date. Beyond improved reviews, additional rigorous research on whether periodontal treatment affects systemic health is needed. We highlight the potential of large-scale databases containing matched medical and dental record data to inform and complement future clinical research studying the effect of periodontal treatment on systemic outcomes.
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Affiliation(s)
- H L Taylor
- Department of Health Policy and Management, NLM Public and Population Health Informatics Fellow, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
| | - S Rahurkar
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA.,The Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), The Ohio State University College of Medicine, Columbus, OH, USA
| | - T J Treat
- Department of Biomedical Sciences and Comprehensive Care, Indiana University School of Dentistry, Indianapolis, IN, USA
| | - T P Thyvalikakath
- Department of Cariology, Operative Dentistry & Dental Public Health, Indiana University School of Dentistry, IUPUI, Indianapolis, IN, USA.,Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
| | - T K Schleyer
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA.,Indiana University School of Medicine, Indianapolis, IN, USA
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13
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Dixon BE, Rahurkar S, Ho Y, Arno JN. Reliability of administrative data to identify sexually transmitted infections for population health: a systematic review. BMJ Health Care Inform 2020; 26:bmjhci-2019-100074. [PMID: 31399425 PMCID: PMC7062345 DOI: 10.1136/bmjhci-2019-100074] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 07/23/2019] [Indexed: 12/20/2022] Open
Abstract
Introduction International Classification of Diseases (ICD) codes in administrative health data are used to identify cases of disease, including sexually transmitted infections (STIs), for population health research. The purpose of this review is to examine the extant literature on the reliability of ICD codes to correctly identify STIs. Methods We conducted a systematic review of empirical articles in which ICD codes were validated with respect to their ability to identify cases of chlamydia, gonorrhoea, syphilis or pelvic inflammatory disease (PID). Articles that included sensitivity, specificity and positive predictive value of ICD codes were the target. In addition to keyword searches in PubMed and Scopus databases, we further examined bibliographies of articles selected for full review to maximise yield. Results From a total of 1779 articles identified, only two studies measured the reliability of ICD codes to identify cases of STIs. Both articles targeted PID, a serious complication of chlamydia and gonorrhoea. Neither article directly assessed the validity of ICD codes to identify cases of chlamydia, gonorrhoea or syphilis independent of PID. Using ICD codes alone, the positive predictive value for PID was mixed (range: 18%–79%). Discussion and conclusion While existing studies have used ICD codes to identify STI cases, their reliability is unclear. Further, available evidence from studies of PID suggests potentially large variation in the accuracy of ICD codes indicating the need for primary studies to evaluate ICD codes for use in STI-related public health research.
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Affiliation(s)
- Brian E Dixon
- Department of Epidemiology, Indiana University Richard M Fairbanks School of Public Health, Indianapolis, Indiana, USA .,Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA
| | - Saurabh Rahurkar
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA.,Department of Biomedical Informatics, Ohio State University, Columbus, Ohio, USA
| | - Yenling Ho
- Department of Epidemiology, Indiana University Richard M Fairbanks School of Public Health, Indianapolis, Indiana, USA
| | - Janet N Arno
- Division of Infectious Diseases, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Bell Flower STD Control Program, Marion County Public Health Department, Indianapolis, Indiana, USA
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14
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Schleyer TKL, Rahurkar S, Baublet AM, Kochmann M, Ning X, Martin DK, Finnell JT, Kelley KW, Schaffer JT. Preliminary evaluation of the Chest Pain Dashboard, a FHIR-based approach for integrating health information exchange information directly into the clinical workflow. AMIA Jt Summits Transl Sci Proc 2019; 2019:656-664. [PMID: 31259021 PMCID: PMC6568135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Despite efforts aimed at improving the integration of clinical data from health information exchanges (HIE) and electronic health records (EHR), interoperability remains limited. Barriers due to inefficiencies and workflow interruptions make using HIE data during care delivery difficult. Capitalizing on the development of the Fast Healthcare Interoperability Resource (FHIR) specification, we designed and developed a Chest Pain Dashboard that integrates HIE data into EHRs. This Dashboard was implemented in one emergency department (ED) of Indiana University Health in Indiana. In this paper, we present the preliminary findings from a mixed-methods evaluation of the Dashboard. A difference-in-difference analysis suggests that the ED with the Dashboard implementation resulted in a significant increase in HIE use compared to EDs without. This finding was supported by qualitative interviews. While these results are encouraging, we also identified areas for improvement. FHIR-based solutions may offer promising approaches to encourage greater accessibility and use of HIE data.
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Affiliation(s)
- Titus K L Schleyer
- Regenstrief Institute, Indianapolis, IN
- Indiana University School of Medicine, Indianapolis, IN
| | | | | | - Matthias Kochmann
- Regenstrief Institute, Indianapolis, IN
- Indiana University School of Medicine, Indianapolis, IN
| | - Xia Ning
- Ohio State University, Columbus, OH
| | - Douglas K Martin
- Regenstrief Institute, Indianapolis, IN
- Indiana University School of Medicine, Indianapolis, IN
| | - John T Finnell
- Regenstrief Institute, Indianapolis, IN
- Indiana University School of Medicine, Indianapolis, IN
| | | | - Jason T Schaffer
- Regenstrief Institute, Indianapolis, IN
- Indiana University School of Medicine, Indianapolis, IN
- Indiana University Health, Indianapolis, IN
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15
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Menachemi N, Rahurkar S, Harle CA, Vest JR. The benefits of health information exchange: an updated systematic review. J Am Med Inform Assoc 2018; 25:1259-1265. [PMID: 29718258 PMCID: PMC7646861 DOI: 10.1093/jamia/ocy035] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 03/08/2018] [Accepted: 03/18/2018] [Indexed: 11/14/2022] Open
Abstract
Objective Widespread health information exchange (HIE) is a national objective motivated by the promise of improved care and a reduction in costs. Previous reviews have found little rigorous evidence that HIE positively affects these anticipated benefits. However, early studies of HIE were methodologically limited. The purpose of the current study is to review the recent literature on the impact of HIE. Methods We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to conduct our systematic review. PubMed and Scopus databases were used to identify empirical articles that evaluated HIE in the context of a health care outcome. Results Our search strategy identified 24 articles that included 63 individual analyses. The majority of the studies were from the United States representing 9 states; and about 40% of the included analyses occurred in a handful of HIEs from the state of New York. Seven of the 24 studies used designs suitable for causal inference and all reported some beneficial effect from HIE; none reported adverse effects. Conclusions The current systematic review found that studies with more rigorous designs all reported benefits from HIE. Such benefits include fewer duplicated procedures, reduced imaging, lower costs, and improved patient safety. We also found that studies evaluating community HIEs were more likely to find benefits than studies that evaluated enterprise HIEs or vendor-mediated exchanges. Overall, these finding bode well for the HIEs ability to deliver on anticipated improvements in care delivery and reduction in costs.
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Affiliation(s)
- Nir Menachemi
- Department of Health Policy and Management, Indiana University (IU) Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
| | - Saurabh Rahurkar
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
| | - Christopher A Harle
- Department of Health Policy and Management, Indiana University (IU) Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
| | - Joshua R Vest
- Department of Health Policy and Management, Indiana University (IU) Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
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16
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Rahurkar S, McFarlane TD, Wang J, Hoover S, Hammond F, Kean J, Dixon BE. Leveraging Health Information Exchange to Construct a Registry for Traumatic Brain Injury, Spinal Cord Injury and Stroke in Indiana. AMIA Annu Symp Proc 2018; 2017:1440-1449. [PMID: 29854213 PMCID: PMC5977570] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Traumatic brain injury (TBI), spinal cord injury (SCI) and stroke are conditions of interest to public health as they can result in long-term outcomes and disabilities. Specialized registries can facilitate public health surveillance, however only 4% of hospitals in the United States actively engage in electronic reporting to these registries. We leveraged electronic claims and clinical data from a health information exchange to create a statewide TBI/SCI/Stroke registry to facilitate the study of long-term outcomes and health services utilization. The registry contains 109,943 TBI patients, 9,027 SCI patients and 117,084 stroke patients with a mean of 3 years of follow-up data after injury. Additionally, the registry contains data on individual patient encounters, prescriptions and clinical variables. The high-dimensional data with large sample sizes may present a valuable informatics resource for injury research as well as public health surveillance.
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Affiliation(s)
- Saurabh Rahurkar
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
| | - Timothy D McFarlane
- Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA
| | - Jane Wang
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
| | - Sarah Hoover
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
| | - Flora Hammond
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jacob Kean
- Population Health Sciences, Univ. of Utah School of Medicine, Salt Lake City, UT, USA
| | - Brian E Dixon
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
- Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA
- Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13-416, Indianapolis, IN, USA
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17
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Menachemi N, Rahurkar S, Rahurkar M. Using Web-Based Search Data to Study the Public's Reactions to Societal Events: The Case of the Sandy Hook Shooting. JMIR Public Health Surveill 2017; 3:e12. [PMID: 28336508 PMCID: PMC5383805 DOI: 10.2196/publichealth.6033] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 10/29/2016] [Accepted: 02/03/2017] [Indexed: 11/21/2022] Open
Abstract
Background Internet search is the most common activity on the World Wide Web and generates a vast amount of user-reported data regarding their information-seeking preferences and behavior. Although this data has been successfully used to examine outbreaks, health care utilization, and outcomes related to quality of care, its value in informing public health policy remains unclear. Objective The aim of this study was to evaluate the role of Internet search query data in health policy development. To do so, we studied the public’s reaction to a major societal event in the context of the 2012 Sandy Hook School shooting incident. Methods Query data from the Yahoo! search engine regarding firearm-related searches was analyzed to examine changes in user-selected search terms and subsequent websites visited for a period of 14 days before and after the shooting incident. Results A total of 5,653,588 firearm-related search queries were analyzed. In the after period, queries increased for search terms related to “guns” (+50.06%), “shooting incident” (+333.71%), “ammunition” (+155.14%), and “gun-related laws” (+535.47%). The highest increase (+1054.37%) in Web traffic was seen by news websites following “shooting incident” queries whereas searches for “guns” (+61.02%) and “ammunition” (+173.15%) resulted in notable increases in visits to retail websites. Firearm-related queries generally returned to baseline levels after approximately 10 days. Conclusions Search engine queries present a viable infodemiology metric on public reactions and subsequent behaviors to major societal events and could be used by policymakers to inform policy development.
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Affiliation(s)
- Nir Menachemi
- Richard M. Fairbanks School of Public HealthHealth Policy and ManagementIndiana University-IUPUIIndianapolis, INUnited States.,Regenstrief InstituteCenter for Biomedical InformaticsIndianapolis, INUnited States
| | - Saurabh Rahurkar
- Regenstrief InstituteCenter for Biomedical InformaticsIndianapolis, INUnited States
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18
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Mennemeyer ST, Menachemi N, Rahurkar S, Ford EW. Impact of the HITECH Act on physicians' adoption of electronic health records. J Am Med Inform Assoc 2015; 23:375-9. [PMID: 26228764 DOI: 10.1093/jamia/ocv103] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 06/17/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The Health Information Technology for Economic and Clinical Health (HITECH) Act has distributed billions of dollars to physicians as incentives for adopting certified electronic health records (EHRs) through the meaningful use (MU) program ultimately aimed at improving healthcare outcomes. The authors examine the extent to which the MU program impacted the EHR adoption curve that existed prior to the Act. METHODS Bass and Gamma Shifted Gompertz (G/SG) diffusion models of the adoption of "Any" and "Basic" EHR systems in physicians' offices using consistent data series covering 2001-2013 and 2006-2013, respectively, are estimated to determine if adoption was stimulated during either a PrePay (2009-2010) period of subsidy anticipation or a PostPay (2011-2013) period when payments were actually made. RESULTS Adoption of Any EHR system may have increased by as much as 7 percentage points above the level predicted in the absence of the MU subsidies. This estimate, however, lacks statistical significance and becomes smaller or negative under alternative model specifications. No substantial effects are found for Basic systems. The models suggest that adoption was largely driven by "imitation" effects (q-coefficient) as physicians mimic their peers' technology use or respond to mandates. Small and often insignificant "innovation" effects (p-coefficient) are found suggesting little enthusiasm by physicians who are leaders in technology adoption. CONCLUSION The authors find weak evidence of the impact of the MU program on EHR uptake. This is consistent with reports that many current EHR systems reduce physician productivity, lack data sharing capabilities, and need to incorporate other key interoperability features (e.g., application program interfaces).
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Affiliation(s)
- Stephen T Mennemeyer
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nir Menachemi
- Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA
| | - Saurabh Rahurkar
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Eric W Ford
- Department of Health Policy, Bloomberg School of Public Health, Johns Hopkins University, Baltimore MD, USA
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Rahurkar S, Vest JR, Menachemi N. Health Information Exchange: The Authors Reply. Health Aff (Millwood) 2015; 34:1070. [DOI: 10.1377/hlthaff.2015.0457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Rahurkar S, Vest JR, Menachemi N. Despite The Spread Of Health Information Exchange, There Is Little Evidence Of Its Impact On Cost, Use, And Quality Of Care. Health Aff (Millwood) 2015; 34:477-83. [DOI: 10.1377/hlthaff.2014.0729] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Saurabh Rahurkar
- Saurabh Rahurkar is a doctoral candidate in health care organization and policy at the School of Public Health, University of Alabama at Birmingham
| | - Joshua R. Vest
- Joshua R. Vest is an assistant professor in the Department of Public Health, Division of Quality and Medical Informatics, at Weill Cornell Medical College, in New York City
| | - Nir Menachemi
- Nir Menachemi (
) is a professor in and chair of the Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, at Indiana University, in Indianapolis
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Ferdinand AO, Sen B, Rahurkar S, Engler S, Menachemi N. The relationship between built environments and physical activity: a systematic review. Am J Public Health 2012; 102:e7-e13. [PMID: 22897546 PMCID: PMC3490655 DOI: 10.2105/ajph.2012.300740] [Citation(s) in RCA: 178] [Impact Index Per Article: 14.8] [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] [Accepted: 02/09/2012] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We conducted a systematic review of the literature examining the relationship between built environments (e.g., parks, trails, sidewalks) and physical activity (PA) or obesity rates. METHODS We performed a 2-step inclusion protocol to identify empirical articles examining any form of built environment and any form of PA (or obesity rate) as the outcome. We extracted data from included abstracts for analysis by using a standard code sheet developed for this study. RESULTS Of 169 included articles, 89.2% reported beneficial relationships-but virtually all articles utilized simple observational study designs not suited for determining causality. Studies utilizing objective PA measures (e.g., pedometer) were 18% less likely to identify a beneficial relationship. Articles focusing on children in community settings (-14.2%), those examining direct measures of obesity (-6.2%), or those with an academic first author (-3.4%) were less likely to find a beneficial relationship. CONCLUSIONS Policymakers at federal and local levels should encourage more rigorous scientific research to determine whether altered built environments will result in increased PA and decreased obesity rates.
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Affiliation(s)
- Alva O Ferdinand
- Department of Health Care Organization and Policy, University of Alabama at Birmingham, USA
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