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Forth VE, Cardet JC, Chang KL, Ericson B, Hurley LP, Maher NE, Staton EW, Sosa BT, Israel E. What Patients Call Their Inhalers Is Associated with "Asthma Attacks". J Am Board Fam Med 2023; 36:650-661. [PMID: 37468217 DOI: 10.3122/jabfm.2022.220270r2] [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: 08/05/2022] [Revised: 11/08/2023] [Accepted: 03/06/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Clinician-patient miscommunication contributes to worse asthma outcomes. What patients call their asthma inhalers and its relationship with asthma morbidity are unknown. METHODS Inhaler names were ascertained from Black and Latinx adults with moderate-severe asthma and categorized as "standard" if based on brand/generic name or inhaler type (i.e., controller vs. rescue) or "non-standard" for other terms (i.e., color, device type, e.g., "puffer," or unique names). Clinical characteristics and asthma morbidity measures were evaluated at baseline: self-reported asthma exacerbations one year before enrollment (i.e., systemic corticosteroid bursts, emergency department (ED)/urgent care (UC) visits, or hospitalizations), and asthma control and quality of life. Multivariable regression models tested the relationship between non-standard names and asthma morbidity measures, with adjustments. RESULTS Forty-four percent (502/1150) of participants used non-standard inhaler names. These participants were more likely to be Black (p=0.006), from the Southeast (p<0.001), and have fewer years with asthma (p=0.012) relative to those who used standard names. Non-standard inhaler names was associated with an incidence rate ratio (IRR) of 1.29 (95% confidence interval [CI], 1.11-1.50, p=0.001; 1.8 vs. 1.5 events) for corticosteroid bursts for asthma, an IRR=1.43 (95% CI, 1.21-1.69, p<0.001; 1.9 vs. 1.4 events) for ED/UC visits for asthma, and an odds ratio=1.57 (95% CI, 1.12-2.18, p=0.008; 0.5 vs. 0.3 events) for asthma hospitalizations after adjustment. CONCLUSIONS Patients who use non-standard names for asthma inhalers experience increased asthma morbidity. Ascertaining what patients call their inhalers may be a quick method to identify those at higher risk of poor outcomes.
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Affiliation(s)
- Victoria E Forth
- From the Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA (VEF, BE, NEM, EI, PAH, JK, JRL, JC, JDS); Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida, Morsani College of Medicine, Tampa, FL (JCC); Denver Health and Hospital Authority, Denver, CO (LPH); Lucas Research, Morehead City, NC (KLC); American Academy of Family Physicians National Research Network, Leawood, KS (EWS, JKC, BKM, WDP, JBS); University of Colorado Department of Family Medicine, Aurora, CO (EWS, JKC); Department of Internal Medicine, Allergy/Immunology Section, University of Puerto Rico, San Juan, PR (BTS); Division of Allergy and Immunology, Brigham and Women's Hospital, Boston, MA (EI); Pulmonary Science and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO (ALF); DARTNet Institute, Aurora, CO (WDP); Division of Immunology, Boston Children's Hospital, Boston, MA (WP); University of Miami Health System, Miami, FL (MF); Division of Allergy and Immunology, Department of Medicine, NorthShore University Health System, Glenview, IL (GM); Morehouse School of Medicine, Atlanta, GA (FO)
| | - Juan Carlos Cardet
- From the Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA (VEF, BE, NEM, EI, PAH, JK, JRL, JC, JDS); Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida, Morsani College of Medicine, Tampa, FL (JCC); Denver Health and Hospital Authority, Denver, CO (LPH); Lucas Research, Morehead City, NC (KLC); American Academy of Family Physicians National Research Network, Leawood, KS (EWS, JKC, BKM, WDP, JBS); University of Colorado Department of Family Medicine, Aurora, CO (EWS, JKC); Department of Internal Medicine, Allergy/Immunology Section, University of Puerto Rico, San Juan, PR (BTS); Division of Allergy and Immunology, Brigham and Women's Hospital, Boston, MA (EI); Pulmonary Science and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO (ALF); DARTNet Institute, Aurora, CO (WDP); Division of Immunology, Boston Children's Hospital, Boston, MA (WP); University of Miami Health System, Miami, FL (MF); Division of Allergy and Immunology, Department of Medicine, NorthShore University Health System, Glenview, IL (GM); Morehouse School of Medicine, Atlanta, GA (FO)
| | - Ku-Lang Chang
- From the Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA (VEF, BE, NEM, EI, PAH, JK, JRL, JC, JDS); Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida, Morsani College of Medicine, Tampa, FL (JCC); Denver Health and Hospital Authority, Denver, CO (LPH); Lucas Research, Morehead City, NC (KLC); American Academy of Family Physicians National Research Network, Leawood, KS (EWS, JKC, BKM, WDP, JBS); University of Colorado Department of Family Medicine, Aurora, CO (EWS, JKC); Department of Internal Medicine, Allergy/Immunology Section, University of Puerto Rico, San Juan, PR (BTS); Division of Allergy and Immunology, Brigham and Women's Hospital, Boston, MA (EI); Pulmonary Science and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO (ALF); DARTNet Institute, Aurora, CO (WDP); Division of Immunology, Boston Children's Hospital, Boston, MA (WP); University of Miami Health System, Miami, FL (MF); Division of Allergy and Immunology, Department of Medicine, NorthShore University Health System, Glenview, IL (GM); Morehouse School of Medicine, Atlanta, GA (FO)
| | - Brianna Ericson
- From the Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA (VEF, BE, NEM, EI, PAH, JK, JRL, JC, JDS); Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida, Morsani College of Medicine, Tampa, FL (JCC); Denver Health and Hospital Authority, Denver, CO (LPH); Lucas Research, Morehead City, NC (KLC); American Academy of Family Physicians National Research Network, Leawood, KS (EWS, JKC, BKM, WDP, JBS); University of Colorado Department of Family Medicine, Aurora, CO (EWS, JKC); Department of Internal Medicine, Allergy/Immunology Section, University of Puerto Rico, San Juan, PR (BTS); Division of Allergy and Immunology, Brigham and Women's Hospital, Boston, MA (EI); Pulmonary Science and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO (ALF); DARTNet Institute, Aurora, CO (WDP); Division of Immunology, Boston Children's Hospital, Boston, MA (WP); University of Miami Health System, Miami, FL (MF); Division of Allergy and Immunology, Department of Medicine, NorthShore University Health System, Glenview, IL (GM); Morehouse School of Medicine, Atlanta, GA (FO)
| | - Laura P Hurley
- From the Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA (VEF, BE, NEM, EI, PAH, JK, JRL, JC, JDS); Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida, Morsani College of Medicine, Tampa, FL (JCC); Denver Health and Hospital Authority, Denver, CO (LPH); Lucas Research, Morehead City, NC (KLC); American Academy of Family Physicians National Research Network, Leawood, KS (EWS, JKC, BKM, WDP, JBS); University of Colorado Department of Family Medicine, Aurora, CO (EWS, JKC); Department of Internal Medicine, Allergy/Immunology Section, University of Puerto Rico, San Juan, PR (BTS); Division of Allergy and Immunology, Brigham and Women's Hospital, Boston, MA (EI); Pulmonary Science and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO (ALF); DARTNet Institute, Aurora, CO (WDP); Division of Immunology, Boston Children's Hospital, Boston, MA (WP); University of Miami Health System, Miami, FL (MF); Division of Allergy and Immunology, Department of Medicine, NorthShore University Health System, Glenview, IL (GM); Morehouse School of Medicine, Atlanta, GA (FO)
| | - Nancy E Maher
- From the Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA (VEF, BE, NEM, EI, PAH, JK, JRL, JC, JDS); Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida, Morsani College of Medicine, Tampa, FL (JCC); Denver Health and Hospital Authority, Denver, CO (LPH); Lucas Research, Morehead City, NC (KLC); American Academy of Family Physicians National Research Network, Leawood, KS (EWS, JKC, BKM, WDP, JBS); University of Colorado Department of Family Medicine, Aurora, CO (EWS, JKC); Department of Internal Medicine, Allergy/Immunology Section, University of Puerto Rico, San Juan, PR (BTS); Division of Allergy and Immunology, Brigham and Women's Hospital, Boston, MA (EI); Pulmonary Science and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO (ALF); DARTNet Institute, Aurora, CO (WDP); Division of Immunology, Boston Children's Hospital, Boston, MA (WP); University of Miami Health System, Miami, FL (MF); Division of Allergy and Immunology, Department of Medicine, NorthShore University Health System, Glenview, IL (GM); Morehouse School of Medicine, Atlanta, GA (FO)
| | - Elizabeth W Staton
- From the Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA (VEF, BE, NEM, EI, PAH, JK, JRL, JC, JDS); Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida, Morsani College of Medicine, Tampa, FL (JCC); Denver Health and Hospital Authority, Denver, CO (LPH); Lucas Research, Morehead City, NC (KLC); American Academy of Family Physicians National Research Network, Leawood, KS (EWS, JKC, BKM, WDP, JBS); University of Colorado Department of Family Medicine, Aurora, CO (EWS, JKC); Department of Internal Medicine, Allergy/Immunology Section, University of Puerto Rico, San Juan, PR (BTS); Division of Allergy and Immunology, Brigham and Women's Hospital, Boston, MA (EI); Pulmonary Science and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO (ALF); DARTNet Institute, Aurora, CO (WDP); Division of Immunology, Boston Children's Hospital, Boston, MA (WP); University of Miami Health System, Miami, FL (MF); Division of Allergy and Immunology, Department of Medicine, NorthShore University Health System, Glenview, IL (GM); Morehouse School of Medicine, Atlanta, GA (FO)
| | - Bonnie Telón Sosa
- From the Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA (VEF, BE, NEM, EI, PAH, JK, JRL, JC, JDS); Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida, Morsani College of Medicine, Tampa, FL (JCC); Denver Health and Hospital Authority, Denver, CO (LPH); Lucas Research, Morehead City, NC (KLC); American Academy of Family Physicians National Research Network, Leawood, KS (EWS, JKC, BKM, WDP, JBS); University of Colorado Department of Family Medicine, Aurora, CO (EWS, JKC); Department of Internal Medicine, Allergy/Immunology Section, University of Puerto Rico, San Juan, PR (BTS); Division of Allergy and Immunology, Brigham and Women's Hospital, Boston, MA (EI); Pulmonary Science and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO (ALF); DARTNet Institute, Aurora, CO (WDP); Division of Immunology, Boston Children's Hospital, Boston, MA (WP); University of Miami Health System, Miami, FL (MF); Division of Allergy and Immunology, Department of Medicine, NorthShore University Health System, Glenview, IL (GM); Morehouse School of Medicine, Atlanta, GA (FO)
| | - Elliot Israel
- From the Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA (VEF, BE, NEM, EI, PAH, JK, JRL, JC, JDS); Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida, Morsani College of Medicine, Tampa, FL (JCC); Denver Health and Hospital Authority, Denver, CO (LPH); Lucas Research, Morehead City, NC (KLC); American Academy of Family Physicians National Research Network, Leawood, KS (EWS, JKC, BKM, WDP, JBS); University of Colorado Department of Family Medicine, Aurora, CO (EWS, JKC); Department of Internal Medicine, Allergy/Immunology Section, University of Puerto Rico, San Juan, PR (BTS); Division of Allergy and Immunology, Brigham and Women's Hospital, Boston, MA (EI); Pulmonary Science and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO (ALF); DARTNet Institute, Aurora, CO (WDP); Division of Immunology, Boston Children's Hospital, Boston, MA (WP); University of Miami Health System, Miami, FL (MF); Division of Allergy and Immunology, Department of Medicine, NorthShore University Health System, Glenview, IL (GM); Morehouse School of Medicine, Atlanta, GA (FO).
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Chiang YC, Ni W, Zhang G, Shi X, Patel MR. The Association Between Cost-Related Non-Adherence Behaviors and Diabetes Outcomes. J Am Board Fam Med 2023; 36:15-24. [PMID: 36759134 PMCID: PMC10626976 DOI: 10.3122/jabfm.2022.220272r2] [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: 08/08/2022] [Revised: 10/01/2022] [Accepted: 10/11/2022] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND We examined the impact of various comorbid conditions on diabetes and condition-specific cost-related nonadherence (CRN), and HbA1c in adults with diabetes. METHODS This was a cross-sectional analysis of participants with diabetes and poor glycemic control in an ongoing trial (n = 600). We computed prevalence of condition-specific CRN, prevalence of specific types of diabetes-related CRN by comorbid condition, prevalence of specific types of condition-specific CRN within each comorbidity, and the association between condition-specific and diabetes-related CRN and HbA1c for each comorbid condition. RESULTS Fifty-eight percent (n = 350) of participants reported diabetes-related CRN. Diabetes-related CRN rates were highest in those with liver problems (63%), anemia (61%), respiratory diseases (60%), and hyperlipidemia (60%). Condition-specific CRN rates were high in those with respiratory diseases (44%), back pain (41%), and depression (40%). Participants with cancer and kidney diseases reported the lowest rates of diabetes-related and condition-specific CRN. Delaying getting diabetes prescriptions filled was the most commonly reported form of diabetes-related CRN across all comorbid conditions and was the highest in those with liver problems (47%), anemia (46%), and respiratory diseases (45%). In adjusted models, those with back pain (beta-coefficient, 0.45; 95%CI 0.02-0.88; P = .04) and hyperlipidemia (beta-coefficient, 0.50; 95%CI 0.11-0.88; P = .01) who reported both diabetes-related and condition-specific CRN had higher HbA1c. CONCLUSIONS CRN in patients with diabetes is higher than in other comorbid conditions and is associated with poor diabetes control. These findings may be driven by higher out-of-pocket costs for medications to manage diabetes, lack of symptoms associated with poor diabetes control, or other factors, with implications for both clinicians and health insurance programs.
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Affiliation(s)
- Yu-Chyn Chiang
- From the College of Pharmacy, University of Michigan (YC,WN); Department of Biostatistics, University of Michigan School of Public Health (GZ, XS); Department of Health Behavior and Health Education, University of Michigan School of Public Health (MP)
| | - William Ni
- From the College of Pharmacy, University of Michigan (YC,WN); Department of Biostatistics, University of Michigan School of Public Health (GZ, XS); Department of Health Behavior and Health Education, University of Michigan School of Public Health (MP)
| | - Guanghao Zhang
- From the College of Pharmacy, University of Michigan (YC,WN); Department of Biostatistics, University of Michigan School of Public Health (GZ, XS); Department of Health Behavior and Health Education, University of Michigan School of Public Health (MP)
| | - Xu Shi
- From the College of Pharmacy, University of Michigan (YC,WN); Department of Biostatistics, University of Michigan School of Public Health (GZ, XS); Department of Health Behavior and Health Education, University of Michigan School of Public Health (MP)
| | - Minal R Patel
- From the College of Pharmacy, University of Michigan (YC,WN); Department of Biostatistics, University of Michigan School of Public Health (GZ, XS); Department of Health Behavior and Health Education, University of Michigan School of Public Health (MP).
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Weiss DJ, Wang C, Basford JR, Suen KY, Alvarado IM, Cheville A. Does the Mode of PROM Administration Affect the Responses of Hospitalized Patients? Arch Phys Med Rehabil 2021; 103:S59-S66.e3. [PMID: 34606758 PMCID: PMC8971138 DOI: 10.1016/j.apmr.2021.07.813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/29/2021] [Accepted: 07/21/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine whether a multidimensional computerized adaptive test, the Functional Assessment in Acute Care Multidimensional Computerized Adaptive Test (FAMCAT), could be administered to hospitalized patients via a tablet computer rather than being orally administered by an interviewer. DESIGN A randomized comparison of the responses of hospitalized patients to interviewer vs. tablet delivery of the FAMCAT and its assessment of Applied Cognition, Daily Activity, and Basic Mobility. SETTING Two quaternary teaching hospitals in the Upper Midwest. PARTICIPANTS A total of 300 patients (127 men, 165 females ), average age 61.2 (range 18 to 97)) hospitalized on medical, or re-hospitalized on surgical, services were randomly assigned to either a tablet (150) or an interview (150) group. INTERVENTION Electronic tablet versus interview. MAIN OUTCOME MEASURES Item response theory (IRT) point estimates of the FAMCAT latent scales, their psychometric standard errors, number of items administered per domain, the determinant (an indicator of overall precision of the latent trait vector), as well as the time that patients required to complete their FAMCAT sessions. RESULTS Of the 300 patients, 292 completed their assessments. (The assessments of 4 individuals in each group were interrupted by clinical care and were not included in the analyses.) A significant (p = .009) mode effect (i.e., interview vs. tablet) was identified when all outcome variables were considered simultaneously. However, the only outcome that was affected by the administration mode was test duration: tablet administration reduced the roughly 6-minute test time required by both approaches by only 20 seconds which, while statistically significant, was clinically insignificant. CONCLUSIONS The results of a FAMCAT assessment, at least for this cohort of hospitalized patients, are independent of administration via tablet computer or interview.
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Affiliation(s)
- David J Weiss
- Department of Psychology, University of Minnesota, Minneapolis, MN.
| | - Chun Wang
- College of Education, University of Washington, Seattle, WA
| | - Jeffrey R Basford
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN
| | - King Yiu Suen
- Department of Psychology, University of Minnesota, Minneapolis, MN
| | - Isabella M Alvarado
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN
| | - Andrea Cheville
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN
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Pizetta B, Raggi LG, Rocha KSS, Cerqueira-Santos S, de Lyra-Jr DP, dos Santos Júnior GA. Does drug dispensing improve the health outcomes of patients attending community pharmacies? A systematic review. BMC Health Serv Res 2021; 21:764. [PMID: 34340700 PMCID: PMC8330087 DOI: 10.1186/s12913-021-06770-0] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 07/21/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Drug dispensing is a clinical pharmacy service that promotes access to medicines and their rational use. However, there is a lack of evidence for the impact of drug dispensing on patients' health outcomes. Thus, the purpose of this study was to assess the influence of drug dispensing on the clinical, humanistic, and economic outcomes of patients attending community pharmacies. METHODS A systematic literature search was performed in April 2021 using PubMed, Web of Science, Cochrane Library, LILACS, and Open Thesis. Two reviewers screened titles, abstracts, and full-text articles according to the eligibility criteria. Methodological quality was assessed using tools from the Joanna Briggs Institute, and the literature was synthesized narratively. RESULTS We retrieved 3,685 articles and included nine studies that presented 13 different outcomes. Regarding the design, they were cross-sectional (n = 4), randomized clinical trials (n = 4), and quasi-experimental (n = 1). A positive influence of drug dispensing on health outcomes was demonstrated through six clinical, four humanistic and three economic outcomes. Eight studies (88,9 %) used intermediate outcomes. The assessment of methodological quality was characterized by a lack of clarity and/or lack of information in primary studies. CONCLUSIONS Most articles included in this review reported a positive influence of drug dispensing performed by community pharmacists on patients' health outcomes. The findings of this study may be of interest to patients, pharmacists, decision makers, and healthcare systems, since they may contribute to evidence-based decision-making, strengthening the contribution of community pharmacists to health care. TRIAL REGISTRATION Registration: PROSPERO CRD42020191701 .
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Affiliation(s)
- Bárbara Pizetta
- Research Group on Implementation and Integration of Clinical Pharmacy Services in Brazilian Health System (SUS), Department of Pharmacy and Nutrition, Federal University of Espírito Santo, ES Alegre, Brazil
| | - Lívia Gonçalves Raggi
- Research Group on Implementation and Integration of Clinical Pharmacy Services in Brazilian Health System (SUS), Department of Pharmacy and Nutrition, Federal University of Espírito Santo, ES Alegre, Brazil
| | - Kérilin Stancine Santos Rocha
- Health Sciences Graduate Program, Graduate Program in Pharmaceutical Sciences, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, SE São Cristóvão, Brazil
| | - Sabrina Cerqueira-Santos
- Health Sciences Graduate Program, Graduate Program in Pharmaceutical Sciences, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, SE São Cristóvão, Brazil
| | - Divaldo Pereira de Lyra-Jr
- Health Sciences Graduate Program, Graduate Program in Pharmaceutical Sciences, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, SE São Cristóvão, Brazil
| | - Genival Araujo dos Santos Júnior
- Research Group on Implementation and Integration of Clinical Pharmacy Services in Brazilian Health System (SUS), Department of Pharmacy and Nutrition, Federal University of Espírito Santo, ES Alegre, Brazil
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Tanael M. Use of Point-of-Care Ultrasonography in Primary Care to Redress Health Inequities. J Am Board Fam Med 2021; 34:853-5. [PMID: 34312279 DOI: 10.3122/jabfm.2021.04.200452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 01/21/2021] [Accepted: 03/23/2021] [Indexed: 11/08/2022] Open
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Berdahl CT, Easterlin MC, Ryan G, Needleman J, Nuckols TK. Primary Care Physicians' Conceptualization of Quality in Medicare's Merit-Based Incentive Payment System. J Am Board Fam Med 2021; 34:590-601. [PMID: 34088819 DOI: 10.3122/jabfm.2021.03.200555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/19/2021] [Accepted: 01/20/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND While administrators of pay-for-performance may have good intentions, physicians may be reluctant to participate for various reasons, including poor program alignment with realities of clinical practice. In this study, we sought to characterize how primary care physicians (PCPs) participating in Medicare's Merit-Based Incentive Payment System (MIPS) conceptualize the quality of health care to help inform future measurement strategies that physicians would understand and appreciate. METHODS We performed semi-structured qualitative interviews with a nationwide sample of 20 PCPs in MIPS. We asked PCPs how they would characterize quality and what distinguished exceptional, good, and poor quality. Interviews were transcribed and 2 coders independently read transcripts, allowing data to emerge from the interviews and developing theories about the data. The coders met intermittently to discuss findings, harmonize the coding scheme, develop a final list of themes and subthemes, and aggregate a list of representative quotations. RESULTS Participants described quality as consisting of 2 components: (1) evidence-based care that is safe, which included health maintenance and chronic disease control, accurate diagnoses, and guideline adherence, and (2) patient-centered care, which included spending enough time with patients, responding to patient concerns, and establishing long-term relationships founded on trust. CONCLUSIONS PCPs consider patient-centered care necessary for the provision of exceptional quality. Program administrators for quality measurement and pay-for-performance programs should explore new ways to reward PCPs for providing outstanding patient-centered care. Future research should be undertaken to determine whether patient-centered activities such as forging long-term, favorable patient-physician relationships, are associated with improved health outcomes.
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Hong YR, Huo J, Jo A, Cardel M, Mainous AG 3rd. Association of Patient-Provider Teach-Back Communication with Diabetic Outcomes: A Cohort Study. J Am Board Fam Med 2020; 33:903-12. [PMID: 33219069 DOI: 10.3122/jabfm.2020.06.200217] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/15/2020] [Accepted: 07/20/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The purpose of this study is to examine the patterns of patient teach-back experience (also known as "interactive communication loop") and determine its association with risk for diabetic complications and hospitalization, and health expenditures among individuals with diabetes. METHODS A retrospective cohort study of 2901 US adults aged 18 years or older with a confirmed diagnosis of diabetes was conducted using data from the 2011 to 2016 Longitudinal Medical Expenditure Panel Survey. Survey-design adjusted multivariable models were used to examine whether having patient teach-back experience at the baseline year (Year 1) is associated with development of diabetic complications, hospitalization, and health expenditure at follow-up year (Year 2). Health expenditures were adjusted for inflation and expressed in 2017 US dollars. All adjusted models included patient sociodemographic and clinical characteristics. RESULTS Analyses found that patients with teach-back experience were less likely to develop diabetic complications (adjusted odds ratio [AOR], 0.70; 95% CI, 0.52-0.96) and be admitted to the hospital due to diabetic complications (AOR, 0.51; 95% CI, 0.29-0.88) at 1-year followup. Patients having teach-back experience also had a significantly smaller increase in total expenditures of $1920 compared with those not having teach-back of $3639 (a differential change of -$1579; 95% CI, -$1717 to -$1443; P < .001). CONCLUSIONS Teach-back could be an effective communication strategy that has potential to improve health outcomes, resulting in savings in diabetes care.
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Stransky ML, Oshita JY, Morris MA. Prevalence of Behavioral Health Problems Among Adults With and Without Communication Disabilities. J Am Board Fam Med 2020; 33:932-41. [PMID: 33219072 DOI: 10.3122/jabfm.2020.06.200216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/09/2020] [Accepted: 07/09/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Adults with communication disabilities (CDs) experience poor health and health care outcomes. Few studies have examined behavioral health outcomes among this population. We compare the behavioral health of adults with CDs to their peers without such disabilities. METHODS Retrospective cohort study examining the 2012 National Health Interview Survey Voice, Speech, and Language Supplement. We compared adults (> 17 years old) with voice only (n = 2169), speech/language (SL) only (n = 730), and speech/language and voice (SLV; n = 450) disabilities to adults without CDs (n = 29,873). Outcomes include behavioral health diagnoses (eg, depression), substance misuse (eg, excessive alcohol or tobacco use), experiences (eg, nonspecific psychological distress), and health care utilization. Unadjusted Pearson's χ2 and adjusted logistic regression analyses controlling for sociodemographic, health, and other disability measures were conducted. RESULTS Adults with CDs more frequently reported diagnoses (7.1% to 35.9% vs 1.8% to 8.6%), substance misuse (SL only: 15.5% vs 5.5%), and nonspecific psychological distress (SL only: 14.7%; SLV: 22.3% vs 2.3%) compared with adults without CDs (all P < .001). These findings were consistent for all outcomes and in multivariate analyses. Odds ratios ranged from 1.4 (99.7% CI, 1.1-1.7) to 5.0 (99.7% CI, 3.6-6.8). Adults with CDs more frequently endorsed visiting mental health professionals compared with adults without CDs (voice only: 11.4%; SL only: 19.1%; SLV: 23.1%; vs 6.8%, all P < .001), but these differences became nonsignificant in multivariate analyses. CONCLUSIONS Adults with CDs experience poorer behavioral health and health care outcomes compared with persons without CDs. Barriers to identification and treatment related to CDs must be addressed for persons with CDs.
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Spithoff S, Mathieson S, Sullivan F, Guan Q, Sud A, Hum S, O'Brien MA. Clinical Decision Support Systems for Opioid Prescribing for Chronic Non-Cancer Pain in Primary Care: A Scoping Review. J Am Board Fam Med 2020; 33:529-40. [PMID: 32675264 DOI: 10.3122/jabfm.2020.04.190199] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 02/20/2020] [Accepted: 02/23/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Clinical decision support systems (CDSSs) may help clinicians prescribe opioids for chronic noncancer pain (CNCP) more appropriately. This scoping review determined the extent and range of the current evidence on CDSSs for opioid prescribing for CNCP in primary care, and whether investigators followed best evidence and current guidance in designing, implementing and evaluating these complex interventions. METHODS We searched 9 electronic databases and other data sources for studies from January 1, 2008 to October 11, 2019. Two reviewers independently screened the citations. One reviewer extracted data and a second verified for accuracy. INCLUSION CRITERIA study of a CDSS for opioid prescribing for CNCP in a primary care clinical setting. We reported quantitative results in tables and qualitative results in narrative form. RESULTS Our search yielded 5068 records, of which 14 studies met our inclusion criteria. All studies were conducted in the United States. Six studies examined local (eg, health center) CDSSs and 8 examined prescription drug monitoring program CDSSs. Three CDSSs incorporated evidence-based components. Study aims were heterogeneous and study designs included both quantitative and qualitative methodologies. No studies assessed patient health outcomes. Few studies appeared to be following guidance for evaluating complex interventions. CONCLUSIONS Few studies have rigorously assessed the use of CDSSs for opioid prescribing for CNCP in primary care settings. Going forward, investigators should include evidence-based components into the design of CDSSs and follow guidance for the development and evaluation of complex interventions.
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Saba MA, Goharpey S, Attarbashi Moghadam B, Salehi R, Afshani SM. Validation and responsiveness of the Persian version of HeartQoL questionnaire in cardiac rehabilitation after coronary artery bypass grafting: An observational study. ARYA Atheroscler 2020; 16:170-177. [PMID: 33598037 PMCID: PMC7867308 DOI: 10.22122/arya.v16i4.2098] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 04/22/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Decision making and the quality of care provided for chronic diseases have been shown to improve through patient participation. The HeartQoL questionnaire is a core health-related quality of life (HRQOL) tool specifically designed for individuals with ischemic heart disease (IHD) who have undergone interventions such as cardiac rehabilitation (CR). METHODS In this observational and multicenter study, 150 patients were recruited. The participants completed the HeartQoL, MacNew Heart Disease Questionnaire, and Short Form Health Survey (SF-36) on entering CR for validity assessment. The HeartQoL along with a Global Rating of Change (GRoC) scale (for responsiveness measurement) were completed by 100 participants 3 months later. RESULTS The mean age of all participants in validity assessment was 61.87 ± 8.13 years. Cronbach's alphas of the total scales ranged from 0.70 to 0.81 and of the subscales from 0.70 to 0.82. The Pearson correlation coefficient was used to determine construct validity; similar constructs were confirmed with correlation coefficients ranging from 0.50 to 0.69 and dissimilar constructs with correlation coefficients ranging from 0.28 to 0.29 (P < 0.010). The assessment of the responsiveness of the questionnaire indicated that the area under curve (AUC) was greater than 0.70 (range: 0.74 to 0.91) and the optimal cut-off point was 0.65. CONCLUSION The Persian version of the HeartQoL questionnaire demonstrated satisfactory psychometric properties in the sample of participants admitted to CR after coronary artery bypass grafting (CABG). The present study results showed that the HRQOL can be used by clinicians and researchers in conjunction with other outcome measures to gain additional information about symptoms relevant to HRQOL in patients referred to CR and to evaluate change over time.
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Affiliation(s)
- Maryam A. Saba
- PhD Candidate, Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Shahin Goharpey
- Assistant Professor, Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Behrouz Attarbashi Moghadam
- Associate Professor, Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Salehi
- Associate Professor, Rehabilitation Research Center, Department of Rehabilitation Management, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Sayed Mohammadreza Afshani
- Assistant Professor, Department of Cardiovascular Disease, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Stack M, LaRouche V, Zhang Y, Warden D, Stack C, Klugiene EA. Effects of Implementing a Comprehensive Opioid Reduction Protocol on Overall Opioid Prescribing Among Patients with Chronic, Non-Cancer Pain in a Rural Family Medicine Clinic: A Controlled Cross-over Trial. J Am Board Fam Med 2020; 33:502-11. [PMID: 32675261 DOI: 10.3122/jabfm.2020.04.200060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 04/28/2020] [Accepted: 04/28/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The opioid crisis presents many challenges for family practice providers in rural communities who treat patients with chronic non-cancer pain (CNCP). Unfortunately, evidence for effective opioid reduction strategies is sparse. We evaluated the effects of implementing a comprehensive opioid reduction protocol on overall opioid prescribing among patients with chronic non-cancer pain in our rural family medicine clinics. METHODS We compared mean daily milligrams morphine equivalent (MME) prescribed to patients with CNCP in our rural family medicine clinic (n = 93) with another matched clinic (n =93) after implementation of our comprehensive protocol. We also compared mean daily MME prescribed to our patients with CNCP before and after implementation of the protocol. In a subsequent cross over phase, we examined the effects of the protocol when applied to the original control group patients. RESULTS Mean daily MME in the intervention clinic (29.77) was significantly lower than the control clinic (93.2) after the intervention (t = 6.03; P < .00). Mean daily MME in the intervention group was significantly lower after implementation of the protocol (29.77) than before the protocol (MME 80.34) (t = 5.889; P < .00). After crossover, the mean daily MME was significantly lower (14.34) in the original control group than prior to the cross over intervention (85.68); (t = 8.19; P = .00). DISCUSSION Our comprehensive opioid reduction protocol led to significant reductions in opioid prescribing in our rural family medicine clinics. Future studies should include important qualitative outcome measures such as patient function.
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Johansen ME, Yun J, Griggs JM, Jackson EA, Richardson CR. Anti-Hypertensive Medication Combinations in the United States. J Am Board Fam Med 2020; 33:143-6. [PMID: 31907256 DOI: 10.3122/jabfm.2020.01.190134] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 07/12/2019] [Accepted: 07/19/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Examining the anti-hypertensive regimens of individuals with different comorbidities may offer insights into how we can improve hypertension management. METHODS The Medical Expenditure Panel Survey (2013-2015) was used to describe the most common single-, two-, three-, and four-drug hypertension regimens among hypertensive adults in four different comorbidity groups: 1. Hypertension only; 2. Hypertension and diabetes; 3. Hypertension and cardiovascular disease (coronary heart disease or stroke history); and 4. Hypertension, diabetes, and cardiovascular disease. RESULTS 15,901 adults with hypertension taking anti-hypertensive medications were included in the study. 58.6% (95% CI: 57.3-59.8) took multiple anti-hypertensive medications, but the proportion of adults taking multiple anti-hypertensives varied by comorbidity group. Regimens including an ACE-inhibitor/ARB were the most prevalent regimens among individuals taking ≥2 anti-hypertensive medications. The most common two-drug regimen for both the hypertension-only and hypertension-diabetes groups was an ACE-inhibitor/ARB with thiazide. The most prevalent regimen for the two cardiovascular disease groups was an ACE-inhibitor/ARB with beta-blocker. CONCLUSIONS Most individuals with hypertension use between 2-5 medications and the medications comprising these regimens vary by comorbidity. The ACCOMPLISH trial suggested that certain combinations may lead to superior cardiovascular outcomes. Research comparing the efficacy of different hypertension medication combinations among individuals with different comorbidities could lead to better patient hypertensionrelated outcomes.
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Martin P, Liaw W, Bazemore A, Jetty A, Petterson S, Kushel M. Adults with Housing Insecurity Have Worse Access to Primary and Preventive Care. J Am Board Fam Med 2019; 32:521-30. [PMID: 31300572 DOI: 10.3122/jabfm.2019.04.180374] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 03/26/2019] [Accepted: 03/31/2019] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Housing insecurity has been linked to high-risk behaviors and chronic disease, although less is known about the pathways leading to poor health. We sought to determine whether housing insecurity is associated with access to preventive and primary care. METHODS We conducted weighted univariate, bivariate, and multivariate analyses by using 2011 to 2015 Behavioral Risk factor Surveillance Survey data (N = 228,131 adults). The independent variable was housing insecurity derived from the question on worry about paying rent or mortgage. The outcome measures were health services utilization (no usual source of care, no routine checkup in the past 1 year, and delayed medical care due to cost), self-rated health (number of days reported physical, mental health not good, and poor overall health), and number of chronic diseases (0, 1, 2 or more). The covariates included age, sex, race/ethnicity, income, level of education, marital status, and number of children in the family. We also adjusted for state fixed effects and survey year. We performed χ2 tests and binary logistic regressions on categorical variables and ran t tests and estimated linear regression models on continuous variables. Multinomial logistic regressions were estimated for the number of chronic diseases. RESULTS Of the 228,131 adults in the study sample, 28,704 adults reported housing insecurity. We found that those with housing insecurity were more likely to forgo routine check-ups and lack usual sources of care. Low-income individuals, minorities, the unmarried, and middle-aged adults were more likely to report housing insecurity. CONCLUSION Housing insecurity is associated with worse access to preventive and primary care. Interventions to enhance access for these patients should be developed and studied.
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Parach A, Sadeghi-Ghahroudi M, Saeid Y, Ebadi A. The effect of evidence-based care guidelines on outcomes after removal of arterial sheath in patients undergoing angioplasty. ARYA Atheroscler 2019; 14:237-241. [PMID: 31143223 PMCID: PMC6527151 DOI: 10.22122/arya.v14i6.1380] [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] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Evidence-based clinical care guidelines effectively assists medical teams to increase the quality of clinical practice, and improve outcomes in patients. This study aimed to design and implement evidence-based care guidelines for removing arterial sheath in patients undergoing angioplasty of coronary artery. METHODS This clinical trial study was performed on 200 patients (two groups of 100 patients) with mean age of 62.5 ± 10.8 years, from July 2014 to February 2014 in Baqiyatallah University of Medical Sciences (BUMS), Tehran, Iran. First, we designed a five-step guideline for removing arterial sheath. Then, the designed guideline (based on five-step Stetler model, i.e. preparation, validation, comparative study, implementation, and execution) in the current study, and the routine guideline were used for removing arterial sheath in patients in the intervention and the control groups, respectively. In both groups, the relevant outcomes including bleeding, vasovagal reactions, urinary retention, and pain were evaluated. RESULTS There were significant differences between the two groups in terms of bleeding, hematoma, vasovagal reactions (n = 11 versus n = 24), urinary retention (n = 8 versus n = 31), and back pain after removing arterial sheath (P < 0.050 for all). CONCLUSION Based on the results of this study, the use of evidence-based care guidelines after removal of atrial sheath in patients undergoing angioplasty is recommended.
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Affiliation(s)
- Alireza Parach
- Department of Medical Surgical, School of Nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohsen Sadeghi-Ghahroudi
- Assistant Professor, Department of Cardiology, School of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Yaser Saeid
- Department of Medical Surgical, School of Nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Abbas Ebadi
- Professor, Behavioral Science Research Center, Life Style Institute, School of Nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Colborn KL, Helmkamp L, Bender BG, Kwan BM, Schilling LM, Sills MR. Colorado Asthma Toolkit Implementation Improves Some Process Measures of Asthma Care. J Am Board Fam Med 2019; 32:37-49. [PMID: 30610140 PMCID: PMC6943943 DOI: 10.3122/jabfm.2019.01.180155] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 09/30/2018] [Accepted: 10/02/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The Colorado Asthma Toolkit Program (CATP) has been shown to improve processes of care with less evidence demonstrating improved outcomes. OBJECTIVE To model the association between pre-and-post-CATP status and asthma-related process and outcome measures among patients ages 5 to 64 years receiving care in safety-net primary care practices. METHODS This is an implementation study involving secondary prepost analysis of existing structured clinical, administrative, and claims data. Nine primary care practices in a federally qualified health center network implemented the CATP. Processes of care and health and utilization outcomes were evaluated prepost implementation in a cohort of patients with asthma using generalized linear mixed models. RESULTS The study cohort included 2678 patients age 5 to 64 years with at least one visit to one of the 9 participating practices during the study period (March 12, 2010 to December 1, 2012). A comparison of 12 months pre- and post-CATP implementation showed improvement in some process measures of asthma care associated with the intervention, including the rate of asthma-severity measurement, although no change in 2 Health care Effectiveness Data and Information Set measures: asthma medication ratio and medication management for people with asthma. We also found no change in asthma outcomes measured across multiple domains: exacerbations, utilization, symptom scores, and pulmonary physiology measures. CONCLUSIONS Implementation of the CATP in a primary care setting led to some improved processes of asthma care, but no changes in measured outcomes. Recommendations for future work include supplemental follow-up training including case review.
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Affiliation(s)
- Kathryn L Colborn
- From the Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado (KLC); Adult & Child Consortium for Health Outcomes Research & Delivery Science, Aurora, CO (LH); Department of Pediatrics, National Jewish Health, Denver (BGB); Department of Medicine, University of Colorado School of Medicine, Aurora (BMK, LMS); Pediatrics, University of Colorado School of Medicine, Aurora (MRS).
| | - Laura Helmkamp
- From the Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado (KLC); Adult & Child Consortium for Health Outcomes Research & Delivery Science, Aurora, CO (LH); Department of Pediatrics, National Jewish Health, Denver (BGB); Department of Medicine, University of Colorado School of Medicine, Aurora (BMK, LMS); Pediatrics, University of Colorado School of Medicine, Aurora (MRS)
| | - Bruce G Bender
- From the Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado (KLC); Adult & Child Consortium for Health Outcomes Research & Delivery Science, Aurora, CO (LH); Department of Pediatrics, National Jewish Health, Denver (BGB); Department of Medicine, University of Colorado School of Medicine, Aurora (BMK, LMS); Pediatrics, University of Colorado School of Medicine, Aurora (MRS)
| | - Bethany M Kwan
- From the Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado (KLC); Adult & Child Consortium for Health Outcomes Research & Delivery Science, Aurora, CO (LH); Department of Pediatrics, National Jewish Health, Denver (BGB); Department of Medicine, University of Colorado School of Medicine, Aurora (BMK, LMS); Pediatrics, University of Colorado School of Medicine, Aurora (MRS)
| | - Lisa M Schilling
- From the Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado (KLC); Adult & Child Consortium for Health Outcomes Research & Delivery Science, Aurora, CO (LH); Department of Pediatrics, National Jewish Health, Denver (BGB); Department of Medicine, University of Colorado School of Medicine, Aurora (BMK, LMS); Pediatrics, University of Colorado School of Medicine, Aurora (MRS)
| | - Marion R Sills
- From the Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado (KLC); Adult & Child Consortium for Health Outcomes Research & Delivery Science, Aurora, CO (LH); Department of Pediatrics, National Jewish Health, Denver (BGB); Department of Medicine, University of Colorado School of Medicine, Aurora (BMK, LMS); Pediatrics, University of Colorado School of Medicine, Aurora (MRS)
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Starzec M, Truszczyńska-Baszak A, Stuge B, Tarnowski A, Rongies W. Cross-cultural Adaptation of the Pelvic Girdle Questionnaire for the Polish Population. J Manipulative Physiol Ther 2018; 41:698-703. [PMID: 30594333 DOI: 10.1016/j.jmpt.2018.04.002] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 04/03/2018] [Accepted: 04/05/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The purpose of this study was to translate and culturally adapt the Pelvic Girdle Questionnaire (PGQ) into Polish to allow pelvic girdle pain (PGP) assessment in Polish women. METHODS The translation process comprised 4 stages: forward translation, backward translation, committee review, and pretest. We then conducted a pilot study of the final version of the questionnaire in 49 women (mean age: 31.2 years, standard deviation: 3.74 years) who had PGP when pregnant or within a year postpartum. RESULTS The internal consistency of the newly created questionnaire assessed with Cronbach's α was 0.916. CONCLUSION The internal consistency of the process of translation and cross-cultural adaptation of the Polish version of the PGQ was satisfactory. The Polish version of the PGQ may be used both in clinical practice and for research among Polish women with PGP.
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Affiliation(s)
- Małgorzata Starzec
- Department of Rehabilitation, Physiotherapy Division, Second Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland.
| | | | - Britt Stuge
- Division of Orthopaedics, Oslo University Hospital, Oslo, Norway
| | | | - Witold Rongies
- Department of Rehabilitation, Physiotherapy Division, Second Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
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Abou-Foul AK, Taghi A, Tolley NS, Awad Z. Assessment of progress and competence in tonsillectomy surgery using cumulative sum analysis. J Laryngol Otol 2018; 132:734-8. [PMID: 29998814 DOI: 10.1017/S0022215118001081] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To assess the feasibility of using cumulative sum analysis to show trainees' performance curves and highlight concerns in tonsillectomy surgery. METHODS In this prospective study, the performance of eight otolaryngology trainees (in their first 6-12 months in the specialty) was compared to that of experts (over 150 tonsillectomies performed) in terms of operative time and post-operative complications. Cumulative sum analysis curves were generated to highlight trainees' performance, and were updated after each performance. RESULTS The average operative time was 23 minutes (standard deviation = 11) for experts and 38 minutes (standard deviation = 16) for trainees (p < 0.0001). Cumulative sum analysis charts for trainees' operative time initially rose and then started to plateau after a number of cases (range, 25-30), while that of experts remained low. Cumulative sum analysis charts for complications can be used to monitor performance. In this study, complications were combined (because of low incidence) to allow use of this outcome measure. CONCLUSION The flexibility of the cumulative sum analysis makes it adaptable to any outcome. It is a strong adjunct in surgical training to monitor progress and competence. Its sensitivity also allows early detection of poor performance, to instigate intervention.
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Ehlers AP, Roy SB, Khor S, Mandagani P, Maria M, Alfonso-Cristancho R, Flum DR. Improved Risk Prediction Following Surgery Using Machine Learning Algorithms. EGEMS (Wash DC) 2017; 5:3. [PMID: 29881747 PMCID: PMC5983054 DOI: 10.13063/2327-9214.1278] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background: Machine learning is used to analyze big data, often for the purposes of prediction. Analyzing a patient’s healthcare utilization pattern may provide more precise estimates of risk for adverse events (AE) or death. We sought to characterize healthcare utilization prior to surgery using machine learning for the purposes of risk prediction. Methods: Patients from MarketScan Commercial Claims and Encounters Database undergoing elective surgery from 2007–2012 with ≥1 comorbidity were included. All available healthcare claims occurring within six months prior to surgery were assessed. More than 300 predictors were defined by considering all combinations of conditions, encounter types, and timing along with sociodemographic factors. We used a supervised Naive Bayes algorithm to predict risk of AE or death within 90 days of surgery. We compared the model’s performance to the Charlson’s comorbidity index, a commonly used risk prediction tool. Results: Among 410,521 patients (mean age 52, 52 ± 9.4, 56% female), 4.7% had an AE and 0.01% died. The Charlson’s comorbidity index predicted 57% of AE’s and 59% of deaths. The Naive Bayes algorithm predicted 79% of AE’s and 78% of deaths. Claims for cancer, kidney disease, and peripheral vascular disease were the primary drivers of AE or death following surgery. Conclusions: The use of machine learning algorithms improves upon one commonly used risk estimator. Precisely quantifying the risk of an AE following surgery may better inform patient-centered decision-making and direct targeted quality improvement interventions while supporting activities of accountable care organizations that rely on accurate estimates of population risk.
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Affiliation(s)
| | - Senjuti Basu Roy
- Department of Computer Science, New Jersey Institute of Technology
| | - Sara Khor
- University of Washington Surgical Outcomes Research Center
| | - Prathyusha Mandagani
- University of Washington, Seattle Campus.,Department of Computer Science, New Jersey Institute of Technology.,University of Washington Surgical Outcomes Research Center.,GlaxoSmithKline.,University of Washington School of Medicine
| | - Moushumi Maria
- University of Washington, Seattle Campus.,Department of Computer Science, New Jersey Institute of Technology.,University of Washington Surgical Outcomes Research Center.,GlaxoSmithKline.,University of Washington School of Medicine
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Zahoor T, Dawson R, Sen M, Makura Z. Transoral laser resection or radiotherapy? Patient choice in the treatment of early laryngeal cancer: a prospective observational cohort study. J Laryngol Otol 2017; 131:541-5. [PMID: 28367790 DOI: 10.1017/S0022215116010057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The choices made by patients offered treatment for early laryngeal cancer with radiotherapy or transoral laser resection were reviewed. METHODS A prospective review was conducted of all patients diagnosed and treated for early laryngeal carcinoma from December 2002 to September 2009 at the Leeds Teaching Hospitals NHS Trust. A total of 209 patients with tumour stage T1 or T2 laryngeal cancer were treated; each new patient suitable for radiotherapy or transoral laser resection was seen jointly by the clinical (radiation) oncologist and head and neck surgeon, and offered the choice of treatment. RESULTS Of the patients, 47.4 per cent were given a choice between radiotherapy and transoral laser resection; 51.2 per cent were advised to have radiotherapy, and there were no records for the remaining 1.4 per cent. From those given the choice, 59.6 per cent chose transoral laser resection (p < 0.02 (t-test)) and 35.4 per cent chose radiotherapy. CONCLUSION When given the choice, a statistically significant majority of patients choose transoral laser resection rather than radiotherapy.
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Egeland MT, Tarangen M, Gay C, Døsen LK, Haye R. Evaluation of non-response in quality control of nasal septal surgery. J Laryngol Otol 2016; 130:1130-6. [PMID: 27786145 DOI: 10.1017/S002221511600921X] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Questionnaires are often used to assess the results of nasal septoplasty, but response rates vary widely. The possible bias caused by non-responders was evaluated to determine the validity of questionnaire results. METHODS Post-operative questionnaires employing visual analogue scales for nasal obstruction were mailed to 182 patients. The 62 non-responders (34.1 per cent) were contacted by telephone, 58 (93.5 per cent) of whom were contactable and responded orally to the questionnaire. RESULTS Non-responders were younger, but no different from responders with regard to gender, smoking habits or allergies. Post-operative visual analogue scale obstruction scores were slightly, but not statistically, higher in non-responders. However, because non-responders' pre-operative scores were lower, obstruction scores improved less than in responders. The main reason for not responding was forgetfulness. Some would have preferred an electronic version of the questionnaire. CONCLUSION Although post-operative obstruction scores did not differ between the groups, nasal obstruction scores improved more among responders than non-responders. Thus, low response rates may cause bias.
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Sauer BC, Jones BE, Globe G, Leng J, Lu CC, He T, Teng CC, Sullivan P, Zeng Q. Performance of a Natural Language Processing (NLP) Tool to Extract Pulmonary Function Test (PFT) Reports from Structured and Semistructured Veteran Affairs (VA) Data. EGEMS (Wash DC) 2016; 4:1217. [PMID: 27376095 PMCID: PMC4909376 DOI: 10.13063/2327-9214.1217] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Introduction/Objective: Pulmonary function tests (PFTs) are objective estimates of lung function, but are not reliably stored within the Veteran Health Affairs data systems as structured data. The aim of this study was to validate the natural language processing (NLP) tool we developed—which extracts spirometric values and responses to bronchodilator administration—against expert review, and to estimate the number of additional spirometric tests identified beyond the structured data. Methods: All patients at seven Veteran Affairs Medical Centers with a diagnostic code for asthma Jan 1, 2006–Dec 31, 2012 were included. Evidence of spirometry with a bronchodilator challenge (BDC) was extracted from structured data as well as clinical documents. NLP’s performance was compared against a human reference standard using a random sample of 1,001 documents. Results: In the validation set NLP demonstrated a precision of 98.9 percent (95 percent confidence intervals (CI): 93.9 percent, 99.7 percent), recall of 97.8 percent (95 percent CI: 92.2 percent, 99.7 percent), and an F-measure of 98.3 percent for the forced vital capacity pre- and post pairs and precision of 100 percent (95 percent CI: 96.6 percent, 100 percent), recall of 100 percent (95 percent CI: 96.6 percent, 100 percent), and an F-measure of 100 percent for the forced expiratory volume in one second pre- and post pairs for bronchodilator administration. Application of the NLP increased the proportion identified with complete bronchodilator challenge by 25 percent. Discussion/Conclusion: This technology can improve identification of PFTs for epidemiologic research. Caution must be taken in assuming that a single domain of clinical data can completely capture the scope of a disease, treatment, or clinical test.
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Affiliation(s)
- Brian C Sauer
- Salt Lake IDEAS Center, Veteran Affairs; Division of Epidemiology, Department of Internal Medicine, School of Medicine, University of Utah
| | - Barbara E Jones
- Salt Lake IDEAS Center, Veteran Affairs; Division of Epidemiology, Department of Internal Medicine, School of Medicine, University of Utah
| | | | - Jianwei Leng
- Division of Epidemiology, Department of Internal Medicine, School of Medicine, University of Utah
| | - Chao-Chin Lu
- Division of Epidemiology, Department of Internal Medicine, School of Medicine, University of Utah
| | - Tao He
- Division of Epidemiology, Department of Internal Medicine, School of Medicine, University of Utah
| | - Chia-Chen Teng
- Division of Epidemiology, Department of Internal Medicine, School of Medicine, University of Utah
| | - Patrick Sullivan
- Department of Pharmacy Practice, School of Pharmacy, Regis University
| | - Qing Zeng
- Salt Lake IDEAS Center, Veteran Affairs; Department of Biomedical Informatics, School of Medicine, University of Utah
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Abstract
OBJECTIVES To determine the outcome of myringoplasty as undertaken by ENT surgeons in the UK, and to assess the current systems available for providing national outcome data. METHODS A prospective national multicentre audit was conducted involving multiple hospitals throughout the UK. Participants consisted of ENT surgeons practising in the UK. RESULTS Data were prospectively collected over a three-year period between 1 March 2006 and 1 March 2009 using the web-based Common Otology Database. In total, 33 surgeons provided valid and complete data for 495 procedures. The overall closure rate for myringoplasty was 89.5 per cent. The average hearing gain for successful primary myringoplasties was 9.14 dB (standard deviation = 10.62). The Common Otology Database provided an effective platform for capturing outcome data. CONCLUSION Myringoplasty is a safe and effective procedure in the UK. With the introduction of revalidation by the General Medical Council, participation in national audits will be mandatory in the future. This study demonstrates that a web-based audit tool would be suitable for performing such audits.
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Abstract
OBJECTIVE This study aimed to assess the experiences and outcomes of patients who underwent surgical repair of a perilymph fistula in Norfolk, UK. METHODS The study involved a retrospective questionnaire-based patient survey and case note review of patients who had undergone tympanotomy and perilymph fistula repair between 1998 and 2012 in two district general hospitals. RESULTS Fourteen patients underwent 20 procedures, of whom 7 completed the pre- and post-operative Vertigo Symptom Scale. In five patients, there was no obvious precipitating cause. Perilymph fistula was precipitated by noise in one patient, by a pressure-increasing event in six patients and by trauma in two patients. The Vertigo Symptom Scale scores showed a statistically significant improvement following surgical repair, from a median of 67 (out of 175) pre-operatively to 19 post-operatively. CONCLUSION In selected patients with vertigo, perilymph fistula should be considered; surgical repair can significantly improve symptoms.
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Annen M, Peterson C, Leemann S, Schmid C, Anklin B, Humphreys BK. Comparison of Outcomes in MRI Confirmed Lumbar Disc Herniation Patients With and Without Modic Changes Treated With High Velocity, Low Amplitude Spinal Manipulation. J Manipulative Physiol Ther 2016; 39:200-9. [PMID: 27046146 DOI: 10.1016/j.jmpt.2016.02.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 10/16/2015] [Accepted: 10/16/2015] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The purpose of this study was to determine if there is a difference in outcomes between Modic positive and negative lumbar disc herniation (LDH) patients treated with spinal manipulative therapy (SMT). METHODS This prospective outcomes study includes 72 MRI confirmed symptomatic LDH patients treated with SMT. Numerical rating scale (NRS) pain and Oswestry disability data were collected at baseline. NRS, patient global impression of change to assess overall improvement, and Oswestry data were collected at 2 weeks, 1, 3, 6 months and 1 year. MRI scans were analyzed for Modic change present/absent and classified as Modic I or II when present. Chi-squared test compared the proportion of patients reporting relevant 'improvement' between patients with and without Modic changes and those with Modic I vs. II. NRS and Oswestry scores were compared at baseline and change scores at all follow-up time points using the unpaired Student t test. RESULTS 76.5% of Modic positive patients reported 'improvement' compared to 53.3% of Modic negative patients (P = .09) at 2 weeks. Modic positive patients had larger decreases in leg pain (P = .02) and disability scores (P = .012) at 2 weeks. Modic positive patients had larger reductions in disability levels at 3 (P = .049) and 6 months (P = .001). A significant difference (P = .001) between patients with Modic I vs. Modic II was found at 1 year, where Modic II patients did significantly better. CONCLUSION Modic positive patients reported higher levels of clinically relevant improvement 2 weeks, 3 and 6 months compared to Modic negative patients. However, at 1 year Modic I patients were significantly less likely to report 'improvement', suggesting they may be prone to relapse.
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Affiliation(s)
- Michelé Annen
- Chiropractic Medicine Student, Chiropractic Medicine Department, Faculty of Medicine, Orthopaedic University Hospital Balgrist, University of Zürich, Zürich, Switzerland
| | - Cynthia Peterson
- Professor, Chiropractic Medicine Department, Faculty of Medicine, Orthopaedic University Hospital Balgrist, University of Zürich, Zürich, Switzerland.
| | | | | | | | - B Kim Humphreys
- Professor and Department Head, Chiropractic Medicine Department, Faculty of Medicine, Orthopaedic University Hospital Balgrist, University of Zürich, Zürich, Switzerland
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Peterson CK, Pfirrmann CWA, Hodler J, Leemann S, Schmid C, Anklin B, Humphreys BK. Symptomatic, Magnetic Resonance Imaging-Confirmed Cervical Disk Herniation Patients: A Comparative-Effectiveness Prospective Observational Study of 2 Age- and Sex-Matched Cohorts Treated With Either Imaging-Guided Indirect Cervical Nerve Root Injections or Spinal Manipulative Therapy. J Manipulative Physiol Ther 2016; 39:210-7. [PMID: 27040033 DOI: 10.1016/j.jmpt.2016.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 10/14/2015] [Accepted: 10/14/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of this study was to compare the outcomes of overall improvement, pain reduction, and treatment costs in matched patients with symptomatic, magnetic resonance imaging-confirmed cervical disk herniations treated with either spinal manipulative therapy (SMT) or imaging-guided cervical nerve root injection blocks (CNRI). METHODS This prospective cohort comparative-effectiveness study included 104 patients with magnetic resonance imaging-confirmed symptomatic cervical disk herniation. Fifty-two patients treated with CNRI were age and sex matched with 52 patients treated with SMT. Baseline numerical rating scale (NRS) pain data were collected. Three months after treatment, NRS pain levels were recorded and overall "improvement" was assessed using the Patient Global Impression of Change scale. Only responses "much better" or "better" were considered "improved." The proportion of patients "improved" was calculated for each treatment method and compared using the χ(2) test. The NRS and NRS change scores for the 2 groups were compared at baseline and 3 months using the unpaired t test. Acute and subacute/chronic patients in the 2 groups were compared for "improvement" using the χ(2) test. RESULTS "Improvement" was reported in 86.5% of SMT patients and 49.0% of CNRI patients (P = .0001). Significantly more CNRI patients were in the subacute/chronic category (77%) compared with SMT patients (46%). A significant difference between the proportion of subacute/chronic CNRI patients (37.5%) and SMT patients (78.3%) reporting "improvement" was noted (P = .002). CONCLUSION Subacute/chronic patients treated with SMT were significantly more likely to report relevant "improvement" compared with CNRI patients. There was no difference in outcomes when comparing acute patients only.
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Affiliation(s)
- Cynthia K Peterson
- Professor, Radiology Department, Orthopaedic University Hospital Balgrist, University of Zürich, Switzerland; Professor, Chiropractic Medicine Department, Orthopaedic University Hospital Balgrist, University of Zürich, Switzerland.
| | - Christian W A Pfirrmann
- Professor, Head of Radiology Department, Orthopaedic University Hospital Balgrist, University of Zürich, Switzerland
| | - Jürg Hodler
- Professor, Head of Radiology Department, University Hospital, University of Zürich
| | | | | | | | - B Kim Humphreys
- Professor, Department Head, Chiropractic Medicine, Faculty of Medicine, Orthopaedic University Hospital Balgrist, University of Zürich, Switzerland
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Emons MF, Bae JP, Hoogwerf BJ, Kindermann SL, Taylor RJ, Nathanson BH. Risk factors for 30-day readmission following hypoglycemia-related emergency room and inpatient admissions. BMJ Open Diabetes Res Care 2016; 4:e000160. [PMID: 27110366 PMCID: PMC4838663 DOI: 10.1136/bmjdrc-2015-000160] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 01/29/2016] [Accepted: 03/04/2016] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Hypoglycemia is a serious complication of diabetes treatment. This retrospective observational study characterized hypoglycemia-related hospital emergency room (ER) and inpatient (in-pt) admissions and identified risk factors for 30-day all-cause and hypoglycemia-related readmission. RESEARCH DESIGN AND METHODS 4476 hypoglycemia-related ER and in-pt encounters with discharge dates from 1/1/2009 to 3/31/2014 were identified in a large, multicenter electronic health record database. Outcomes were 30-day all-cause ER/hospital readmission and hypoglycemia-related readmission. Multivariable logistic regression methods identified risk factors for both outcomes. RESULTS 1095 (24.5%) encounters had ER/hospital all-cause readmission within 30 days and 158 (14.4%) of these were hypoglycemia-related. Predictors of all-cause 30-day readmission included recent exposure to a hospital/nursing home (NH)/skilled nursing facility (SNF; OR 1.985, p<0.001); age 25-34 and 35-44 (OR 2.334 and 1.996, respectively, compared with age 65-74, both p<0.001); and African-American (AA) race versus all other race categories (OR 1.427, p=0.011). Other factors positively associated with readmission include chronic obstructive pulmonary disease, cerebrovascular disease, cardiac dysrhythmias, congestive heart disease, hypertension, and mood disorders. Predictors of readmissions attributable to hypoglycemia included recent exposure to a hospital/NH/SNF (OR 2.299, p<0.001), AA race (OR 1.722, p=0.002), age 35-44 (OR 3.484, compared with age 65-74, p<0.001), hypertension (OR 1.891, p=0.019), and delirium/dementia and other cognitive disorders (OR 1.794, p=0.038). Obesity was protective against 30-day hypoglycemia-related readmission (OR 0.505, p=0.017). CONCLUSIONS Factors associated with 30-day all-cause and hypoglycemia-related readmission among patients with diabetic hypoglycemia include recent exposure to hospital/SNF/NH, adults <45 years, AAs, and several cardiovascular and respiratory-related comorbid conditions.
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Kuhn L, Reeves K, Taylor Y, Tapp H, McWilliams A, Gunter A, Cleveland J, Dulin M. Planning for Action: The Impact of an Asthma Action Plan Decision Support Tool Integrated into an Electronic Health Record (EHR) at a Large Health Care System. J Am Board Fam Med 2015; 28:382-93. [PMID: 25957371 DOI: 10.3122/jabfm.2015.03.140248] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Asthma is a chronic airway disease that can be difficult to manage, resulting in poor outcomes and high costs. Asthma action plans assist patients with self-management, but provider compliance with this recommendation is limited in part because of guideline complexity. This project aimed to embed an electronic asthma action plan decision support tool (eAAP) into the medical record to streamline evidence-based guidelines for providers at the point of care, create individualized patient handouts, and evaluate effects on disease outcomes. METHODS eAAP development occurred in 4 phases: web-based prototype creation, multidisciplinary team engagement, pilot, and system-wide dissemination. Medical record and hospital billing data compared frequencies of asthma exacerbations before and after eAAP receipt with matched controls. RESULTS Between December 2012 and September 2014, 5174 patients with asthma (∼10%) received eAAPs. Results showed an association between eAAP receipt and significant reductions in pediatric asthma exacerbations, including 33% lower odds of requiring oral steroids (P < .001), compared with controls. Equivalent adult measures were not statistically significant. CONCLUSIONS This study supports existing evidence that patient self-management plays an important role in reducing asthma exacerbations. We show the feasibility of leveraging technology to provide guideline-based decision support through an eAAP, addressing known challenges of implementation into routine practice.
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Abstract
INTRODUCTION Hip fractures are a significant cause of morbidity and mortality and care of hip fracture patients places a heavy burden on healthcare systems due to prolonged recovery time. Measuring quality of care delivered to hip fracture patients is important to help target efforts to improve care for patients and efficiency of the health system. The purpose of this study is to synthesise the evidence surrounding quality of care indicators for patients who have sustained a hip fracture. Using a scoping review methodology, the research question that will be addressed is: "What patient, institutional, and system-level indicators are currently in use or proposed for measuring quality of care across the continuum for individuals following a hip fracture?". METHODS AND ANALYSIS We will employ the methodological frameworks used by Arksey and O'Malley and Levac et al. The synthesis will be limited to quality of care indicators for individuals who suffered low trauma hip fracture. All English peer-reviewed studies published from the year 2000-most recent will be included. Literature search strategies will be developed using medical subject headings and text words related to hip fracture quality indicators and the search will be peer-reviewed. Numerous electronic databases will be searched. Two reviewers will independently screen titles and abstracts for inclusion, followed by screening of the full text of potentially relevant articles to determine final inclusion. Abstracted data will include study characteristics and indicator definitions. DISSEMINATION To improve quality of care for patients and create a more efficient healthcare system, mechanisms for the measurement of quality of care are required. The implementation of quality of care indicators enables stakeholders to target areas for improvement in service delivery. Knowledge translation activities will occur throughout the review with dissemination of the project goals and findings to local, national, and international stakeholders.
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Affiliation(s)
- Kristen B Pitzul
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Sarah E P Munce
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Laure Perrier
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Lauren Beaupre
- Department of Physical Therapy, University of Alberta, Edmonton, Canada
- Department of Surgery, University of Alberta, Edmonton, Canada
| | | | | | - Susan B Jaglal
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Canada
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Lu W, Tao Y, Wisniewski AB, Frimberger D, Kropp BP. Different outcomes of hypospadias surgery between north america, europe and china: is patient age a factor? Nephrourol Mon 2012; 4:609-12. [PMID: 23573500 PMCID: PMC3614301 DOI: 10.5812/numonthly.1853] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [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: 07/10/2011] [Revised: 07/21/2011] [Accepted: 07/30/2011] [Indexed: 11/16/2022] Open
Abstract
Background and Objects The patient’s age at the first hypospadias repair may be an important factor for determining postoperative outcomes. Age at the first procedure differs between Western countries and medical centers in China. This review examines the differences between the incidence of surgical complications and surgical age in boys receiving hypospadias repairs in North America, Europe and China. Materials and Methods Literature reports were reviewed in PubMed and WanFang databases using the key terms and phrases; ‘hypospadias outcomes’, ‘complications of hypospadias repair’ and ‘timing of hypospadias repair’. All peer-reviewed articles published over the past decade (2001-2011) were considered if; a full text was available, the article included age at the first hypospadias procedure and surgical complications. Results In total, 16 131 patients were reported in 113 papers from North America, Europe and China according to our inclusion criteria. There was a significant difference in age at the first hypospadias surgery (P < 0.0005) and in the incidence of complications (P <0.001) between the different global regions investigated, with the earliest surgeries occurring in North American patients. Urethral fistulas were the most common complication reported in all of the regions included in this study. Conclusions Fellowship training in pediatric urology could improve surgical outcomes, particularly in young children. Younger children experience fewer complications following hypospadias surgeries, independent of training and access to resources.
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Affiliation(s)
- Wenli Lu
- Department of Pediatrics, Shanghai Ruijin Hospital, Medical School of Shanghai Jiao Tong University, Shanghai, China
- Corresponding author: Wenli Lu, Department of Pediatrics, Shanghai Ruijin Hospital, Medical School of Shanghai Jiao Tong University, Shanghai, China. Tel.: +86-4052273185, Fax: E-mail:
| | - Yuehong Tao
- Department of Pediatrics, Subei People’s Hospital of Jiangsu Province, Jiangsu, China
| | - Amy B. Wisniewski
- Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Dominic Frimberger
- Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Brad P. Kropp
- Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, USA
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Lee KS, Han DH, Lee YS, Choo MS, Yoo TK, Park HJ, Yoon H, Jeong H, Lee SJ, Kim H, Park WH. Efficacy and safety of tamsulosin for the treatment of non-neurogenic voiding dysfunction in females: a 8-week prospective study. J Korean Med Sci 2010; 25:117-22. [PMID: 20052356 PMCID: PMC2800025 DOI: 10.3346/jkms.2010.25.1.117] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2008] [Accepted: 03/06/2009] [Indexed: 11/20/2022] Open
Abstract
We evaluated the therapeutic effects of tamsulosin for women with non-neurogenic voiding dysfunction. Women who had voiding dysfunctions for at least 3 months were included. Inclusion criteria were age > or =18 yr, International Prostate Symptom Score (IPSS) of > or =15, and maximum flow rate (Q(max)) of > or =12 mL/sec and/or postvoid residuals (PVR) of > or =150 mL. Patients with neurogenic voiding dysfunction or anatomical bladder outlet obstruction were excluded. All patients were classified according to the Blaivas-Groutz nomogram as having no or mild obstruction (group A) or moderate or severe obstruction (group B). After 8 weeks of treatment, treatment outcomes and adverse effects were evaluated. One hundred and six patients were evaluable (70 in group A, 36 in group B). After treatments, mean IPSS, bother scores, Q(max), PVR, diurnal and nocturnal micturition frequencies and scored form of the Bristol Female Lower Urinary Tract Symptoms questionnaire (BFLUTS-SF) were changed significantly. Eighty-nine patients (84%) reported that the treatment was beneficial. The proportion of patients reported that their bladder symptoms caused "moderate to many severe problems" were significantly decreased. No significant difference were observed between the groups in terms of IPSS, bother score, Q(max), PVR, micturition frequency, and BFLUTS-SF changes. Adverse effects related to medication were dizziness (n=3), de novo stress urinary incontinence (SUI) (n=3), aggravation of underlying SUI (n=1), fatigue (n=1). Tamsulosin was found to be effective in female patients with voiding dysfunction regardless of obstruction grade.
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Affiliation(s)
- Kyu-Sung Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Deok Hyun Han
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Suk Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Myung-Soo Choo
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Tag Keun Yoo
- Department of Urology, Eulji University School of Medicine, Eulji University Hospital, Daejeon, Korea
| | - Heung Jae Park
- Department of Urology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Korea
| | - Hana Yoon
- Department of Urology, School of Medicine, Ewha Womans University, Ehwa Women's University Mokdong Hospital, Seoul, Korea
| | - Hyeon Jeong
- Department of Urology, Seoul National University Boramae Hospital, Seoul, Korea
| | - Sun Ju Lee
- Department of Urology, Kyung-Hee University Hospital, Seoul, Korea
| | - Hayoung Kim
- Department of Urology, Kangdong Sacred Heart Hospital, Hallym University, Seoul, Korea
| | - Won Hee Park
- Department of Urology, College of Medicine Inha University, Inha University Hospital, Incheon, Korea
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