1
|
Gurwitz JH, Quinn CC, Abi-Elias IH, Adams AS, Bartel R, Bonner A, Boxer R, Delude C, Gifford D, Hanson B, Ito K, Jain P, Magaziner JS, Mazor KM, Mitchell SL, Mody L, Nace D, Ouslander J, Reifsnyder J, Resnick B, Zimmerman S. Advancing clinical trials in nursing homes: A proposed roadmap to success. Geriatr Nurs 2022; 45:230-234. [PMID: 35361514 PMCID: PMC8960155 DOI: 10.1016/j.gerinurse.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
An effective clinical research effort in nursing homes to address prevention and treatment of COVID-19 faced overwhelming challenges. Under the Health Care Systems Research Network-Older Americans Independence Centers AGING Initiative, a multidisciplinary Stakeholder Advisory Panel was convened to develop recommendations to improve the capability of the clinical research enterprise in US nursing homes. The Panel considered the nursing home as a setting for clinical trials, reviewed the current state of clinical trials in nursing homes, and ultimately developed recommendations for the establishment of a nursing home clinical trials research network that would be centrally supported and administered. This report summarizes the Panel's recommendations, which were developed in alignment with the following core principles: build on available research infrastructure where appropriate; leverage existing productive partnerships of researchers with groups of nursing homes and nursing home corporations; encompass both efficacy and effectiveness clinical trials; be responsive to a broad range of stakeholders including nursing home residents and their care partners; be relevant to an expansive range of clinical and health care delivery research questions; be able to pivot as necessary to changing research priorities and circumstances; create a pathway for industry-sponsored research as appropriate; invest in strategies to increase diversity in study populations and the research workforce; and foster the development of the next generation of nursing home researchers.
Collapse
Affiliation(s)
- Jerry H Gurwitz
- Meyers Health Care Institute, Worcester, MA, USA; UMass Chan Medical School, Worcester, MA, USA.
| | | | | | - Alyce S Adams
- Stanford University School of Medicine, Stanford, CA, USA
| | - Rosie Bartel
- AGING Patient/Caregiver Advisory Council, Worcester, MA, USA
| | - Alice Bonner
- Institute for Healthcare Improvement, Boston, MA, USA; Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | | | | | - David Gifford
- American Health Care Association, Washington, DC, USA
| | - Bruce Hanson
- AGING Patient/Caregiver Advisory Council, Worcester, MA, USA
| | - Kouta Ito
- Meyers Health Care Institute, Worcester, MA, USA; UMass Chan Medical School, Worcester, MA, USA
| | - Paavani Jain
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jay S Magaziner
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kathleen M Mazor
- Meyers Health Care Institute, Worcester, MA, USA; UMass Chan Medical School, Worcester, MA, USA
| | - Susan L Mitchell
- Hebrew SeniorLife Hinda and Arthur Marcus Institute for Aging Research, Boston, MA, USA
| | - Lona Mody
- University of Michigan, Ann Arbor, MI, USA
| | - David Nace
- University of Pittsburgh, Pittsburgh, PA, USA
| | | | | | - Barbara Resnick
- University of Maryland School of Nursing, Baltimore, MD, USA
| | | |
Collapse
|
2
|
Gurwitz JH, Quinn CC, Abi-Elias IH, Adams AS, Bartel R, Bonner A, Boxer R, Delude C, Gifford D, Hanson B, Ito K, Jain P, Magaziner JS, Mazor KM, Mitchell SL, Mody L, Nace D, Ouslander J, Reifsnyder J, Resnick B, Zimmerman S. Advancing Clinical Trials in Nursing Homes: A Proposed Roadmap to Success. J Am Geriatr Soc 2022; 70:701-708. [PMID: 35195276 PMCID: PMC8910690 DOI: 10.1111/jgs.17696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/01/2022] [Indexed: 02/02/2023]
Abstract
An effective clinical research effort in nursing homes to address prevention and treatment of COVID-19 faced overwhelming challenges. Under the Health Care Systems Research Network-Older Americans Independence Centers AGING Initiative, a multidisciplinary Stakeholder Advisory Panel was convened to develop recommendations to improve the capability of the clinical research enterprise in US nursing homes. The Panel considered the nursing home as a setting for clinical trials, reviewed the current state of clinical trials in nursing homes, and ultimately developed recommendations for the establishment of a nursing home clinical trials research network that would be centrally supported and administered. This report summarizes the Panel's recommendations, which were developed in alignment with the following core principles: build on available research infrastructure where appropriate; leverage existing productive partnerships of researchers with groups of nursing homes and nursing home corporations; encompass both efficacy and effectiveness clinical trials; be responsive to a broad range of stakeholders including nursing home residents and their care partners; be relevant to an expansive range of clinical and health care delivery research questions; be able to pivot as necessary to changing research priorities and circumstances; create a pathway for industry-sponsored research as appropriate; invest in strategies to increase diversity in study populations and the research workforce; and foster the development of the next generation of nursing home researchers.
Collapse
Affiliation(s)
- Jerry H. Gurwitz
- Meyers Health Care Institute, Worcester, MA, USA,UMass Chan Medical School, Worcester, MA, USA,Address correspondence to Jerry H. Gurwitz MD, Meyers Health Care Institute, 385 Grove Street, Worcester, MA 01605, USA. (J.H. Gurwitz)
| | | | | | - Alyce S. Adams
- Stanford University School of Medicine, Stanford, CA, USA
| | - Rosie Bartel
- AGING Patient/Caregiver Advisory Council, Worcester, MA, USA
| | - Alice Bonner
- Institute for Healthcare Improvement, Boston, MA, USA,Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | | | | | - David Gifford
- American Health Care Association, Washington, DC, USA
| | - Bruce Hanson
- AGING Patient/Caregiver Advisory Council, Worcester, MA, USA
| | - Kouta Ito
- Meyers Health Care Institute, Worcester, MA, USA,UMass Chan Medical School, Worcester, MA, USA
| | - Paavani Jain
- University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Kathleen M. Mazor
- Meyers Health Care Institute, Worcester, MA, USA,UMass Chan Medical School, Worcester, MA, USA
| | - Susan L. Mitchell
- Hebrew SeniorLife Hinda and Arthur Marcus Institute for Aging Research, Boston, MA, USA
| | - Lona Mody
- University of Michigan, Ann Arbor, MI, USA
| | - David Nace
- University of Pittsburgh, Pittsburgh, PA, USA
| | | | | | - Barbara Resnick
- University of Maryland School of Nursing, Baltimore, MD, USA
| | | |
Collapse
|
3
|
Gruber-Baldini AL, Quinn CC, Roggio AX, Browne BJ, Magaziner JS. Telemedicine for Older Adult Nursing Home Residents to Avoid Emergency Department Visits: The Experience of the NHTeleED Project in Maryland. J Am Med Dir Assoc 2022; 23:1311-1312. [PMID: 35231439 PMCID: PMC8881981 DOI: 10.1016/j.jamda.2022.01.061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 01/11/2022] [Accepted: 01/14/2022] [Indexed: 10/25/2022]
Affiliation(s)
| | | | | | - Brian J Browne
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jay S Magaziner
- University of Maryland School of Medicine, Baltimore, MD, USA.
| |
Collapse
|
4
|
Delude C, Abi‐Elias IH, Quinn CC, Adams AS, Magaziner JS, Ito K, Jain P, Gurwitz JH, Mazor KM. Stakeholders’ Views on Priorities Essential for Establishing a Supportive Environment for Clinical Trials in Nursing Homes. J Am Geriatr Soc 2022; 70:950-959. [PMID: 35188222 PMCID: PMC8986625 DOI: 10.1111/jgs.17710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND The U.S. clinical research enterprise in nursing homes was unprepared to mount clinical trials in nursing homes to address urgent questions relevant to prevention and treatment during the COVID-19 pandemic. We identify priorities essential for establishing a supportive environment for future clinical trials in nursing homes. METHODS Two cross-sectional online questionnaires were administered between January and February 2021. One was administered to nursing home providers, researchers, and policymakers; respondents rated the importance of attributes of researchers, facilities, leaders and staff for conducting clinical trials in nursing homes. Because importance may depend on trial type, respondents rated each attribute for efficacy trials (testing an intervention in ideal circumstances) and effectiveness trials (testing an intervention in "real world" circumstances). We calculated the attribute rating means and standard deviations, and used content analysis to characterize open-ended responses. The second questionnaire for resident family members and advocates included open-ended questions about nursing home research, and factors influencing willingness to participate. RESULTS The attributes rated as most essential for conducting efficacy and effectiveness trials in nursing homes are research team attributes, that is, that researchers recognize regulatory constraints; understand and adapt to nursing home workflow; and work collaboratively with nursing home leaders to identify priorities. Resident and facility diversity emerged as essential for effectiveness trials; important dimensions included resident race, ethnicity and income, as well as nursing home urban/rural location, quality ratings, geography, staffing ratios, size, and profit status. Caregivers and resident advocates stressed the importance of communication among participants, researchers, and nursing home leadership and staff at all stages of a trial. CONCLUSION Developing a robust U.S. clinical research enterprise capable of efficiently mounting future clinical trials in nursing homes will require a reimagining of the relationships that exist between researchers, facilities, nursing home leaders, and residents, with a research infrastructure specifically focused on supporting and fostering these connections.
Collapse
Affiliation(s)
| | | | | | | | | | - Kouta Ito
- Meyers Health Care Institute
- UMass Chan Medical School
| | | | | | | |
Collapse
|
5
|
Gurwitz JH, Quinn CC, Abi-Elias IH, Adams AS, Bartel R, Bonner A, Boxer R, Delude C, Gifford D, Hanson B, Ito K, Jain P, Magaziner JS, Mazor KM, Mitchell SL, Mody L, Nace D, Ouslander J, Reifsnyder J, Resnick B, Zimmerman S. Advancing Clinical Trials in Nursing Homes: A Proposed Roadmap to Success. J Am Med Dir Assoc 2021; 23:345-349. [PMID: 34953784 PMCID: PMC8692165 DOI: 10.1016/j.jamda.2021.11.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 11/26/2021] [Indexed: 12/26/2022]
Abstract
An effective clinical research effort in nursing homes to address prevention and treatment of COVID-19 faced overwhelming challenges. Under the Health Care Systems Research Network-Older Americans Independence Centers AGING Initiative, a multidisciplinary Stakeholder Advisory Panel was convened to develop recommendations to improve the capability of the clinical research enterprise in US nursing homes. The Panel considered the nursing home as a setting for clinical trials, reviewed the current state of clinical trials in nursing homes, and ultimately developed recommendations for the establishment of a nursing home clinical trials research network that would be centrally supported and administered. This report summarizes the Panel’s recommendations, which were developed in alignment with the following core principles: build on available research infrastructure where appropriate; leverage existing productive partnerships of researchers with groups of nursing homes and nursing home corporations; encompass both efficacy and effectiveness clinical trials; be responsive to a broad range of stakeholders including nursing home residents and their care partners; be relevant to an expansive range of clinical and health care delivery research questions; be able to pivot as necessary to changing research priorities and circumstances; create a pathway for industry-sponsored research as appropriate; invest in strategies to increase diversity in study populations and the research workforce; and foster the development of the next generation of nursing home researchers.
Collapse
Affiliation(s)
- Jerry H Gurwitz
- Meyers Health Care Institute, Worcester, MA, USA; UMass Chan Medical School, Worcester, MA, USA.
| | | | | | - Alyce S Adams
- Stanford University School of Medicine, Stanford, CA, USA
| | - Rosie Bartel
- AGING Patient/Caregiver Advisory Council, Worcester, MA, USA
| | - Alice Bonner
- Institute for Healthcare Improvement, Boston, MA, USA; Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | | | | | - David Gifford
- American Health Care Association, Washington, DC, USA
| | - Bruce Hanson
- AGING Patient/Caregiver Advisory Council, Worcester, MA, USA
| | - Kouta Ito
- Meyers Health Care Institute, Worcester, MA, USA; UMass Chan Medical School, Worcester, MA, USA
| | - Paavani Jain
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jay S Magaziner
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kathleen M Mazor
- Meyers Health Care Institute, Worcester, MA, USA; UMass Chan Medical School, Worcester, MA, USA
| | - Susan L Mitchell
- Hebrew SeniorLife Hinda and Arthur Marcus Institute for Aging Research, Boston, MA, USA
| | - Lona Mody
- University of Michigan, Ann Arbor, MI, USA
| | - David Nace
- University of Pittsburgh, Pittsburgh, PA, USA
| | | | | | - Barbara Resnick
- University of Maryland School of Nursing, Baltimore, MD, USA
| | | |
Collapse
|
6
|
Quinn CC, Adams AS, Magaziner JS, Gurwitz JH. Coronavirus disease 2019 and clinical research in U.S. nursing homes. J Am Geriatr Soc 2021; 69:1748-1751. [PMID: 33872385 PMCID: PMC8250950 DOI: 10.1111/jgs.17191] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 04/10/2021] [Indexed: 12/02/2022]
Affiliation(s)
| | | | | | - Jerry H Gurwitz
- Meyers Primary Care Institute, A Joint Endeavor of University of Massachusetts Medical School, Fallon Health and Reliant Medical Group, Worcester, MA.,Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester, MA
| |
Collapse
|
7
|
Quinn CC, Knopp KL, Marsiglia CA, Bearch RC, LeFever A, Barr EA, Liang Y, Gruber-Baldini AL. Mobile Technology Care Coordination of Long-Term Services and Support: Cluster Randomized Clinical Trial. J Appl Gerontol 2020; 40:529-535. [PMID: 32705913 DOI: 10.1177/0733464820944043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The purpose of the study was to assess whether the effects of a mobile predictive intervention used by Service Coordinators (SCs) reduce hospital utilization in a Medicaid Long-Term Services and Supports (LTSS) population in Baltimore city during a 5-month intervention. SC participants (n = 11) were recruited to treatment or control groups. LTSS clients (n = 420) followed their SC randomization assignment. Utilization data were obtained from the Maryland Chesapeake Regional Information System for our Patients (CRISP) Health Information Exchange (HIE) system and linked to service coordination records. Study groups were similar in age, gender, race, and years receiving LTSS. SCs' satisfaction with use of the mobile tool was surveyed. SC perceptions were neutral (mean scores ranged from 2.3 to 3.3 on a 5-point scale). No significant differences between groups were observed for all utilization metrics. The mobile technology software system used in this study did not improve health care utilization for a LTSS population needing ongoing clinical and social services coordinated care.
Collapse
Affiliation(s)
| | - Kasey L Knopp
- University of Maryland School of Medicine, Baltimore, USA
| | | | | | | | - Erik A Barr
- University of Maryland School of Nursing, Baltimore, USA
| | - Yuanyuan Liang
- University of Maryland School of Medicine, Baltimore, USA
| | | |
Collapse
|
8
|
Park S, Zachary WW, Gittelsohn J, Quinn CC, Surkan PJ. Neighborhood Influences on Physical Activity Among Low-Income African American Adults With Type 2 Diabetes Mellitus. Diabetes Educ 2020; 46:181-190. [PMID: 32100614 DOI: 10.1177/0145721720906082] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE The purpose of the study was to explore the influences of the neighborhood environment on physical activity (PA) among people living with type 2 diabetes mellitus (T2DM) in a community with limited resources. METHODS Participants were adults with T2DM and their family members or friends who help in the management of T2DM and who were living in a low-income African American (AA) community. Health care providers working in the neighborhood were also included. Using an emergent design, qualitative data were collected through 7 focus group discussions (N = 63) and 13 in-depth interviews. Verbatim transcriptions were analyzed via thematic coding to explore contextual factors that limit PA and meaning around neighborhood features that promote or discourage PA. RESULTS Levels of PA were strongly limited by neighborhood insecurity and a lack of recreational facilities in the neighborhood. People with T2DM and physical/mobility disabilities were more affected by the neighborhood environment than those without disabilities, particularly due to perceived safety concerns and social stigma. Despite socioeconomic inequalities within neighborhoods, participants showed resilience and made efforts to overcome social-environmental barriers to PA, applied various coping strategies, and received social support. CONCLUSIONS Results suggested that in an underserved neighborhood, individual barriers to physical activity were amplified by neighborhood-level factors such as crime, especially among individuals who have T2DM and disabilities. Socioeconomic inequalities should be addressed further to improve management of T2DM and its complications.
Collapse
Affiliation(s)
- Soim Park
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland
| | | | - Joel Gittelsohn
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland
| | | | - Pamela J Surkan
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland
| |
Collapse
|
9
|
Bilgrami Z, Abutaleb A, Chudy-Onwugaje K, Langenberg P, Regueiro M, Schwartz DA, Tracy JK, Ghazi L, Patil SA, Quezada SM, Russman KM, Quinn CC, Jambaulikar G, Beaulieu DB, Horst S, Cross RK. Correction to: Effect of TELEmedicine for Inflammatory Bowel Disease on Patient Activation and Self-Efficacy. Dig Dis Sci 2020; 65:668. [PMID: 31792670 DOI: 10.1007/s10620-019-05953-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
This manuscript is a secondary analysis of a large multicenter randomized controlled trial. The primary study is Cross RK et al., A Randomized Controlled Trial of TELEmedicine for patients with Inflammatory Bowel Disease (TELE-IBD). Am J Gastroenterol, 2019 Mar.
Collapse
Affiliation(s)
- Zaid Bilgrami
- University of Maryland School of Medicine, 685 West Baltimore Street, Suite 8-00, Baltimore, MD, 21201, USA
| | - Ameer Abutaleb
- University of Maryland School of Medicine, 685 West Baltimore Street, Suite 8-00, Baltimore, MD, 21201, USA
| | - Kenechukwu Chudy-Onwugaje
- University of Maryland School of Medicine, 685 West Baltimore Street, Suite 8-00, Baltimore, MD, 21201, USA
| | - Patricia Langenberg
- University of Maryland School of Medicine, 685 West Baltimore Street, Suite 8-00, Baltimore, MD, 21201, USA
| | - Miguel Regueiro
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - J Kathleen Tracy
- University of Maryland School of Medicine, 685 West Baltimore Street, Suite 8-00, Baltimore, MD, 21201, USA
| | - Leyla Ghazi
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Seema A Patil
- University of Maryland School of Medicine, 685 West Baltimore Street, Suite 8-00, Baltimore, MD, 21201, USA
| | - Sandra M Quezada
- University of Maryland School of Medicine, 685 West Baltimore Street, Suite 8-00, Baltimore, MD, 21201, USA
| | - Katharine M Russman
- University of Maryland School of Medicine, 685 West Baltimore Street, Suite 8-00, Baltimore, MD, 21201, USA
| | - Charlene C Quinn
- University of Maryland School of Medicine, 685 West Baltimore Street, Suite 8-00, Baltimore, MD, 21201, USA
| | | | - Dawn B Beaulieu
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Sara Horst
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Raymond K Cross
- University of Maryland School of Medicine, 685 West Baltimore Street, Suite 8-00, Baltimore, MD, 21201, USA.
| |
Collapse
|
10
|
Bilgrami Z, Abutaleb A, Chudy-Onwugaje K, Langenberg P, Regueiro M, Schwartz DA, Tracy JK, Ghazi L, Patil SA, Quezada SM, Russman KM, Quinn CC, Jambaulikar G, Beaulieu DB, Horst S, Cross RK. Effect of TELEmedicine for Inflammatory Bowel Disease on Patient Activation and Self-Efficacy. Dig Dis Sci 2020; 65:96-103. [PMID: 30604373 PMCID: PMC7883399 DOI: 10.1007/s10620-018-5433-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 12/12/2018] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Limitations in inflammatory bowel disease (IBD) care necessitate greater patient activation and self-efficacy, measures associated with positive health outcomes. METHODS We assessed change in patient activation and general self-efficacy from baseline to 12 months through our TELEmedicine for IBD trial, a multicenter, randomized controlled trial consisting of a web-based monitoring system that interacts with participants via text messaging. A total of 222 adults with IBD who had experienced an IBD flare within 2 years prior to the trial were randomized into either a control arm that received standard care (SC) or an intervention arm that completed self-testing through the TELE-IBD system every other week (EOW) or weekly (W). RESULTS Changes in self-efficacy scores were not significantly different between control and experimental groups. Patient activation scores were significantly different between standard care and the TELE-IBD EOW group only (p = 0.03). CONCLUSIONS Use of remote monitoring did not improve self-efficacy or patient activation compared to routine care.
Collapse
Affiliation(s)
- Zaid Bilgrami
- University of Maryland School of Medicine, 685 West Baltimore Street, Suite 8-00, Baltimore, MD, 21201, USA
| | - Ameer Abutaleb
- University of Maryland School of Medicine, 685 West Baltimore Street, Suite 8-00, Baltimore, MD, 21201, USA
| | - Kenechukwu Chudy-Onwugaje
- University of Maryland School of Medicine, 685 West Baltimore Street, Suite 8-00, Baltimore, MD, 21201, USA
| | - Patricia Langenberg
- University of Maryland School of Medicine, 685 West Baltimore Street, Suite 8-00, Baltimore, MD, 21201, USA
| | - Miguel Regueiro
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - J Kathleen Tracy
- University of Maryland School of Medicine, 685 West Baltimore Street, Suite 8-00, Baltimore, MD, 21201, USA
| | - Leyla Ghazi
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Seema A Patil
- University of Maryland School of Medicine, 685 West Baltimore Street, Suite 8-00, Baltimore, MD, 21201, USA
| | - Sandra M Quezada
- University of Maryland School of Medicine, 685 West Baltimore Street, Suite 8-00, Baltimore, MD, 21201, USA
| | - Katharine M Russman
- University of Maryland School of Medicine, 685 West Baltimore Street, Suite 8-00, Baltimore, MD, 21201, USA
| | - Charlene C Quinn
- University of Maryland School of Medicine, 685 West Baltimore Street, Suite 8-00, Baltimore, MD, 21201, USA
| | | | - Dawn B Beaulieu
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Sara Horst
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Raymond K Cross
- University of Maryland School of Medicine, 685 West Baltimore Street, Suite 8-00, Baltimore, MD, 21201, USA.
| |
Collapse
|
11
|
Quinn CC, Roggio A, Erik B, Gruber-Baldini A. NURSING HOME TELEED INTERVENTION: ADVANCING NEW CARE MODELS. Innov Aging 2019. [PMCID: PMC6840395 DOI: 10.1093/geroni/igz038.1225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
New reimbursement and managed care models demonstrate the need to reduce avoidable Emergency Department (ED) use and limit preventable inpatient admissions for older adults in Skilled Nursing Facilities (SNF). The objective was to develop an ED telemedicine consultation intervention for SNF residents with acute medical problems. Secondary objectives including evaluation of health care utilization, provider satisfaction. Demonstration evaluation in three urban SNFs, telemedicine linked to university medical center ED. Mobile telemedicine cart equipment assessed SNF residents for any change in condition. ED physicians used tablets with secure access to conduct the resident assessment. Provider satisfaction measures imbedded in EMRs were completed at consultation visit end. 460 patients had changes in condition, 327 resulted in 911 calls, 85 deemed eligible for telemedicine consult. Conducted 57 telehealth consults. Forty (70%) telemedicine consult residents remained in the SNF. Fourteen residents were transferred to the ED. Average satisfaction scores were 5.8/7 for SNF nurses (n=49) and 5.6 for ED physicians (n=45). Lower-rated items related to technical equipment problems. ED physicians reported residents transferred to ED after telehealth visit had better continuity of care. The intervention was effective in preventing or delaying transfer of acutely ill, medically complex SNF residents. Implementation of the intervention identified need for SNF admission policy and procedure changes; weekly telemedicine training; SNF clinical advocates; on-site tracking and linkage of EMRs across providers; HIPAA shared medical record concerns. Future research plans include analyses of detailed SNF resident characteristics and business case assessment for reduction of transfers, ED and hospital utilization.
Collapse
Affiliation(s)
- Charlene C Quinn
- University of Maryland School of Medicine, Baltimore, Maryland, United States
| | - Anthony Roggio
- University of Maryland Medical Center, Baltimore, Maryland, United States
| | - Barr Erik
- University of Maryland School of Medicine, Baltimore, Maryland, United States
| | - Ann Gruber-Baldini
- University of Maryland Baltimore School of Medicine, Baltimore, Maryland, United States
| |
Collapse
|
12
|
Quinn CC, Greene BR, McManus K, Redmond SJ, Caulfield B. SENSOR-BASED ASSESSMENT OF FALLS RISK OF THE TIMED UP AND GO IN REAL-WORLD SETTINGS. Innov Aging 2019. [PMCID: PMC6840247 DOI: 10.1093/geroni/igz038.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Falls are the leading cause of older adult injury and cost $50bn annually. New digital technologies can quantitatively measure falls risk. Objective is to report on a validated wearable sensor-based Timed Up and Go (QTUG) assessment detailing 11 measures of falls risk, frailty and mobility impairment in older adults in six countries in 38 clinical and community settings. Second objective is to generate individual targeted falls prevention programs. 14,611 QTUG records from 8,521 participants (63% female) (72.7±10.7 years) available for analysis. QTUG time was 13.9±7.4 s; gait velocity was 101.9±32.5 cm/s. 25.8% of patients reported falling in previous 12 months; 26.2% of patients were at high fall risk. 21.5% not reporting a fall, were high fall risk. Participants had slow walking speed (29.8%); high gait variability (19.8%); problems with transfers (17.5%). Easily captured and interpreted sensor data is useful in a population-based approach to quantify falls risk stratification.
Collapse
Affiliation(s)
- Charlene C Quinn
- University of Maryland School of Medicine, Baltimore, Maryland, United States
| | - Barry R Greene
- Kinesis Health Technologies Ltd, Insight Centre for Data Analytics, Dublin, Dublin, Ireland
| | - Killian McManus
- Kinesis Health Technologies Ltd, Insight Centre for Data Analytics, Dublin, Dublin, Ireland
| | - Stephen J Redmond
- School of Electrical and Electronic Engineering, Dublin, Dublin, Ireland
| | | |
Collapse
|
13
|
Dodia NN, Richert ME, Deitchman AR, Quinn CC, Marciniak ET, Brown CH, Terrin ML, Amariei DE, Shanholtz CB, Hasday JD. A Survey of Academic Intensivists' Use of Neuromuscular Blockade in Subjects With ARDS. Respir Care 2019; 65:362-368. [PMID: 31506341 DOI: 10.4187/respcare.07026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Our Cooling to Help Injured Lungs (CHILL) trial of therapeutic hypothermia in ARDS includes neuromuscular blockade (NMB) as an inclusion criterion to avoid shivering. NMB has been used to facilitate mechanical ventilation in ARDS and was shown to reduce mortality in the ACURASYS trial. To assess the feasibility of a multi-center CHILL trial, we conducted a survey of academic intensivists about their NMB use in patients with ARDS. METHODS We distributed via email a 16-question survey about NMB use in patients with ARDS including frequency, indications, and dosing strategy. RESULTS 212 (24.3%) of 871 respondents completed the survey: 94.7% were board-certified in internal medicine, 88% in pulmonary and critical care; 90.3% practiced in academic medical centers, with 87% working in medical ICUs; 96.6% of respondents who treat ARDS use NMB, and 39.7% use NMB in ≥ 50% of these patients. Of 4 listed indications for initiating NMB in ARDS, allowing adherence with lung-protective ventilator strategies and patient-ventilator synchrony were cited as the most important reasons, followed by the results of the ACURASYS trial and facilitating prone positioning. CONCLUSIONS We conclude that NMB is frequently used by academic intensivists to facilitate mechanical ventilation in patients with moderate to severe ARDS.
Collapse
Affiliation(s)
- Neal N Dodia
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Mary E Richert
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Andrew R Deitchman
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Charlene C Quinn
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Ellen T Marciniak
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Clayton H Brown
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Michael L Terrin
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Diana E Amariei
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Carl B Shanholtz
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jeffrey D Hasday
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland. .,Baltimore Veterans Administration Medical Center, Baltimore, Maryland
| |
Collapse
|
14
|
Surkan PJ, Mezzanotte KS, Sena LM, Chang LW, Gittelsohn J, Trolle Lagerros Y, Quinn CC, Zachary WW. Community-Driven Priorities in Smartphone Application Development: Leveraging Social Networks to Self-Manage Type 2 Diabetes in a Low-Income African American Neighborhood. Int J Environ Res Public Health 2019; 16:ijerph16152715. [PMID: 31366047 PMCID: PMC6695754 DOI: 10.3390/ijerph16152715] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 07/26/2019] [Accepted: 07/27/2019] [Indexed: 12/19/2022]
Abstract
Social networks have the potential to enhance Type 2 Diabetes Mellitus (T2DM) self-management. We used qualitative methods to study if and how mobile application (app) functions that mobilize social resources to improve T2DM management would be desired in a low-income African American community. Data were collected through community discussions and in-depth interviews with 78 participants in 2016–2018. Participants included individuals with self-reported pre-diabetes, T2DM, close family members or friends of a T2DM patient, and healthcare providers. Open-ended questions solicited information about challenges with T2DM management and gathered ideas on features of a mobile app that could address them. Data were transcribed and thematically coded by two coders using Atlas-ti. Regarding types of app functions, main themes included: (1) the importance of having support in diabetes self-care; (2) using informal networks to help to each other; and (3) monitoring one another through an app. Suggested app features included reminders for and transportation to medical visits, sharing information and exercise companionship, and providing opportunities for monitoring by friends/family members, especially in case of emergencies. Participants viewed an app as a potential vehicle for reinforcing accomplishments in T2DM self-management. Future research should implement and test an app with these features in this or similar communities.
Collapse
Affiliation(s)
- Pamela J Surkan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
| | - Kathryne S Mezzanotte
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Laura M Sena
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Larry W Chang
- Department of Medicine, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Joel Gittelsohn
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Ylva Trolle Lagerros
- Department of Medicine, Karolinska Institute, Clinical Epidemiology Unit, Stockholm, and Obesity Center, Academic Specialist Center, Stockholm Health Services, 113 64 Stockholm, Sweden
| | - Charlene C Quinn
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Wayne W Zachary
- Starship Health Technologies, LLC, 610 Sentry Parkway, Blue Bell, PA 19422, USA
| |
Collapse
|
15
|
Quinn CC, Staub S, Barr E, Gruber-Baldini A. Mobile Support for Older Adults and Their Caregivers: Dyad Usability Study. JMIR Aging 2019; 2:e12276. [PMID: 31518271 PMCID: PMC6715004 DOI: 10.2196/12276] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 03/08/2019] [Accepted: 04/23/2019] [Indexed: 12/24/2022] Open
Abstract
Background Evaluation of digital health applications to support older adults’ independence and family caregiving is needed. Digital health is increasingly providing opportunities for older adults and their family caregivers to educate, engage, and share health information across digital platforms. Few apps have documented evidence of usability by older adults and their caregivers. Objective The objective of this study was to determine the usability of a mobile app in a community-based older adult population aged ≥65 years. The app was designed to improve engagement of the patient-informal caregiver team. Methods This observational usability study was conducted in participants’ homes and independent living facilities in Baltimore, Maryland. Community-dwelling older adults aged ≥65 years and their caregivers enrolled as a dyad (n=24, 12 dyads). The usability evaluation was a mobile and Web-based app that allowed older adult users to record social and health information and share this information with their caregivers. The older adult-caregiver dyad downloaded the app to a smart phone or accessed the Web version, participated in training and onboarding, and used the app for a 1-month period. Participants responded to weekly surveys sent by app push notifications and to the usability and satisfaction surveys at the end of the study. Participant satisfaction and usability were assessed using the Modified Mobile Application Rating Scale (M-MARS) and the System Usability Scale (SUS). Results The final sample comprised 16 people (8 dyads). Responses to the M-MARS were comparable between older adults and caregiver respondents in terms of engagement and functionality. Caregivers rated aesthetics slightly higher (mean 3.7) than older adult participants did (mean 3.3). Although most responses to the SUS were around the mean (2.3-3.4), older adults and their caregivers differed with regard to integration of app features (mean 3.7 vs 2.8) and the need to learn more before using the app (mean 2.3 vs 3.1). Conclusions Technology ownership and use among older adults and caregivers was high. Usability and engagement of the mobile app was average. Additional training is recommended for older adults and their caregivers, including that on targeted behaviors for digital health record keeping.
Collapse
Affiliation(s)
- Charlene C Quinn
- Division of Gerontology, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Sheila Staub
- University of Maryland Marlene & Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, United States
| | - Erik Barr
- University of Maryland School of Nursing, Baltimore, MD, United States
| | - Ann Gruber-Baldini
- Division of Gerontology, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, United States
| |
Collapse
|
16
|
Pearson CF, Quinn CC, Loganathan S, Datta AR, Mace BB, Grabowski DC. The Forgotten Middle: Many Middle-Income Seniors Will Have Insufficient Resources For Housing And Health Care. Health Aff (Millwood) 2019; 38:101377hlthaff201805233. [PMID: 31017490 DOI: 10.1377/hlthaff.2018.05233] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
As people age and require more assistance with daily living and health needs, a range of housing and care options is available. Over the past four decades the market for seniors housing and care-including assisted living and independent living communities-has greatly expanded to accommodate people with more complex needs. These settings provide housing in a community environment that often includes personal care assistance services. Unfortunately, these settings are often out of the financial reach of many of this country's eight million middle-income seniors (those ages seventy-five and older). The private seniors housing industry has generally focused on higher-income people instead. We project that by 2029 there will be 14.4 million middle-income seniors, 60 percent of whom will have mobility limitations and 20 percent of whom will have high health care and functional needs. While many of these seniors will likely need the level of care provided in seniors housing, we project that 54 percent of seniors will not have sufficient financial resources to pay for it. This gap suggests a role for public policy and the private sector in meeting future long-term care and housing needs for middle-income seniors.
Collapse
Affiliation(s)
- Caroline F Pearson
- Caroline F. Pearson ( ) is a senior vice president at NORC at the University of Chicago in Illinois
| | - Charlene C Quinn
- Charlene C. Quinn is an associate professor in the Department of Epidemiology and Public Health at the University of Maryland School of Medicine, in Baltimore
| | - Sai Loganathan
- Sai Loganathan is a senior health economist at NORC at the University of Chicago in Bethesda, Maryland
| | - A Rupa Datta
- A. Rupa Datta is a vice president at NORC at the University of Chicago in Illinois
| | - Beth Burnham Mace
- Beth Burnham Mace is chief economist at the National Investment Center for Seniors Housing and Care, in Annapolis, Maryland
| | - David C Grabowski
- David C. Grabowski is a professor in the Department of Health Care Policy, Harvard Medical School, in Boston, Massachusetts
| |
Collapse
|
17
|
Quinn CC, Swasey KK, Torain JM, Shardell MD, Terrin ML, Barr EA, Gruber-Baldini AL. An mHealth Diabetes Intervention for Glucose Control: Health Care Utilization Analysis. JMIR Mhealth Uhealth 2018; 6:e10776. [PMID: 30322839 PMCID: PMC6231737 DOI: 10.2196/10776] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 07/05/2018] [Accepted: 07/16/2018] [Indexed: 12/19/2022] Open
Abstract
Background Type 2 diabetes (T2D) is a major chronic condition requiring management through lifestyle changes and recommended health service visits. Mobile health (mHealth) is a promising tool to encourage self-management, but few studies have investigated the impact of mHealth on health care utilization. Objective The objective of this analysis was to determine the change in 2-year health service utilization and whether utilization explained a 1.9% absolute decrease in glycated hemoglobin (HbA1c) over 1-year in the Mobile Diabetes Intervention Study (MDIS). Methods We used commercial claims data from 2006 to 2010 linked to enrolled patients’ medical chart data in 26 primary care practices in Maryland, USA. Secondary claims data analyses were available for 56% (92/163) of participants. In the primary MDIS study, physician practices were recruited and randomized to usual care and 1 of 3 increasingly complex interventions. Patients followed physician randomization assignment. The main variables in the analysis included health service utilization by type of service and change in HbA1c. The claims data was aggregated into 12 categories of utilization to assess change in 2-year health service usage, comparing rates of usage pre- and posttrial. We also examined whether utilization explained the 1.9% decrease in HbA1c over 1 year in the MDIS cluster randomized clinical trial. Results A significant group by time effect was observed in physician office visits, general practitioner visits, other outpatient services, prescription medications, and podiatrist visits. Physician office visits (P=.01) and general practitioner visits (P=.02) both decreased for all intervention groups during the study period, whereas prescription claims (P<.001) increased. The frequency of other outpatient services (P=.001) and podiatrist visits (P=.04) decreased for the control group and least complex intervention group but increased for the 2 most complex intervention groups. No significant effects of utilization were observed to explain the clinically significant change in HbA1c. Conclusions Claims data analyses identified patterns of utilization relevant to mHealth interventions. Findings may encourage patients and health providers to discuss the utilization of treatment-recommended services, lab tests, and prescribed medications. Trial Registration ClinicalTrials.gov NCT01107015; https://clinicaltrials.gov/ct2/show/NCT01107015 (Archived by Webcite at http://www.webcitation.org/72XgTaxIj)
Collapse
Affiliation(s)
- Charlene C Quinn
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Krystal K Swasey
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Jamila M Torain
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Michelle D Shardell
- Translational Gerontology Branch, National Institutes on Aging, Baltimore, MD, United States
| | - Michael L Terrin
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Erik A Barr
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Ann L Gruber-Baldini
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, United States
| |
Collapse
|
18
|
Abutaleb A, Buchwald A, Chudy-Onwugaje K, Langenberg P, Regueiro M, Schwartz DA, Tracy JK, Ghazi L, Patil SA, Quezada SM, Russman KM, Quinn CC, Jambaulikar G, Beaulieu DB, Horst S, Cross RK. Inflammatory Bowel Disease Telemedicine Clinical Trial: Impact of Educational Text Messages on Disease-Specific Knowledge Over 1 Year. Inflamm Bowel Dis 2018; 24:2191-2197. [PMID: 29788137 PMCID: PMC7190916 DOI: 10.1093/ibd/izy149] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND Effective treatments are available for patients with inflammatory bowel disease (IBD); however, suboptimal outcomes occur and are often linked to patients' limited disease knowledge. The aim of this analysis was to determine if delivery of educational messages through a telemedicine system improves IBD knowledge. METHODS TELEmedicine for Patients with IBD (TELE-IBD) was a randomized controlled trial with visits at baseline, 6 months, and 12 months; patient knowledge was a secondary aim of the study. Patients were randomized to receive TELE-IBD every other week (EOW), weekly (TELE-IBD W), or standard of care. Knowledge was assessed at each visit with the Crohn's and Colitis Knowledge (CCKNOW) survey. The primary outcome was change in CCKNOW score over 1 year compared between the TELE-IBD and control groups. RESULTS This analysis included 219 participants. Participants in the TELE-IBD arms had a greater improvement in CCKNOW score compared with standard care (TELE-IBD EOW +2.4 vs standard care +1.8, P = 0.03; TELE-IBD W +2.0 vs standard care +1.8, P = 0.35). Participants with lower baseline CCKNOW scores had a greater change in their score over time (P < 0.01). However, after adjusting for race, site, and baseline knowledge, there was no difference in CCKNOW score change between the control and telemedicine arms. CONCLUSIONS Telemedicine improves IBD-specific knowledge through text messaging, although the improvement is not additive with greater frequency of text messages. However, after adjustment for confounding variables, telemedicine is not superior to education given through standard visits at referral centers. Further research is needed to determine if revised systems with different modes of delivery and/or frequency of messages improve disease knowledge.
Collapse
Affiliation(s)
- Ameer Abutaleb
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Andrea Buchwald
- University of Maryland School of Medicine, Baltimore, Maryland
| | | | | | - Miguel Regueiro
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | | | - Leyla Ghazi
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Seema A Patil
- University of Maryland School of Medicine, Baltimore, Maryland
| | | | | | | | | | - Dawn B Beaulieu
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Sara Horst
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Raymond K Cross
- University of Maryland School of Medicine, Baltimore, Maryland,Address correspondence to: Raymond K. Cross, MD, MS, AGAF, 685 West Baltimore Street, Suite 8-00, Baltimore, MD 21201 ()
| |
Collapse
|
19
|
Quinn CC, Swasey KK, Crabbe JCF, Shardell MD, Terrin ML, Barr EA, Gruber-Baldini AL. The Impact of a Mobile Diabetes Health Intervention on Diabetes Distress and Depression Among Adults: Secondary Analysis of a Cluster Randomized Controlled Trial. JMIR Mhealth Uhealth 2017; 5:e183. [PMID: 29217502 PMCID: PMC5740263 DOI: 10.2196/mhealth.8910] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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: 09/06/2017] [Revised: 10/16/2017] [Accepted: 10/29/2017] [Indexed: 12/15/2022] Open
Abstract
Background Diabetes is a complex, demanding disease that requires the constant attention of patients. The burden of self-management, including different medication regimens, routine self-care activities, and provider visits, has an impact on patients’ emotional well-being. Diabetes distress and depression are two important components of emotional well-being that may negatively affect diabetes outcomes. Objective The aim was to determine the impact of the 1-year Mobile Diabetes Intervention Study cluster randomized clinical trial on emotional well-being measured by diabetes distress and depression among adults with type 2 diabetes (T2D). Methods A total of 163 adults with not-well-managed T2D were enrolled from community primary care practices. Primary care practices were cluster randomized into either a usual care control group or intervention group. Intervention participants were given a mobile phone with coaching software including a Web portal to communicate with providers. A priori established secondary outcomes included distress measured by the Diabetes Distress Scale (DDS), with subscales measuring emotional burden, interpersonal distress, physician-related distress, and regimen-related distress, as well as depression measured by the Patient Health Questionnaire (PHQ-9). Linear mixed models were used to calculate the effect of the intervention on diabetes distress levels over time, both overall and separately by sex, and to determine if the intervention affected distress or depression. The impact of total DDS on changes in HbA1c was also studied. Results There were no significant treatment group effects for DDS total (baseline: P=.07; differences over time: P=.38) or for depression (P=.06 over time). Significant declines in total DDS were observed over the 12-month intervention period (P=.01). Regimen-related distress significantly decreased for all study participants (P<.001), but no significant change over time was observed for emotional burden (P=.83), interpersonal distress (P=.64), or physician-related distress (P=.73). Women in both the usual care and intervention groups were more likely to have higher overall DDS, emotional burden, physician-related distress, and regimen-related distress, but not interpersonal distress. Women also reported higher baseline depression compared to men (P=.006). Overall, depression decreased over the treatment period (P=.007), but remained unaffected by group assignment (P=.06) or by sex (P=.97). Diabetes distress had no effect on the change in HbA1c (P=.91) over the treatment period. Conclusions Although we found no definitive overall or sex-specific effect of the intervention on diabetes distress or depression, this study makes an important contribution to the understanding of mobile health interventions and the impact on emotional health. Our study verified previous work that although diabetes distress and depression are highly correlated, these measures are not evaluating the same construct. Design of future mobile technology provides an opportunity to personalize, contextualize, and intervene in the emotional well-being of persons with diabetes. Trial Registration Clinicaltrials.gov NCT01107015; https://clinicaltrials.gov/ct2/show/NCT01107015 (Archived by WebCite at http://www.webcitation.org/6vVgRCLAF)
Collapse
Affiliation(s)
- Charlene C Quinn
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, MD, United States
| | - Krystal K Swasey
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, MD, United States
| | | | - Michelle D Shardell
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, MD, United States
| | - Michael L Terrin
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, MD, United States
| | - Erik A Barr
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, MD, United States
| | - Ann L Gruber-Baldini
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, MD, United States
| |
Collapse
|
20
|
Cho J, Stock EM, Liao IC, Zeber JE, Ahmedani BK, Basu R, Quinn CC, Copeland LA. Multiple chronic condition profiles and survival among oldest-old male patients with hip fracture. Arch Gerontol Geriatr 2017; 74:184-190. [PMID: 29126081 DOI: 10.1016/j.archger.2017.10.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 09/01/2017] [Accepted: 10/20/2017] [Indexed: 10/18/2022]
Abstract
To improve understanding of survival among very elderly male patients with surgically repaired hip fractures, this study applied classification techniques to multiple chronic conditions (MCC) then modeled survival by latent class. Veterans Health Administration (VHA)'s electronic medical records on male inpatients age 85-100 years (n=896) with hip fracture diagnosis and repair were used. MCC defined by Charlson and Elixhauser disorders, medications, demographic covariates, and 5 years follow-up survival were included. Latent Class Analysis (LCA) identified three classes based on patterns of MCC, medications, and demographic covariates: Low-comorbidity (16%), High-longevity (55%), and High-comorbidity (29%). Overall, survival censored at 5 years post-op averaged 717days. The Low-comorbidity group was more likely to be Hispanic, less disabled per VHA determination of eligibility for care, with less risk of postoperative emergency department (ED) visit, and taking no prescription medications. The High-longevity group had longer survival. The High-comorbidity group had more MCC, more prescription medications and shorter survival than the other two groups. Accelerated failure time (AFT) modeled associations between MCC and 5-year survival by class. In AFT models, fewer days until first postoperative ED visit was significantly associated with survival across the three classes. About one in male hip fractured veteran patients over the age of 85 had high levels of MCC and ED use and experienced shorter survival. Hip fracture patients with MCC may merit enhanced post-discharge management. Close investigation targeted to MCC and hip fractures is needed to optimize clinical practices for oldest-old patients in community healthcare systems as well as VHA.
Collapse
Affiliation(s)
- Jinmyoung Cho
- Baylor Scott & White Health, Temple, TX, United States; Texas A&M School of Public Health, College Station, TX, United States.
| | - Eileen M Stock
- Cooperative Studies Program Coordinating Center, Department of Veterans Affairs, Perry Point, MD, United States
| | - I-Chia Liao
- Baylor Scott & White Health, Temple, TX, United States; Central Texas Veterans Health Care System, Temple, TX, United States
| | - John E Zeber
- Baylor Scott & White Health, Temple, TX, United States; Texas A&M School of Public Health, College Station, TX, United States; Central Texas Veterans Health Care System, Temple, TX, United States; Texas A&M College of Medicine, Temple, TX, United States
| | | | - Rashmita Basu
- Baylor Scott & White Health, Temple, TX, United States; Texas A&M College of Medicine, Temple, TX, United States
| | | | - Laurel A Copeland
- Baylor Scott & White Health, Temple, TX, United States; Texas A&M School of Public Health, College Station, TX, United States; VA Central Western Massachusetts Healthcare System, Leeds, MA, United States; Texas A&M College of Medicine, Temple, TX, United States
| |
Collapse
|
21
|
Chard S, Harris-Wallace B, Roth EG, Girling LM, Rubinstein R, Reese AM, Quinn CC, Eckert JK. Successful Aging Among African American Older Adults With Type 2 Diabetes. J Gerontol B Psychol Sci Soc Sci 2017; 72:319-327. [PMID: 27655950 DOI: 10.1093/geronb/gbw119] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 08/24/2016] [Indexed: 12/20/2022] Open
Abstract
Objectives Rowe and Kahn's concept of successful aging remains an important model of well-being; additional research is needed, however, to identify how economically and socially disadvantaged older adults experience well-being, including the role of life events. The findings presented here help address this gap by examining the subjective construction of well-being among urban African American adults (age ≥ 50) with Type 2 diabetes. Method As part of the National Institute on Aging-funded Subjective Experience of Diabetes among Urban Older Adults study, ethnographers interviewed African American older adults with diabetes (n = 41) using an adaptation of the McGill Illness Narrative Interview. Data were coded using an inductively derived codebook. Codes related to aging, disease prognosis, and "worldview" were thematically analyzed to identify constructions of well-being. Results Participants evaluate their well-being through comparisons to the past and to the illnesses of friends and family. Diabetes self-care motivates social engagement and care of others. At times, distrust of medical institutions means well-being also is established through nonadherence to suggested biomedical treatment. Discussion Hardship and illness in participants' lives frame their diabetes experience and notions of well-being. Providers need to be aware of the social, economic, and political lenses shaping diabetes self-management and subjective well-being.
Collapse
Affiliation(s)
- Sarah Chard
- Department of Sociology, Anthropology, and Health Administration & Policy, Center for Aging Studies, UMBC, Baltimore, Maryland
| | - Brandy Harris-Wallace
- Department of Sociology, Anthropology, and Health Administration & Policy, Center for Aging Studies, UMBC, Baltimore, Maryland
| | - Erin G Roth
- Department of Sociology, Anthropology, and Health Administration & Policy, Center for Aging Studies, UMBC, Baltimore, Maryland
| | - Laura M Girling
- Department of Sociology, Anthropology, and Health Administration & Policy, Center for Aging Studies, UMBC, Baltimore, Maryland
| | - Robert Rubinstein
- Department of Sociology, Anthropology, and Health Administration & Policy, Center for Aging Studies, UMBC, Baltimore, Maryland
| | - Ashanté M Reese
- Sociology and Anthropology, Spelman College, Atlanta, Georgia
| | - Charlene C Quinn
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - J Kevin Eckert
- Department of Sociology, Anthropology, and Health Administration & Policy, Center for Aging Studies, UMBC, Baltimore, Maryland
| |
Collapse
|
22
|
Zachary WW, Michlig G, Kaplan A, Nguyen NT, Quinn CC, Surkan PJ. Participatory Design of a Social Networking App to Support Type II Diabetes Self-Management in Low-Income Minority Communities. ACTA ACUST UNITED AC 2017; 6:37-43. [PMID: 31157286 DOI: 10.1177/2327857917061010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Participatory design (PD) is an emerging alternative to existing methods of user-centered design (UCD), and may be a more appropriate approach for designing patient-facing products in the health care sector than conventional UCD. Type 2 Diabetes Mellitus (T2D) is a serious chronic illness that requires life-long treatment and life-long self-management of food intake, physical activity, and self-testing to avoid complications. T2D disproportionately affects low-income minority communities. Using PD, we have developed an app to help T2D patients. Called the Diabetes Networking Tool (DNT), the app is intended to help patients better self-manage by empowering their network of family and friends to better contribute and support the patient's self-management needs. PD was used to involve a low-income African American community into the process of identifying the specific problems and issues DNT needed to address. We then used multiple complementary analytical methods to condense and abstract the community inputs to yield a functional and user interface design for DNT.
Collapse
Affiliation(s)
- Wayne W Zachary
- Starship Health Technologies, LLC, Plymouth Meeting, PA, USA
| | - Georgia Michlig
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Avril Kaplan
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Pamela J Surkan
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
23
|
Stuart BC, Shen X, Quinn CC, Brandt N, Roberto P, Loh FE, Hendrick F, Kim C, Huang X, Rajpathak S. Proximal Predictors of Long-Term Discontinuance with Noninsulin Antihyperglycemic Agents. J Manag Care Spec Pharm 2016; 22:1019-27. [PMID: 27574743 PMCID: PMC10398303 DOI: 10.18553/jmcp.2016.22.9.1019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Noninsulin antihyperglycemic agents (NAAs) are the mainstay of treatment for type 2 diabetes, yet persistence in NAA use is suboptimal in many diabetes patients. Most of the research on NAA discontinuance has focused on sociodemographic characteristics and general health status, but such factors are inherently limited in explaining dynamic events such as discontinuance. OBJECTIVE To assess the relative importance of static and proximal dynamic factors in explaining long-term NAA discontinuance among Medicare beneficiaries with diabetes. METHODS Two sets of probability models were estimated to predict NAA discontinuance as a function of static variables (age, sex, race, original reason for Medicare entitlement, low-income subsidy and dual Medicare/Medicaid eligibility status, and disease burden) and 21 dynamic factors capturing month-by-month changes in drug use, health status, and use of medical services leading up to discontinuance (defined as month 0) and the previous 4 months (designated months -1 to -4) among 71,619 patients with diabetes enrolled in Medicare Part D plans in 2006-2008. RESULTS Static variables explained just 1.2% of the variance in probability of NAA discontinuance compared with 14% for all variables combined. Key time-related predictors of NAA discontinuance included discontinuation with angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs) and statins, hypoglycemia, NAA usage gaps, insulin use, and discharge from hospitals and skilled nursing facilities (SNFs). The strongest significant predictors (P < 0.05) of NAA discontinuance were discontinuation with statins and ACEIs/ARBs in month 0 (predicted probabilities of 37% and 34%, respectively). Other variables that significantly increased the probability of NAA discontinuance by 10% or more were hypoglycemia in month 0 (14%) and month -1 (17%), discontinuance with ACEIs/ARBs in months -1 (15%) and -2 (10%), discontinuance with statins in month -1 (13%), and insulin use in month 0 (12%). Experiencing a previous gap in NAA therapy was associated with higher likelihood of discontinuance if the gap occurred in month -2 (10%) or month -4 (6%), but a gap in therapy in month -1 actually reduced the likelihood of discontinuance by 13%. Discharge from a hospital or SNF was consistently associated with higher probabilities of NAA discontinuance ranging between 4% and 10%, with higher probabilities occurring closer to month 0. CONCLUSIONS A cascade of dynamic changes preceding discontinuance with NAA therapy among Medicare Part D enrollees with diabetes was observed between 2006 and 2008. Understanding that lack of persistence in drug use is a dynamic rather than a static phenomenon opens up new avenues for investigating and ultimately improving adherence behavior in the elderly. DISCLOSURES This study was funded by Merck & Co. Huang and Raipathak are employees of Merck & Co. Brandt reports consultancy and speaker fees from Catapult, Omnicare, RAND, HRSA, CMS, and AGS Beers Criteria. Loh is currently employed at Touro College of Pharmacy. All other authors have no relevant potential conflicts of interest to disclose. Study concept and design were primarily contributed by Stuart, Quinn, and Brandt, along with Shen, Roberto, Hendrick, Huang, and Rajpathak. Shen, Loh, Hendrick, and Kim collected the data, and data interpretation was performed primarily by Stuart, Shen, and Roberto, assisted by Quinn, Brandt, Hendrick, Huang, and Rajpathak. The manuscript was written primarily by Stuart, with assistance from the other authors, and revised by Huang, Rajpathak, and Stuart, with assistance from the other authors.
Collapse
Affiliation(s)
- Bruce C Stuart
- 1 University of Maryland School of Pharmacy, Baltimore, Maryland
| | - Xian Shen
- 1 University of Maryland School of Pharmacy, Baltimore, Maryland
| | - Charlene C Quinn
- 2 University of Maryland School of Medicine, Baltimore, Maryland
| | - Nicole Brandt
- 1 University of Maryland School of Pharmacy, Baltimore, Maryland
| | - Pamela Roberto
- 3 Pharmaceutical Research and Manufacturers of America, Washington, DC, and University of Maryland School of Pharmacy, Baltimore, Maryland
| | - F Ellen Loh
- 1 University of Maryland School of Pharmacy, Baltimore, Maryland
| | | | - Caroline Kim
- 1 University of Maryland School of Pharmacy, Baltimore, Maryland
| | - Xingyue Huang
- 4 Merck Research Labs, Merck & Co., Kenilworth, New Jersey
| | | |
Collapse
|
24
|
Cho J, Stock EM, Zeber JE, Ahmedani BK, Basu R, Quinn CC, Copeland LA. Factors Associated With Longevity Among Oldest-Old Male Patients With Hip Fractures. J Patient Cent Res Rev 2016. [DOI: 10.17294/2330-0698.1313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
25
|
Burke LE, Ma J, Azar KMJ, Bennett GG, Peterson ED, Zheng Y, Riley W, Stephens J, Shah SH, Suffoletto B, Turan TN, Spring B, Steinberger J, Quinn CC. Current Science on Consumer Use of Mobile Health for Cardiovascular Disease Prevention: A Scientific Statement From the American Heart Association. Circulation 2015; 132:1157-213. [PMID: 26271892 DOI: 10.1161/cir.0000000000000232] [Citation(s) in RCA: 358] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
|
26
|
Greenwood DA, Blozis SA, Young HM, Nesbitt TS, Quinn CC. Overcoming Clinical Inertia: A Randomized Clinical Trial of a Telehealth Remote Monitoring Intervention Using Paired Glucose Testing in Adults With Type 2 Diabetes. J Med Internet Res 2015. [PMID: 26199142 PMCID: PMC4527012 DOI: 10.2196/jmir.4112] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [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] [Indexed: 12/26/2022] Open
Abstract
Background Type 2 diabetes mellitus is a worldwide challenge. Practice guidelines promote structured self-monitoring of blood glucose (SMBG) for informing health care providers about glycemic control and providing patient feedback to increase knowledge, self-efficacy, and behavior change. Paired glucose testing—pairs of glucose results obtained before and after a meal or physical activity—is a method of structured SMBG. However, frequent access to glucose data to interpret values and recommend actions is challenging. A complete feedback loop—data collection and interpretation combined with feedback to modify treatment—has been associated with improved outcomes, yet there remains limited integration of SMBG feedback in diabetes management. Incorporating telehealth remote monitoring and asynchronous electronic health record (EHR) feedback from certified diabetes educators (CDEs)—specialists in glucose pattern management—employ the complete feedback loop to improve outcomes. Objective The purpose of this study was to evaluate a telehealth remote monitoring intervention using paired glucose testing and asynchronous data analysis in adults with type 2 diabetes. The primary aim was change in glycated hemoglobin (A1c)—a measure of overall glucose management—between groups after 6 months. The secondary aims were change in self-reported Summary of Diabetes Self-Care Activities (SDSCA), Diabetes Empowerment Scale, and Diabetes Knowledge Test. Methods A 2-group randomized clinical trial was conducted comparing usual care to telehealth remote monitoring with paired glucose testing and asynchronous virtual visits. Participants were aged 30-70 years, not using insulin with A1c levels between 7.5% and 10.9% (58-96 mmol/mol). The telehealth remote monitoring tablet computer transmitted glucose data and facilitated a complete feedback loop to educate participants, analyze actionable glucose data, and provide feedback. Data from paired glucose testing were analyzed asynchronously using computer-assisted pattern analysis and were shared with patients via the EHR weekly. CDEs called participants monthly to discuss paired glucose testing trends and treatment changes. Separate mixed-effects models were used to analyze data. Results Participants (N=90) were primarily white (64%, 56/87), mean age 58 (SD 11) years, mean body mass index 34.1 (SD 6.7) kg/m2, with diabetes for mean 8.2 (SD 5.4) years, and a mean A1c of 8.3% (SD 1.1; 67 mmol/mol). Both groups lowered A1c with an estimated average decrease of 0.70 percentage points in usual care group and 1.11 percentage points in the treatment group with a significant difference of 0.41 percentage points at 6 months (SE 0.08, t159=–2.87, P=.005). Change in medication (SE 0.21, t157=–3.37, P=.009) was significantly associated with lower A1c level. The treatment group significantly improved on the SDSCA subscales carbohydrate spacing (P=.04), monitoring glucose (P=.001), and foot care (P=.02). Conclusions An eHealth model incorporating a complete feedback loop with telehealth remote monitoring and paired glucose testing with asynchronous data analysis significantly improved A1c levels compared to usual care. Trial Registration Clinicaltrials.gov NCT01715649; https://www.clinicaltrials.gov/ct2/show/NCT01715649 (Archived by WebCite at http://www.webcitation.org/6ZinLl8D0).
Collapse
Affiliation(s)
- Deborah A Greenwood
- Clinical Performance Improvement Consultant, Office of Patient Experience, Quality and Clinical Effectiveness, Sutter Health, Sacramento, CA, United States.
| | | | | | | | | |
Collapse
|
27
|
Abstract
The purpose of this study was to evaluate participant self-efficacy and use of a mobile phone diabetes health intervention for older adults during a 4-week period. Participants included seven adults (mean age, 70.3 years) with type 2 diabetes cared for by community-based primary care physicians. Participants entered blood glucose data into a mobile phone and personalized patient Internet Web portal. Based on blood glucose values, participants received automatic messages and educational information to self-manage their diabetes. Study measures included prior mobile phone/Internet use, the Stanford Self-Efficacy for Diabetes Scale, the Stanford Energy/Fatigue Scale, the Short Form-36, the Patient Health Questionnaire-9 (depression), the Patient Reported Diabetes Symptom Scale, the Diabetes Stages of Change measure, and a summary of mobile system use. Participants had high self-efficacy and high readiness and confidence in their ability to monitor changes to control their diabetes. Participants demonstrated ability to use the mobile intervention and communicate with diabetes educators.
Collapse
Affiliation(s)
- Charlene C. Quinn
- Division of Gerontology, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Bilal Khokhar
- Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, Maryland
| | - Kelly Weed
- Division of Gerontology, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Erik Barr
- Division of Gerontology, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Ann L. Gruber-Baldini
- Division of Gerontology, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| |
Collapse
|
28
|
Cross RK, Jambaulikar G, Langenberg P, Tracy JK, Collins JF, Katz J, Regueiro M, Schwartz DA, Quinn CC. TELEmedicine for Patients with Inflammatory Bowel Disease (TELE-IBD): Design and implementation of randomized clinical trial. Contemp Clin Trials 2015; 42:132-44. [PMID: 25812483 DOI: 10.1016/j.cct.2015.03.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 03/16/2015] [Accepted: 03/17/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND Inflammatory bowel diseases (IBD), comprised of ulcerative colitis and Crohn's disease, are chronic disorders characterized by worsening of symptoms followed by symptom-free periods. Symptoms have a profound negative impact on quality of life and are associated with increased health care utilization. Despite effective treatments, outcomes are suboptimal secondary to nonadherence, medication intolerance, inconsistent monitoring, poor patient knowledge and limited access to care. OBJECTIVES Compare disease activity and quality of life over 1 year in a randomized trial of IBD patients receiving standard care versus telemedicine. METHODS Patients evaluated at 3 IBD referral centers with worsening symptoms within the last 2 years are eligible for randomization to one of two interventions or standard care. The interventions consist of either every other week or weekly assessment of symptoms, side effects, weight and delivery of medication prompts and education via texts to the participant's mobile phone. Individualized alerts and action plans are created on a secure portal. Participants in the standard care group undergo routine and urgent follow-up visits and telephone calls. The primary outcomes group comparisons of changes in disease activity and quality of life scores from baseline to 6 and 12 months. CONCLUSIONS Methods such as telemedicine are needed to improve monitoring, adherence, self-efficacy, and patient knowledge in IBD. If effective, telemedicine should decrease symptoms, improve quality of life, and decrease health care utilization. The burden associated with use of telemedicine for patients and providers needs to be assessed. The trial is ongoing and will be completed in July 2016.
Collapse
Affiliation(s)
- Raymond K Cross
- University of Maryland, Baltimore, Department of Medicine, Division of Gastroenterology and Hepatology, Baltimore, MD, United States.
| | - Guruprasad Jambaulikar
- University of Maryland, Baltimore, Department of Medicine, Division of Gastroenterology and Hepatology, Baltimore, MD, United States
| | - Patricia Langenberg
- University of Maryland, Baltimore, Department of Epidemiology and Public Health, Baltimore, MD, United States
| | - J Kathleen Tracy
- University of Maryland, Baltimore, Department of Epidemiology and Public Health, Baltimore, MD, United States
| | - Joseph F Collins
- University of Maryland, Baltimore, Department of Epidemiology and Public Health, Baltimore, MD, United States; Veterans Affairs Cooperative Studies Program, Perry Point, MD, United States
| | | | - Miguel Regueiro
- University of Pittsburgh, Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, Pittsburgh, PA, United States
| | - David A Schwartz
- Vanderbilt University, Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, Nashville, TN, United States
| | - Charlene C Quinn
- University of Maryland, Baltimore, Department of Epidemiology and Public Health, Baltimore, MD, United States
| |
Collapse
|
29
|
Ng X, Quinn CC, Burcu M, Harrington D. Assessment of an Expanded Functional Disability Scale for Older Adults With Diabetes. J Appl Gerontol 2014; 35:529-48. [DOI: 10.1177/0733464814563607] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 11/08/2014] [Indexed: 12/26/2022] Open
Abstract
Although prior literature has shown the plausibility of combining the Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) items to form an expanded scale for measuring the degree of functional decline, this has not been shown in older adults with diabetes who are disproportionately affected by functional disability. Using the 2009 Medicare Current Beneficiary Survey data, we evaluated the factor structure of the pooled ADL and IADL items. Based on our study comprising 2,158 community-dwelling older adults (≥65 years) with diabetes, the unidimensional model exhibited good fit. Despite well-fitting indices, high correlations were observed between the latent constructs (>.70) of the multi-factor models, suggesting a lack of discriminant validity. These findings provide empirical support for a combined scale that can comprehensively and efficiently characterize the extent of functional disability in older adults with diabetes for research, risk adjustment, and evaluation in patient-centered medical homes.
Collapse
Affiliation(s)
- Xinyi Ng
- University of Maryland, Baltimore, USA
| | | | | | | |
Collapse
|
30
|
Quinn CC, Shardell MD, Terrin ML, Barr EA, Park D, Shaikh F, Guralnik JM, Gruber-Baldini AL. Mobile Diabetes Intervention for Glycemic Control in 45- to 64-Year-Old Persons With Type 2 Diabetes. J Appl Gerontol 2014; 35:227-43. [PMID: 25098253 DOI: 10.1177/0733464814542611] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 06/14/2014] [Indexed: 12/23/2022] Open
Abstract
The purpose of this study was to assess effects of a mobile coaching system on glycated hemoglobin (HbA1c) levels in younger versus older patients over 1 year. Participants (n = 118) included adult patients with Type 2 diabetes cared for by community physicians. Intervention patients received mobile phone coaching and individualized web portal. Control patients received usual care. Patients were stratified into two age groups: younger (<55 years) and older (≥ 55 years). The intervention resulted in greater 12-month declines in HbA1c, compared with usual care, for patients in both age groups (p < .0001). Among older patients, HbA1c changed by -1.8% (95% confidence interval [CI] = [-2.4, -1.1]) in the intervention group and -0.3% (95% CI = [-0.9, +0.3]) in the control group. Among younger patients, HbA1c changed by -2.0% (95% CI = [-2.5, -1.5]) in the intervention group and -1.0% (95% CI = [-1.6, -0.4]) in the control group. The mobile health intervention was as effective at managing Type 2 diabetes in older adults as younger persons.
Collapse
Affiliation(s)
| | | | | | - Erik A Barr
- University of Maryland School of Medicine, Baltimore, USA
| | - DoHwan Park
- University of Maryland Baltimore County, USA
| | | | | | | |
Collapse
|
31
|
Abstract
The aim was to summarize research on telehealth remote patient monitoring interventions that incorporate key elements of structured self-monitoring of blood glucose (SMBG) identified as essential for improving A1C. A systematic review was conducted using the Medline, Cumulative Index to Nursing and Allied Health Literature, EMBASE, and OVID Medline databases with search terms "Telemedicine" AND "Monitoring, Physiologic" AND "Diabetes Mellitus, Type 2." Study selection criteria included original randomized clinical trials evaluating the impact of telehealth remote patient monitoring on A1C among adults with type 2 diabetes and incorporated 1 or more essential elements of SMBG identified by the International Diabetes Federation (patient education, provider education, structured SMBG profile, SMBG goals, feedback, data used to modify treatment, interactive communication or shared decision making). Fifteen studies were included, with interventions ranging from 3 to 12 months (mean 8 months) with sample sizes from 30 to 1665. Key SMBG elements were grouped into 3 categories: education, SMBG protocols, and feedback. Research incorporating 5 of the 7 elements consistently achieved significant A1C improvements between study groups. Interventions using more SMBG elements are associated with an improvement in A1C. Studies with the largest A1C decrease incorporated 6 of the 7 elements and computer decision support. Two studies with 5 of the 7 elements and active medication management achieved significant A1C decreases. Telehealth remote patient monitoring interventions in type 2 diabetes have not included all structured monitoring elements recommended by the IDF. Incorporating more elements of structured SMBG is associated with improved A1C.
Collapse
Affiliation(s)
- Deborah A Greenwood
- Betty Irene Moore School of Nursing at University of California Davis, Sacramento, CA, USA
| | - Heather M Young
- Betty Irene Moore School of Nursing at University of California Davis, Sacramento, CA, USA
| | | |
Collapse
|
32
|
Quinn CC, Sareh PL, Shardell ML, Terrin ML, Barr EA, Gruber-Baldini AL. Mobile Diabetes Intervention for Glycemic Control: Impact on Physician Prescribing. J Diabetes Sci Technol 2014; 8:362-370. [PMID: 24876589 PMCID: PMC4455407 DOI: 10.1177/1932296813514503] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [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] [Indexed: 01/01/2023]
Abstract
Of adults with type 2 diabetes, 84% take antihyperglycemic medication. Successful treatment requires active monitoring and medication dose adjustment by health providers. The objective of this study was to determine how a mobile-phone-based coaching system for diabetes management influences physician prescribing behavior. This secondary data analysis is based on a cluster randomized clinical trial that reported patients provided with mobile self-management had reduction in glycated hemoglobin (HbA1c) of 1.9% over 1 year, compared to 0.7% in control patients (P < .001). Participants were primary care patients with type 2 diabetes randomized at physician practice level into a control group (n = 55) and intervention group (n = 62). Main study measures were patients' medication records (medication, dose, frequency, start and end date) abstracted at baseline and study end. Antihyperglycemic medications, including sulfonylureas or thiazolidinediones, and antihypertensive and antilipemic medications were analyzed. A higher percentage of patients in the intervention group had modification and intensification of incretin mimetics during the 1-year study period (9.7% vs 0.0% and 8.1% vs 0.0%, both P = .008). A higher percentage of patients in the intervention group had modification and intensification of metformin (24.2% vs 7.3%, P = .033). The overall difference in physician prescribing of oral antihyperglycemic medications was not statistically significant. Our results suggest mobile diabetes interventions can encourage physicians to modify and intensify antihyperglycemic medications in patients with type 2 diabetes. Differences in physician prescribing behavior were modest, and do not appear to be large enough to explain a 1.2% decrease in HbA1c.
Collapse
Affiliation(s)
- Charlene C Quinn
- Division of Gerontology, Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Patricia L Sareh
- Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Michelle L Shardell
- Division of Gerontology, Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Michael L Terrin
- Division of Gerontology, Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Erik A Barr
- Division of Gerontology, Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ann L Gruber-Baldini
- Division of Gerontology, Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| |
Collapse
|
33
|
Quinn CC, Shardell MD, Terrin ML, Barr EA, Ballew SH, Gruber-Baldini AL. Cluster-randomized trial of a mobile phone personalized behavioral intervention for blood glucose control. Diabetes Care 2011; 34:1934-42. [PMID: 21788632 PMCID: PMC3161305 DOI: 10.2337/dc11-0366] [Citation(s) in RCA: 417] [Impact Index Per Article: 32.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To test whether adding mobile application coaching and patient/provider web portals to community primary care compared with standard diabetes management would reduce glycated hemoglobin levels in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS A cluster-randomized clinical trial, the Mobile Diabetes Intervention Study, randomly assigned 26 primary care practices to one of three stepped treatment groups or a control group (usual care). A total of 163 patients were enrolled and included in analysis. The primary outcome was change in glycated hemoglobin levels over a 1-year treatment period. Secondary outcomes were changes in patient-reported diabetes symptoms, diabetes distress, depression, and other clinical (blood pressure) and laboratory (lipid) values. Maximal treatment was a mobile- and web-based self-management patient coaching system and provider decision support. Patients received automated, real-time educational and behavioral messaging in response to individually analyzed blood glucose values, diabetes medications, and lifestyle behaviors communicated by mobile phone. Providers received quarterly reports summarizing patient's glycemic control, diabetes medication management, lifestyle behaviors, and evidence-based treatment options. RESULTS The mean declines in glycated hemoglobin were 1.9% in the maximal treatment group and 0.7% in the usual care group, a difference of 1.2% (P = 0.001) [corrected] over 12 months. Appreciable differences were not observed between groups for patient-reported diabetes distress, depression, diabetes symptoms, or blood pressure and lipid levels (all P > 0.05). CONCLUSIONS The combination of behavioral mobile coaching with blood glucose data, lifestyle behaviors, and patient self-management data individually analyzed and presented with evidence-based guidelines to providers substantially reduced glycated hemoglobin levels over 1 year.
Collapse
Affiliation(s)
- Charlene C Quinn
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA.
| | | | | | | | | | | |
Collapse
|
34
|
Quinn CC, Shardell MD, Terrin ML, Barr EA, Ballew SH, Gruber-Baldini AL. Cluster-randomized trial of a mobile phone personalized behavioral intervention for blood glucose control. Diabetes Care 2011. [PMID: 21788632 DOI: 10.2337/dc11-0366/-/dc1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To test whether adding mobile application coaching and patient/provider web portals to community primary care compared with standard diabetes management would reduce glycated hemoglobin levels in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS A cluster-randomized clinical trial, the Mobile Diabetes Intervention Study, randomly assigned 26 primary care practices to one of three stepped treatment groups or a control group (usual care). A total of 163 patients were enrolled and included in analysis. The primary outcome was change in glycated hemoglobin levels over a 1-year treatment period. Secondary outcomes were changes in patient-reported diabetes symptoms, diabetes distress, depression, and other clinical (blood pressure) and laboratory (lipid) values. Maximal treatment was a mobile- and web-based self-management patient coaching system and provider decision support. Patients received automated, real-time educational and behavioral messaging in response to individually analyzed blood glucose values, diabetes medications, and lifestyle behaviors communicated by mobile phone. Providers received quarterly reports summarizing patient's glycemic control, diabetes medication management, lifestyle behaviors, and evidence-based treatment options. RESULTS The mean declines in glycated hemoglobin were 1.9% in the maximal treatment group and 0.7% in the usual care group, a difference of 1.2% (P = 0.001) [corrected] over 12 months. Appreciable differences were not observed between groups for patient-reported diabetes distress, depression, diabetes symptoms, or blood pressure and lipid levels (all P > 0.05). CONCLUSIONS The combination of behavioral mobile coaching with blood glucose data, lifestyle behaviors, and patient self-management data individually analyzed and presented with evidence-based guidelines to providers substantially reduced glycated hemoglobin levels over 1 year.
Collapse
Affiliation(s)
- Charlene C Quinn
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA.
| | | | | | | | | | | |
Collapse
|
35
|
Quinn CC, Royak-Schaler R, Lender D, Steinle N, Gadalla S, Zhan M. Patient understanding of diabetes self-management: participatory decision-making in diabetes care. J Diabetes Sci Technol 2011; 5:723-30. [PMID: 21722588 PMCID: PMC3192639 DOI: 10.1177/193229681100500327] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Our aim was to determine whether patient participation in decision-making about diabetes care is associated with understanding of diabetes self-management and subsequent self-care practices. We also identified issues that would impact messaging for use in mobile diabetes communication. RESEARCH DESIGN AND METHODS A cross-sectional observational study was conducted with type 2 diabetes patients (n = 81) receiving their care at the University of Maryland Joslin Diabetes Center. A convenience sample of patients were eligible to participate if they were aged 25-85 years, had type 2 diabetes, spoke English, and visited their physician diabetes manager within the past 6 months. In-person patient interviews were conducted at the time of clinic visits to assess patient understanding of diabetes management, self-care practices, and perceptions of participation in decision-making about diabetes care. RESULTS African Americans reported fewer opportunities to participate in decision-making than Caucasians, after controlling for education [mean difference (MD) = -2.4, p = .02]. This association became insignificant after controlling for patient-physician race concordance (MD = -1.5, p = .21). Patient understanding of self-care was predicted by having greater than high school education (MD = 3.6, p = .001) and having physicians who involved them in decision-making about their care. For each unit increase in understanding of diabetes self-care, the mean patient self-care practice score increased by 0.16 (p = .003), after adjustment for patient race and education. CONCLUSIONS Patient participation in decision-making is associated with better understanding of care. Participation in decision-making plays a key role in patient understanding of diabetes self-management and subsequent self-care practices. Patients with limited education need specific instruction in foot care, food choices, and monitoring hemoglobin A1c.
Collapse
Affiliation(s)
- Charlene C Quinn
- Department of Epidemiology and Public Health, Division of Gerontology, University of Maryland School of Medicine, Baltimore, Maryland, USA.
| | | | | | | | | | | |
Collapse
|
36
|
Horn SD, Sharkey SS, Hudak S, Smout RJ, Quinn CC, Yody B, Fleshner I. Response to Dr Murad. J Am Med Dir Assoc 2011. [DOI: 10.1016/j.jamda.2010.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
37
|
Horn SD, Sharkey SS, Hudak S, Smout RJ, Quinn CC, Yody B, Fleshner I. Beyond CMS Quality Measure Adjustments: Identifying Key Resident and Nursing Home Facility Factors Associated With Quality Measures. J Am Med Dir Assoc 2010; 11:500-5. [DOI: 10.1016/j.jamda.2009.10.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2009] [Accepted: 10/20/2009] [Indexed: 11/28/2022]
|
38
|
Gruber-Baldini AL, Stuart B, Zuckerman IH, Hsu VD, Boockvar KS, Zimmerman S, Kittner S, Quinn CC, Hebel JR, May C, Magaziner J. Sensitivity of nursing home cost comparisons to method of dementia diagnosis ascertainment. Int J Alzheimers Dis 2009; 2009:780720. [PMID: 20526431 PMCID: PMC2880523 DOI: 10.4061/2009/780720] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2009] [Accepted: 08/06/2009] [Indexed: 11/20/2022] Open
Abstract
This study compared the association of differing methods of dementia ascertainment, derived from multiple sources, with nursing home (NH) estimates of prevalence of dementia, length of stay, and costs an understudied issue.
Subjects were 2050 new admissions to 59 Maryland NHs, from 1992 to 1995 followed longitudinally for 2 years. Dementia was ascertained at admission from charts, Medicare claims, and expert panel. Overall 59.5% of the sample had some indicator of dementia. The expert panel found a higher prevalence of dementia (48.0%) than chart review (36.9%) or Medicare claims (38.6%). Dementia cases had lower relative average per patient monthly costs, but longer NH length of stay compared to nondementia cases across all methods. The prevalence of dementia varied widely by method of ascertainment, and there was only moderate agreement across methods. However, lower costs for dementia among NH admissions are a robust finding across these methods.
Collapse
Affiliation(s)
- Ann L Gruber-Baldini
- Division of Gerontology, Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Quinn CC, Gruber-Baldini AL, Port CL, May C, Stuart B, Hebel JR, Zimmerman S, Burton L, Zuckerman IH, Fahlman C, Magaziner J. The role of nursing home admission and dementia status on care for diabetes mellitus. J Am Geriatr Soc 2009; 57:1628-33. [PMID: 19682125 DOI: 10.1111/j.1532-5415.2009.02382.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To study the role of nursing home (NH) admission and dementia status on the provision of five procedures related to diabetes mellitus. DESIGN Retrospective cohort study using data from a large prospective study in which an expert panel determined the prevalence of dementia. SETTING Fifty-nine Maryland NHs. PARTICIPANTS Three hundred ninety-nine new admission NH patients with diabetes mellitus. MEASUREMENTS Medicare administrative claims records matched to the NH medical record data were used to measure procedures related to diabetes mellitus received in the year before NH admission and up to a year after admission (and before discharge). Procedures included glycosylated hemoglobin, fasting blood glucose, dilated eye examination, lipid profile, and serum creatinine. RESULTS For all but dilated eye examinations, higher rates of procedures related to diabetes mellitus were seen in the year after NH admission than in the year before. Residents without dementia received more procedures than those with dementia, although this was somewhat attenuated after controlling for demographic, health, and healthcare utilization variables. Persons without dementia experience greater increases in procedure rates after admission than those with dementia. CONCLUSION The structured environment of care provided by the NH may positively affect monitoring procedures provided to elderly persons with diabetes mellitus, especially those without dementia. Medical decisions related to the risks and benefits of intensive treatment for diabetes mellitus to patients of varying frailty and expected longevity may lead to lower rates of procedures for residents with dementia.
Collapse
Affiliation(s)
- Charlene C Quinn
- Division of Gerontology, Department of Epidemiology and Preventive Medicine, School of Medicine, University of Maryland, Baltimore, Maryland 21201, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
|
41
|
Rich SE, Gruber-Baldini AL, Quinn CC, Zimmerman SI. Discussion as a factor in racial disparity in advance directive completion at nursing home admission. J Am Geriatr Soc 2009; 57:146-52. [PMID: 19170791 DOI: 10.1111/j.1532-5415.2008.02090.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Studies have consistently shown racial disparities in advance directive completion for nursing home residents but have not examined whether this disparity is due to differences in interactions with healthcare providers. This study had two aims: to determine whether the racial disparity in advance directive completion by nursing home residents is related to differences in discussion of treatment restrictions with healthcare providers and to examine whether there is a racial disparity in perceptions of residents' significant others that additional discussions would be helpful. Participants were 2,171 white or black (16% of sample) residents newly admitted to 59 nursing homes. Data were collected from structured interviews with residents' significant others and review of nursing home charts. Questions included whether advance directives were completed, whether treatment restrictions were discussed with the resident or family, and whether more discussion would have been helpful. Frequencies according to race were determined for each question; P-values and logistic regression models were obtained. Black residents were less likely to have completed any advance directives (P<.001), and they (P<.001) and their family members (P<.001) were less likely than whites to have discussed treatment restrictions with healthcare providers. Logistic regression models indicated that disparity in treatment restrictions narrowed when these discussions occurred. Significant others of black residents were more likely than those of white residents to consider further discussion helpful (P<.001), especially with physicians. Racial disparity in treatment restrictions may be due in part to a difference in discussion with healthcare providers; increasing discussion may narrow this disparity.
Collapse
Affiliation(s)
- Shayna E Rich
- Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.
| | | | | | | |
Collapse
|
42
|
Quinn CC, Gruber-Baldini AL, Shardell M, Weed K, Clough SS, Peeples M, Terrin M, Bronich-Hall L, Barr E, Lender D. Mobile diabetes intervention study: testing a personalized treatment/behavioral communication intervention for blood glucose control. Contemp Clin Trials 2009; 30:334-46. [PMID: 19250979 DOI: 10.1016/j.cct.2009.02.004] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2008] [Revised: 02/12/2009] [Accepted: 02/13/2009] [Indexed: 12/27/2022]
Abstract
BACKGROUND National data find glycemic control is within target (A1c<7.0%) for 37% of patients with diabetes, and only 7% meet recommended glycemic, lipid, and blood pressure goals. OBJECTIVES To compare active interventions and usual care for glucose control in a randomized clinical trial (RCT) among persons with diabetes cared for by primary care physicians (PCPs) over the course of 1 year. METHODS Physician practices (n=36) in 4 geographic areas are randomly assigned to 1 of 4 study groups. The intervention is a diabetes communication system, using mobile phones and patient/physician portals to allow patient-specific treatment and communication. All physicians receive American Diabetes Association (ADA) Guidelines for diabetes care. Patients with poor diabetes control (A1c> or =7.5%) at baseline (n=260) are enrolled in study groups based on PCP randomization. All study patients receive blood glucose (BG) meters and a year's supply of testing materials. Patients in three treatment groups select one of two mobile phone models, receive one-year unlimited mobile phone data and service plan, register on the web-based individual patient portal and receive study treatment phone software based on study assignment. Control group patients receive usual care from their PCP. The primary outcome is mean change in A1c over a 12-month intervention period. CONCLUSION Traditional methods of disease management have not achieved adequate control for BG and other conditions important to persons with diabetes. Tools to improve communication between patients and PCPs may improve patient outcomes and be satisfactory to patients and physicians. This RCT is ongoing.
Collapse
Affiliation(s)
- Charlene C Quinn
- Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, 660 W. Redwood Street, Baltimore, MD 21201, United States.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Quinn CC, Port CL, Zimmerman S, Gruber-Baldini AL, Kasper JD, Fleshner I, Yody B, Loome J, Magaziner J. Short-stay nursing home rehabilitation patients: transitional care problems pose research challenges. J Am Geriatr Soc 2008; 56:1940-5. [PMID: 18691277 DOI: 10.1111/j.1532-5415.2008.01852.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A clinical intervention pilot study to improve depression care for short-stay nursing home Medicare-reimbursed rehabilitation patients funded by the National Institute on Aging was conducted. Despite solid theoretical and clinical grounding and the support of a large nursing home company, several roadblocks to implementation were encountered, including involving patients and families, communication between providers, involving community primary care physicians, staff time constraints, and conducting research with short-stay patients. Although frustrating from a research standpoint, these roadblocks closely reflect problems identified by the American Geriatrics Society as impeding the delivery of high-quality transitional care in geriatrics. These research roadblocks are described as they were encountered in the clinical setting, and each is placed within the larger context of challenges associated with care transitions, especially for older persons with complex health needs receiving nursing home rehabilitation. Finally, recommendations are offered for researchers conducting much-needed research within geriatric transitional care settings, including starting early in the care transition chain and assisting patients and families with providing continuity across care settings.
Collapse
Affiliation(s)
- Charlene C Quinn
- Department of Epidemiology and Preventive Medicine, Division of Gerontology, School of Medicine, University of Maryland, Baltimore, Maryland, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Quinn CC, Clough SS, Minor JM, Lender D, Okafor MC, Gruber-Baldini A. WellDoc mobile diabetes management randomized controlled trial: change in clinical and behavioral outcomes and patient and physician satisfaction. Diabetes Technol Ther 2008; 10:160-8. [PMID: 18473689 DOI: 10.1089/dia.2008.0283] [Citation(s) in RCA: 268] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Less than 63% of individuals with diabetes meet professional guidelines target of hemoglobin A1c <7.0%, and only 7% meet combined glycemic, lipid, and blood pressure goals. The primary study aim was to assess the impact on A1c of a cell phone-based diabetes management software system used with web-based data analytics and therapy optimization tools. Secondary aims examined health care provider (HCP) adherence to prescribing guidelines and assessed HCPs' adoption of the technology. METHODS Thirty patients with type 2 diabetes were recruited from three community physician practices for a 3-month study and evenly randomized. The intervention group received cell phone-based software designed by endocrinologists and CDEs (WellDoc Communications, Inc., Baltimore, MD). The software provided real-time feedback on patients' blood glucose levels, displayed patients' medication regimens, incorporated hypo- and hyperglycemia treatment algorithms, and requested additional data needed to evaluate diabetes management. Patient data captured and transferred to secure servers were analyzed by proprietary statistical algorithms. The system sent computer-generated logbooks (with suggested treatment plans) to intervention patients' HCPs. RESULTS The average decrease in A1c for intervention patients was 2.03%, compared to 0.68% (P < 0.02, one-tailed) for control patients. Of the intervention patients, 84% had medications titrated or changed by their HCP compared to controls (23%, P = 0.002). Intervention patients' HCPs reported the system facilitated treatment decisions, provided organized data, and reduced logbook review time. CONCLUSIONS Adults with type 2 diabetes using WellDoc's software achieved statistically significant improvements in A1c. HCP and patient satisfaction with the system was clinically and statistically significant.
Collapse
Affiliation(s)
- Charlene C Quinn
- Division of Gerontology, Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
| | | | | | | | | | | |
Collapse
|
45
|
Zimmerman S, Gruber-Baldini AL, Hebel JR, Burton L, Boockvar K, Taler G, Quinn CC, Magaziner J. Nursing home characteristics related to medicare costs for residents with and without dementia. Am J Alzheimers Dis Other Demen 2008; 23:57-65. [PMID: 18276958 PMCID: PMC10846144 DOI: 10.1177/1533317507308778] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To evaluate the relationship of nursing home characteristics to Medicare costs overall and by dementia status. DESIGN New admissions followed for 2 years. Setting. Random stratified sample of 55 Maryland nursing homes. PARTICIPANTS Sample of 1257 residents. MEASURES Records, interview, and observation. RESULTS Medicare costs were lower in facilities that have a better environmental quality, hospice beds, and more food service workers; costs were higher in hospital-based facilities and those that have a higher Medicaid case mix, X-ray, and some specified types of staff. Across all characteristics, costs for residents with dementia were consistently two-thirds the cost of other residents. DISCUSSION In terms of dementia status, resident characteristics drive Medicare costs, as opposed to facility characteristics. Using alternative residential settings for individuals with dementia may increase Medicare costs of nursing home residents and Medicare costs of residents with dementia who are cared for in settings less able to attend to medical needs.
Collapse
Affiliation(s)
- Sheryl Zimmerman
- Program on Aging, Disability and Long-Term Care, Cecil G. Sheps Center for Health Services Research and the School of Social Work, University of North Carolina at Chapel Hill, North Carolina 27514, USA.
| | | | | | | | | | | | | | | |
Collapse
|
46
|
Stuart B, Shaffer TJ, Simoni-Wastila LJ, Zuckerman IH, Quinn CC. Variation in antidiabetic medication intensity among Medicare beneficiaries with diabetes mellitus. Am J Geriatr Pharmacother 2007; 5:195-208. [PMID: 17996659 DOI: 10.1016/j.amjopharm.2007.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/20/2007] [Indexed: 05/25/2023]
Abstract
BACKGROUND Recent guidelines for treating older patients with diabetes mellitus (DM) and significant disease burden place less emphasis on glycemic control and stress the potential harms that may arise from adherence to strict regimens with antidiabetic medications. However, there are few empirical benchmarks against which clinicians can compare their prescribing practices for patients who have DM and varying levels of comorbidity. OBJECTIVE The current study had 2 goals: (1) to provide national estimates showing how the intensity of antidiabetic medication regimens for Medicare beneficiaries with DM varies by level of medical spending (a proxy for overall disease burden); and (2) to identify potential predictive factors associated with the observed differences. METHODS This study analyzed 2002 Medicare Current Beneficiary Survey (MCBS) data to benchmark intensity of antidiabetic medication regimens for Medicare beneficiaries with DM arrayed by decile of cumulative medical care spending. The study involved 3 steps: (1) stratification of the study population into 10 mutually exclusive deciles by cumulative all-source annual medical spending; (2) assessment of the unconditional association between decile assignment and intensity of antidiabetic medication use; and (3) identification of mediating factors that differentially explain medication intensity across the spectrum of disease burden. We evaluated 3 outcomes: (1) prevalence of any antidiabetic agent in 2002; (2) annual utilization rates for 5 different classes of oral hypoglycemic agents (sulfonylurea, metformin, thiazolidinedione, alpha-glucosidase inhibitors, and meglitinides) plus insulins; and (3) counts of annual prescription fills. RESULTS The final study sample comprised 1956 Medicare beneficiaries representing 23.1% of the MCBS sample after exclusions. We found a pronounced inverted U-shaped pattern in intensity of antidiabetic treatment. Compared with individuals in the group with the highest prevalence of antidiabetic use (decile 7), the unadjusted treatment odds ratios were 0.40 in decile 1 (95% CI, 0.26-0.60) and 0.54 in decile 10 (95% CI, 0.36-0.81). We found similar patterns in the complexity of drug regimens and numbers of antidiabetic prescriptions filled among users. Controlling for disease severity and other factors eliminated the inverted U-shaped pattern among higher cost beneficiaries but not for those in the lower spending deciles. CONCLUSIONS This national study found that high-cost Medicare beneficiaries with DM received substantially less intensive antidiabetic regimens compared with those incurring more modest medical expenditures in 2002. Longitudinal analysis is necessary to determine whether this finding indicates suboptimal therapy or has a more benign explanation. However, the magnitude of the association warrants the attention of clinicians who treat elderly and disabled diabetic patients with high disease burden.
Collapse
Affiliation(s)
- Bruce Stuart
- Peter Lamy Center on Drug Therapy and Aging, University of Maryland, Baltimore, Maryland 21201, USA.
| | | | | | | | | |
Collapse
|
47
|
Magaziner J, Zimmerman S, Gruber-Baldini AL, van Doorn C, Hebel JR, German P, Burton L, Taler G, May C, Quinn CC, Port CL, Baumgarten M. Mortality and Adverse Health Events in Newly Admitted Nursing Home Residents with and without Dementia. J Am Geriatr Soc 2005; 53:1858-66. [PMID: 16274365 DOI: 10.1111/j.1532-5415.2005.53551.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [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: 11/30/2022]
Abstract
OBJECTIVES To evaluate the association between dementia and mortality, adverse health events, and discharge disposition of newly admitted nursing home residents. It was hypothesized that residents with dementia would die at a higher rate and develop more adverse health events (e.g., infections, fevers, pressure ulcers, falls) than residents without dementia because of communication and self-care difficulties. DESIGN An expert clinician panel diagnosed an admission cohort from a stratified random sample of 59 Maryland nursing homes, between 1992 and 1995. The cohort was followed for up to 2 years or until discharge. SETTING Fifty-nine Maryland nursing homes. PARTICIPANTS Two thousand one hundred fifty-three newly admitted residents aged 65 and older not having resided in a nursing home for 8 or more days in the previous year. MEASUREMENTS Mortality, infection, fever, pressure ulcers, fractures, and discharge home. RESULTS Residents with dementia had significantly lower overall rates of infection (relative risk (RR)=0.77, 95% confidence interval (CI)=0.70-0.85) and mortality (RR=0.61, 95% CI=0.53-0.71) than those without dementia, whereas rates of fever, pressure ulcers, and fractures were similar for the two groups. These results persisted when rates were adjusted for demographic characteristics, comorbid conditions, and functional status. During the first 90 days of the nursing home stay, residents with dementia had significantly lower rates of mortality if not admitted for rehabilitative care under a Medicare qualifying stay (RR=0.25, 95% CI=0.14-0.45), were less often discharged home (RR=0.33, 95% CI=0.28-0.38), and tended to have lower fever rates (RR=0.78, 95% CI=0.63-0.96) than residents without dementia. CONCLUSION Newly admitted nursing home residents with dementia have a profile of health events that is distinct from that of residents without dementia, indicating that the two groups have different long-term care needs. Results suggest that further investigation of whether residents with dementia can be well managed in alternative residential settings would be valuable.
Collapse
Affiliation(s)
- Jay Magaziner
- Department of Epidemiology and Preventive Medicine, School of Medicine, University of Maryland, Baltimore, Maryland 21201, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Stuart B, Gruber-Baldini AL, Fahlman C, Quinn CC, Burton L, Zuckerman IH, Hebel JR, Zimmerman S, Singhal PK, Magaziner J. Medicare cost differences between nursing home patients admitted with and without dementia. Gerontologist 2005; 45:505-15. [PMID: 16051913 DOI: 10.1093/geront/45.4.505] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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: 11/13/2022] Open
Abstract
PURPOSE Our objective in this study was to compare Medicare costs of treating older adults with and without dementia in nursing home settings. DESIGN AND METHODS An expert panel established the dementia status of a stratified random sample of newly admitted residents in 59 Maryland nursing homes between 1992 and 1995. Medicare expenditures per-person month (PPM) were compared for 640 residents diagnosed with dementia and 636 with no dementia for 1 year preadmission and 2 years postadmission. Multivariate analysis with generalized estimating equations was used to identify the source of Medicare cost differentials between the two groups. RESULTS Medicare expenditures peaked in the month immediately preceding admission and dropped to preadmission levels by the third month in a nursing home. Adjusted PPM costs postadmission for the dementia group as a whole were 79% (p < .001) of the Medicare costs of treating residents without dementia. For the subgroup of residents admitted without a Medicare qualified stay (MQS), those with dementia had Medicare costs of just 63% (p < .001) of those without dementia. Overall Medicare costs PPM were insignificantly different between the two groups admitted with a MQS. IMPLICATIONS Whether nursing home residents are admitted with a MQS is the single most important factor in assessing treatment cost differentials between residents admitted with and without dementia. Failure to consider this factor may lead researchers and policy makers to misdirect their attention from the true source of the differential-dementia patients admitted without a qualifying stay.
Collapse
Affiliation(s)
- Bruce Stuart
- The Peter Lamy Center on Drug Therapy and Aging, Department of Pharmaceutical Health Services Research, University of Maryland Baltimore, 515 W. Lombard Street, Suite 157, Baltimore, MD 21201, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
van Doorn C, Gruber-Baldini AL, Zimmerman S, Hebel JR, Port CL, Baumgarten M, Quinn CC, Taler G, May C, Magaziner J. Dementia as a risk factor for falls and fall injuries among nursing home residents. J Am Geriatr Soc 2003; 51:1213-8. [PMID: 12919232 DOI: 10.1046/j.1532-5415.2003.51404.x] [Citation(s) in RCA: 292] [Impact Index Per Article: 13.9] [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: 11/20/2022]
Abstract
OBJECTIVES To compare rates of falling between nursing home residents with and without dementia and to examine dementia as an independent risk factor for falls and fall injuries. DESIGN Prospective cohort study with 2 years of follow-up. SETTING Fifty-nine randomly selected nursing homes in Maryland, stratified by geographic region and facility size. PARTICIPANTS Two thousand fifteen newly admitted residents aged 65 and older. MEASUREMENTS During 2 years after nursing home admission, fall data were collected from nursing home charts and hospital discharge summaries. RESULTS The unadjusted fall rate for residents in the nursing home with dementia was 4.05 per year, compared with 2.33 falls per year for residents without dementia (P<.0001). The effect of dementia on the rate of falling persisted when known risk factors were taken into account. Among fall events, those occurring to residents with dementia were no more likely to result in injury than falls of residents without dementia, but, given the markedly higher rates of falling by residents with dementia, their rate of injurious falls was higher than for residents without dementia. CONCLUSION Dementia is an independent risk factor for falling. Although most falls do not result in injury, the fact that residents with dementia fall more often than their counterparts without dementia leaves them with a higher overall risk of sustaining injurious falls over time. Nursing home residents with dementia should be considered important candidates for fall-prevention and fall-injury-prevention strategies.
Collapse
Affiliation(s)
- Carol van Doorn
- Department of Epidemiology and Preventive Medicine, School of Medicine, University of Maryland, Baltimore, Maryland 21201, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Hussain NK, Jenna S, Glogauer M, Quinn CC, Wasiak S, Guipponi M, Antonarakis SE, Kay BK, Stossel TP, Lamarche-Vane N, McPherson PS. Endocytic protein intersectin-l regulates actin assembly via Cdc42 and N-WASP. Nat Cell Biol 2001; 3:927-32. [PMID: 11584276 DOI: 10.1038/ncb1001-927] [Citation(s) in RCA: 277] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Intersectin-s is a modular scaffolding protein regulating the formation of clathrin-coated vesicles. In addition to the Eps15 homology (EH) and Src homology 3 (SH3) domains of intersectin-s, the neuronal variant (intersectin-l) also has Dbl homology (DH), pleckstrin homology (PH) and C2 domains. We now show that intersectin-l functions through its DH domain as a guanine nucleotide exchange factor (GEF) for Cdc42. In cultured cells, expression of DH-domain-containing constructs cause actin rearrangements specific for Cdc42 activation. Moreover, in vivo studies reveal that stimulation of Cdc42 by intersectin-l accelerates actin assembly via N-WASP and the Arp2/3 complex. N-WASP binds directly to intersectin-l and upregulates its GEF activity, thereby generating GTP-bound Cdc42, a critical activator of N-WASP. These studies reveal a role for intersectin-l in a novel mechanism of N-WASP activation and in regulation of the actin cytoskeleton.
Collapse
Affiliation(s)
- N K Hussain
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, Quebec, H3A 2B4, Canada
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|