A/B Testing of User Enrollment Forms to Enhance Diversity in the Biomedical Workforce via the National Research Mentoring Network: User-Centered Design Case Study

Background

The National Research Mentoring Network (NRMN) is a National Institutes of Health-funded program for diversifying the science, technology, engineering, math, and medicine research workforce through the provision of mentoring, networking, and professional development resources. The NRMN provides mentoring resources to members through its online platform-MyNRMN.

Objective

MyNRMN helps members build a network of mentors. Our goal was to expand enrollment and mentoring connections, especially among those who have been historically underrepresented in biomedical training and the biomedical workforce.

Methods

To improve the ease of enrollment, we implemented the split testing of iterations of our user interface for platform registration. To increase mentoring connections, we developed multiple features that facilitate connecting via different pathways.

Results

Our improved user interface yielded significantly higher rates of completed registrations (P<.001). Our analysis showed improvement in completed enrollments that used the version 1 form when compared to those that used the legacy form (odds ratio 1.52, 95% CI 1.30-1.78). The version 2 form, with its simplified, 1-step process and fewer required fields, outperformed the legacy form (odds ratio 2.18, 95% CI 1.90-2.50). By improving the enrollment form, the rate of MyNRMN enrollment completion increased from 57.3% (784/1368) with the legacy form to 74.5% (2016/2706) with the version 2 form. Our newly developed features delivered an increase in connections between members.

Conclusions

Our technical efforts expanded MyNRMN's membership base and increased connections between members. Other platform development teams can learn from these efforts to increase enrollment among underrepresented groups and foster continuing, successful engagement.

The content and characteristics of face-to-face interventions to encourage patients' enrollment in cardiac rehabilitation; a scoping review

PURPOSE

To provide an overview of the content and characteristics of face-to-face interventions to encourage enrollment in exercise-based cardiac rehabilitation (CR).

METHODS

Following a published protocol describing the methods, six databases were searched. The search was limited to studies published from January 2000 to December 2021. Two reviewers independently performed study selection and data extraction.

RESULTS

5583 studies were identified and 20 studies with a variety of study designs met the inclusion criteria. Eight studies specified important content in face-to-face interventions to be: Education, problem-solving, support of autonomy, exploring reasons for change, emotional and cognitive support while showing understanding. Studies targeting patients' experiences used motivational interviewing and addressed worries and anticipated difficulties. Intention to attend, CR barriers, practical barriers, exercise self-efficacy, and patients asking questions supported enrollment. Reassurance could lead to nonattendance if patients had a high degree of worry and distress.

CONCLUSION

Face-to-face interventions are important to support patients' enrollment in CR and should integrate a person-centered dialogue exploring reasons for change and providing support to overcome barriers. Focus on the patients' perspectives, the mechanisms of change, and the evaluation of the intervention to inform implementation should be further explored.Implications for RehabilitationIn-hospital face-to-face interventions support enrollment in cardiac rehabilitation (CR) in patients with ischemic heart disease.This study suggests that individual worries and barriers toward CR should be jointly explored while considering patients' capacity for making choices as well as their vulnerability.Patients should be encouraged to ask questions.A too strong focus on reassurance and problem-solving can impede enrollment.

Spatial distribution and geographical heterogeneity factors associated with households' enrollment level in community-based health insurance

Background

Healthcare service utilization is unequal among different subpopulations in low-income countries. For healthcare access and utilization of healthcare services with partial or full support, households are recommended to be enrolled in a community-based health insurance system (CBHIS). However, many households in low-income countries incur catastrophic health expenditure. This study aimed to assess the spatial distribution and factors associated with households' enrollment level in CBHIS in Ethiopia.

Methods

A cross-sectional study design with two-stage sampling techniques was used. The 2019 Ethiopian Mini Demographic and Health Survey (EMDHS) data were used. STATA 15 software and Microsoft Office Excel were used for data management. ArcMap 10.7 and SaTScan 9.5 software were used for geographically weighted regression analysis and mapping the results. A multilevel fixed-effect regression was used to assess the association of variables. A variable with a p < 0.05 was considered significant with a 95% confidence interval.

Results

Nearly three out of 10 (28.6%) households were enrolled in a CBHIS. The spatial distribution of households' enrollment in the health insurance system was not random, and households in the Amhara and Tigray regions had good enrollment in community-based health insurance. A total of 126 significant clusters were detected, and households in the primary clusters were more likely to be enrolled in CBHIS. Primary education (AOR: 1.21, 95% CI: 1.05, 1.31), age of the head of the household >35 years (AOR: 2.47, 95% CI: 2.04, 3.02), poor wealth status (AOR: 0.31, 95% CI: 0.21, 1.31), media exposure (AOR: 1.35, 95% CI: 1.02, 2.27), and residing in Afar (AOR: 0.01, 95% CI: 0.003, 0.03), Gambela (AOR: 0.03, 95% CI: 0.01, 0.08), Harari (AOR: 0.06, 95% CI: 0.02, 0.18), and Dire Dawa (AOR: 0.02, 95% CI: 0.01, 0.06) regions were significant factors for households' enrollment in CBHIS. The secondary education status of household heads, poor wealth status, and media exposure had stationary significant positive and negative effects on the enrollment of households in CBHIS across the geographical areas of the country.

Conclusion

The majority of households did not enroll in the CBHIS. Effective CBHIS frameworks and packages are required to improve the households' enrollment level. Financial support and subsidizing the premiums are also critical to enhancing households' enrollment in CBHIS.

Trends in enrollment, retention, and graduation of United States veterinary technicians/nurses schools

Objective

There is a significant shortage of veterinary technicians. To help address this issue, there has been a call to increase the capacity of United States VT/N educational programs. Yet, the current challenges within the field may be negatively impacting the number of people deciding to pursue VT/N certification. To assess this possibility, this study was designed to explore the enrollment, retention, and graduation trends within United States VT/N educational programs. Explore the trends between 2018 and 2022 in enrollment, retention, and graduation of veterinary technicians/nurses (VT/N) at educational programs located in the United States.

Sample

Educators and administrators working in United States VT/N educational programs.

Procedures

An electronic survey distributed via an anonymous link within emails sent from the Association of Veterinary Technician Educators.

Results

A total of 82 responses from educators and administrators working in United States VT/N educational programs were received. Forty-three percent of participants indicated a decrease in student enrollment in the last 5 years. The factors seen to have the largest significant impact were "More potential students not convinced being credentialed will lead to a difference in job duties when compared to non-credentialed work," "More potential students who do not think being credentialed will lead to a substantial increase in pay when compared to non-credentialed work" and "More potential students not willing/able to invest the time needed to become credentialed." A total of 60% reported an increase in retention efforts within the last 5 years. The services most commonly reported as increasing included mental health support and academic mentoring.

Conclusions and clinical relevance

This study suggests that an increased number of potential VT/N students are deciding that being credentialed is not worth the time or money. While additional resources directed toward recruitment and retention are needed within VT/N educational programs, without systematic changes within the field, it is likely that there will be a continued decline in the number of interested applicants.

A service-oriented approach to clinical trial recruitment for dementia and brain health: Methods and case examples of MyAlliance for Brain Health

INTRODUCTION

Recruitment of sufficient and diverse participants into clinical research for Alzheimer's disease and related dementias remains a formidable challenge. The primary goal of this manuscript is to provide an overview of an approach to diversifying research recruitment and to provide case examples of several methods for achieving greater diversity in clinical research enrollment.

METHODS

The University of Kansas Alzheimer's Disease Research Center (KU ADRC) developed MyAlliance for Brain Health (MyAlliance), a service-oriented recruitment model. MyAlliance comprises a Primary Care Provider Network, a Patient and Family Network, and a Community Organization Network, each delivering tailored value to relevant parties while facilitating research referrals.

RESULTS

We review three methods for encouraging increased diversity in clinical research participation. Initial outcomes reveal an increase in underrepresented participants from 17% to 27% in a research registry. Enrollments into studies supported by the research registry experienced a 51% increase in proportion of participants from underrepresented communities.

DISCUSSION

MyAlliance shifts power, resources, and knowledge to community advocates, promoting brain health awareness and research participation, and demands substantial financial investment and administrative commitment. MyAlliance offers valuable lessons for building sustainable, community-centered research recruitment infrastructure, emphasizing the importance of localized engagement and cultural understanding.

Highlights

MyAlliance led to a significant increase in the representation of underrepresented racial and ethnic groups and individuals from rural areas.The service-oriented approach facilitated long-term community engagement and trust-building, extending partnerships between an academic medical center and community organizations.While effective, MyAlliance required substantial financial investment, with costs including infrastructure development, staff support, partner organization compensation, and promotional activities, underscoring the resource-intensive nature of inclusive research recruitment efforts.

Survey of NAACLS accredited histotechnology programs in the United States

Histotechnology educational programs are accredited by the National Accrediting Agency for Clinical Laboratory Sciences (NAACLS) and currently number fewer than 50 in the United States which contributes to the shortages of laboratory personnel. A survey tool designed with REDCap software was distributed to all programs identified on the NAACLS website and consisted of three parts: a) program information, b) facility information, and c) challenges. Programs are located primarily in large urban centers where populations are most concentrated. The median class size was 6 which may explain the excellent student outcomes to include 96% graduation rates and 90.7% board of registry examination pass rates. Overall, programs had ample equipment, funding, and administrative support. Costs to attend the programs were relatively low (<$3,000 per semester) for over half of the programs. However, due to the small number of accredited education programs across the US, potential students do not often have access to an institution in their area. The programs indicated that the most common challenge was recruitment of adequate high-quality candidates which may explain, in part, the persistent shortage of personnel in the histology laboratory.

Exploring Factors Influencing Family's Enrollment in Community-Based Health Insurance in the City of Gondar Peri-Urban Community, Northwest Ethiopia: A Health Belief Model Approach

Background

A research gap exists in finding practical solutions to provide affordable and accessible health insurance coverage to improve CBHI enrollment and sustainability to people in resource-poor settings and contribute to achieving universal health coverage (UHC) in Ethiopia. This research was initiated to analyze the role of community trust in scheme management and health choice to identify significant factors based on the health belief model (HBM). This psychological framework explains and predicts health behavior by considering individual perceptions.

Methods

Cross-sectional information was gathered from 358 families, and original facts were utilized. Descriptive data and the Binary logistics in the econometric model were applied for data analysis.

Findings

The descriptive findings demonstrated that other variables were established to possess a significant consequence except for job and occupation variables. The results of the logistic regression model showed that the distance of the nearest health station from the family's home in a minute [AOR (95% CI) =0.177 (0.015, -0.399)], being a member of the families having an official position in local government or cultural structure [AOR (95% CI) =0.574 (0.355, 0.793)], having an experience of visiting health facilities [AOR (95% CI) =0.281 (0.166, 0.396)], and perceiving the local CBHI scheme management as trustworthy [AOR (95% CI) =0.404 (0.233, 0.575)] were positively associated with family enrollment in the CBHI scheme. On the other hand, being a member of the "rotating saving and credit association" (ROSCA) [AOR (95% CI) =-.299 (-.478, -0.120)] was negatively associated with the family's enrollment in the CBHI scheme.

Conclusion

Trust in CBHI scheme management, family's experience of visiting health facilities, and distance from the nearest health station were essential factors influencing enrollment in CBHI schemes. "Rotating saving and credit association" (ROSCA) ° negatively and statistically significantly impacted the family's CBHI enrolment status. Income level was not associated with enrollment.

Going Viral: Assessing the Impact of Social Media on Enrollment in a Coronavirus Disease 2019 (COVID-19) Cohort Study

Objective This study aimed to quantify the effect of social media posts on study enrollment among children with mild coronavirus disease 2019 (COVID-19). Methods The primary outcome was weekly study enrollments analyzed using a run chart. A secondary analysis used linear regression to assess study enrollments two days before and after a social media post, adjusted for the statewide pediatric seven-day-average severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) case rate, social media posting day, and the interaction of these two variables. Results In seven months before social media posting, only eight patients were enrolled. One week after social media posting began, the median weekly enrollment increased (0 to 3). In the regression model, neither social media post day nor the pediatric SARS-CoV-2 case rate was significantly associated with enrollment rate. However, the interaction of a post day and the pediatric case rate was significant. Conclusion Social media posts significantly increased enrollment among children with mild COVID-19 in a prospective study. This effect was amplified by the presence of high community case rates during the Omicron wave.

Enrollment forecast for clinical trials at the portfolio planning phase based on site-level historical data

An accurate forecast of a clinical trial enrollment timeline at the planning phase is of great importance to both corporate strategic planning and trial operational excellence. The naive approach often calculates an average enrollment rate from historical data and generates an inaccurate prediction based on a linear trend with the average rate. Under the traditional framework of a Poisson-Gamma model, site activation delays are often modeled with either fixed initiation time or a simple random distribution while incorporating the user-provided site planning information to achieve good forecast accuracy. However, such user-provided information is not available at the early portfolio planning stage. We present a novel statistical approach based on generalized linear mixed-effects models and the use of non-homogeneous Poisson processes through the Bayesian framework to model the country initiation, site activation, and subject enrollment sequentially in a systematic fashion. We validate the performance of our proposed enrollment modeling framework based on a set of 25 preselected studies from four therapeutic areas. Our modeling framework shows a substantial improvement in prediction accuracy in comparison to the traditional statistical approach. Furthermore, we show that our modeling and simulation approach calibrates the data variability appropriately and gives correct coverage rates for prediction intervals of various nominal levels. Finally, we demonstrate the use of our approach to generate the predicted enrollment curves through time with confidence bands overlaid.

Using artificial intelligence to improve administrative process in Medicaid

Administrative burden across state-federal benefits programs is unsustainable, and artificial intelligence (AI) and associated technologies have emerged and resulted in significant interest as possible solutions. While early in development, AI has significant potential to reduce administrative waste and increase efficiency, with many government agencies and state legislators eager to adopt the new technology. Turning to existing frameworks defining what functions are considered "inherently governmental" can help determine where more autonomous implementation could be not only appropriate but also provide unique advantages. Such areas could include eligibility and redetermination of Medicaid eligibility as well as preventing improper Medicaid payments. However, while AI is promising, this technology may not be ready for fully autonomous implementation and instead could be deployed to augment human capabilities with robust safeguards until it has proven to be more reliable. In the meantime, the Centers for Medicare and Medicaid Services should release clear guidance around the use of AI by state Medicaid programs, and policymakers must work together to harness AI technologies in order to improve the efficiency and effectiveness of the Medicaid program.

Who enrolls and why? Examining center-specific underlying patterns behind enrollment: a New York City-based traumatic brain injury model systems study

BACKGROUND

To elucidate the sociodemographic and study factors involved in enrollment in the Traumatic Brain Injury Model System (TBIMS) database, this study examined the effect of a variety of variables on enrollment at a local TBIMS center.

METHODS

A sample of 654 individuals from the local TBIMS center was studied examining enrollment by age, gender, race, ethnicity, homelessness status at date of injury, history of homelessness, health insurance status, presence of social support, primary language, consenting in hospital or after discharge, and the need for an interpreter. Binary logistic regression was conducted to identify variables that predict center-based enrollment into TBIMS.

RESULTS

Results demonstrated that older age was associated with decreasing enrollment (OR = 0.99, p = 0.01), needing an interpreter made enrollment less likely (OR = 0.33, p < 0.01), being primarily Spanish speaking predicted enrollment (OR = 3.20, p = 0.02), Hispanic ethnicity predicted enrollment (OR = 7.31, p = 0.03), and approaching individuals in the hospital predicted enrollment (OR = 6.94, p < 0.01). Here, OR denotes the odds ratio estimate from a logistic regression model and P denotes the corresponding p-value.

CONCLUSIONS

These results can be useful in driving enrollment strategies at this center for other similar TBI research, and to contribute a representative TBI sample to the national database.

Email-Based Recruitment Into the Health eHeart Study: Cohort Analysis of Invited Eligible Patients

BACKGROUND

Web- or app-based digital health studies allow for more efficient collection of health data for research. However, remote recruitment into digital health studies can enroll nonrepresentative study samples, hindering the robustness and generalizability of findings. Through the comprehensive evaluation of an email-based campaign on recruitment into the Health eHeart Study, we aim to uncover key sociodemographic and clinical factors that contribute to enrollment.

OBJECTIVE

This study sought to understand the factors related to participation, specifically regarding enrollment, in the Health eHeart Study as a result of a large-scale remote email recruitment campaign.

METHODS

We conducted a cohort analysis on all invited University of California, San Francisco (UCSF) patients to identify sociodemographic and clinical predictors of enrollment into the Health eHeart Study. The primary outcome was enrollment, defined by account registration and consent into the Health eHeart Study. The email recruitment campaign was carried out from August 2015 to February 2016, with electronic health record data extracted between September 2019 and December 2019.

RESULTS

The email recruitment campaign delivered at least 1 email invitation to 93.5% (193,606/206,983) of all invited patients and yielded a 3.6% (7012/193,606) registration rate among contacted patients and an 84.1% (5899/7012) consent rate among registered patients. Adjusted multivariate logistic regression models analyzed independent sociodemographic and clinical predictors of (1) registration among contacted participants and (2) consent among registered participants. Odds of registration were higher among patients who are older, women, non-Hispanic White, active patients with commercial insurance or Medicare, with a higher comorbidity burden, with congestive heart failure, and randomized to receive up to 2 recruitment emails. The odds of registration were lower among those with medical conditions such as dementia, chronic pulmonary disease, moderate or severe liver disease, paraplegia or hemiplegia, renal disease, or cancer. Odds of subsequent consent after initial registration were different, with an inverse trend of being lower among patients who are older and women. The odds of consent were also lower among those with peripheral vascular disease. However, the odds of consent remained higher among patients who were non-Hispanic White and those with commercial insurance.

CONCLUSIONS

This study provides important insights into the potential returns on participant enrollment when digital health study teams invest resources in using email for recruitment. The findings show that participant enrollment was driven more strongly by sociodemographic factors than clinical factors. Overall, email is an extremely efficient means of recruiting participants from a large list into the Health eHeart Study. Despite some improvements in representation, the formulation of truly diverse studies will require additional resources and strategies to overcome persistent participation barriers.

Including Socially Isolated Black, Older Old Adults (Aged 80 and Above) with and without Mild Cognitive Impairment in a Clinical Trial: Recruitment Strategies and Perspectives

Objective

This study describes strategies for the recruitment of socially isolated older old Black individuals to participate in the "Internet-based conversational engagement clinical trial (I-CONECT)" (Clinical Trial.gov: NCT02871921) and lessons learned in this critical population segment.

Methods

Best practice strategies to recruit the target population included mass mailings, advertisements, and direct community outreach, including the collaboration with a community group created to reach Black individuals interested in research participation. We also made protocol changes to measure recruitment criteria for older old Black adults more accurately and to increase their participation.

Results

Descriptive data related to the challenges and successes in recruiting Black participants compared to the White participants is presented. The primary site contacted 17,523 primarily White potential participants and enrolled/randomized 145 White and 2 Asian/mixed race participants (0.8%). The Midwest site contacted 12,141 Black potential participants and enrolled/randomized 39 (0.3%) participants.

Discussion

While best practices were employed, several factors complicated recruitment, including the need to adjust recruitment criteria, navigate regional regulations, and respect diverse community preferences.

Conclusion

Older old African Americans are reachable and willing to participate in research when considering their beliefs and practices, influenced by their community and experience.

Participation in genetic screening: testing different outreach methods across a diverse hospital system based patient population

Introduction: Genomics has the potential to transform medicine by identifying genetic risk factors that predispose people to certain illnesses. Use of genetic screening is rapidly expanding and shifting towards screening all patients regardless of known risk factors, but research is limited on the success of broad population-level outreach for genetic testing and the effectiveness of different outreach methods across diverse populations. In this study, we tested the effectiveness of Digital Only (emailing and texting) and Brochure Plus Digital (mailed brochure, emailing, and texting) outreach to encourage a diverse patient population to participate in a large hospital system's whole genome sequencing program. Methods: Disproportionate stratified sampling was used to create a study population more demographically diverse than the eligible population and response rates were analyzed overall and by demographics to understand the effectiveness of different outreach strategies. Results: 7.5% of all eligible patients enrolled in the program. While approximately 70% of patients invited to complete genetic testing identified in their EHR as being Hispanic, Black or African America, Asian, or another non-White race, these patients generally enrolled at lower rates than the overall population. Other underrepresented groups had higher enrollment rates including people with Medicaid coverage (8.7%) and those residing in rural areas (10.6%). We found no significant difference in enrollment rates between our Digital-Only and our Brochure Plus Digital outreach approaches in the overall population, but enrollment rates were significantly higher for Asian patients and patients who resided in rural areas in the Brochure Plus Digital group. Across both outreach approaches, links provided in emails were most commonly used for enrollment. Discussion: Our study reveals expected enrollment rates for proactive outreach by a hospital system for genetic testing in a diverse population. As more hospital systems are adopting population-scale genetic testing, these findings can inform future outreach efforts to recruit patients for genetic testing including those patients traditionally underrepresented in genomics.

Enhancing Enrollment in Acute Stroke Trials: Current State and Consensus Recommendations

The Stroke Treatment Academic Industry Roundtable (STAIR) convened a session and workshop regarding enrollment in acute stroke trials during the STAIR XII meeting on March 22, 2023. This forum brought together stroke physicians and researchers, members of the National Institute of Neurological Disorders and Stroke, industry representatives, and members of the US Food and Drug Administration to discuss the current status and opportunities for improving enrollment in acute stroke trials. The workshop identified the most relevant issues impacting enrollment in acute stroke trials and addressed potential action items for each. Focus areas included emergency consent in the United States and other countries; careful consideration of eligibility criteria to maximize enrollment and representativeness; investigator, study coordinator, and pharmacist availability outside of business hours; trial enthusiasm/equipoise; site start-up including contractual issues; site champions; incorporation of study procedures into standard workflow as much as possible; centralized enrollment at remote sites by study teams using telemedicine; global trials; and coenrollment in trials when feasible. In conclusion, enrollment of participants is the lifeblood of acute stroke trials and is the rate-limiting step for testing an exciting array of new approaches to improve patient outcomes. In particular, efforts should be undertaken to broaden the medical community's understanding and implementation of emergency consent procedures and to adopt designs and processes that are easily incorporated into standard workflow and that improve trials' efficiencies and execution. Research and actions to improve enrollment in ongoing and future trials will improve stroke outcomes more broadly than any single therapy under consideration.

Social and Emotional Skills Predict Postsecondary Enrollment and Retention

INTRODUCTION

Social and emotional (SE) skills are known to be linked to important life outcomes, many of which fall into the academic domain. For example, meta-analytic data show that the skill of Sustaining Effort is nearly or just as important for academic performance as intelligence. In a recent study with long-term tracking of high school students, those who came from schools with a strong emphasis on SE skill development were more likely to enroll in college within two years of high school graduation. Longitudinal studies like this one are rare, however.

METHOD

The focus of the present study is on the SE skills of 6662 students assessed during high school and their relationship with high school academic performance, standardized college admissions test performance, and ultimately postsecondary enrollment and retention.

RESULTS

We examined mean-level differences in household income, high school GPA, ACT Composite scores, and SE skills by college enrollment and retention status and found several significant differences, often favoring the enrolled or retained group. Moreover, we found support for the incremental validity of SE skills as they predicted enrollment and retention above household income, high school GPA, and ACT scores.

DISCUSSION

Understanding SE skills' effects on later academic outcomes is important to help inform early SE skill intervention and development efforts in secondary and postsecondary settings. Additional implications and future directions are discussed.

Recruitment and Retention Strategies Used in Dietary Randomized Controlled Interventions with Cancer Survivors: A Systematic Review

BACKGROUND

The purpose of this review was to systematically evaluate the quality of reporting of recruitment and retention methods in diet-related intervention trials among cancer survivors.

METHODS

A systematic search of five databases in Spring 2023 identified dietary intervention randomized controlled trials with a minimum of 50 cancer survivors, an intervention of at least eight weeks, and at least six months of study duration. Outcomes investigated include methodologic description and reporting of recruitment and retention rates.

RESULTS

Seventeen trials met inclusion criteria. Recruitment methods included cancer registry and clinician referral, hospital records, flyers, and media campaigns, and were reported in 88.2% of studies. Eleven of 17 studies (64.7%) met a priori recruitment goals. Eleven studies identified an a priori retention goal and seven met the goal. Retention goals were met more often for studies of less than one year (71.4%) versus greater than one year (50%), and for studies with remote or hybrid delivery (66.7%) versus only in-person delivery (50%).

CONCLUSIONS

Recruitment goals and methods are frequently reported; reporting of retention methods and goals is limited. Efforts are needed to improve reporting of retention methods and rates to inform best practices and enhance the rigor of future dietary intervention trials.

Cost of wound dressing: Implication for enrollment into the National Health Insurance scheme, Nigeria

BACKGROUND

 Enrollment into the National Health Insurance scheme (NHIS) still poses a challenge in Nigeria despite the established Group, Individual and Family Social Health Insurance Programme (GIFSHIP) during the coronavirus disease 2019 (COVID-19) pandemic.

OBJECTIVES

 This study examined the direct cost of wound dressing and enrollment into the health insurance scheme among hospitalised patients.

METHOD

 A descriptive cross-sectional research design was utilised to investigate the cost of wound dressing and enrollment into health insurance scheme among hospitalised patients in three selected hospitals of South-West Nigeria. The study was conducted from March 2021 to June 2021, and 190 patients were recruited via an interviewer-administered questionnaire. Ethical approvals were obtained from the hospitals while COVID-19 preventive protocols and ethical principles of autonomy, confidentiality and non-maleficence were observed.

RESULTS

 Majority of the respondents (91%) were not on any healthcare insurance scheme, only 4.2% were enrolled in NHIS while over 70% could not personally pay for their wound dressing. The minimum average cost of wound dressing materials per week and per acute care episode was ₦10 000.00 (Nigerian naira) and ₦50 000.00, respectively, while the minimum average cost for hospitalisation per week and per acute care episode was ₦18 000.00 and ₦130 000.00, respectively, ($1.00 equaled ₦600.00, June 2022).

CONCLUSION

 A lack of health insurance coverage is a precursor of 'out of pocket' payment. A political will is required to scale up enrollment of the indigenous population into the NHIS in Nigeria.Contribution: Many hospitalised patients are not enrolled in the NHIS and they are at a higher risk of catastrophic healthcare expenditure.

Choosing Veterans Affairs: Determinants of post-9/11 Veterans' enrollment in Veterans Affairs health care

Following recent policy changes, younger Veterans have particularly increased options for where to receive their health care. Although existing research provides some understanding of non-modifiable individual (e.g., age) and external community (e.g., non-VA provider supply) factors that influence VA enrollment, this study focused on modifiable facility access and quality factors that could influence Veterans' decisions to enroll in VA. In this cohort study, we examined enrollment in and use of VA services in the year following military separation as the binary outcome using mixed-effects logistic regressions, stratified by Active and Reserve Components. This study included 260,777 Active and 101,572 Reserve Component post-9/11 Veterans separated from the military in fiscal years 2016 to 2017. Independent variables included 4 access measures for timeliness of VA care and 3 VA quality measures, which are included in VA Medical Centers' performance plans. Eligible Veterans were more likely to enroll in VA when the closest VA had higher quality scores. After accounting for timeliness of VA care and non-modifiable characteristics, rating of primary care (PC) providers was associated with higher VA enrollment for Active Component (odds ratio [OR] = 1.014, 95% confidence interval [CI]: 1.007-1.020). Higher mental health (MH) continuity (OR = 1.039, 95% CI: 1.000-1.078) and rating of PC providers (OR = 1.009, 95% CI: 1.000-1.017) were associated with higher VA enrollment for Reserve Component. Improving facility-specific quality of care may be a way to increase VA enrollment. In a changing policy environment, study results will help VA leadership target changes they can make to manage enrollment of Veterans in VA and deliver needed foundational services.

The impact of treatment preferences: A narrative review

Attending to treatment preferences is an element of person-centred care, reported as beneficial in improving treatment adherence, satisfaction, and outcome, in practice. The results of preference trials were inconsistent in supporting these benefits in intervention evaluation research. Informed by the conceptualisation of treatment preferences positing their indirect impact on outcomes, this narrative review aimed to summarise the evidence on the effects of preferences on enrolment; withdrawal or attrition; engagement, enactment, and satisfaction with treatment; and outcomes. The search yielded 72 studies (57 primary trials and 15 reviews). The results of vote counting indicated that (1) offering participants the opportunity to choose treatment enhances enrolment (reported in 87.5% of studies), and (2) providing treatments that match participants' preferences reduces attrition (48%); enhances engagement (67%), enactment (50%) and satisfaction with (43%) treatment; and improves outcomes (35%). The results are attributed to conceptual and methodological issues including less-than-optimal assessment of treatment preferences, which contributes to ill-identified preferences, accounting for withdrawal, low enactment, and limited satisfaction with treatment. These treatment processes, in turn, mediate the impact of treatment preferences on outcomes. It is important to refine and standardise the methods for assessing preferences and to examine their indirect impact (mediated by treatment processes) on outcomes in future preference trials to validly identify their benefits.

Strategies to Improve Enrollment and Participation in Pulmonary Rehabilitation Following a Hospitalization for COPD: RESULTS OF A NATIONAL SURVEY

PURPOSE

Pulmonary rehabilitation (PR) improves outcomes for patients with chronic obstructive pulmonary disease (COPD); however, very few patients attend. We sought to describe strategies used to promote participation in PR after a hospitalization for COPD.

METHODS

A random sample of 323 United States based PR programs was surveyed. Using a positive deviance approach, a 39-item survey was developed based on interviews with clinicians at hospitals demonstrating high rates of participation in PR. Items focused on strategies used to promote participation as well as relevant contextual factors.

RESULTS

Responses were received from 209 programs (65%), of which 88% (n = 184) were hospital-based outpatient facilities. Most (91%, n = 190) programs described enrolling patients continuously, and 80% (n = 167) reported a wait time from referral to the initial PR visit of <4 wk. Organization-level strategies to increase referral to PR included active surveillance (48%, n = 100) and COPD-focused staff (49%, n = 102). Provider-level strategies included clinician education (45%, n = 94), provider outreach (43%, n = 89), order sets (45%, n = 93), and automated referrals (23%, n = 48). Patient-level strategies included bedside education (53%, n = 111), flyers (49%, n = 103), motivational interviewing (33%, n = 69), financial counseling (64%, n = 134), and transportation assistance (35%, n = 73). Fewer than one-quarter (18%, n = 38) of PR programs reported using both bedside education and automatic referral, and 42% (n = 88) programs did not use either strategy.

CONCLUSIONS

This study describes current practices in the United States, and highlights opportunities for improvement at the organization, provider, and patient level. Future research needs to demonstrate the effectiveness of these strategies, alone or in combination.

Factors Associated With Enrollment into Inpatient Coronavirus Disease 2019 Randomized Controlled Trials: A Cross-sectional Analysis

Background

Clinical trials for coronavirus disease 2019 (COVID-19) have struggled to achieve diverse patient enrollment, despite underrepresented groups bearing the largest burden of the disease and, presumably, being most in need of the treatments under investigation.

Methods

To assess the willingness of patients to enroll into inpatient COVID-19 clinical trials when invited, we conducted a cross-sectional analysis of adults hospitalized with COVID-19 who were approached regarding enrollment. Associations between patient and temporal factors and enrollment were assessed by multivariable logistic regression analysis.

Results

A total of 926 patients were included in this analysis. Overall, Hispanic/Latinx ethnicity was associated with a nearly half-fold decrease in the likelihood to enroll (adjusted odds ratio [aOR], 0.60 [95% confidence interval {CI}, .41-.88]). Greater baseline disease severity (aOR, 1.09 [95% CI, 1.02-1.17]), age 40-64 years (aOR, 1.83 [95% CI, 1.03-3.25]), and age ≥65 years (aOR, 1.92 [95% CI, 1.08-3.42]) were each independently associated with higher likelihood to enroll. Over the course of the pandemic, patients were less likely to enroll during the summer 2021 wave in COVID-19-related hospitalizations (aOR, 0.14 [95% CI, .10-.19]) compared with patients from the first wave in winter 2020.

Conclusions

The decision to enroll into clinical trials is multifactorial. Amid a pandemic disproportionately affecting vulnerable groups, Hispanic/Latinx patients were less likely to participate when invited, whereas older adults were more likely. Future recruitment strategies must consider the nuanced perceptions and needs of diverse patient populations to ensure equitable trial participation that advances the quality of healthcare for all.

Considering Retention and Curricula in Reframing Pharmacy Enrollment Challenges

Enrollment in pharmacy education has been a topic of extensive discussions as the number of applications has declined. Some pharmacy programs have either not met enrollment goals or decreased incoming class sizes. This Commentary poses two questions that we must ask ourselves as an Academy. First, is it possible to realistically do more to recruit our way out of this situation in the next three to five years and beyond. Second, how, if possible, will pharmacy colleges and schools avoid the significant and transformative forces that could impact higher education in the future. Forces that are impacting higher education include changing demographics, transitioning from an industrial-based economy to a knowledge-based economy, and the continuing advances in technology with increased globalization as a component of all three of these forces. To address these questions, the concepts of student retention and success as well as considerations for reframing current curricular and pedagogical models and beliefs are challenged. In that pharmacy enrollment challenges are not likely to be easily resolved in the next few years, the Academy must place additional emphasis on issues related to student success and the design of our educational models and programs.