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Niño de Rivera J, Albrecht SS. Determinants of Diabetes Awareness Among Hispanic/Latino Adults in the U.S., 2005-2018. Diabetes Care 2024; 47:1432-1440. [PMID: 38861648 PMCID: PMC11272968 DOI: 10.2337/dc24-0520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 05/16/2024] [Indexed: 06/13/2024]
Abstract
OBJECTIVE Despite improvements in screening, Hispanic/Latino individuals bear a disproportionate burden of undiagnosed diabetes in the U.S. Identifying who is at risk within this large and diverse population is important for targeting interventions. In this study, we sought to characterize risk factors for undiagnosed diabetes among Hispanic/Latino adults. We also investigated determinants among insured adults to explore barriers for those with access to care. RESEARCH DESIGN AND METHODS We used data from 1,883 Hispanic/Latino adults aged ≥20 years from the National Health and Nutrition Examination Surveys (2005-2018). Sequential multivariable logistic regression models were used to examine a range of social, health care, and individual-level determinants of undiagnosed diabetes (defined as having elevated fasting plasma glucose ≥126 mg/dL or HbA1c ≥6.5% [48 mmol/mol] in participants self-reporting as not having diabetes) in the overall sample and among those with health insurance (n = 1,401). RESULTS Younger age (20-44 years), male sex, and having immigrated (compared with being U.S. born), but not socioeconomic factors, were significantly associated with a higher odds of undiagnosed diabetes compared with being diagnosed. These estimates were attenuated after adjusting for health care utilization variables. In fully adjusted models, having no health care visits in the past year, reporting no family history of diabetes, and having better self-reported health were the predominant risk factors for undiagnosed diabetes in the overall sample and among insured Hispanic/Latino adults. CONCLUSIONS Our findings highlight the importance of reaching younger, male, and immigrant Hispanic/Latino adults and addressing barriers to health care utilization, even among insured adults, to improve diabetes awareness.
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Affiliation(s)
| | - Sandra S. Albrecht
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY
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McDonough C, Li YC, Vangeepuram N, Liu B, Pandey G. A Comprehensive Youth Diabetes Epidemiological Data Set and Web Portal: Resource Development and Case Studies. JMIR Public Health Surveill 2024; 10:e53330. [PMID: 38666756 PMCID: PMC11252623 DOI: 10.2196/53330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 02/06/2024] [Accepted: 04/26/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND The prevalence of type 2 diabetes mellitus (DM) and pre-diabetes mellitus (pre-DM) has been increasing among youth in recent decades in the United States, prompting an urgent need for understanding and identifying their associated risk factors. Such efforts, however, have been hindered by the lack of easily accessible youth pre-DM/DM data. OBJECTIVE We aimed to first build a high-quality, comprehensive epidemiological data set focused on youth pre-DM/DM. Subsequently, we aimed to make these data accessible by creating a user-friendly web portal to share them and the corresponding codes. Through this, we hope to address this significant gap and facilitate youth pre-DM/DM research. METHODS Building on data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018, we cleaned and harmonized hundreds of variables relevant to pre-DM/DM (fasting plasma glucose level ≥100 mg/dL or glycated hemoglobin ≥5.7%) for youth aged 12-19 years (N=15,149). We identified individual factors associated with pre-DM/DM risk using bivariate statistical analyses and predicted pre-DM/DM status using our Ensemble Integration (EI) framework for multidomain machine learning. We then developed a user-friendly web portal named Prediabetes/diabetes in youth Online Dashboard (POND) to share the data and codes. RESULTS We extracted 95 variables potentially relevant to pre-DM/DM risk organized into 4 domains (sociodemographic, health status, diet, and other lifestyle behaviors). The bivariate analyses identified 27 significant correlates of pre-DM/DM (P<.001, Bonferroni adjusted), including race or ethnicity, health insurance, BMI, added sugar intake, and screen time. Among these factors, 16 factors were also identified based on the EI methodology (Fisher P of overlap=7.06×106). In addition to those, the EI approach identified 11 additional predictive variables, including some known (eg, meat and fruit intake and family income) and less recognized factors (eg, number of rooms in homes). The factors identified in both analyses spanned across all 4 of the domains mentioned. These data and results, as well as other exploratory tools, can be accessed on POND. CONCLUSIONS Using NHANES data, we built one of the largest public epidemiological data sets for studying youth pre-DM/DM and identified potential risk factors using complementary analytical approaches. Our results align with the multifactorial nature of pre-DM/DM with correlates across several domains. Also, our data-sharing platform, POND, facilitates a wide range of applications to inform future youth pre-DM/DM studies.
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Affiliation(s)
- Catherine McDonough
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Yan Chak Li
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Nita Vangeepuram
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Bian Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Gaurav Pandey
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Egede LE, Walker RJ, Linde S, Williams JS. Identifying Individuals with Highest Social Risk in Adults with Type 2 Diabetes Using Item Response Theory. J Gen Intern Med 2024; 39:1642-1648. [PMID: 38565767 PMCID: PMC11255170 DOI: 10.1007/s11606-024-08742-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 03/21/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE The aim of this analysis was to create a parsimonious tool to screen for high social risk using item response theory to discriminate across social risk factors in adults with type 2 diabetes. METHODS Cross-sectional data of 615 adults with diabetes recruited from two primary care clinics were used. Participants completed assessments including validated scales on economic instability (financial hardship), neighborhood and built environment (crime, violence, neighborhood rating), education (highest education, health literacy), food environment (food insecurity), social and community context (social isolation), and psychological risk factors (perceived stress, depression, serious psychological distress, diabetes distress). Item response theory (IRT) models were used to understand the association between a participant's underlying level of a particular social risk factor and the probability of that response. A two-parameter logistic IRT model was used with each of the 12 social determinant factors being added as a separate parameter in the model. Higher values in item discrimination indicate better ability of a specific social risk factor in differentiating participants from each other. RESULTS Rate of crime reported in a neighborhood (discrimination 3.13, SE 0.50; item difficulty - 0.68, SE 0.07) and neighborhood rating (discrimination 4.02, SE 0.87; item difficulty - 1.04, SE 0.08) had the highest discrimination. CONCLUSIONS Based on these findings, crime and neighborhood rating discriminate best between individuals with type 2 diabetes who have high social risk and those with low social risk. These two questions can be used as a parsimonious social risk screening tool to identify high social risk.
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Affiliation(s)
- Leonard E Egede
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA.
| | - Rebekah J Walker
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
| | - Sebastian Linde
- Department of Health Policy & Management, Texas A&M School of Public Health, 212 Adriance Lab Rd, College Station, TX, 77843, USA
| | - Joni S Williams
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
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Kazi S, Starling C, Milicia A, Buckley B, Grisham R, Gruber E, Miller K, Arem H. Barriers and facilitators to screen for and address social needs in primary care practices in Maryland: a qualitative study. FRONTIERS IN HEALTH SERVICES 2024; 4:1380589. [PMID: 38952646 PMCID: PMC11215188 DOI: 10.3389/frhs.2024.1380589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 05/21/2024] [Indexed: 07/03/2024]
Abstract
Background Social needs screening can help modify care delivery to meet patient needs and address non-medical barriers to optimal health. However, there is a need to understand how factors that exist at multiple levels of the healthcare ecosystem influence the collection of these data in primary care settings. Methods We conducted 20 semi-structured interviews involving healthcare providers and primary care clinic staff who represented 16 primary care practices. Interviews focused on barriers and facilitators to awareness of and assistance for patients' social needs in primary care settings in Maryland. The interviews were coded to abstract themes highlighting barriers and facilitators to conducting social needs screening. The themes were organized through an inductive approach using the socio-ecological model delineating individual-, clinic-, and system-level barriers and facilitators to identifying and addressing patients' social needs. Results We identified several individual barriers to awareness, including patient stigma about verbalizing social needs, provider frustration at eliciting needs they were unable to address, and provider unfamiliarity with community-based resources to address social needs. Clinic-level barriers to awareness included limited appointment times and connecting patients to appropriate community-based organizations. System-level barriers to awareness included navigating documentation challenges on the electronic health record. Conclusions Overcoming barriers to effective screening for social needs in primary care requires not only practice- and provider-level process change but also an alignment of community resources and advocacy of policies to redistribute community assets to address social needs.
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Affiliation(s)
- Sadaf Kazi
- National Center for Human Factors in Healthcare, MedStar Health Research Institute, Washington, DC, United States
- Department of Emergency Medicine, Georgetown University School of Medicine, Washington, DC, United States
| | - Claire Starling
- Implementation Science, Healthcare Delivery Research Program, MedStar Health Research Institute, Hyattsville, MD, United States
| | - Arianna Milicia
- National Center for Human Factors in Healthcare, MedStar Health Research Institute, Washington, DC, United States
| | - Bryan Buckley
- National Committee for Quality Assurance, Washington, DC, United States
| | - Rachel Grisham
- Maryland Primary Care Program, Maryland Department of Health, Baltimore, MD, United States
| | - Emily Gruber
- Maryland Primary Care Program, Maryland Department of Health, Baltimore, MD, United States
| | - Kristen Miller
- National Center for Human Factors in Healthcare, MedStar Health Research Institute, Washington, DC, United States
- Department of Emergency Medicine, Georgetown University School of Medicine, Washington, DC, United States
| | - Hannah Arem
- Implementation Science, Healthcare Delivery Research Program, MedStar Health Research Institute, Hyattsville, MD, United States
- Department of Oncology, Georgetown University School of Medicine, Washington, DC, United States
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Stockdill ML, King A, Johnson M, Karim Z, Cooper D, Armstrong TS. The relationship between social determinants of health and neurocognitive and mood-related symptoms in the primary brain tumor population: A systematic review. Neurooncol Pract 2024; 11:226-239. [PMID: 38737608 PMCID: PMC11085846 DOI: 10.1093/nop/npae016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024] Open
Abstract
Social determinants of health (SDOH) impact cancer-related health outcomes, including survival, but their impact on symptoms is less understood among the primary brain tumor (PBT) population. We conducted a systematic review to examine the relationships between SDOH and neurocognitive and mood-related symptoms among the PBT population. PubMed, EMBASE, and CINAHL were searched using PROGRESS criteria (place of residence, race/ethnicity, occupation, gender/sex, religion, education, socioeconomic status, and social capital) on March 8th, 2022. Two individuals screened and assessed study quality using the NHLBI Assessment Tool for Observational Cohort and Cross-sectional Studies. Of 3006 abstracts identified, 150 full-text articles were assessed, and 48 were included for a total sample of 28 454 study participants. Twenty-two studies examined 1 SDOH; none examined all 8. Four studies measured place of residence, 2 race/ethnicity, 13 occupation, 42 gender, 1 religion, 18 education, 4 socioeconomic status, and 15 social capital. Fifteen studies assessed neurocognitive and 37 mood-related symptoms. While higher education was associated with less neurocognitive symptoms, and among individuals with meningioma sustained unemployment after surgery was associated with depressive symptoms, results were otherwise disparate among SDOH and symptoms. Most studies were descriptive or exploratory, lacking comprehensive inclusion of SDOH. Standardizing SDOH collection, reducing bias, and recruiting diverse samples are recommended in future interventions.
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Affiliation(s)
- Macy L Stockdill
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | - Amanda King
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | - Morgan Johnson
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | - Zuena Karim
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | - Diane Cooper
- National Institutes of Health Library, National Institutes of Health, Bethesda, USA
| | - Terri S Armstrong
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, USA
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McDaniel CC, Lo-Ciganic WH, Huang J, Chou C. A machine learning model to predict therapeutic inertia in type 2 diabetes using electronic health record data. J Endocrinol Invest 2024; 47:1419-1433. [PMID: 38160431 DOI: 10.1007/s40618-023-02259-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/24/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE To estimate the therapeutic inertia prevalence for patients with type 2 diabetes, develop and validate a machine learning model predicting therapeutic inertia, and determine the added predictive value of area-level social determinants of health (SDOH). METHODS This prognostic study with a retrospective cohort design used OneFlorida data (linked electronic health records (EHRs) from 1240 practices/clinics in Florida). The study cohort included adults (aged ≥ 18) with type 2 diabetes, HbA1C ≥ 7% (53 mmol/mol), ≥one ambulatory visit, and ≥one antihyperglycemic medication prescribed (excluded patients prescribed insulin before HbA1C). The outcome was therapeutic inertia, defined as absence of treatment intensification within six months after HbA1C ≥ 7% (53 mmol/mol). The predictors were patient, provider, and healthcare system factors. Machine learning methods included gradient boosting machines (GBM), random forests (RF), elastic net (EN), and least absolute shrinkage and selection operator (LASSO). The DeLong test compared the discriminative ability (represented by C-statistics) between models. RESULTS The cohort included 31,087 patients with type 2 diabetes (mean age = 58.89 (SD = 13.27) years, 50.50% male, 58.89% White). The therapeutic inertia prevalence was 39.80% among the 68,445 records. GBM outperformed (C-statistic from testing sample = 0.84, 95% CI = 0.83-0.84) RF (C-statistic = 0.80, 95% CI = 0.79-0.80), EN (C-statistic = 0.80, 95% CI = 0.80-0.81), and LASSO (C-statistic = 0.80, 95% CI = 0.80-0.81), p < 0.05. Area-level SDOH significantly increased the discriminative ability versus models without SDOH (C-statistic for GBM = 0.84, 95% CI = 0.84-0.85 vs. 0.84, 95% CI = 0.83-0.84), p < 0.05. CONCLUSIONS Using EHRs of patients with type 2 diabetes from a large state, machine learning predicted therapeutic inertia (prevalence = 40%). The model's ability to predict patients at high risk of therapeutic inertia is clinically applicable to diabetes care.
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Affiliation(s)
- C C McDaniel
- Department of Health Outcomes Research and Policy, Harrison College of Pharmacy, Auburn University, 4306 Walker Building, Auburn, AL, 36849, USA.
| | - W-H Lo-Ciganic
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
- Division of General Internal Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Center for Pharmaceutical Policy and Prescribing, University of Pittsburgh, Pittsburgh, PA, USA
- North Florida/South Georgia Veterans Health System, Geriatric Research Education and Clinical Center, Gainesville, FL, USA
| | - J Huang
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - C Chou
- Department of Health Outcomes Research and Policy, Harrison College of Pharmacy, Auburn University, 4306 Walker Building, Auburn, AL, 36849, USA
- Department of Medical Research, China Medical University Hospital, Taichung City, Taiwan
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Ahmed BH, Voss JG, Schiltz N, Naif AA, Ruksakulpiwat S, Griggs S. An Integrative Review of Social Determinants of Glycemic Targets Achievement in Adults with Type 2 Diabetes in the United States. Clin Nurs Res 2024; 33:405-415. [PMID: 38281104 DOI: 10.1177/10547738231223577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
Several individual social determinants of health have been identified as significant factors contributing to achieving glycemic targets (glycated hemoglobin < 7). However, it remains unclear how these social variables individually or collectively contribute to glycemic targets among adults with type 2 diabetes (T2D) in the United States (U.S.) The purpose of the current integrative review (IR) was to describe and synthesize findings from studies on social determinants of glycemic target achievement in adults with T2D in the U.S. and integrate them into the United States Department of Health and Human Services Conceptual Framework. The databases searched included PubMed, CINAHL Plus with Full Text, Medline with Full Text [EBSCO], Google Scholar, bibliography, and hand searching. A total of 948 records were identified. After excluding duplicates and irrelevant studies based on inclusion and exclusion criteria through title, abstract, and full-text screening, 13 studies were finally included in this IR. The results revealed that race/ethnicity, economic access and stability, educational access and quality, healthcare access and quality, neighborhood and built environment, and social and community context contribute to glycemic target achievement among adult patients with T2D in the U.S. Integrating findings from key studies on social determinants of glycemic health may contribute to developing interventions aimed at reducing and eventually eradicating health disparities for individuals with and at risk for T2D in the U.S.
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Affiliation(s)
| | - Joachim G Voss
- Case Western Reserve University, Samson Pavilion, Cleveland, OH, USA
| | - Nicholas Schiltz
- Case Western Reserve University, Samson Pavilion, Cleveland, OH, USA
| | | | | | - Stephanie Griggs
- Case Western Reserve University, Samson Pavilion, Cleveland, OH, USA
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Buchmann M, Koschollek C, Du Y, Mauz E, Krause L, Neuperdt L, Tuncer O, Baumert J, Scheidt-Nave C, Heidemann C. Type 2 diabetes among people with selected citizenships in Germany: risk, healthcare, complications. JOURNAL OF HEALTH MONITORING 2024; 9:e12159. [PMID: 39081466 PMCID: PMC11262741 DOI: 10.25646/12159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 05/27/2024] [Indexed: 08/02/2024]
Abstract
Background Migration-related factors, such as language barriers, can be relevant to the risk, healthcare and complications of type 2 diabetes in people with a history of migration. Diabetes-related data from people with selected citizenships were analysed on the basis of the nationwide survey German Health Update: Fokus (GEDA Fokus). Methods The diabetes risk of persons without diabetes (n = 4,698, 18 - 79 years), key figures on healthcare and secondary diseases of persons with type 2 diabetes (n = 326, 45 - 79 years) and on concomitant diseases (n = 326 with type 2 diabetes compared to n = 2,018 without diabetes, 45 - 79 years) were stratified according to sociodemographic and migration-related characteristics. Results Better German language proficiency is associated with a lower risk of diabetes. Diabetes-related organ complications are observed more frequently in persons who report experiences of discrimination in the health or care sector. Both persons with and without diabetes are more likely to have depressive symptoms when they reported experiences of discrimination. A stronger sense of belonging to the society in Germany is associated with reporting depressive symptoms less often in people without diabetes, but not in people with type 2 diabetes. Conclusions The differences according to migration-related characteristics indicate a need for improvement in the prevention and care of type 2 diabetes. Migration-sensitive indicators should be integrated into the surveillance of diabetes.
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Affiliation(s)
- Maike Buchmann
- Robert Koch Institute, Department of Epidemiology and Health Monitoring, Berlin, Germany
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Khalilnejad A, Sun RT, Kompala T, Painter S, James R, Wang Y. Proactive Identification of Patients with Diabetes at Risk of Uncontrolled Outcomes during a Diabetes Management Program: Conceptualization and Development Study Using Machine Learning. JMIR Form Res 2024; 8:e54373. [PMID: 38669074 PMCID: PMC11087850 DOI: 10.2196/54373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/12/2024] [Accepted: 01/20/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND The growth in the capabilities of telehealth have made it possible to identify individuals with a higher risk of uncontrolled diabetes and provide them with targeted support and resources to help them manage their condition. Thus, predictive modeling has emerged as a valuable tool for the advancement of diabetes management. OBJECTIVE This study aimed to conceptualize and develop a novel machine learning (ML) approach to proactively identify participants enrolled in a remote diabetes monitoring program (RDMP) who were at risk of uncontrolled diabetes at 12 months in the program. METHODS Registry data from the Livongo for Diabetes RDMP were used to design separate dynamic predictive ML models to predict participant outcomes at each monthly checkpoint of the participants' program journey (month-n models) from the first day of onboarding (month-0 model) up to the 11th month (month-11 model). A participant's program journey began upon onboarding into the RDMP and monitoring their own blood glucose (BG) levels through the RDMP-provided BG meter. Each participant passed through 12 predicative models through their first year enrolled in the RDMP. Four categories of participant attributes (ie, survey data, BG data, medication fills, and health signals) were used for feature construction. The models were trained using the light gradient boosting machine and underwent hyperparameter tuning. The performance of the models was evaluated using standard metrics, including precision, recall, specificity, the area under the curve, the F1-score, and accuracy. RESULTS The ML models exhibited strong performance, accurately identifying observable at-risk participants, with recall ranging from 70% to 94% and precision from 40% to 88% across the 12-month program journey. Unobservable at-risk participants also showed promising performance, with recall ranging from 61% to 82% and precision from 42% to 61%. Overall, model performance improved as participants progressed through their program journey, demonstrating the importance of engagement data in predicting long-term clinical outcomes. CONCLUSIONS This study explored the Livongo for Diabetes RDMP participants' temporal and static attributes, identification of diabetes management patterns and characteristics, and their relationship to predict diabetes management outcomes. Proactive targeting ML models accurately identified participants at risk of uncontrolled diabetes with a high level of precision that was generalizable through future years within the RDMP. The ability to identify participants who are at risk at various time points throughout the program journey allows for personalized interventions to improve outcomes. This approach offers significant advancements in the feasibility of large-scale implementation in remote monitoring programs and can help prevent uncontrolled glycemic levels and diabetes-related complications. Future research should include the impact of significant changes that can affect a participant's diabetes management.
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Rawas H, De Beer J, Alturki O, Altorki M, Alhelali T, Althagfi A, Faisal N, Albalawi F, Anwar Khan M. Hopelessness and Social Support among Cancer Patients in Saudi Arabia. Asian Pac J Cancer Prev 2024; 25:1363-1370. [PMID: 38679998 PMCID: PMC11162714 DOI: 10.31557/apjcp.2024.25.4.1363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 04/12/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND Receiving a cancer diagnosis can be extremely stressful for patients, as it is a life-threatening disease. However, when this topic is discussed or researched, the psychological state of cancer patients is often ignored or forgotten. The study aimed to measure the levels of hopelessness and social support among cancer patients. It also aimed to assess the relationship between different demographic variables, hopelessness, and social support of these patients. METHODS The study followed a cross-sectional quantitative design. The setting included Princess Norah Oncology Center, at King Abdul-Aziz Medical City, Jeddah. A convenience sampling technique including 300 cancer patients was followed. Data collection included a demographic questionnaire, the Beck Hopelessness Scale (BHS), and the Multidimensional Scale of Perceived Social Support (MSPSS). Ethical principles of anonymity and confidentiality were followed. RESULTS The total number of respondents was 300, with 50% being male and 50% being female. The mean age of patients was 52.6±14.83 years. The most prevalent types of cancer were breast cancer (21.4%), colorectal (15.2%), and lymphoma (12.1%) respectively. Most of the patients were married (71.3%). The mean value of the BHS was 4.5, whereas the mean value of the MSPSS was 67.7. Moreover, the type of cancer showed a significant association between family support and total social support. In colorectal cancer patients, the total social support (71.2 ± 20.1) and family support (26.2 ± 5.0) provided was the highest followed by leukemia (70.3 ± 15.5 and 25.2 ± 5.1) and breast cancer (68.3-± 20.3. and 24.3 ± 6.8). CONCLUSION The findings of the present study suggest that the levels of hopelessness in cancer patients are moderate, and the levels of social support received by participants are high. In addition, the relationship between the levels of hopelessness and the levels of social support received is inversely proportional.
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Affiliation(s)
- Hawazen Rawas
- College of Nursing, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.
- Ministry of the National Guard - Health Affairs, Jeddah, Saudi Arabia.
| | - Jennifer De Beer
- King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.
| | - Osamah Alturki
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.
- Ministry of the National Guard - Health Affairs, Jeddah, Saudi Arabia.
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.
| | - Mohammed Altorki
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.
- Ministry of the National Guard - Health Affairs, Jeddah, Saudi Arabia.
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.
| | - Tareq Alhelali
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.
- Ministry of the National Guard - Health Affairs, Jeddah, Saudi Arabia.
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.
| | - Anas Althagfi
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.
- Ministry of the National Guard - Health Affairs, Jeddah, Saudi Arabia.
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.
| | - Nawaf Faisal
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.
- Ministry of the National Guard - Health Affairs, Jeddah, Saudi Arabia.
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.
| | - Faisal Albalawi
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.
- Ministry of the National Guard - Health Affairs, Jeddah, Saudi Arabia.
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.
| | - Muhammad Anwar Khan
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.
- Ministry of the National Guard - Health Affairs, Jeddah, Saudi Arabia.
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.
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Hunt TN, Roberts K, Taylor EM, Quintana CP, Kossman MK. The Effect of Social Determinants of Health on Clinical Recovery Following Concussion: A Systematic Review. J Sport Rehabil 2024:1-9. [PMID: 38508176 DOI: 10.1123/jsr.2023-0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 01/24/2024] [Accepted: 01/26/2024] [Indexed: 03/22/2024]
Abstract
CONTEXT Concussion evaluations include a multifaceted approach; however, individual differences can influence test score interpretations and validity. Social determinants of health (SDoH) differentially affect disease risk and outcomes based upon social and environmental characteristics. Efforts to better define, diagnose, manage, and treat concussion have increased, but minimal efforts have focused on examining SDoH that may affect concussion recovery. OBJECTIVE This review examined previous research that examined the effect of SDoH on concussion recovery of athletes. EVIDENCE ACQUISITION CINAHL, MEDLINE, PsycInfo, and SPORTDiscus databases were used to search the terms "concussion" AND "recovery," "youth, adolescent, teen and/or adult," and "social determinants of health" and variations of these terms. The evidence level for each study was evaluated using the 2011 Oxford Center for Evidence-Based Medicine Guide. EVIDENCE SYNTHESIS Seven thousand nine hundred and twenty-one articles were identified and screened for inclusion. Five studies met the inclusion criteria and were included in this systematic review. Using the Downs and Black Quality Index, the studies included in this review were deemed high quality. CONCLUSION Though limited literature exists, there is preliminary evidence to suggest that SDoH (specifically, economic stability, education access and quality, and social and community context) may have an impact on the clinical recovery from concussion. The dimensions evaluated varied between studies and the results were inconsistent. No single factor consistently affected clinical recovery; however, private insurance and race appear to have an association with the speed of recovery. Unfortunately, the potential intersection of these variables and other preinjury factors limits the ability to make clear recommendations. While most of the studies in this review are retrospective in nature, future efforts should focus on training clinicians to prospectively evaluate the effect of SDoH on concussion recovery and injury outcomes. Funding and registration for this systematic review were not obtained nor required.
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Affiliation(s)
| | | | - Erica M Taylor
- Columbus State University, Columbus, GA, USA
- The University of Kansas Medical Center, Kansas, KS, USA
| | - Carolina P Quintana
- The University of Kansas Medical Center, Kansas, KS, USA
- The University of Southern Mississippi, Hattiesburg, MS, USA
| | - Melissa K Kossman
- Columbus State University, Columbus, GA, USA
- The University of Southern Mississippi, Hattiesburg, MS, USA
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12
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Parchman ML, Stefanik-Guizlo K, Penfold RB, Holden E, Shah AC. Improving Diabetes Control in a Medicaid Managed Care Population With Complex Needs. Perm J 2024; 28:62-67. [PMID: 38115756 PMCID: PMC10940240 DOI: 10.7812/tpp/23.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
INTRODUCTION People enrolled in Medicaid managed care who struggle with diabetes control often have complex medical, behavioral, and social needs. Here the authors report the results of a program designed to partner with primary care teams to address those needs. METHODS A nonprofit organization partnered with a Medicaid managed care plan and a Federally Qualified Health Center in California to enroll people with A1cs >9% in a 12-month program. The program team included a community health worker, certified diabetes care and education specialist/registered dietitian, behavioral health counselor, and registered nurse. They developed patient-led action plans, connected patients to community resources, and supported behavior changes to improve diabetes control. Baseline assessments of behavioral health conditions and social needs were collected. Monthly A1c values were tracked for participants and a comparison group. RESULTS Of the 51 people enrolled, 83% had at least 1 behavioral health condition. More than 90% reported at least 1 unmet social need. The average monthly A1c among program participants was 0.699 lower than the comparison group post-enrollment (P = .0008), and the disparity in A1c between Hispanic and non-Hispanic White participants at enrollment declined. DISCUSSION Participants had high levels of unmet medical, behavioral, and social needs. Addressing these needs resulted in a rapid and sustained improvement in A1c control compared to non-enrollees and a reduction in disparity of control among Hispanic participants. CONCLUSION By partnering with a primary care team, a program external to Federally Qualified Health Center primary care can improve clinical outcomes for people with complex needs living with diabetes.
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Affiliation(s)
- Michael L Parchman
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | | | - Robert B Penfold
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Erika Holden
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
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13
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Broglio SP, Register-Mihalik JK, Guskiewicz KM, Leddy JJ, Merriman A, Valovich McLeod TC. National Athletic Trainers' Association Bridge Statement: Management of Sport-Related Concussion. J Athl Train 2024; 59:225-242. [PMID: 38530653 DOI: 10.4085/1062-6050-0046.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
OBJECTIVE To provide athletic trainers and team physicians with updated recommendations to the 2014 National Athletic Trainers' Association (NATA) concussion position statement regarding concussion management, specifically in the areas of education, assessment, prognostic factors, mental health, return to academics, physical activity, rest, treatment, and return to sport. BACKGROUND Athletic trainers have benefited from the 2 previous NATA position statements on concussion management, and although the most recent NATA position statement is a decade old, knowledge gains in the medical literature warrant updating several (but not all) recommendations. Furthermore, in various areas of the body of literature, current evidence now exists to address items not adequately addressed in the 2014 statement, necessitating the new recommendations. This document therefore serves as a bridge from the 2014 position statement to the current state of concussion evidence, recommendations from other organizations, and discrepancies between policy and practice. RECOMMENDATIONS These recommendations are intended to update the state of the evidence concerning the management of patients with sport-related concussion, specifically in the areas of education; assessment advances; prognostic recovery indicators; mental health considerations; academic considerations; and exercise, activity, and rehabilitation management strategies.
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Affiliation(s)
| | - Johna K Register-Mihalik
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science and Injury Prevention Research Center, University of North Carolina at Chapel Hill
| | - Kevin M Guskiewicz
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science and Injury Prevention Research Center, University of North Carolina at Chapel Hill
| | - John J Leddy
- UBMD Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, NY
| | | | - Tamara C Valovich McLeod
- Athletic Training Program, A.T. Still University, Mesa, AZ. Dr Guskiewicz is now at the Department of Kinesiology, Michigan State University, East Lansing
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Mohottige D. Paving a Path to Equity in Cardiorenal Care. Semin Nephrol 2024; 44:151519. [PMID: 38960842 DOI: 10.1016/j.semnephrol.2024.151519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Abstract
Cardiorenal syndrome encompasses a dynamic interplay between cardiovascular and kidney disease, and its prevention requires careful examination of multiple predisposing underlying conditions. The unequal distribution of diabetes, heart failure, hypertension, and kidney disease requires special attention because of the influence of these conditions on cardiorenal disease. Despite growing evidence regarding the benefits of disease-modifying agents (e.g., sodium-glucose cotransporter 2 inhibitors) for cardiovascular, kidney, and metabolic (CKM) disease, significant disparities remain in access to and utilization of these essential therapeutics. Multilevel barriers impeding their use require multisector interventions that address patient, provider, and health system-tailored strategies. Burgeoning literature also describes the critical role of unequal social determinants of health, or the sociopolitical contexts in which people live and work, in cardiorenal risk factors, including heart failure, diabetes, and chronic kidney disease. This review outlines (i) inequality in the burden and treatment of hypertension, type 2 diabetes, and heart failure; (ii) disparities in the use of key disease-modifying therapies for CKM diseases; and (iii) multilevel barriers and solutions to achieve greater pharmacoequity in the use of disease-modifying therapies. In addition, this review provides summative evidence regarding the role of unequal social determinants of health in cardiorenal health disparities, further outlining potential considerations for future research and intervention. As proposed in the 2023 American Heart Association presidential advisory on CKM health, a paradigm shift will be needed to achieve cardiorenal health equity. Through a deeper understanding of CKM health and a commitment to equity in the prevention, detection, and treatment of CKM disease, we can achieve this critical goal.
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Affiliation(s)
- Dinushika Mohottige
- Institute for Health Equity Research, Department of Population Health, Icahn School of Medicine at Mount Sinai, New York, NY; Barbara T. Murphy Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
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Holt KD, Roman G, McIntosh L, Kleinsorge J, Holden-Wiltse J, Bennett NM. RocHealthData.org: Development and usage of a publicly available, geographic source of social determinants of health data. J Clin Transl Sci 2024; 8:e41. [PMID: 38476248 PMCID: PMC10928699 DOI: 10.1017/cts.2024.484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 12/27/2023] [Accepted: 02/02/2024] [Indexed: 03/14/2024] Open
Abstract
Access to local, population specific, and timely data is vital in understanding factors that impact population health. The impact of place (neighborhood, census tract, and city) is particularly important in understanding the Social Determinants of Health. The University of Rochester Medical Center's Clinical and Translational Science Institute created the web-based tool RocHealthData.org to provide access to thousands of geographically displayed publicly available health-related datasets. The site has also hosted a variety of locally curated datasets (eg., COVID-19 vaccination rates and community-derived health indicators), helping set community priorities and impacting outcomes. Usage statistics (available through Google Analytics) show returning visitors with a lower bounce rate (leaving a site after a single page access) and spent longer at the site than new visitors. Of the currently registered 1033 users, 51.7% were from within our host university, 20.1% were from another educational institution, and 28.2% identified as community members. Our assessments indicate that these data are useful and valued across a variety of domains. Continuing site improvement depends on new sources of locally relevant data, as well as increased usage of data beyond our local region.
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Affiliation(s)
- Kathleen D. Holt
- Clinical and Translational Science Institute, University of Rochester, Rochester, NY, USA
- Center for Community Health and Prevention, University of Rochester, Rochester, NY, USA
| | - Gretchen Roman
- Department of Family Medicine, University of Rochester, Rochester, NY, USA
| | - Laura McIntosh
- Center for Community Health and Prevention, University of Rochester, Rochester, NY, USA
| | - Jamie Kleinsorge
- Center for Applied Research and Engagement Systems, University of Missouri, Columbia, MO, USA
| | - Jeanne Holden-Wiltse
- Clinical and Translational Science Institute, University of Rochester, Rochester, NY, USA
| | - Nancy M. Bennett
- Clinical and Translational Science Institute, University of Rochester, Rochester, NY, USA
- Department of Medicine, School of Medicine and Dentistry, Rochester, NY, USA
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Maciejewski ML, Greene L, Grubber JM, Blalock DV, Jacobs J, Rao M, Zulman DM, Smith VA. Association between patient-reported social and behavioral risks and health care costs in high-risk Veterans health administration patients. Health Serv Res 2024; 59:e14243. [PMID: 37767603 PMCID: PMC10771909 DOI: 10.1111/1475-6773.14243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023] Open
Abstract
OBJECTIVE Social risks complicate patients' ability to manage their conditions and access healthcare, but their association with health expenditures is not well established. To identify patient-reported social risk, behavioral, and health factors associated with health expenditures in Veterans Affairs (VA) patients at high risk for hospitalization or death. DATA SOURCES, STUDY SETTING, AND STUDY DESIGN Prospective cohort study among high-risk Veterans obtaining VA care. Patient-reported social risk, function, and other measures derived from a 2018 survey sent to 10,000 VA patients were linked to clinical and demographic characteristics extracted from VA data. Response-weighted generalized linear and marginalized two-part models were used to examine VA expenditures (total, outpatient, medication, inpatient) 1 year after survey completion in adjusted models. PRINCIPAL FINDINGS Among 4680 survey respondents, the average age was 70.9 years, 6.3% were female, 16.7% were African American, 20% had body mass index ≥35, 42.4% had difficulty with two or more basic or instrumental activities of daily living, 19.3% reported transportation barriers, 12.5% reported medication insecurity and 21.8% reported food insecurity. Medication insecurity was associated with lower outpatient expenditures (-$1859.51 per patient per year, 95% confidence interval [CI]: -3200.77 to -518.25) and lower total expenditures (-$4304.99 per patient per year, 95% CI: -7564.87 to -1045.10). Transportation barriers were negatively associated with medication expenditures (-$558.42, 95% CI: -1087.93 to -31.91). Patients with one functional impairment had higher outpatient expenditures ($2997.59 per patient year, 95% CI: 1185.81-4809.36) than patients without functional impairments. No social risks were associated with inpatient expenditures. CONCLUSIONS In this study of VA patients at high risk for hospitalization and mortality, few social and functional measures were independently associated with the costs of VA care. Individuals with functional limitations and those with barriers to accessing medications and transportation may benefit from targeted interventions to ensure that they are receiving the services that they need.
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Affiliation(s)
- Matthew L. Maciejewski
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT)Durham Veterans Affairs Health Care SystemDurhamNorth CarolinaUSA
- Department of Population Health SciencesDuke UniversityDurhamNorth CarolinaUSA
- Division of General Internal Medicine, Department of MedicineDuke UniversityDurhamNorth CarolinaUSA
| | - Liberty Greene
- Center for Innovation to ImplementationVA Palo Alto Health Care SystemMenlo ParkCaliforniaUSA
- Division of Primary Care and Population HealthStanford University School of MedicineStanfordCaliforniaUSA
| | - Janet M. Grubber
- Cooperative Studies Program Coordinating CenterBoston Veterans Affairs Health Care SystemBostonMassachusettsUSA
| | - Dan V. Blalock
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT)Durham Veterans Affairs Health Care SystemDurhamNorth CarolinaUSA
- Department of Psychiatry and Behavioral SciencesDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Josephine Jacobs
- Center for Innovation to ImplementationVA Palo Alto Health Care SystemMenlo ParkCaliforniaUSA
- Health Economics Resource CenterVA Palo Alto Health Care SystemMenlo ParkCaliforniaUSA
| | - Mayuree Rao
- Seattle‐Denver Center of Innovation for Veteran‐Centered and Value‐Driven CareVA Puget Sound Health Care SystemSeattleWashingtonUSA
| | - Donna M. Zulman
- Center for Innovation to ImplementationVA Palo Alto Health Care SystemMenlo ParkCaliforniaUSA
- Division of Primary Care and Population HealthStanford University School of MedicineStanfordCaliforniaUSA
| | - Valerie A. Smith
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT)Durham Veterans Affairs Health Care SystemDurhamNorth CarolinaUSA
- Department of Population Health SciencesDuke UniversityDurhamNorth CarolinaUSA
- Division of General Internal Medicine, Department of MedicineDuke UniversityDurhamNorth CarolinaUSA
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Short E, Thompson D, Taren D, Bryant H, Gonzalez R, Sheava J, Hingle M. Feasibility of a food-based diabetes self-management education intervention for food insecure patients with type 2 diabetes: a convergent mixed methods study. Public Health Nutr 2023; 26:3100-3111. [PMID: 37759394 PMCID: PMC10755446 DOI: 10.1017/s1368980023002082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 08/22/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023]
Abstract
OBJECTIVE To assess the feasibility of a food-based diabetes self-management education and support (DSMES) intervention delivered to persons with type 2 diabetes (T2DM) and food insecurity. DESIGN This single arm pre-/post convergent mixed methods study tested the feasibility of a 3-month intervention using food boxes, recipes, DSMES and dietitian visits. Feasibility benchmarks assessed were acceptability (> 50 % participants satisfied), demand (> 50 % used program components) and implementation (75 % adherence, 80 % retention). Assessments included: self-reported food security, health-related quality of life, diabetes self-efficacy, socio-demographic and dietary intake, height, weight, and HbA1c and one in-depth interview with participants and key staff. Enrollment, recruitment and retention rates were summarised; qualitative data were analysed using structured thematic analysis (participant interviews) and key point summaries (staff interviews). Quantitative/qualitative data integration was conducted using a joint display. SETTING Food bank and Federally Qualified Health Center in the Southwestern U.S. PARTICIPANTS English- or Spanish-speaking adults with T2DM and food insecurity. RESULTS In total, 247 patients with T2DM and food insecurity were recruited, seventy-one expressed interest and twenty-five consented. Twenty-one participants completed study measurements. 71 % (n 15) received six home food deliveries and ≥ 1 dietitian visit. A priori benchmarks were approached or met within each feasibility criterion - most participants found the intervention to be acceptable, used most or all intervention components, and reported some challenges within intervention implementation (e.g. timing of food deliveries). Data integration provided deeper understanding of reported intervention implementation challenges, yet high adherence to the intervention. CONCLUSIONS The intervention was feasible. Next steps include a clinical trial to establish intervention efficacy.
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Affiliation(s)
- Eliza Short
- University of Arizona School of Nutritional Sciences and Wellness, 1177 E 4th St, Tucson, AZ85721, USA
| | - Debbe Thompson
- USDA/ARS Children’s Nutrition Research Center, Baylor College of Medicine, 1100 Bates St, Houston, TX77030, USA
| | - Douglas Taren
- University of Colorado School of Medicine, 12631 East 17th Avenue, Mail Stop F561, Aurora, CO80045, USA
| | - Holly Bryant
- El Rio Community Health Center, 450 W Paseo Redondo, Tucson, AZ, 85701, USA
| | - Rhonda Gonzalez
- Community Food Bank of Southern Arizona, 3003 S Country Club Rd, Tucson, AZ85713, USA
| | - Jessi Sheava
- Community Food Bank of Southern Arizona, 3003 S Country Club Rd, Tucson, AZ85713, USA
| | - Melanie Hingle
- University of Arizona School of Nutritional Sciences and Wellness, 1177 E 4th St, Tucson, AZ85721, USA
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Bashar H, Kobo O, Khunti K, Banerjee A, Bullock‐Palmer RP, Curzen N, Mamas MA. Impact of Social Vulnerability on Diabetes-Related Cardiovascular Mortality in the United States. J Am Heart Assoc 2023; 12:e029649. [PMID: 37850448 PMCID: PMC10727374 DOI: 10.1161/jaha.123.029649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 09/13/2023] [Indexed: 10/19/2023]
Abstract
Background Social vulnerability impacts the natural history of diabetes as well as cardiovascular disease (CVD). However, there are little data regarding the social vulnerability association with diabetes-related CVD mortality. Methods and Results County-level mortality data (where CVD was the underlying cause of death with diabetes among the multiple causes) extracted from the Centers for Disease Control multiple cause of death (2015-2019) and the 2018 Social Vulnerability Index databases were aggregated into quartiles based on their Social Vulnerability Index ranking from the least (first quartile) to the most vulnerable (fourth quartile). Stratified by demographic groups, the data were analyzed for overall CVD, as well as for ischemic heart disease, hypertensive disease, heart failure, and cerebrovascular disease. In the 5-year study period, 387 139 crude diabetes-related cardiovascular mortality records were identified. The age-adjusted mortality rate for CVD was higher in the fourth quartile compared with the first quartile (relative risk [RR], 1.66 [95% CI, 1.64-1.67]) with an estimated 39 328 excess deaths. Among the youngest age group (<55 years), those with the highest social vulnerability had 2 to 4 times the rate of cardiovascular mortality compared with the first quartile: ischemic heart disease (RR, 2.07 [95% CI, 1.97-2.17]; heart failure (RR, 3.03 [95% CI, 2.62-3.52]); hypertensive disease (RR, 3.79 [95% CI, 3.45-4.17]; and cerebrovascular disease (RR, 4.39 [95% CI, 3.75-5.13]). Conclusions Counties with greater social vulnerability had higher diabetes-related CVD mortality, especially among younger adults. Targeted health policies that are designed to reduce these disparities are warranted.
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Affiliation(s)
- Hussein Bashar
- Faculty of MedicineUniversity of SouthamptonSouthamptonUnited Kingdom
- Department of CardiologyUniversity Hospital Southampton NHS Foundation TrustSouthamptonUnited Kingdom
- Keele Cardiovascular Research Group, Centre for Prognosis ResearchInstitute for Primary Care and Health Sciences, Keele UniversityKeeleUnited Kingdom
| | - Ofer Kobo
- Keele Cardiovascular Research Group, Centre for Prognosis ResearchInstitute for Primary Care and Health Sciences, Keele UniversityKeeleUnited Kingdom
- Department of CardiologyHillel Yaffe Medical CentreHaderaIsrael
| | - Kamlesh Khunti
- Diabetes Research CentreUniversity of LeicesterLeicesterUnited Kingdom
| | - Amitava Banerjee
- Institute of Health Informatics, University College LondonLondonUnited Kingdom
| | | | - Nick Curzen
- Faculty of MedicineUniversity of SouthamptonSouthamptonUnited Kingdom
- Department of CardiologyUniversity Hospital Southampton NHS Foundation TrustSouthamptonUnited Kingdom
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis ResearchInstitute for Primary Care and Health Sciences, Keele UniversityKeeleUnited Kingdom
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Oyegbile-Chidi T, Harvey D, Dunn D, Jones J, Byars A, Fastenau P, Austin J, Hermann B. The Impact of Sociodemographic Disadvantage on Cognitive Outcomes in Children With Newly Diagnosed Seizures and Their Unaffected Siblings Over 36 Months. Pediatr Neurol 2023; 148:178-188. [PMID: 37742443 DOI: 10.1016/j.pediatrneurol.2023.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/25/2023] [Accepted: 08/19/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Accumulating evidence indicates that children with newly diagnosed epilepsy have comorbidities including cognitive challenges. Research investigating comorbidities has focused on clinical epilepsy characteristics and neurobiological/genetic correlates. The role that sociodemographic disadvantage (SD) may play has received less attention. We investigated the role of SD in cognitive status in youth with newly diagnosed epilepsy over a follow-up of 36 months to determine the degree, extent, and duration of the role of disadvantage. METHODS A total of 289 children (six to 16 years) within six weeks of their first seizure along with 167 siblings underwent comprehensive neuropsychological assessments (intelligence, language, memory, executive function, processing speed, and academic achievement) at baseline, 18 months later, and at 36 months from baseline. Baseline demographic information (race, caregivers education, household income, and parental marital status), clinical epilepsy characteristics (e.g., age of onset), and magnetic resonance imaging (MRI) and electroencephalographic (EEG) information was collected. RESULTS An SD index was computed for each family and categorized into four groups by level of disadvantage. In children and siblings, the least disadvantaged group exhibited the highest Full-Scale IQ, neuropsychological factor scores, and academic performances, whereas the most disadvantaged showed the polar opposite with the worst performances across all tests. Findings remained stable and significant over 36 months. Linear regression analyses indicated that disadvantage was a more constant and stable predictor of cognitive and academic performance over time compared with clinical epilepsy characteristics and MRI/EEG abnormalities. CONCLUSIONS This study indicates the strong association between SD and cognitive/academic performance in children with newly diagnosed epilepsy and their siblings is significant and predictive of three-year cognitive outcomes.
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Affiliation(s)
| | - Danielle Harvey
- Department of Public Health Sciences, University of California Davis, Sacramento, California
| | - David Dunn
- Departments of Psychiatry and Neurology, Indiana University, Indianapolis, Indiana
| | - Jana Jones
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Anna Byars
- Department of Pediatrics, Cincinnati Children's Hospital at the University of Cincinnati, Cincinnati, Ohio
| | - Philip Fastenau
- Department of Neurology, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Joan Austin
- Distinguished Professor Emerita, School of Nursing, Indiana University, Indianapolis, Indiana
| | - Bruce Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Yang L, Gabriel N, Bian J, Bilello LA, Wright DR, Hernandez I, Guo J. Individual and social determinants of adherence to sodium-glucose cotransporter 2 inhibitor therapy: A trajectory analysis. J Manag Care Spec Pharm 2023; 29:1242-1251. [PMID: 37889868 PMCID: PMC10776261 DOI: 10.18553/jmcp.2023.29.11.1242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
BACKGROUND: Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are known to improve cardiovascular and renal outcomes in patients with type 2 diabetes (T2D). Understanding the longitudinal patterns of adherence and the associated predictors is critical to addressing the suboptimal use of this outcome-improving treatment. OBJECTIVE: To characterize the distinct trajectories of adherence to SGLT2is in patients with T2D and to identify patient characteristics and social determinants of health (SDOHs) associated with SGLT2i adherence. METHODS: In this retrospective cohort study, we identified patients with T2D who initiated and filled at least 1 SGLT2i prescription according to 2012-2016 national Medicare claims data. The monthly proportion of days covered with SGLT2is for each patient was incorporated into group-based trajectory models to identify groups with similar adherence patterns. A multinomial logistic regression model was constructed to examine the association between patient characteristics and group membership. In addition, the association between context-specific SDOHs (eg, neighborhood median income and neighborhood employment rate) and adherence to an SGLT2i regimen was explored in both the overall cohort and the racial and ethnic subgroups. RESULTS: The final sample comprised 6,719 patients with T2D. Four trajectories of SGLT2i adherence were identified: continuously adherent users (49.6%), early discontinuers (27.5%), late discontinuers (14.5%), and intermediately adherent users (8.4%). Patient age, sex, race, diabetes duration, and Medicaid eligibility were significantly associated with trajectory group membership. Areas with a higher unemployment rate, lower income level, lower high school education rate, worse nutrition environment, fewer health care facilities, and greater Area Deprivation Index scores were found to be associated with low adherence to SGLT2is. CONCLUSIONS: Four distinct trajectories of adherence to SGLT2is were identified, with only half of the patients remaining continuously adherent to their treatment regimen during the first year after initiation. Several contextual SDOHs were associated with suboptimal adherence to SGLT2is.
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Affiliation(s)
- Lanting Yang
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, PA
| | - Nico Gabriel
- Division of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego
| | - Jiang Bian
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville
| | - Lori A. Bilello
- Department of Medicine, University of Florida College of Medicine, Jacksonville
| | - Davene R. Wright
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA
| | - Inmaculada Hernandez
- Division of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego
| | - Jingchuan Guo
- Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville
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Bunce AE, Morrissey S, Kaufmann J, Krancari M, Bowen M, Gold R. Finding meaning: a realist-informed perspective on social risk screening and relationships as mechanisms of change. FRONTIERS IN HEALTH SERVICES 2023; 3:1282292. [PMID: 37936880 PMCID: PMC10626542 DOI: 10.3389/frhs.2023.1282292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/09/2023] [Indexed: 11/09/2023]
Abstract
Background Social risk screening rates in many US primary care settings remain low. This realist-informed evaluation explored the mechanisms through which a tailored coaching and technical training intervention impacted social risk screening uptake in 26 community clinics across the United States. Methods Evaluation data sources included the documented content of interactions between the clinics and implementation support team and electronic health record (EHR) data. Following the realist approach, analysis was composed of iterative cycles of developing, testing and refining program theories about how the intervention did-or didn't-work, for whom, under what circumstances. Normalization Process Theory was applied to the realist program theories to enhance the explanatory power and transferability of the results. Results Analysis identified three overarching realist program theories. First, clinic staff perceptions about the role of standardized social risk screening in person-centered care-considered "good" care and highly valued-strongly impacted receptivity to the intervention. Second, the physicality of the intervention materials facilitated collaboration and impacted clinic leaders' perception of the legitimacy of the social risk screening implementation work. Third, positive relationships between the implementation support team members, between the support team and clinic champions, and between clinic champions and staff motivated and inspired clinic staff to engage with the intervention and to tailor workflows to their settings' needs. Study clinics did not always exhibit the social risk screening patterns anticipated by the program theories due to discrepant definitions of success between clinic staff (improved ability to provide contextualized, person-centered care) and the trial (increased rates of EHR-documented social risk screening). Aligning the realist program theories with Normalization Process Theory constructs clarified that the intervention as implemented emphasized preparation over operationalization and appraisal, providing insight into why the intervention did not successfully embed sustained systematic social risk screening in participating clinics. Conclusion The realist program theories highlighted the effectiveness and importance of intervention components and implementation strategies that support trusting relationships as mechanisms of change. This may be particularly important in social determinants of health work, which requires commitment and humility from health care providers and vulnerability on the part of patients.
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Affiliation(s)
- Arwen E. Bunce
- Research Department, OCHIN Inc., Portland, OR, United States
| | | | - Jorge Kaufmann
- Oregon Health & Science University, Portland, OR, United States
| | - Molly Krancari
- Research Department, OCHIN Inc., Portland, OR, United States
| | - Megan Bowen
- Research Department, OCHIN Inc., Portland, OR, United States
| | - Rachel Gold
- Research Department, OCHIN Inc., Portland, OR, United States
- Kaiser Center for Health Research, Portland, OR, United States
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22
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Thielen SC, Reusch JEB, Regensteiner JG. A narrative review of exercise participation among adults with prediabetes or type 2 diabetes: barriers and solutions. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2023; 4:1218692. [PMID: 37711232 PMCID: PMC10499496 DOI: 10.3389/fcdhc.2023.1218692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 08/02/2023] [Indexed: 09/16/2023]
Abstract
Type 2 diabetes (T2D) has been rising in prevalence over the past few decades in the US and worldwide. T2D contributes to significant morbidity and premature mortality, primarily due to cardiovascular disease (CVD). Exercise is a major cornerstone of therapy for T2D as a result of its positive effects on glycemic control, blood pressure, weight loss and cardiovascular risk as well as other measures of health. However, studies show that a majority of people with T2D do not exercise regularly. The reasons given as to why exercise goals are not met are varied and include physiological, psychological, social, cultural and environmental barriers to exercise. One potential cause of inactivity in people with T2D is impaired cardiorespiratory fitness, even in the absence of clinically evident complications. The exercise impairment, although present in both sexes, is greater in women than men with T2D. Women with T2D also experience greater perceived exertion with exercise than their counterparts without diabetes. These physiological barriers are in addition to constructed societal barriers including cultural expectations of bearing the burden of childrearing for women and in some cultures, having limited access to exercise because of additional cultural expectations. People at risk for and with diabetes more commonly experience unfavorable social determinants of health (SDOH) than people without diabetes, represented by neighborhood deprivation. Neighborhood deprivation measures lack of resources in an area influencing socioeconomic status including many SDOH such as income, housing conditions, living environment, education and employment. Higher indices of neighborhood deprivation have been associated with increased risk of all-cause, cardiovascular and cancer related mortality. Unfavorable SDOH is also associated with obesity and lower levels of physical activity. Ideally regular physical activity should be incorporated into all communities as part of a productive and healthy lifestyle. One potential solution to improve access to physical activity is designing and building environments with increased walkability, greenspace and safe recreational areas. Other potential solutions include the use of continuous glucose monitors as real-time feedback tools aimed to increase motivation for physical activity, counseling aimed at improving self-efficacy towards exercise and even acquiring a dog to increase walking time. In this narrative review, we aim to examine some traditional and novel barriers to exercise, as well as present evidence on novel interventions or solutions to overcome barriers to increase exercise and physical activity in all people with prediabetes and T2D.
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Affiliation(s)
- Samantha C. Thielen
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Jane E. B. Reusch
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
- Ludeman Family Center for Women’s Health Research, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
- Division of Endocrinology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
- Rocky Mountain Regional Department of Veterans Affairs Medical Center (VAMC), Aurora, CO, United States
| | - Judith G. Regensteiner
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
- Ludeman Family Center for Women’s Health Research, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
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23
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Mehta S, Lyles CR, Rubinsky AD, Kemper KE, Auerbach J, Sarkar U, Gottlieb L, Brown Iii W. Social Determinants of Health Documentation in Structured and Unstructured Clinical Data of Patients With Diabetes: Comparative Analysis. JMIR Med Inform 2023; 11:e46159. [PMID: 37621203 PMCID: PMC10466443 DOI: 10.2196/46159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/06/2023] [Accepted: 06/10/2023] [Indexed: 08/26/2023] Open
Abstract
Background Electronic health records (EHRs) have yet to fully capture social determinants of health (SDOH) due to challenges such as nonexistent or inconsistent data capture tools across clinics, lack of time, and the burden of extra steps for the clinician. However, patient clinical notes (unstructured data) may be a better source of patient-related SDOH information. Objective It is unclear how accurately EHR data reflect patients' lived experience of SDOH. The manual process of retrieving SDOH information from clinical notes is time-consuming and not feasible. We leveraged two high-throughput tools to identify SDOH mappings to structured and unstructured patient data: PatientExploreR and Electronic Medical Record Search Engine (EMERSE). Methods We included adult patients (≥18 years of age) receiving primary care for their diabetes at the University of California, San Francisco (UCSF), from January 1, 2018, to December 31, 2019. We used expert raters to develop a corpus using SDOH in the compendium as a knowledge base as targets for the natural language processing (NLP) text string mapping to find string stems, roots, and syntactic similarities in the clinical notes of patients with diabetes. We applied advanced built-in EMERSE NLP query parsers implemented with JavaCC. Results We included 4283 adult patients receiving primary care for diabetes at UCSF. Our study revealed that SDOH may be more significant in the lives of patients with diabetes than is evident from structured data recorded on EHRs. With the application of EMERSE NLP rules, we uncovered additional information from patient clinical notes on problems related to social connectionsisolation, employment, financial insecurity, housing insecurity, food insecurity, education, and stress. Conclusions We discovered more patient information related to SDOH in unstructured data than in structured data. The application of this technique and further investment in similar user-friendly tools and infrastructure to extract SDOH information from unstructured data may help to identify the range of social conditions that influence patients' disease experiences and inform clinical decision-making.
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Affiliation(s)
- Shivani Mehta
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, United States
| | - Courtney R Lyles
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, United States
- Center for Vulnerable Populations, University of California San Francisco, San Francisco, CA, United States
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
- Bakar Computational Health Science Institute, University of California San Francisco, San Francisco, CA, United States
| | - Anna D Rubinsky
- Academic Research Services, Information Technology, University of California San Francisco, San Francisco, CA, United States
| | - Kathryn E Kemper
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, United States
| | - Judith Auerbach
- Prevention Science, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Urmimala Sarkar
- Center for Vulnerable Populations, University of California San Francisco, San Francisco, CA, United States
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Laura Gottlieb
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA, United States
| | - William Brown Iii
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, United States
- Center for Vulnerable Populations, University of California San Francisco, San Francisco, CA, United States
- Bakar Computational Health Science Institute, University of California San Francisco, San Francisco, CA, United States
- Center for Digital Health Innovation, University of California San Francisco, San Francisco, CA, United States
- Center for AIDS Prevention Studies, Division of Prevention Science, University of California San Francisco, San Francisco, CA, United States
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24
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Anim SB, Spurlark R, Turkson-Ocran RA, Bohr N, Soco C, Simonovich SD. A Systematic Review of the Relationship Between Discrimination, Racism, and Type 2 Diabetes Healthcare Outcomes for Black Americans. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01751-x. [PMID: 37580438 DOI: 10.1007/s40615-023-01751-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND Disparities in type 2 diabetes (T2DM) risk, care, and complications impact Black Americans more than that of their White counterparts. This study aims to examine the association between discrimination, racism, and T2DM care and outcomes in Black Americans. METHOD The systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. RESULTS A total of six original research articles met the inclusion criteria, comprising three quantitative and three qualitative studies. Overall, the systematic review findings revealed that among Black Americans, perceived interpersonal discrimination and racism by healthcare professionals are associated with patients' behaviors that impact T2DM outcomes. The findings also revealed that provider-level factors such as communication, provider assumptions and attitudes, information sharing, shared decision-making, and disease management behaviors might influence T2DM outcomes in this population. DISCUSSION Better T2DM-related outcomes depend on optimal disease control through adequate disease management. Building a therapeutic and culturally appropriate relationship free of discrimination and racism is vital for optimal disease management and decreasing health disparities in this patient population. CONCLUSION Perceived interpersonal racism and discrimination by healthcare providers, among other sociocultural factors, play a crucial role in influencing some patient behaviors that affect T2DM health outcomes in this population. Efforts to decrease health disparities in this specific community should also focus on interventions addressing provider-level factors and behaviors perceived as racist or discriminatory.
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Affiliation(s)
- Sandra B Anim
- DePaul University School of Nursing, Chicago, IL, USA
| | | | | | | | - Cheryl Soco
- DePaul University School of Nursing, Chicago, IL, USA
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25
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McDonough C, Li YC, Vangeepuram N, Liu B, Pandey G. Facilitating youth diabetes studies with the most comprehensive epidemiological dataset available through a public web portal. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.08.02.23293517. [PMID: 37577465 PMCID: PMC10418570 DOI: 10.1101/2023.08.02.23293517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
The prevalence of type 2 diabetes mellitus (DM) and prediabetes (preDM) is rapidly increasing among youth, posing significant health and economic consequences. To address this growing concern, we created the most comprehensive youth-focused diabetes dataset to date derived from National Health and Nutrition Examination Survey (NHANES) data from 1999 to 2018. The dataset, consisting of 15,149 youth aged 12 to 19 years, encompasses preDM/DM relevant variables from sociodemographic, health status, diet, and other lifestyle behavior domains. An interactive web portal, POND (Prediabetes/diabetes in youth ONline Dashboard), was developed to provide public access to the dataset, allowing users to explore variables potentially associated with youth preDM/DM. Leveraging statistical and machine learning methods, we conducted two case studies, revealing established and lesser-known variables linked to youth preDM/DM. This dataset and portal can facilitate future studies to inform prevention and management strategies for youth prediabetes and diabetes.
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Affiliation(s)
- Catherine McDonough
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yan Chak Li
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nita Vangeepuram
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bian Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gaurav Pandey
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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26
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Patel MR, Anthony Tolentino D, Smith A, Heisler M. Economic burden, financial stress, and cost-related coping among people with uncontrolled diabetes in the U.S. Prev Med Rep 2023; 34:102246. [PMID: 37252071 PMCID: PMC10209691 DOI: 10.1016/j.pmedr.2023.102246] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 01/02/2023] [Accepted: 05/11/2023] [Indexed: 05/31/2023] Open
Abstract
Granular information on material deprivation including financial and economic well-being among people with diabetes can better inform policy, practice and interventions to support diabetes management. The purpose of this study was to describe in-depth the state of economic burden, financial stress, and coping among people with high A1c. Data came from the 2019-2021 baseline assessment in an ongoing U.S. trial that addresses social determinants of health among people with diabetes and high A1c who report at least one financial burden or cost-related non-adherence (CRN) (n = 600). Mean age of participants was 53 years. Planning behaviors were the most common financial well-being behavior, while savings was least frequently endorsed. Nearly a quarter of participants report spending more than $300 per month out-of-pocket to manage all of their health conditions. Participants reported spending the most out-of-pocket on medications (52%), special foods (40%), doctor's visits (27%), and blood glucose supplies (22%). Along with health insurance, these were also the most cited as sources of financial stress and where assistance. Seventy-two percent reported high levels of financial stress. Maladaptive coping was evident through CRN, and less than half engaged in adaptive coping such as talking to a doctor about cost or using a resource to address their needs. Economic burden, financial stress, and cost-related coping are highly relevant constructs among people with diabetes and high A1cs. More evidence-generation is needed for diabetes self-management programs to address sources of financial stress, facilitate behaviors to enhance financial well-being, and address unmet social needs to alleviate economic burdens.
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Affiliation(s)
- Minal R. Patel
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, United States
| | | | - Alyssa Smith
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, United States
| | - Michele Heisler
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, United States
- Department of Internal Medicine, Michigan Medicine, United States
- U.S. Department of Veterans Affairs VA Ann Arbor Healthcare System, United States
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27
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Temmann LJ, Reifegerste D, Wiedicke A, Scherr S. Effects of Health Responsibility Frames: Testing a Mediation Model of Attributions, Emotions, and Social Support Intentions. JOURNAL OF HEALTH COMMUNICATION 2023:1-10. [PMID: 37470376 DOI: 10.1080/10810730.2023.2232326] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
When news stories cover health and illness, they often address issues of responsibility. These responsibility frames can affect recipients' responsibility beliefs (i.e. attributions) and thereby indirectly affect emotions and motivation to support people affected by health problems. To date, it is not fully understood how responsibility frames affect social support intentions, and if attributions and emotions mediate this effect. In an online experiment with N = 1,088 German participants, we tested the effects of responsibility frames (individually controllable vs. non-controllable) for type 2 diabetes and depression on social support intentions through responsibility attributions and emotional reactions. Mediation analyses show that responsibility frames indirectly affect social support intentions through social-societal attributions and sympathy. This mediation effect was observed in both depression and type 2 diabetes, despite issue-specific differences in attributions, emotions, and social support intentions. We discuss these findings considering framing effects research and health reporting.
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Affiliation(s)
| | | | | | - Sebastian Scherr
- Center for Interdisciplinary Health Research & Department of Media, Knowledge, and Communication, University of Augsburg, Germany
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28
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McDaniel CC, Lo-Ciganic WH, Garza KB, Kavookjian J, Fox BI, Chou C. Medication use and contextual factors associated with meeting guideline-based glycemic levels in diabetes among a nationally representative sample. Front Med (Lausanne) 2023; 10:1158454. [PMID: 37324129 PMCID: PMC10264805 DOI: 10.3389/fmed.2023.1158454] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/16/2023] [Indexed: 06/17/2023] Open
Abstract
Introduction Based on the long-lasting diabetes management challenges in the United States, the objective was to examine glycemic levels among a nationally representative sample of people with diabetes stratified by prescribed antihyperglycemic treatment regimens and contextual factors. Methods This serial cross-sectional study used United States population-based data from the 2015 to March 2020 National Health and Nutrition Examination Surveys (NHANES). The study included non-pregnant adults (≥20 years old) with non-missing A1C and self-reported diabetes diagnosis from NHANES. Using A1C lab values, we dichotomized the outcome of glycemic levels into <7% versus ≥7% (meeting vs. not meeting guideline-based glycemic levels, respectively). We stratified the outcome by antihyperglycemic medication use and contextual factors (e.g., race/ethnicity, gender, chronic conditions, diet, healthcare utilization, insurance, etc.) and performed multivariable logistic regression analyses. Results The 2042 adults with diabetes had a mean age of 60.63 (SE = 0.50), 55.26% (95% CI = 51.39-59.09) were male, and 51.82% (95% CI = 47.11-56.51) met guideline-based glycemic levels. Contextual factors associated with meeting guideline-based glycemic levels included reporting an "excellent" versus "poor" diet (aOR = 4.21, 95% CI = 1.92-9.25) and having no family history of diabetes (aOR = 1.43, 95% CI = 1.03-1.98). Contextual factors associated with lower odds of meeting guideline-based glycemic levels included taking insulin (aOR = 0.16, 95% CI = 0.10-0.26), taking metformin (aOR = 0.66, 95% CI = 0.46-0.96), less frequent healthcare utilization [e.g., none vs. ≥4 times/year (aOR = 0.51, 95% CI = 0.27-0.96)], being uninsured (aOR = 0.51, 95% CI = 0.33-0.79), etc. Discussion Meeting guideline-based glycemic levels was associated with medication use (taking vs. not taking respective antihyperglycemic medication classes) and contextual factors. The timely, population-based estimates can inform national efforts to optimize diabetes management.
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Affiliation(s)
- Cassidi C. McDaniel
- Department of Health Outcomes Research and Policy, Harrison College of Pharmacy, Auburn University, Auburn, AL, United States
| | - Wei-Hsuan Lo-Ciganic
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL, United States
- Center for Drug Evaluation and Safety, College of Pharmacy, University of Florida, Gainesville, FL, United States
| | - Kimberly B. Garza
- Department of Health Outcomes Research and Policy, Harrison College of Pharmacy, Auburn University, Auburn, AL, United States
| | - Jan Kavookjian
- Department of Health Outcomes Research and Policy, Harrison College of Pharmacy, Auburn University, Auburn, AL, United States
| | - Brent I. Fox
- Department of Health Outcomes Research and Policy, Harrison College of Pharmacy, Auburn University, Auburn, AL, United States
| | - Chiahung Chou
- Department of Health Outcomes Research and Policy, Harrison College of Pharmacy, Auburn University, Auburn, AL, United States
- Department of Medical Research, China Medical University Hospital, Taichung City, Taiwan
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29
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Teteh DK, Love M, Ericson M, Chan M, Phillips T, Toor A, Ferrell B, Erhunmwunsee L, Montgomery SB, Sun V, Kim JY. Social determinants of health among family caregiver centered outcomes in lung cancer: a systematic review. J Thorac Dis 2023; 15:2824-2835. [PMID: 37324097 PMCID: PMC10267915 DOI: 10.21037/jtd-22-1613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 04/13/2023] [Indexed: 06/17/2023]
Abstract
Background Lung cancer is the leading cause of cancer death globally. Both lung cancer patients and family caregivers (FCGs) have unmet quality of life (QOL) needs. An understudied topic in lung cancer research is the role of social determinants of health (SDOH) on QOL outcomes for this population. The purpose of this review was to explore the state of research on SDOH FCGs centered outcomes in lung cancer. Methods The databases PubMed/MEDLINE, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, and American Psychological Association (APA) PsycInfo were searched for peer-reviewed manuscripts evaluating defined SDOH domains on FCGs published within the last ten years. The information extracted using Covidence included patients, FCGs and study characteristics. Level of evidence and quality of articles were assessed using the Johns Hopkins Nursing Evidence-Based Practice Rating Scale. Results Of the 344 full-text articles assessed, 19 were included in this review. The social and community context domain focused on caregiving stressors and interventions to reduce its effects. The health care access and quality domain showed barriers and underuse of psychosocial resources. The economic stability domain indicated marked economic burdens for FCGs. Four interconnected themes emerged among articles on the influence of SDOH on FCG-centered outcomes in lung cancer: (I) psychological well-being, (II) overall quality of life, (III) relationship quality, and (IV) economic hardship. Notably, most participants in the studies were White females. The tools used to measure SDOH factors included primarily demographic variables. Conclusions Current studies provide evidence on the role of SDOH factors on lung cancer FCGs' QOL. Expanded utilization of validated SDOH measures in future studies would provide greater consistency in data, that could in turn inform interventions to improve QOL. Further research focusing on the domains of education quality and access and neighborhood and built environment should be carried out to bridge gaps in knowledge.
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Affiliation(s)
- Dede K. Teteh
- Department of Health Sciences, Crean College of Health and Behavioral Sciences, Chapman University, Orange, CA, USA
| | - Madeleine Love
- Division of Nursing Research and Education, Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Marissa Ericson
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Marissa Chan
- Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA
| | - Tanyanika Phillips
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Aroona Toor
- Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Betty Ferrell
- Division of Nursing Research and Education, Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Loretta Erhunmwunsee
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | | | - Virginia Sun
- Division of Nursing Research and Education, Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Jae Y. Kim
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
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30
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Sittner KJ, Herman KA, Gonzalez MB, Walls ML. A longitudinal study of positive mental health and coping among Indigenous adults with type 2 diabetes. ANXIETY, STRESS, AND COPING 2023; 36:339-352. [PMID: 35587950 PMCID: PMC9674796 DOI: 10.1080/10615806.2022.2076082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 04/13/2022] [Accepted: 05/02/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Indigenous Peoples and scholars call for strengths-based approaches to research inclusive of Indigenous resiliency and positive outcomes. The purpose of this study was to examine positive mental health for Indigenous adults with type 2 diabetes and to determine if positive mental health is linked to community connectedness (a coping resource) and active coping (a coping response). METHODS Participants (N = 194 at baseline) were randomly selected from clinical records, at least 18 years old with a type 2 diabetes diagnosis, and self-identified as American Indian. RESULTS Latent growth curve models revealed that average positive mental health was predicted to decrease over the four waves of the study, although not for participants with above-average active coping at baseline. Community connectedness at baseline was associated with higher initial levels of positive mental health. Within-person change in active coping and community connectedness were both associated with increases in positive mental health. CONCLUSION This study aligns with previous research demonstrating that coping can influence health outcomes, and furthers the stress process literature by showing that active coping and community connectedness can impact positive mental health for Indigenous adults with Type 2 Diabetes.
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Affiliation(s)
| | - Kaley A. Herman
- Johns Hopkins Bloomberg School of Public Health, Department of International Health; Center for American Indian Health; Duluth, MN
| | - Miigis B. Gonzalez
- Johns Hopkins Bloomberg School of Public Health, Department of International Health; Center for American Indian Health; Duluth, MN
| | - Melissa L. Walls
- Johns Hopkins Bloomberg School of Public Health, Department of International Health; Center for American Indian Health; Duluth, MN
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31
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Huang J, Yeung AM, Kerr D, Gentile S, Heinemann L, Al-Sofiani ME, Joseph JI, Seley JJ, Klonoff DC. Lipohypertrophy and Insulin. An Old Dog that Needs New Tricks. Endocr Pract 2023:S1530-891X(23)00386-5. [PMID: 37098370 DOI: 10.1016/j.eprac.2023.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/12/2023] [Accepted: 04/17/2023] [Indexed: 04/27/2023]
Abstract
OBJECTIVE To review the current status of practical knowledge related to insulin-associated lipohypertrophy (LH) - an accumulation of fatty subcutaneous nodules commonly caused by repeated injections and/or infusions of insulin into the same site. METHODS Review of published literature with additional contributions from leading multidisciplinary experts with the emphasis on clinical aspects including pathophysiology, clinical and economic consequences, diagnosis, prevention and treatment. RESULTS LH is the most common dermatologic complication of insulin therapy. Risk factors for the development of lipohypertrophy include repeated delivery of large amounts of insulin into the same location over time, repeated injection trauma to the skin and subcutaneous tissue, and multiple injections using the same needle. Subcutaneous insulin injection in skin areas with lipohypertrophy is associated with reduced pain; however, this problem can interfere with insulin absorption, thereby increasing the likelihood of glucose variability, hypo- and hyperglycemia when a site is changed. Modern visualization technology of the subcutaneous space with ultrasound can demonstrate lipohypertrophy early in the course of its development. CONCLUSIONS The physiological and psychological consequences of developing insulin lipohypertrophy can be prevented and treated with education focusing on insulin injection techniques.
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Affiliation(s)
- Jingtong Huang
- Diabetes Technology Society, Burlingame, California, USA.
| | - Andrea M Yeung
- Diabetes Technology Society, Burlingame, California, USA
| | - David Kerr
- Diabetes Technology Society, Burlingame, California, USA
| | - Sandro Gentile
- Department of Internal Medicine, Campania University "Luigi Vanvitelli", Naples, Italy; NefroCenter Research Network, Torre del Greco, Naples, Italy
| | | | - Mohammed E Al-Sofiani
- Division of Endocrinology, Department of Internal Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Division of Endocrinology, Diabetes and Metabolism, The Johns Hopkins University, Baltimore, Maryland, USA; Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Jeffrey I Joseph
- Jefferson Artificial Pancreas Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - David C Klonoff
- Diabetes Technology Society, Burlingame, California, USA; Diabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, California, USA
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Kingsbury P, Abajian H, Abajian M, Angyan P, Espinoza J, MacDonald B, Meeker D, Wilson JP, Bahroos N. SEnDAE: A resource for expanding research into social and environmental determinants of health. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 238:107542. [PMID: 37224727 DOI: 10.1016/j.cmpb.2023.107542] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 02/14/2023] [Accepted: 04/07/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND AND OBJECTIVE Social and Environmental Determinants of Health (SEDoH) are of increasing interest to researchers in personal and public health. Collecting SEDoH and associating them with patient medical record can be challenging, especially for environmental variables. We announce here the release of SEnDAE, the Social and Environmental Determinants Address Enhancement toolkit, and open-source resource for ingesting a range of environmental variables and measurements from a variety of sources and associated them with arbitrary addresses. METHODS SEnDAE includes optional components for geocoding addresses, in case an organization does not have independent capabilities in that area, and recipes for extending the OMOP CDM and the ontology of an i2b2 instance to display and compute over the SEnDAE variables within i2b2. RESULTS On a set of 5000 synthetic addresses, SEnDAE was able to geocode 83%. SEnDAE geocodes addresses to the same Census tract as ESRI 98.1% of the time. CONCLUSION Development of SEnDAE is ongoing, but we hope that teams will find it useful to increase their usage of environmental variables and increase the field's general understanding of these important determinants of health.
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Affiliation(s)
- Paul Kingsbury
- Keck School of Medicine, University of Southern California, 2250 Alcazar St CSC 212, Los Angeles CA 90033, USA
| | - Hakob Abajian
- Keck School of Medicine, University of Southern California, 2250 Alcazar St CSC 212, Los Angeles CA 90033, USA
| | - Mark Abajian
- Keck School of Medicine, University of Southern California, 2250 Alcazar St CSC 212, Los Angeles CA 90033, USA
| | - Praveen Angyan
- Keck School of Medicine, University of Southern California, 2250 Alcazar St CSC 212, Los Angeles CA 90033, USA
| | - Juan Espinoza
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles CA USA
| | - Beau MacDonald
- Spatial Sciences Institute, University of Southern California, Los Angeles CA USA
| | - Daniella Meeker
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles CA USA
| | - John P Wilson
- Spatial Sciences Institute, University of Southern California, Los Angeles CA USA
| | - Neil Bahroos
- Keck School of Medicine, University of Southern California, 2250 Alcazar St CSC 212, Los Angeles CA 90033, USA.
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Ryan JL, Franklin SM, Canterberry M, Long CL, Bowe A, Roy BD, Hessler D, Aceves B, Gottlieb LM. Association of Health-Related Social Needs With Quality and Utilization Outcomes in a Medicare Advantage Population With Diabetes. JAMA Netw Open 2023; 6:e239316. [PMID: 37083665 PMCID: PMC10122170 DOI: 10.1001/jamanetworkopen.2023.9316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
Importance Recent research highlights the association of social determinants of health with health outcomes of patients with type 2 diabetes (T2D). Objective To examine associations between health-related social needs (HRSNs) and health care quality and utilization outcomes in a Medicare Advantage population with T2D. Design, Setting, and Participants This cross-sectional study used medical and pharmacy claims data from 2019. An HRSN survey was given between October 16, 2019, and February 29, 2020, to Medicare Advantage beneficiaries. Inclusion criteria were diagnosis of T2D, age of 20 to 89 years, continuous Medicare Advantage enrollment in 2019, and response to the HRSN survey. Data were analyzed between June 2021 and January 2022. Exposures Enrollment in Medicare Advantage, diagnosis of T2D, and completion of a survey on HRSNs. Main Outcomes and Measures Quality outcomes included diabetes medication adherence, statin adherence, completion of a glycated hemoglobin (HbA1c) laboratory test in the past 12 months, and controlled HbA1c. Utilization outcomes included all-cause hospitalization, potentially avoidable hospitalization, emergency department discharge, and readmission. Results Of the 21 528 Medicare Advantage beneficiaries with T2D included in the study (mean [SD] age, 71.0 [8.3] years; 55.4% women), most (56.9%) had at least 1 HRSN. Among the population with T2D reporting HRSNs, the most prevalent were financial strain (73.6%), food insecurity (47.5%), and poor housing quality (39.1%). In adjusted models, loneliness (odds ratio [OR], 0.85; 95% CI, 0.73-0.99), lack of transportation (OR, 0.80; 95% CI, 0.69-0.92), utility insecurity (OR, 0.86; 95% CI, 0.76-0.98), and housing insecurity (OR, 0.78; 95% CI, 0.67-0.91) were each associated with lower diabetes medication adherence. Loneliness and lack of transportation were associated with increased emergency visits (marginal effects of 173.0 [95% CI, 74.2-271.9] and 244.6 [95% CI, 150.4-338.9] emergency visits per 1000 beneficiaries for loneliness and transportation, respectively). Food insecurity was the HRSN most consistently associated with higher acute care utilization (marginal effects of 84.6 [95% CI, 19.8-149.4] emergency visits, 30.4 [95% CI, 9.5-51.3] inpatient encounters, and 17.1 [95% CI, 4.7-29.5] avoidable hospitalizations per 1000 beneficiaries). Conclusions and Relevance In this cross-sectional study of Medicare Advantage beneficiaries with T2D, some HRSNs were associated with care quality and utilization. The results of the study may be used to direct interventions to the social needs most associated with T2D health outcomes and inform policy decisions at the insurance plan and community level.
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Affiliation(s)
| | | | | | | | - Andy Bowe
- Humana Healthcare Research, Louisville, Kentucky
| | | | - Danielle Hessler
- Social Interventions Research & Evaluation Network, Department of Family and Community Medicine, University of California, San Francisco
| | - Benjamin Aceves
- School of Public Health, San Diego State University, San Diego, California
| | - Laura M Gottlieb
- Social Interventions Research & Evaluation Network, Department of Family and Community Medicine, University of California, San Francisco
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Egede LE, Campbell JA, Walker RJ, Linde S. Structural Racism as an Upstream Social Determinant of Diabetes Outcomes: A Scoping Review. Diabetes Care 2023; 46:667-677. [PMID: 36952609 PMCID: PMC10090912 DOI: 10.2337/dci22-0044] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/24/2023] [Indexed: 03/25/2023]
Abstract
OBJECTIVE To evaluate the evidence on the role of structural racism as an upstream factor impacting diabetes outcomes, identify current gaps, and recommend areas for future work. RESEARCH DESIGN AND METHODS A reproducible search of Medline and Ovid was used. Structural factors based on the World Health Organization social determinants of health framework (governance, macroeconomic policy, social policy, public policy, and cultural and societal values) had to be included as measured variables or contextual factors discussed as upstream influences. Outcomes included 1) hemoglobin A1c (HbA1c), 2) LDL, 3) BMI, 4) quality of life, 5) self-efficacy, 6) mortality, 7) years of life lost, and 8) self-care behaviors. RESULTS Thirteen articles were included for final synthesis. Ten studies focused on governance, two on social policies, one on public policies, and one on cultural and societal values. Results highlight significant associations between structural racism and poorer clinical outcomes (HbA1c and blood pressure), worse self-care behaviors (diet and physical activity), lower standards of care, higher mortality, and more years of life lost for adults with diabetes. CONCLUSIONS There is a paucity of work investigating the relationship between structural racism and diabetes outcomes. Five areas for future work include 1) more rigorous research on the relationship between structural racism, downstream social determinants, and health outcomes in diabetes, 2) policy assessments specific to diabetes outcomes, 3) research designed to examine pathways and mechanisms of influence, 4) intervention development to mitigate the impact of structural racism, and 5) tracking and monitoring of change over time.
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Affiliation(s)
- Leonard E. Egede
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Jennifer A. Campbell
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Rebekah J. Walker
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Sebastian Linde
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
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Greene L, Maciejewski ML, Grubber J, Smith VA, Blalock DV, Zulman DM. Association between patient-reported social, behavioral, and health factors and emergency department visits in high-risk VA patients. Health Serv Res 2023; 58:383-391. [PMID: 36310448 PMCID: PMC10012238 DOI: 10.1111/1475-6773.14094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
RESEARCH OBJECTIVE To identify patient-reported social risk, behavioral, and health factors associated with emergency department (ED) utilization in high-risk Veterans Affairs (VA) patients. DATA SOURCES Patient survey, VA, Medicare data. STUDY DESIGN Prospective cohort study using multivariable logistic regression to identify patient-reported factors associated with all-cause and ambulatory care sensitive condition (ACSC)-related ED visits among VA patients at high risk for hospitalization or death. DATA EXTRACTION METHODS Patient-reported measures derived from a 2018 survey sent to 10,000 VA patients; clinical and demographic characteristics derived from VA data; ED visits derived from VA and Medicare claims. PRINCIPAL FINDINGS Among 4680 survey respondents, 52.5% and 16.3% experienced an all-cause or ACSC-related ED visit in the following year, respectively. An ED visit was more likely among individuals with functional status limitations (6.0% points (Confidence Interval [CI] 0.017-0.103)) and transportation barriers (5.2% points [CI 0.005-0.099]). An ACSC-related ED visit was more likely among individuals with functional status limitations (3.2% points [CI 0.003-0.062]) and self-rated poorer health (7.4% points (CI 0.030-0.119) poor; 6.2% points (CI 0.029-0.096) fair; 4.1% points (CI 0.009-0.073) good; compared with excellent/very good). CONCLUSIONS Patient-reported factors not present in most electronic health records were significantly associated with future ED visits in high-risk VA patients.
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Affiliation(s)
- Liberty Greene
- Center for Innovation to ImplementationVA Palo Alto Health Care SystemMenlo ParkCaliforniaUSA
- Division of Primary Care and Population HealthStanford University School of MedicineStanfordCaliforniaUSA
| | - Matthew L. Maciejewski
- Center for Innovation to Accelerate Discovery and Practice Transformation (ADAPT)Durham Veterans Affairs Health Care SystemDurhamNorth CarolinaUSA
- Department of Population Health SciencesDuke UniversityDurhamNorth CarolinaUSA
- Division of General Internal Medicine, Department of MedicineDuke UniversityDurhamNorth CarolinaUSA
| | - Janet Grubber
- Center for Innovation to Accelerate Discovery and Practice Transformation (ADAPT)Durham Veterans Affairs Health Care SystemDurhamNorth CarolinaUSA
- Department of Psychiatry and Behavioral SciencesDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Valerie A. Smith
- Center for Innovation to Accelerate Discovery and Practice Transformation (ADAPT)Durham Veterans Affairs Health Care SystemDurhamNorth CarolinaUSA
- Department of Population Health SciencesDuke UniversityDurhamNorth CarolinaUSA
- Division of General Internal Medicine, Department of MedicineDuke UniversityDurhamNorth CarolinaUSA
- Durham VA Medical CenterDurhamNorth CarolinaUSA
| | - Dan V. Blalock
- Center for Innovation to Accelerate Discovery and Practice Transformation (ADAPT)Durham Veterans Affairs Health Care SystemDurhamNorth CarolinaUSA
- Department of Psychiatry and Behavioral SciencesDuke University School of MedicineDurhamNorth CarolinaUSA
- Durham VA Medical CenterDurhamNorth CarolinaUSA
| | - Donna M. Zulman
- Center for Innovation to ImplementationVA Palo Alto Health Care SystemMenlo ParkCaliforniaUSA
- Division of Primary Care and Population HealthStanford University School of MedicineStanfordCaliforniaUSA
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Lukkahatai N, Rodney T, Ling C, Daniel B, Han HR. Long COVID in the context of social determinants of health. Front Public Health 2023; 11:1098443. [PMID: 37056649 PMCID: PMC10088562 DOI: 10.3389/fpubh.2023.1098443] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/03/2023] [Indexed: 03/30/2023] Open
Abstract
The COVID-19 pandemic has been a challenge for the public health system and has highlighted health disparities. COVID-19 vaccines have effectively protected against infection and severe disease, but some patients continue to suffer from symptoms after their condition is resolved. These post-acute sequelae, or long COVID, continues to disproportionately affect some patients based on their social determinants of health (SDOH). This paper uses the World Health Organization's (WHO) SDOH conceptual framework to explore how SDOH influences long COVID outcomes.
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Affiliation(s)
- Nada Lukkahatai
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States
- *Correspondence: Nada Lukkahatai
| | - Tamar Rodney
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States
| | - Catherine Ling
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States
| | - Brittany Daniel
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States
| | - Hae-Ra Han
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
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Carlozzi NE, Kallen MA, Troost JP, Miner JA, Bragg A, Martin-Howard J, De La Cruz B, Moldovan I, Jack BW, Mitchell S. Development of a New Measure of Housing Security: The REDD-CAT Housing Security Measure. J Gen Intern Med 2023:10.1007/s11606-023-08147-x. [PMID: 36964423 PMCID: PMC10038379 DOI: 10.1007/s11606-023-08147-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 03/09/2023] [Indexed: 03/26/2023]
Abstract
BACKGROUND Housing security is a key social determinant of behavior related to health outcomes. OBJECTIVE The purpose of this study was to develop a new patient-reported outcome measure that evaluates aspects of housing security for use in the Re-Engineered Discharge for Diabetes-Computer Adaptive Test (REDD-CAT) measurement system. DESIGN Qualitative data, literature reviews, and cross-sectional survey study. PARTICIPANTS A total of 225 people with T2DM provided responses to the items in this item pool. MAIN MEASURES A new item pool that evaluates important aspects of housing security was developed using stakeholder data from focus groups of persons with T2DM. KEY RESULTS For the Housing Affordability scale, factor analysis (both exploratory and confirmatory) supported the retention of six items. Of these items, none exhibited sparse cells or problems with monotonicity; no items were deleted due to low item-adjusted total score correlations. For the six affordability items, a constrained graded response model indicated no items exhibited misfit; thus, all were retained. No items indicated differential item functioning (examined for age, sex, education, race, and socioeconomic status). Thus, the final Affordability item bank comprised six items. A Housing Safety index (three items) and a Home Features index (eight items) were also developed. Reliability (i.e., internal consistency and test-retest reliability) and validity (i.e., convergent, discriminant, and known-groups) of the new measures were also supported. CONCLUSIONS The REDD-CAT Housing Security Measure provides a reliable and valid assessment of housing affordability, safety, and home features in people with type 2 diabetes mellitus. Future work is needed to establish the clinical utility of this measure in other clinical populations.
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Affiliation(s)
- Noelle E Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA.
- Center for Clinical Outcomes Development and Application (CODA), Department of Physical Medicine & Rehabilitation, University of Michigan, North Campus Research Complex, 2800 Plymouth Road, Building NCRC B14, Room G216, Ann Arbor, MI, 48109-2800, USA.
| | - Michael A Kallen
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jonathan P Troost
- Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, MI, USA
| | - Jennifer A Miner
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Alexa Bragg
- Department of Family Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Jessica Martin-Howard
- Department of Family Medicine, Boston University School of Medicine, Boston, MA, USA
| | | | - Ioana Moldovan
- Department of Family Medicine, Boston Medical Center, Boston, MA, USA
| | - Brian W Jack
- Department of Family Medicine, Boston University School of Medicine, Boston, MA, USA
- Department of Family Medicine, Boston Medical Center, Boston, MA, USA
| | - Suzanne Mitchell
- Department of Family Medicine, Boston University School of Medicine, Boston, MA, USA
- Department of Family Medicine, Boston Medical Center, Boston, MA, USA
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Dhillon NK, Kufera J, Ghneim M. Emergency General Surgery Procedures in Older Adults: Where You Live Matters! Am Surg 2023:31348231160838. [PMID: 36861456 DOI: 10.1177/00031348231160838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
BACKGROUND Neighborhood location and its built environment are important social determinants of health that impact health outcomes. Older adults (OAs) represent the fastest growing population in the United States with many requiring emergency general surgery procedures (EGSPs). The aim of this study was to evaluate whether neighborhood location, represented by zip code, influences mortality and disposition in OAs undergoing EGSPs in Maryland. METHODS A retrospective review was undertaken of hospital encounters in the Maryland Health Services Cost Review Commission from 2014 to 2018 of OAs undergoing EGSPs. Older adults residing in the 50 most affluent (MANs) and 50 least affluent (LANs) neighborhoods based on zip codes were compared. Data collected included demographics, all patient-refined (APR)-severity of illness (SOI), APR-risk of mortality (ROM), Charlson Comorbidity Index, complications, mortality, and discharge to a higher level of care. RESULTS Of the 8661 OAs analyzed, 2362 (27.3%) resided in MANs and 6299 (72.7%) in LANs. Older adults in LANs were more likely to undergo EGSPs, had higher APR-SOI and APR-ROM, and experienced more complications, discharge to higher level of care, and mortality. Living in LANs was independently associated with discharge to higher level of care (OR 1.56, 95% CI: 1.38-1.77, P < .001) and increased mortality (OR 1.35, 95% CI: 1.07-1.71, P = .01). DISCUSSION Mortality and quality of life in OAs undergoing EGSPs are dependent on environmental factors likely determined by neighborhood location. These factors need to be defined and incorporated in predictive models of outcomes. Public health opportunities to improve outcomes for those who are socially disadvantaged are necessary.
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Affiliation(s)
- Navpreet K Dhillon
- Department of Surgery, Program in Trauma, University of Maryland School of Medicine, 137889R Adams Cowley Shock Trauma Center, Baltimore, MD, USA
| | - Joseph Kufera
- National Study Center for Trauma and Emergency Medical Systems, Center for Shock, Trauma and Anesthesiology Research, 12264University of Maryland School of Medicine, Baltimore MD, USA
| | - Mira Ghneim
- Department of Surgery, Program in Trauma, University of Maryland School of Medicine, 137889R Adams Cowley Shock Trauma Center, Baltimore, MD, USA
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Sukkarieh O, Egede LE, Bassil M. Relationship between social determinants of health and quality of life in low income adults with diabetes in Lebanon. Postgrad Med 2023; 135:169-178. [PMID: 36714928 DOI: 10.1080/00325481.2023.2172283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND & OBJECTIVE Global rates of type 2 diabetes (T2DM) are increasing, with the Middle East and North Africa (MENA) region having the second highest prevalence in the world. Populations from the MENA region, including Lebanon, are also witnessing massive waves of immigration to the western hemisphere. Limited data exist about how social determinants of health (SDOH) impact outcomes for T2DM in this population. Thus, the aim of this study was to assess the relationship between SDOH and quality of life (QoL) in Lebanese adults with T2DM. METHODS Adults with T2DM (n = 300) were recruited from primary healthcare centers in Lebanon. Demographic characteristics and WHO QoL domains (physical health, psychological wellbeing, social relationships, and environment) were assessed. SDOH included socioeconomic, neighborhood/built environment, and psychosocial variables. Partially and fully adjusted regression models were used to test for associations between SDOH and QoL domains. RESULTS Mean age of the participants was 60.3 years, 48% were women, 73% were married, and 64% had less than high-school education. Results from the fully adjusted regression models showed that psychosocial (i.e. adverse childhood experiences and depression), socioeconomic (i.e. employment, income, family size, insurance, financial status, and financial independence), and neighborhood/built environment (i.e. transportation, number of rooms in the household, and certain household items) variables were independent correlates of different QoL domains. CONCLUSIONS This study shows that psychosocial, socioeconomic, and neighborhood/built environment variables are differentially associated with different QoL domains, suggesting that SDOH factors are strongly associated with quality of life in low-income adults with T2DM in Lebanon.
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Affiliation(s)
- Ola Sukkarieh
- Alice Ramez Chagoury School of Nursing, Lebanese American University, Byblos, Lebanon
| | - Leonard E Egede
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Maya Bassil
- Department of Human Nutrition, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
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Lohr AM, Vickery KD, Hernandez V, Ford BR, Gonzalez C, Kavistan S, Patten CA, Njeru JW, Novotny PJ, Larkey LK, Singh D, Wieland ML, Sia IG. Stories for change protocol: A randomized controlled trial of a digital storytelling intervention for Hispanic/Latino individuals with type 2 diabetes. Contemp Clin Trials 2023; 126:107093. [PMID: 36682492 PMCID: PMC9998363 DOI: 10.1016/j.cct.2023.107093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 01/21/2023]
Abstract
BACKGROUND Hispanic/Latino adults are disproportionately impacted by type 2 diabetes mellitus (T2D). The Stories for Change (S4C) Diabetes digital storytelling intervention promotes T2D self-management among Hispanic/Latino people. We describe the S4C protocol and participant baseline characteristics. METHODS Study eligibility criteria: Hispanic or Latino, age 18-70 years, ≥1 office visit within a year at a participating clinic, T2D diagnosis for ≥6 months, HbA1c ≥ 8%, and intention to continue care at the recruitment clinic. We used a two-group, parallel randomized controlled trial design and an intervention derived through a community-based participatory research approach. All participants received usual diabetes care and two cards describing how to engage healthcare teams and access diabetes-related resources. At baseline, the intervention group additionally viewed the 12-min, intervention video (four stories about diabetes self-management). To encourage subsequent video viewing, participants received five monthly text messages. The messages prompted them to self-rate their motivation and self-efficacy for T2D management. The control group received no additional intervention. Bilingual (English/Spanish) staff collected data at baseline, six weeks, three months, and six months including biometric measurements and a survey on diabetes self-management outcomes, theory-based measures, and the number of video views. We reviewed the number of diabetes-related appointments attended using electronic medical record data. RESULTS Participants (n = 451; 70% women, mean age = 53 years) had an average HbA1C ≥9%. Intervention participants reported identifying with the storytellers and engaging with the stories. CONCLUSION We present a digital storytelling intervention protocol that provides a template for future health promotion interventions prioritizing health disparity populations. CLINICALTRIAL gov#NCT03766438.
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Affiliation(s)
- Abby M Lohr
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA; Center for Clinical and Translational Science, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA.
| | - Katherine Diaz Vickery
- Health, Homelessness & Criminal Justice Lab, Hennepin Healthcare Research Institute, 730 S 8th St, Minneapolis, MN 55415, USA
| | | | - Becky R Ford
- Health, Homelessness & Criminal Justice Lab, Hennepin Healthcare Research Institute, 730 S 8th St, Minneapolis, MN 55415, USA
| | - Crystal Gonzalez
- Mountain Park Health Center, 635 E Baseline Rd, Phoenix, AZ 85042, USA
| | - Silvio Kavistan
- Health, Homelessness & Criminal Justice Lab, Hennepin Healthcare Research Institute, 730 S 8th St, Minneapolis, MN 55415, USA
| | - Christi A Patten
- Center for Clinical and Translational Science, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA; Department of Psychiatry and Psychology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Jane W Njeru
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Paul J Novotny
- Division of Biomedical Statistics and Informatics, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Linda K Larkey
- Edson College of Nursing and Health Innovation, Arizona State University, 550 N 3rd Street Ac, Phoenix, AZ 85004, USA
| | - Davinder Singh
- Mountain Park Health Center, 635 E Baseline Rd, Phoenix, AZ 85042, USA
| | - Mark L Wieland
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA; Center for Clinical and Translational Science, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Irene G Sia
- Center for Clinical and Translational Science, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA; Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
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Doss ER, Popejoy LL. Informal Family Caregiving of Patients with Diabetic Extremity Wounds: An Integrative Review. West J Nurs Res 2023; 45:272-281. [PMID: 35919019 DOI: 10.1177/01939459221115694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Annually, 26 million people worldwide develop diabetic extremity wounds, adversely impacting the lives of patients and their family caregivers, who provide vital health assistance to these patients. This integrative review synthesized scientific literature of informal caregiving experiences for patients with diabetic extremity wounds. Five databases were searched for relevant English-language quantitative or qualitative research; ten studies were included in the final analysis. The caregiving experience included disrupted routines, frustration, guilt, poor health care communication, helplessness, and anxiety. Increased caregiver burden and decreased quality of life were associated with higher patient amputation level, worsening wound appearance and patient pain, poor health care communication, lack of social support and/or caregiving help, and lack of caregiver employment outside the home. Future research opportunities include further exploration of caregiver tasks and priorities, caregiving experiences in settings lacking family support structures and equitable health system access, and relationships between the caregiver experience and patient health system utilization.
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Sinha A, Ning H, Cameron N, Bancks M, Carnethon MR, Allen NB, Wilkins JT, Lloyd-Jones DM, Khan SS. Atherosclerotic Cardiovascular Disease or Heart Failure: First Cardiovascular Event in Adults With Prediabetes and Diabetes. J Card Fail 2023; 29:246-254. [PMID: 36343785 DOI: 10.1016/j.cardfail.2022.10.426] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 10/17/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Individuals with prediabetes and diabetes are at increased risk of atherosclerotic cardiovascular disease (ASCVD) and heart failure (HF). Whether ASCVD or HF is more likely to occur first in these populations within different race-sex groups is unknown. OBJECTIVE To determine the competing risk for the first cardiovascular event by subtype in Black and white men and women with prediabetes and diabetes. METHODS Individual-level data from adults without ASCVD or HF were pooled from 6 population-based cohorts. We estimated the competing cumulative incidences of ASCVD, HF and noncardiovascular death as the first event in middle-aged (40-59 years) and older (60-79 years) adults, stratified by race and sex, with normal fasting plasma glucose (FPG < 100 mg/dL), prediabetes (FPG 100-125 mg/dL) and diabetes (FPG ≥ 126 mg/dL or on antihyperglycemic agents) at baseline. Within each race-sex group, we estimated risk the adjusted hazard ratio of ASCVD, HF and noncardiovascular death in adults with prediabetes and diabetes relative to adults with normoglycemia after adjusting for cardiovascular risk factors. RESULTS In 40,117 participants with 638,910 person-years of follow-up, 5781 cases of incident ASCVD and 3179 cases of incident HF occurred. In middle-aged adults with diabetes, competing cumulative incidence of ASCVD as a first event was higher than HF in white men (35.4% vs 11.6%), Black men (31.6% vs 15.1%) and white women (24.3% vs 17.2%) but not in Black women (26.4% vs 28.4%). Within each group, the adjusted hazard ratio of ASCVD and HF was significantly higher in adults with diabetes than in adults with normal FPG levels. Findings were largely similar in middle-aged adults with prediabetes and older adults with prediabetes or diabetes. CONCLUSIONS Black women with diabetes are more likely to develop HF as their first CVD event, whereas individuals with diabetes from other race-sex groups are more likely to present first with ASCVD. These results can inform the tailoring of primary prevention therapies for either HF- or ASCVD-specific pathways based on individual-level risk.
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Affiliation(s)
- Arjun Sinha
- The Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine; Chicago, IL; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; Chicago, IL.
| | - Hongyan Ning
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; Chicago, IL
| | - Natalie Cameron
- Department of Medicine, Northwestern University Feinberg School of Medicine; Chicago, IL
| | - Michael Bancks
- Department of Epidemiology and Prevention, Wake Forest School of Medicine; Winston-Salem, NC
| | - Mercedes R Carnethon
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; Chicago, IL
| | - Norrina B Allen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; Chicago, IL
| | - John T Wilkins
- The Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine; Chicago, IL; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; Chicago, IL
| | - Donald M Lloyd-Jones
- The Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine; Chicago, IL; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; Chicago, IL
| | - Sadiya S Khan
- The Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine; Chicago, IL; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; Chicago, IL
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Cockrell BE, Haiflich AN, Lee YLL, Kinnard CM, Butts CC, Polite NM, Mbaka MI, Bright AC, Simmons JD, Williams AY. Social Determinants of Health Impact Physical Recovery After Blunt Injury. Am Surg 2023:31348231161672. [PMID: 36853832 DOI: 10.1177/00031348231161672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
As defined by the United States Department of Health and Human Services, the Social Determinants of Health (SDOH) are conditions in the environment that affect health function and outcomes. The SDOH are divided into the following categories: economic stability, education access and quality, health care access and quality, neighborhood and built environment, and social and community content. It is known that SDOH impact long-term health outcomes. The influence that SDOH have on physical recovery after acute injury is less understood, however. In this study, patients who suffered a traumatic blunt injury completed a survey 12-14 months post-injury to assess their SDOH and physical health before and after their injury. The results showed that for the cohort of patients studied SDOH was the greatest predictor of long-term recovery, having a stronger correlation with recovery than injury severity score (ISS) or hospital length of stay (HLOS).
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Affiliation(s)
| | - Andrew N Haiflich
- Department of Trauma Surgery, 12214The University of South Alabama College of Medicine, Mobile, AL, USA
| | - Yann-Leei L Lee
- Department of Trauma Surgery, 12214The University of South Alabama College of Medicine, Mobile, AL, USA
| | - Christopher M Kinnard
- Department of Trauma Surgery, 12214The University of South Alabama College of Medicine, Mobile, AL, USA
| | - Charles C Butts
- Department of Trauma Surgery, 12214The University of South Alabama College of Medicine, Mobile, AL, USA
| | - Nathan M Polite
- Department of Trauma Surgery, 12214The University of South Alabama College of Medicine, Mobile, AL, USA
| | - Maryann I Mbaka
- Department of Trauma Surgery, 12214The University of South Alabama College of Medicine, Mobile, AL, USA
| | - Andrew C Bright
- Department of Trauma Surgery, 12214The University of South Alabama College of Medicine, Mobile, AL, USA
| | - Jon D Simmons
- Department of Trauma Surgery, 12214The University of South Alabama College of Medicine, Mobile, AL, USA
| | - Ashley Y Williams
- Department of Trauma Surgery, 12214The University of South Alabama College of Medicine, Mobile, AL, USA
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Li Y, Hu H, Zheng Y, Donahoo WT, Guo Y, Xu J, Chen WH, Liu N, Shenkman EA, Bian J, Guo J. Impact of Contextual-Level Social Determinants of Health on Newer Antidiabetic Drug Adoption in Patients with Type 2 Diabetes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20054036. [PMID: 36901047 PMCID: PMC10001625 DOI: 10.3390/ijerph20054036] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 02/17/2023] [Accepted: 02/22/2023] [Indexed: 05/14/2023]
Abstract
BACKGROUND We aimed to investigate the association between contextual-level social determinants of health (SDoH) and the use of novel antidiabetic drugs (ADD), including sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1a) for patients with type 2 diabetes (T2D), and whether the association varies across racial and ethnic groups. METHODS Using electronic health records from the OneFlorida+ network, we assembled a cohort of T2D patients who initiated a second-line ADD in 2015-2020. A set of 81 contextual-level SDoH documenting social and built environment were spatiotemporally linked to individuals based on their residential histories. We assessed the association between the contextual-level SDoH and initiation of SGTL2i/GLP1a and determined their effects across racial groups, adjusting for clinical factors. RESULTS Of 28,874 individuals, 61% were women, and the mean age was 58 (±15) years. Two contextual-level SDoH factors identified as significantly associated with SGLT2i/GLP1a use were neighborhood deprivation index (odds ratio [OR] 0.87, 95% confidence interval [CI] 0.81-0.94) and the percent of vacant addresses in the neighborhood (OR 0.91, 95% CI 0.85-0.98). Patients living in such neighborhoods are less likely to be prescribed with newer ADD. There was no interaction between race-ethnicity and SDoH on the use of newer ADD. However, in the overall cohort, the non-Hispanic Black individuals were less likely to use newer ADD than the non-Hispanic White individuals (OR 0.82, 95% CI 0.76-0.88). CONCLUSION Using a data-driven approach, we identified the key contextual-level SDoH factors associated with not following evidence-based treatment of T2D. Further investigations are needed to examine the mechanisms underlying these associations.
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Affiliation(s)
- Yujia Li
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
| | - Hui Hu
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Yi Zheng
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - William Troy Donahoo
- Division of Endocrinology, Diabetes and Metabolism, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Yi Guo
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Jie Xu
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Wei-Han Chen
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
| | - Ning Liu
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
| | - Elisabeth A. Shenkman
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Jiang Bian
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Jingchuan Guo
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
- Correspondence: ; Tel.: +1-352-273-6533
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Sullivan MD, Sturgeon JA, Lumley MA, Ballantyne JC. Reconsidering Fordyce's classic article, "Pain and suffering: what is the unit?" to help make our model of chronic pain truly biopsychosocial. Pain 2023; 164:271-279. [PMID: 35972469 PMCID: PMC9840653 DOI: 10.1097/j.pain.0000000000002748] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 07/26/2022] [Indexed: 02/06/2023]
Abstract
ABSTRACT The biopsychosocial model (BPS) of chronic pain aspires to be comprehensive, incorporating psychological and social factors omitted from biomedical models. Although psychosocial factors are viewed as highly influential in understanding behavioral and psychological responses to pain, these factors are usually viewed as modifiers of biological causes of the experience of pain itself, rather than as equal contributors to pain. To further advance the BPS model, we re-examine a classic 1994 article by Wilbert "Bill" Fordyce, "Pain and suffering: what is the unit?" In this article, Fordyce suggested that pain-related disability and suffering should be viewed as "transdermal," as having causes both inside and outside the body. We consider Fordyce's article theoretically important because this concept allows us to more fully break free of the medical model of chronic pain than customary formulations of the BPS model. It makes it possible to place psychological and social factors on an equal footing with biological ones in explaining pain itself and to remove distinctions between pain mechanisms and pain meanings. The brain's salience network now offers a platform on which diverse influences on pain experience-from nociception to multisensory indicators of safety or danger-can be integrated, bridging the gap between impersonal nociceptive mechanisms and personal meanings. We also argue that Fordyce's article is practically important because this concept expands the BPS model beyond the bounds of the clinical encounter, opening the door to the full range of social, psychological, and biological interventions, empowering patients and nonmedical providers to tackle chronic pain.
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Greenlee MC, Bolen S, Chong W, Dokun A, Gonzalvo J, Hawkins M, Herman WH, Leake E, Linder B, Conlin PR. The National Clinical Care Commission Report to Congress: Leveraging Federal Policies and Programs to Improve Diabetes Treatment and Reduce Complications. Diabetes Care 2023; 46:e51-e59. [PMID: 36701593 PMCID: PMC9887628 DOI: 10.2337/dc22-0621] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 09/08/2022] [Indexed: 01/27/2023]
Abstract
The Treatment and Complications subcommittee of the National Clinical Care Commission focused on factors likely to improve the delivery of high-quality care to all people with diabetes. The gap between available resources and the needs of people living with diabetes adversely impacts both treatment and outcomes. The Commission's recommendations are designed to bridge this gap. At the patient level, the Commission recommends reducing barriers and streamlining administrative processes to improve access to diabetes self-management training, diabetes devices, virtual care, and insulin. At the practice level, we recommend enhancing programs that support team-based care and developing capacity to support technology-enabled mentoring interventions. At the health system level, we recommend that the Department of Health and Human Services routinely assess the needs of the health care workforce and ensure funding of training programs directed to meet those needs. At the health policy level, we recommend establishing a process to identify and ensure pre-deductible insurance coverage for high-value diabetes treatments and services and developing a quality measure that reduces risk of hypoglycemia and enhances patient safety. We also identified several areas that need additional research, such as studying the barriers to uptake of diabetes self-management education and support, exploring methods to implement team-based care, and evaluating the importance of digital connectivity as a social determinant of health. The Commission strongly encourages Congress, the Department of Health and Human Services, and other federal departments and agencies to take swift action to implement these recommendations to improve health outcomes and quality of life among people living with diabetes.
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Affiliation(s)
| | - Shari Bolen
- Population Health Research Institute and Center for Health Care Research and Policy, Case Western Reserve at The MetroHealth System, Cleveland, OH
| | - William Chong
- Office of Generic Drugs, Center for Drug Evaluation and Research, Food and Drug Administration, Rockville, MD
| | - Ayotunde Dokun
- Division of Endocrinology and Metabolism, Carver School of Medicine, University of Iowa, Iowa City, IA
| | - Jasmine Gonzalvo
- Center for Health Equity and Innovation, Purdue University, Indianapolis, IN
| | - Meredith Hawkins
- Global Diabetes Institute, Albert Einstein College of Medicine, Bronx, NY
| | | | - Ellen Leake
- Juvenile Diabetes Research Foundation, Jackson, MS
| | - Barbara Linder
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Paul R. Conlin
- Department of Veterans Affairs Boston Healthcare System, Boston, MA
- Harvard Medical School, Boston, MA
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47
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Kepper MM, Walsh‐Bailey C, Prusaczyk B, Zhao M, Herrick C, Foraker R. The adoption of social determinants of health documentation in clinical settings. Health Serv Res 2023; 58:67-77. [PMID: 35862115 PMCID: PMC9836948 DOI: 10.1111/1475-6773.14039] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To understand the frequency of social determinants of health (SDOH) diagnosis codes (Z-codes) within the electronic health record (EHR) for patients with prediabetes and diabetes and examine factors influencing the adoption of SDOH documentation in clinical care. DATA SOURCES EHR data and qualitative interviews with health care providers and stakeholders. STUDY DESIGN An explanatory sequential mixed methods design first examined the use of Z-codes within the EHR and qualitatively examined barriers to documenting SDOH. Data were integrated and interpreted using a joint display. This research was informed by the Framework for Dissemination and Utilization of Research for Health Care Policy and Practice. DATA COLLECTION/EXTRACTION METHODS We queried EHR data for patients with a hemoglobin A1c > 5.7 between October 1, 2015 and September 1, 2020 (n = 118,215) to examine the use of Z-codes and demographics and outcomes for patients with and without social needs. Semi-structured interviews were conducted with 23 participants (n = 15 health care providers; n = 7 billing and compliance stakeholders). The interview questions sought to understand how factors at the innovation-, individual-, organizational-, and environmental-level influence SDOH documentation. We used thematic analysis to analyze interview data. PRINCIPAL FINDINGS Patients with social needs were disproportionately older, female, Black, uninsured, living in low-income and high unemployment neighborhoods, and had a higher number of hospitalizations, obesity, prediabetes, and type 2 diabetes than those without a Z-code. Z-codes were not frequently used in the EHR (<1% of patients), and there was an overall lack of congruence between quantitative and qualitative results related to the prevalence of social needs. Providers faced barriers at multiple levels (e.g., individual-level: discomfort discussing social needs; organizational-level: limited time, competing priorities) for documenting SDOH and identified strategies to improve documentation. CONCLUSIONS Providers recognized the impact of SDOH on patient health and had positive perceptions of screening for and documenting social needs. Implementation strategies are needed to improve systematic documentation.
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Affiliation(s)
- Maura M. Kepper
- Prevention Research Center, Brown SchoolWashington University in St. LouisSt. LouisMissouriUSA
- Institute for Public HealthWashington University in St. LouisSt. LouisMissouriUSA
| | - Callie Walsh‐Bailey
- Prevention Research Center, Brown SchoolWashington University in St. LouisSt. LouisMissouriUSA
| | - Beth Prusaczyk
- Institute for Public HealthWashington University in St. LouisSt. LouisMissouriUSA
- Institute for InformaticsWashington University School of MedicineSt. LouisMissouriUSA
| | - Min Zhao
- Institute for InformaticsWashington University School of MedicineSt. LouisMissouriUSA
| | - Cynthia Herrick
- Institute for Public HealthWashington University in St. LouisSt. LouisMissouriUSA
- Division of EndocrinologyWashington University School of MedicineSt. LouisMissouriUSA
| | - Randi Foraker
- Institute for Public HealthWashington University in St. LouisSt. LouisMissouriUSA
- Institute for InformaticsWashington University School of MedicineSt. LouisMissouriUSA
- Division of General Medical Sciences, Department of MedicineWashington University School of MedicineSt. LouisMissouriUSA
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48
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Weiner M, Adeoye P, Boeh MJ, Bodke K, Broughton J, Butler AR, Dafferner ML, Dirlam LA, Ferguson D, Keegan AL, Keith NR, Lee JL, McCorkle CB, Pino DG, Shan M, Srinivas P, Tang Q, Teal E, Tu W, Savoy A, Callahan CM, Clark DO. Continuous Glucose Monitoring and Other Wearable Devices to Assess Hypoglycemia among Older Adult Outpatients with Diabetes Mellitus. Appl Clin Inform 2023; 14:37-44. [PMID: 36351548 PMCID: PMC9848893 DOI: 10.1055/a-1975-4136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Hypoglycemia (HG) causes symptoms that can be fatal, and confers risk of dementia. Wearable devices can improve measurement and feedback to patients and clinicians about HG events and risk. OBJECTIVES The aim of the study is to determine whether vulnerable older adults could use wearables, and explore HG frequency over 2 weeks. METHODS First, 10 participants with diabetes mellitus piloted a continuous glucometer, physical activity monitor, electronic medication bottles, and smartphones facilitating prompts about medications, behaviors, and symptoms. They reviewed graphs of glucose values, and were asked about the monitoring experience. Next, a larger sample (N = 70) wore glucometers and activity monitors, and used the smartphone and bottles, for 2 weeks. Participants provided feedback about the devices. Descriptive statistics summarized demographics, baseline experiences, behaviors, and HG. RESULTS In the initial pilot, 10 patients aged 50 to 85 participated. Problems addressed included failure of the glucometer adhesive. Patients sought understanding of graphs, often requiring some assistance with interpretation. Among 70 patients in subsequent testing, 67% were African-American, 59% were women. Nearly one-fourth (23%) indicated that they never check their blood sugars. Previous HG was reported by 67%. In 2 weeks of monitoring, 73% had HG (glucose ≤70 mg/dL), and 42% had serious, clinically significant HG (glucose under 54 mg/dL). Eight patients with HG also had HG by home-based blood glucometry. Nearly a third of daytime prompts were unanswered. In 24% of participants, continuous glucometers became detached. CONCLUSION Continuous glucometry occurred for 2 weeks in an older vulnerable population, but devices posed wearability challenges. Most patients experienced HG, often serious in magnitude. This suggests important opportunities to improve wearability and decrease HG frequency among this population.
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Affiliation(s)
- Michael Weiner
- Department of Medicine, Indiana University, Indianapolis, Indiana,Center for Health Services Research, Regenstrief Institute, Inc., Indianapolis, Indiana,Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13–416, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana,Address for correspondence Michael Weiner, MD, MPH Regenstrief Institute, Inc.1101 West 10th Street, Indianapolis, IN 46202United States
| | - Philip Adeoye
- Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana
| | | | - Kunal Bodke
- Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana
| | | | - Anietra R. Butler
- Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana
| | | | - Lindsay A. Dirlam
- Lifestyle Health and Wellness, Eskenazi Health, Indianapolis, Indiana
| | - Denisha Ferguson
- Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana
| | - Amanda L. Keegan
- Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana
| | - NiCole R. Keith
- Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana,Department of Kinesiology, Indiana University, Indianapolis, Indiana
| | - Joy L. Lee
- Department of Medicine, Indiana University, Indianapolis, Indiana,Center for Health Services Research, Regenstrief Institute, Inc., Indianapolis, Indiana
| | - Corrina B. McCorkle
- Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana
| | - Daniel G. Pino
- Department of Medicine, Indiana University, Indianapolis, Indiana,Lifestyle Health and Wellness, Eskenazi Health, Indianapolis, Indiana
| | - Mu Shan
- Department of Biostatistics and Health Data Science, Indiana University, Indianapolis, Indiana
| | - Preethi Srinivas
- Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana
| | - Qing Tang
- Department of Biostatistics and Health Data Science, Indiana University, Indianapolis, Indiana
| | - Evgenia Teal
- Data Services, Regenstrief Institute, Inc., Indianapolis, Indiana
| | - Wanzhu Tu
- Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana,Department of Biostatistics and Health Data Science, Indiana University, Indianapolis, Indiana
| | - April Savoy
- Center for Health Services Research, Regenstrief Institute, Inc., Indianapolis, Indiana,Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13–416, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana,Computer and Information Technology, Purdue School of Engineering and Technology, Indiana University-Purdue University Indianapolis, Indiana
| | - Christopher M. Callahan
- Department of Medicine, Indiana University, Indianapolis, Indiana,Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana,Senior Care, Eskenazi Health, Indianapolis, Indiana
| | - Daniel O. Clark
- Department of Medicine, Indiana University, Indianapolis, Indiana,Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana
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Lindenfeld Z, Chen K, Kapur S, Chang JE. Assessing Differences in Social Determinants of Health Screening Rates in a Large, Urban Safety-Net Health System. J Prim Care Community Health 2023; 14:21501319231207713. [PMID: 37916515 PMCID: PMC10624082 DOI: 10.1177/21501319231207713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/26/2023] [Accepted: 09/28/2023] [Indexed: 11/03/2023] Open
Abstract
INTRODUCTION/OBJECTIVE Previous studies have evaluated the implementation of standardized social determinants of health (SDOH) screening within healthcare settings, however, less is known about where screening gaps may exist following initial implementation based on facility characteristics. The objective of this study is to assess differences in screening rates for SDOH at a large, urban healthcare system. METHODS We used electronic health record data obtained from NYC Health + Hospitals primary care sites from 2019 to 2022. We calculated the mean number of visits that were SDOH screened by visit type, facility size, and the percentages of community characteristics. We conducted 4 logistic regression models predicting the odds of screening for any SDOH and for specific SDOH needs (housing, food, and medical cost assistance) based on facility type, facility size, and the socioeconomic characteristics of the surrounding community. RESULTS Among the 3 212 650 visits included, 16.90% were SDOH screened. Across all 4 multivariate logistic regression models predicting SDOH screening, a visit had significantly lower odds of being screened if based at a midsize or small facility, if it was a telemedicine visit, or based at a facility located in a zip-code with a higher percentage of SDOH needs. CONCLUSIONS Our study found important differences in SDOH screening rates at a large, NYC-based health system based on size, visit type, and community level characteristics. In particular, our findings point to barriers related to facility size and telemedicine workflow that should be addressed to increase uptake of SDOH screening within different visits and facility types.
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Affiliation(s)
- Zoe Lindenfeld
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, NY, USA
| | - Kevin Chen
- New York City Health + Hospitals, New York, NY, USA
- New York University Grossman School of Medicine, New York, NY, USA
| | - Supriya Kapur
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, NY, USA
| | - Ji Eun Chang
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, NY, USA
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50
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Cai J, Islam MS. Interventions incorporating a multi-disciplinary team approach and a dedicated care team can help reduce preventable hospital readmissions of people with type 2 diabetes mellitus: A scoping review of current literature. Diabet Med 2023; 40:e14957. [PMID: 36082498 PMCID: PMC10087324 DOI: 10.1111/dme.14957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/31/2022] [Accepted: 09/07/2022] [Indexed: 11/28/2022]
Abstract
AIMS This review aimed to identify interventions that hospitals can implement to reduce preventable hospital readmissions of people with type 2 diabetes mellitus (T2DM). METHODS A scoping review framework was utilised to inform the overall process. The electronic databases Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, the University of New England (UNE) library search engine and Google Scholar were utilised to search for relevant literature. RESULTS The results from this review demonstrate that interventions started at index admission for people diagnosed with T2DM can result in reductions in hospital readmissions. Common strategies which attributed to the success of interventions in reducing hospital readmissions of people with T2DM included a multidisciplinary team approach, a dedicated care team, certified diabetes educator appointments, basic survival skills education and influencing hospital protocol development and implementation. CONCLUSION This scoping review is an attempt at exploring and synthesising current research on interventions that hospitals can implement to reduce preventable hospital readmissions of people with T2DM.
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Affiliation(s)
- James Cai
- Tamworth Rural Referral Hospital, Tamworth, New South Wales, Australia
| | - Md Shahidul Islam
- Faculty of Medicine and Health, School of Health, University of New England, Armidale, New South Wales, Australia
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