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Corinna Morlacchi L, Privitera E, Rossetti V, Santambrogio M, Bellofiore A, Rosso L, Palleschi A, Nosotti M, Blasi F. Telemonitoring: An opportunity in cystic fibrosis lung transplant recipients. Heliyon 2023; 9:e19931. [PMID: 37818011 PMCID: PMC10560782 DOI: 10.1016/j.heliyon.2023.e19931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 07/26/2023] [Accepted: 09/06/2023] [Indexed: 10/12/2023] Open
Abstract
Introduction Telemedicine has been successfully employed in a wide range of conditions, such as such as chronic lung disease and COVID-19. This study evaluate the role of telemonitoring for the early diagnosis of acute lung allograft dysfunction in cystic fibrosis adults who underwent lung transplant (LuTx). Quality of life and functional level achieved during a 12 months follow up were assessed. Methods Patients were randomized into two groups; control group received traditional hospital-based follow-up, whereas patients in the intervention group received, on top of standard care, a telemonitoring device, with a pulse oximeter and a spirometer integrated. Telemonitoring data were digitally transmitted to our centre. Results Sixteen patients were enrolled in each group. No statistically significant difference was found between the two groups in terms of incidence of allograft dysfunction, time from onset of symptoms to diagnosis and time of occurrence from LuTx. Moreover, both groups achieved similar quality of life and functional level. With reference to the telemonitoring group: 1) hospital reported data were consistent with those being remotely registered; 2) adherence to telemonitoring decreased during the follow up; 3) the majority of patients reported a high degree of satisfaction. Conclusion The COVID19 pandemic highlighted the necessity to investigate alternative practices to treat chronically ill individuals. Telemonitoring is a valuable tool to improve quality care to LuTx recipients.
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Affiliation(s)
- Letizia Corinna Morlacchi
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis, Milan, Italy
| | - Emilia Privitera
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Healthcare Professions Department, Milan, Italy
| | - Valeria Rossetti
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis, Milan, Italy
| | - Martina Santambrogio
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis, Milan, Italy
| | - Angela Bellofiore
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis, Milan, Italy
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Healthcare Professions Department, Milan, Italy
| | - Lorenzo Rosso
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Thoracic Surgery and Lung Transplant Unit, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Italy
| | - Alessandro Palleschi
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Thoracic Surgery and Lung Transplant Unit, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Italy
| | - Mario Nosotti
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Thoracic Surgery and Lung Transplant Unit, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Italy
| | - Francesco Blasi
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Italy
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2
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Velvin G, Dammann B, Haagensen T, Johansen H, Strømme H, Geirdal AØ, Bathen T. Work participation in adults with rare genetic diseases - a scoping review. BMC Public Health 2023; 23:910. [PMID: 37208707 DOI: 10.1186/s12889-023-15654-3] [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: 11/09/2022] [Accepted: 04/11/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Work participation is a crucial aspect of health outcome and an important part of life for most people with rare genetic diseases. Despite that work participation is a social determinant of health and seems necessary for understanding health behaviours and quality of life, it is an under-researched and under-recognized aspect in many rare diseases. The objectives of this study was to map and describe existing research on work participation, identify research gaps, and point to research agendas in a selection of rare genetic diseases. METHODS A scoping review was performed by searching relevant literature in bibliographic databases and other sources. Studies addressing work participation in people with rare genetic diseases published in peer reviewed journals were assessed using EndNote and Rayyan. Data were mapped and extracted based on the research questions concerning the characteristics of the research. RESULTS Of 19,867 search results, 571 articles were read in full text, and 141 satisfied the eligibility criteria covering 33 different rare genetic diseases; 7 were reviews and 134 primary research articles. In 21% of the articles the primary aim was to investigate work participation. The extent of studies varied between the different diseases. Two diseases had more than 20 articles, but most had only one or two articles. Cross-sectional quantitative studies were predominant, with few utilizing prospective or qualitative design. Nearly all articles (96%) reported information about work participation rate, and 45% also included information about factors associated with work participation and work disability. Due to differences in methodologies, cultures and respondents, comparison between and within diseases are difficult. Nevertheless, studies indicated that many people with different rare genetic diseases experience challenges related to work, closely associated to the symptoms of the disease. CONCLUSION While studies indicate high prevalence of work disability in many patients with rare diseases, the research is scarce and fragmented. More research is warranted. Information about the unique challenges of living with different rare diseases is crucial for health and welfare systems to better facilitate work participation. In addition, the changing nature of work in the digital age, may also open up new possibilities for people with rare genetic diseases and should be explored.
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Affiliation(s)
- Gry Velvin
- TRS National Resource Centre for Rare Disorders, Sunnaas Rehabilitation Hospital, Nesoddtangen, Oslo, 1450, Norway.
| | - Brede Dammann
- TRS National Resource Centre for Rare Disorders, Sunnaas Rehabilitation Hospital, Nesoddtangen, Oslo, 1450, Norway
| | - Trond Haagensen
- TRS National Resource Centre for Rare Disorders, Sunnaas Rehabilitation Hospital, Nesoddtangen, Oslo, 1450, Norway
| | - Heidi Johansen
- TRS National Resource Centre for Rare Disorders, Sunnaas Rehabilitation Hospital, Nesoddtangen, Oslo, 1450, Norway
| | - Hilde Strømme
- Library of Medicine and Science, University of Oslo, Oslo, Norway
| | - Amy Østertun Geirdal
- Department of Social Work, Child Welfare and Social Policy, Faculty of Social Science, Oslo Metropolitan University, Oslo, Norway
| | - Trine Bathen
- TRS National Resource Centre for Rare Disorders, Sunnaas Rehabilitation Hospital, Nesoddtangen, Oslo, 1450, Norway
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3
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Jobst S, Schaefer J, Kleiser C, Kugler C. A Systematized Review of Professional Employment Following Thoracic Transplantation. Prog Transplant 2022; 32:55-66. [PMID: 35006009 DOI: 10.1177/15269248211064883] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Acknowledging the evolved landscape in thoracic transplantation, professional employment becomes an important outcome measure to quantify the success of this costly procedure. OBJECTIVE We aimed to assess rates of and characterize factors associated with professional employment in patients following thoracic transplantation, and create an evidence-base on the relationship between professional employment and relevant outcome parameters. METHODS We systematically searched Medline, Cinahl, and GoogleScholar to identify studies published between 1998 and 2021 reporting on professional employment following heart and lung transplantation. RESULTS Twenty-two studies from 11 countries with varying sample sizes (N = 27; 10 066) were included. Employment rates ranged from 19.7% to 69.4% for heart, and from 7.4% to 50.8% for lung transplant recipients. Most frequently reported positively associated factors with employment after transplant were younger age, higher education, and history of pretransplant employment. Longer duration of unemployment prior to transplantation and Medicaid coverage were the most frequently reported negatively associated factors. Relationships between professional employment and clinical outcomes included lower rates of acute and chronic rejection, less infection episodes, and better quality of life among working patients; one study reported a lower 5-year-mortality rate. Reasons not to work were "physical or mental health-related," "employment-related," "financial reasons," and "lifestyle choices." DISCUSSION Substantial proportions of patients following thoracic transplantation are not professionally employed, potentially diminishing the success of transplantation on individual and societal levels. Considering adverse clinical outcomes in employed transplant recipients were low, more efforts are needed to identify modifiable factors for employment in these populations.
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Affiliation(s)
- Stefan Jobst
- Institute of Nursing Science, University of Freiburg, Freiburg, Germany
| | - Jonas Schaefer
- Institute of Nursing Science, University of Freiburg, Freiburg, Germany
| | - Christina Kleiser
- Institute of Nursing Science, University of Freiburg, Freiburg, Germany
| | - Christiane Kugler
- Institute of Nursing Science, University of Freiburg, Freiburg, Germany
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4
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Leso V, Romano R, Santocono C, Caruso M, Iacotucci P, Carnovale V, Iavicoli I. The impact of cystic fibrosis on the working life of patients: A systematic review. J Cyst Fibros 2021; 21:361-369. [PMID: 34470710 DOI: 10.1016/j.jcf.2021.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/30/2021] [Accepted: 08/15/2021] [Indexed: 10/20/2022]
Abstract
Advances in the treatment and management of cystic fibrosis (CF) have led to a substantial increase in patient life expectancy, thus facilitating healthier lives and labour force participation. This review aimed to address the impact of CF on the occupational functioning of patients. A significant proportion of patients were reported to retain a job on a full- or part-time schedule. Less physically demanding occupations were most frequently performed, perhaps due to CF-related inability to sustain a heavy workload. Disease severity parameters (e.g., lung function measurements, or personal, psycho-social, or economic conditions) have been reported as determinant or co-determinant factors for the development of work-related disability. Although further research is necessary, our results may be useful to inform interdisciplinary CF healthcare management, including the assessment of work function, and to define career counselling plans and workplace risk assessment and management strategies to support the personal, social and professional lives of patients.
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Affiliation(s)
- Veruscka Leso
- Section of Occupational Medicine, Department of Public Health, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy
| | - Rosaria Romano
- Section of Occupational Medicine, Department of Public Health, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy
| | - Carolina Santocono
- Section of Occupational Medicine, Department of Public Health, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy
| | - Marilisa Caruso
- Section of Occupational Medicine, Department of Public Health, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy
| | - Paola Iacotucci
- Adult Cystic Fibrosis Center, Department of Translational Medical Sciences, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy
| | - Vincenzo Carnovale
- Adult Cystic Fibrosis Center, Department of Translational Medical Sciences, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy
| | - Ivo Iavicoli
- Section of Occupational Medicine, Department of Public Health, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy.
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5
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Zupanič MV, Škerjanc A. Cystic fibrosis and career counselling. Cent Eur J Public Health 2020; 27:279-284. [PMID: 31951686 DOI: 10.21101/cejph.a5634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 07/22/2019] [Accepted: 07/22/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Cystic fibrosis is a genetic disorder that affects mostly lungs but also other organs. Modern treatment has transformed once fatal disease of childhood into the chronic disease of adulthood. Hence more patients enter the job market. Very few adolescents with cystic fibrosis receive some formal career guidance. There is still no professional career guidance for them in Slovenia. METHODS Literature on workability of patients with cystic fibrosis was reviewed. Following the articles and Slovenian and foreign manuals the guidelines on career counselling of young patients with cystic fibrosis is proposed, as well as the suggestions for professional qualification of these patients. RESULTS The results of the studies present that workability of patients with cystic fibrosis is associated to forced expiratory volume in 1 second (FEV1) (p < 0.05), the achieved educational level more than 3 years of faculty study (p < 0.001-p < 0.013), self-assessment of quality of life (p = 0.005), age (p = 0.01), and the number of admissions to the hospital (p = 0.001). CONCLUSIONS The interactions among work, quality of life and survival require that healthcare workers strive to help their patients with cystic fibrosis to succeed in their professional lives. The young patients should achieve the highest level of education possible and follow their wishes in line with the realistic possibilities.
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Affiliation(s)
- Marija Vita Zupanič
- University Medical Centre Maribor, Department of Ophthalmology, Maribor, Slovenia
| | - Alenka Škerjanc
- University Medical Centre Ljubljana, Clinical Institute for Occupational, Traffic and Sports Medicine, Ljubljana, Slovenia
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Schuurmans MM, Hage R. [Work Reintegration after Lung Transplantation: A Complex and Multifaceted Topic]. PRAXIS 2020; 109:1013-1015. [PMID: 33050814 DOI: 10.1024/1661-8157/a003577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Macé M Schuurmans
- Universitätsspital Zürich, Klinik für Pneumologie, Zürich
- Universität Zürich, Medizinische Fakultät, Zürich
| | - René Hage
- Universitätsspital Zürich, Klinik für Pneumologie, Zürich
- Universität Zürich, Medizinische Fakultät, Zürich
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7
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Schuurmans MM, Hage R. [Arbeitsintegration nach Lungentransplantation: ein komplexes, vielschichtiges Thema]. PRAXIS 2020; 109:1-3. [PMID: 33050818 DOI: 10.1024/1661-8157/a003578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Macé M Schuurmans
- University Hospital Zurich, Division of Pulmonology, Zurich, Switzerland
- University of Zurich, Medical Faculty, Zurich, Switzerland
| | - René Hage
- University Hospital Zurich, Division of Pulmonology, Zurich, Switzerland
- University of Zurich, Medical Faculty, Zurich, Switzerland
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8
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Golembiewski E, Allen KS, Blackmon AM, Hinrichs RJ, Vest JR. Combining Nonclinical Determinants of Health and Clinical Data for Research and Evaluation: Rapid Review. JMIR Public Health Surveill 2019; 5:e12846. [PMID: 31593550 PMCID: PMC6803891 DOI: 10.2196/12846] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 05/23/2019] [Accepted: 07/19/2019] [Indexed: 02/06/2023] Open
Abstract
Background Nonclinical determinants of health are of increasing importance to health care delivery and health policy. Concurrent with growing interest in better addressing patients’ nonmedical issues is the exponential growth in availability of data sources that provide insight into these nonclinical determinants of health. Objective This review aimed to characterize the state of the existing literature on the use of nonclinical health indicators in conjunction with clinical data sources. Methods We conducted a rapid review of articles and relevant agency publications published in English. Eligible studies described the effect of, the methods for, or the need for combining nonclinical data with clinical data and were published in the United States between January 2010 and April 2018. Additional reports were obtained by manual searching. Records were screened for inclusion in 2 rounds by 4 trained reviewers with interrater reliability checks. From each article, we abstracted the measures, data sources, and level of measurement (individual or aggregate) for each nonclinical determinant of health reported. Results A total of 178 articles were included in the review. The articles collectively reported on 744 different nonclinical determinants of health measures. Measures related to socioeconomic status and material conditions were most prevalent (included in 90% of articles), followed by the closely related domain of social circumstances (included in 25% of articles), reflecting the widespread availability and use of standard demographic measures such as household income, marital status, education, race, and ethnicity in public health surveillance. Measures related to health-related behaviors (eg, smoking, diet, tobacco, and substance abuse), the built environment (eg, transportation, sidewalks, and buildings), natural environment (eg, air quality and pollution), and health services and conditions (eg, provider of care supply, utilization, and disease prevalence) were less common, whereas measures related to public policies were rare. When combining nonclinical and clinical data, a majority of studies associated aggregate, area-level nonclinical measures with individual-level clinical data by matching geographical location. Conclusions A variety of nonclinical determinants of health measures have been widely but unevenly used in conjunction with clinical data to support population health research.
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Affiliation(s)
| | - Katie S Allen
- IUPUI Richard M Fairbanks School of Public Health, Indianapolis, IN, United States.,Regenstrief Institute, Inc, Indianapolis, IN, United States
| | - Amber M Blackmon
- IUPUI Richard M Fairbanks School of Public Health, Indianapolis, IN, United States
| | | | - Joshua R Vest
- IUPUI Richard M Fairbanks School of Public Health, Indianapolis, IN, United States.,Regenstrief Institute, Inc, Indianapolis, IN, United States
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Chou H, Groh J, Nicholson K, Krivchenia K, Hayes D, Tobias JD, Tumin D. Education and Employment After Lung Transplantation in Adolescents and Young Adults. Prog Transplant 2018; 29:73-77. [PMID: 30585118 DOI: 10.1177/1526924818817023] [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: 11/15/2022]
Abstract
Pediatric transplant recipients experience barriers to social functioning, including participation in school and work, but our understanding of barriers to these activities is limited by insufficient data collection and standardization. Existing studies rely on cross-sectional surveys of transplant survivors that are subject to survivorship and nonresponse bias, or analyses of large registry data that lack detail on educational progress and work participation. We report our experience using the electronic medical record to retrospectively review work and educational attainment in this population, and identify specific barriers that were encountered and how they were addressed by the patient and care team. We reviewed current literature on post-transplant survey participation and compared questionnaires to our current documentation practice for tracking education and employment progress in the transplant recipient population. Based on this review, we discuss the possibility, barriers, and implications of conducting a standardized assessment to track social participation outcomes of transplantation.
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Affiliation(s)
- Helen Chou
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.,Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, OH, USA.,Center for Epidemiology of Organ Failure and Transplantation, Nationwide Children's Hospital, Columbus, OH, USA.,Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Jaclyn Groh
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.,Center for Epidemiology of Organ Failure and Transplantation, Nationwide Children's Hospital, Columbus, OH, USA.,Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Kerri Nicholson
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.,Center for Epidemiology of Organ Failure and Transplantation, Nationwide Children's Hospital, Columbus, OH, USA.,Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Katelyn Krivchenia
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.,Center for Epidemiology of Organ Failure and Transplantation, Nationwide Children's Hospital, Columbus, OH, USA.,Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Don Hayes
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.,Center for Epidemiology of Organ Failure and Transplantation, Nationwide Children's Hospital, Columbus, OH, USA.,Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA.,Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Joseph D Tobias
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.,Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, OH, USA.,Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Dmitry Tumin
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.,Center for Epidemiology of Organ Failure and Transplantation, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
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10
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Li SS, Tumin D, Krone KA, Boyer D, Kirkby SE, Mansour HM, Hayes D. Risks associated with lung transplantation in cystic fibrosis patients. Expert Rev Respir Med 2018; 12:893-904. [PMID: 30198350 DOI: 10.1080/17476348.2018.1522254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Survival after lung transplantation lags behind outcomes of other solid organ transplants, and complications from lung transplant are the second most common cause of death in cystic fibrosis. Evolving surgical techniques, therapeutics, and perioperative management have improved short-term survival after lung transplantation, yet have not translated into significant improvement in long-term mortality. Areas covered: We review risk factors for poor long-term outcomes among patients with cystic fibrosis undergoing lung transplantation to highlight areas for improvement. This includes reasons for organ dysfunction, complications of immunosuppression, further exacerbation of extrapulmonary complications of cystic fibrosis, and quality of life. A literature search was performed using PubMed-indexed journals. Expert commentary: There are multiple medical and socioeconomic barriers that threaten long-term survival following lung transplant for patients with cystic fibrosis. An understanding of the causes of each could elucidate treatment options. There is a lack of prospective, multicenter, randomized control trials due to cost, complexity, and feasibility. Ongoing prospective studies should be reserved for the most promising interventions identified in retrospective studies in order to improve long-term outcomes.
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Affiliation(s)
- Susan S Li
- a Department of Pediatrics, Nationwide Children's Hospital , The Ohio State University College of Medicine , Columbus , OH , USA
| | - Dmitry Tumin
- a Department of Pediatrics, Nationwide Children's Hospital , The Ohio State University College of Medicine , Columbus , OH , USA
| | - Katie A Krone
- b Division of Respiratory Diseases, Boston Children's Hospital , Harvard Medical School , Boston , MA, OH , USA
| | - Debra Boyer
- b Division of Respiratory Diseases, Boston Children's Hospital , Harvard Medical School , Boston , MA, OH , USA
| | - Stephen E Kirkby
- a Department of Pediatrics, Nationwide Children's Hospital , The Ohio State University College of Medicine , Columbus , OH , USA
| | - Heidi M Mansour
- c Department of Pharmacology and Toxicology , The University of Arizona Colleges of Pharmacy and Medicine , Tucson , AZ , USA
| | - Don Hayes
- a Department of Pediatrics, Nationwide Children's Hospital , The Ohio State University College of Medicine , Columbus , OH , USA
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11
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Frech A, Natale G, Hayes D, Tumin D. Marital Status and Return to Work After Living Kidney Donation. Prog Transplant 2018; 28:226-230. [PMID: 29879858 DOI: 10.1177/1526924818781560] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE Living kidney donation is safe and effective, but patients in need of a transplant continue to outnumber donors. Disincentives to living donation include lost income, risk of job loss, perioperative complications, and unreimbursed medical expenses. METHODS This study uses US registry and follow-up data on living kidney donors from 2013 to 2015 to identify social predictors of return to work across gender following living kidney donation. RESULTS Using logistic regression, we find that predictors of return to work following living kidney donation differ for women and men. Among women, age, education, smoking status, and procedure type are associated with return to work. Among men, education, procedure type, and hospital readmission within 6 weeks postdonation are associated with return to work. Notably, single and divorced men are less likely to return to work compared to married men (odds ratio [OR] for single men 0.51, 95% confidence interval [CI], 0.37-0.69, P < .001; OR for divorced men 0.51, 95% CI, 0.34-0.75, P = .006). Marital status is not associated with return to work for women. Single and divorced men's greater odds of not returning to work are robust to controls for relevant pre- and postdonation characteristics. CONCLUSIONS Single and divorced men's lack of social support may present an obstacle to work resumption following living kidney donation.
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Affiliation(s)
- Adrianne Frech
- 1 Department of Health Sciences, University of Missouri, Kent State University, Ginny Natale, MA, USA
| | | | - Don Hayes
- 3 Nationwide Children's Hospital, Columbus, OH USA
| | - Dmitry Tumin
- 4 Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
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12
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Tumin D, Li SS, Nandi D, Gajarski RJ, McKee C, Tobias JD, Hayes D. Health Insurance Coverage among Young Adult Survivors of Pediatric Heart Transplantation. J Pediatr 2017; 188:82-86. [PMID: 28690004 DOI: 10.1016/j.jpeds.2017.06.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 05/04/2017] [Accepted: 06/06/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To describe the change in health insurance after heart transplantation among adolescents, and characterize the implications of this change for long-term transplant outcomes. STUDY DESIGN Patients age 15-18 years receiving first-time heart transplantation between 1999 and 2011 were identified in the United Network for Organ Sharing registry and included in the analysis if they survived at least 5 years. The primary exposure was change or continuity of health insurance coverage between the time of transplant and the 5-year follow-up. Cox proportional hazards models were used to determine the association between insurance status change and long-term (>5 years) patient and graft survival. RESULTS The analysis included 366 patients (age 16 ± 1 years at transplant), of whom 205 (56%) had continuous private insurance; 96 (26%) had continuous public insurance; and 65 (18%) had a change in insurance status. In stepwise multivariable Cox regression, change in insurance status was associated with greater mortality hazard, compared with continuous private insurance (hazard ratio = 1.9; 95% CI: 1.1, 3.2; P = .016), whereas long-term patient and graft survival did not differ between patients with continuous public and continuous private insurance. CONCLUSIONS Continuity of insurance coverage is associated with improved long-term clinical outcomes among adolescent heart transplant recipients who survive into adulthood.
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Affiliation(s)
- Dmitry Tumin
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH; Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH.
| | - Susan S Li
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH; Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH
| | - Deipanjan Nandi
- Division of Cardiology, Nationwide Children's Hospital, Columbus, OH
| | - Robert J Gajarski
- Division of Cardiology, Nationwide Children's Hospital, Columbus, OH
| | - Christopher McKee
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH; Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH
| | - Joseph D Tobias
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH; Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH; Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, OH
| | - Don Hayes
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH; Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH
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13
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Tumin D, Chou H, Hayes D, Tobias JD, Galantowicz M, McConnell PI. Employment after heart transplantation among adults with congenital heart disease. CONGENIT HEART DIS 2017; 12:794-799. [PMID: 28703426 DOI: 10.1111/chd.12513] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 06/16/2017] [Accepted: 06/26/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Adults with congenital heart disease may require heart transplantation for end-stage heart failure. Whereas heart transplantation potentially allows adults with congenital heart disease to resume their usual activities, employment outcomes in this population are unknown. Therefore, we investigated the prevalence and predictors of work participation after heart transplantation for congenital heart disease. DESIGN Retrospective review of a prospective registry. SETTING United Network for Organ Sharing registry of transplant recipients in the United States. PATIENTS Adult recipients of first-time heart transplantation with a primary diagnosis of congenital heart disease, performed between 2004 and 2015. INTERVENTIONS None. OUTCOME MEASURES Employment status reported by transplant centers at required follow-up intervals up to 5 y posttransplant. RESULTS Among 470 patients included in the analysis (mean follow-up: 5 ± 3 y), 127 (27%) worked after transplant, 69 (15%) died before beginning or returning to work, and 274 (58%) survived until censoring, but did not participate in paid work. Multivariable competing-risks regression analysis examined characteristics associated with posttransplant employment, accounting for mortality as a competing outcome. In descriptive and multivariable analysis, pretransplant work participation was associated with a greater likelihood of posttransplant employment, while the use of Medicaid insurance at the time of transplant was associated with a significantly lower likelihood of working after transplant (subhazard ratio compared to private insurance: 0.55; 95% confidence interval: 0.32, 0.95; P = .032). CONCLUSIONS Employment was rare after heart transplantation for congenital heart disease, and was significantly less common than in the broader population of adults with congenital heart disease. Differences in return to work were primarily related to pretransplant employment and the use of public insurance, rather than clinical characteristics.
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Affiliation(s)
- Dmitry Tumin
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA.,Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Helen Chou
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Don Hayes
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA.,Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA.,Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Joseph D Tobias
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA.,Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Mark Galantowicz
- Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio, USA.,Department of Cardiothoracic Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Patrick I McConnell
- Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio, USA.,Department of Cardiothoracic Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
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14
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Beal EW, Tumin D, Mumtaz K, Nau M, Tobias JD, Hayes D, Washburn K, Black SM. Factors contributing to employment patterns after liver transplantation. Clin Transplant 2017; 31. [PMID: 28314069 DOI: 10.1111/ctr.12967] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Many liver transplant recipients return to work, but their patterns of employment are unclear. We examine patterns of employment 5 years after liver transplantation. METHODS First-time liver transplant recipients ages 18-60 years transplanted from 2002 to 2009 and surviving at least 5 years were identified in the United Network for Organ Sharing registry. Recipients' post-transplant employment status was classified as follows: (i) never employed; (ii) returned to work within 2 years and remained employed (continuous employment); (iii) returned to work within 2 years, but was subsequently unemployed (intermittent employment); or (iv) returned to work ≥3 years post-transplant (delayed employment). RESULTS Of 28 306 liver recipients identified during the study period, 12 998 survived at least 5 years and contributed at least 1 follow-up of employment status. A minority of patients (4654; 36%) were never employed, while 3780 (29%) were continuously employed, 3027 (23%) were intermittently employed, and 1537 (12%) had delayed employment. In multivariable logistic regression analysis, predictors of intermittent and delayed employment included lower socioeconomic status, higher local unemployment rates, and post-transplant comorbidities or complications. CONCLUSION Never, intermittent, and delayed employment are common after liver transplantation. Socioeconomic and labor market characteristics may add to clinical factors that limit liver transplant recipients' continuous employment.
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Affiliation(s)
- Eliza W Beal
- The Department of General Surgery, Division of Transplantation, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Dmitry Tumin
- The Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Khalid Mumtaz
- The Department of Internal Medicine, Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Michael Nau
- The Ohio Colleges of Medicine Government Resource Center, Columbus, OH, USA
| | - Joseph D Tobias
- The Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Don Hayes
- The Department of Internal Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Kenneth Washburn
- The Department of General Surgery, Division of Transplantation, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Sylvester M Black
- The Department of General Surgery, Division of Transplantation, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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15
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Tumin D, Li SS, Kopp BT, Kirkby SE, Tobias JD, Morgan WJ, Hayes D. The effect of the affordable care act dependent coverage provision on patients with cystic fibrosis. Pediatr Pulmonol 2017; 52:458-466. [PMID: 28152283 DOI: 10.1002/ppul.23648] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 10/31/2016] [Accepted: 11/17/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND The Patient Protection and Affordable Care Act (ACA), enacted in 2010, expanded private insurance coverage of young adults through the dependent coverage provision. This policy's implications for patients with cystic fibrosis (CF) are unknown. METHODS The CF Foundation Patient Registry was used to identify patients seen at CF centers, 3 years before and after ACA implementation. Patients were grouped according to eligibility for the dependent care provision (18-25 years old in 2010) or ineligibility (26-35 years old). Year-level difference-in-difference logistic regressions evaluated the association between ACA enactment and insurance status (private, public, or no insurance). Routine annual care consistent with CF Foundation guidelines (≥4 clinic visits, ≥4 respiratory cultures, and ≥2 pulmonary function tests/year) was a secondary outcome. RESULTS The analysis included 4,024 and 3,132 patients in the eligible and ineligible groups, respectively (35,353 patient-years). In the eligible group, 62% had private insurance before and after ACA; 18% had public insurance before and after ACA; and 5% switched from public to private insurance. In the eligible group, lack of insurance coverage became more common in the post-ACA period (relative risk ratio vs. private insurance [RRR] = 1.95; 95%CI: 1.57, 2.43; P < 0.001). Public insurance coverage also became more common (RRR = 1.50; 95%CI: 1.39, 1.62; P < 0.001). Use of routine care increased post-ACA, but more strongly in the ineligible group than in the eligible group. CONCLUSIONS The ACA dependent coverage provision did not increase private insurance coverage or use of routine care among CF patients who were potentially affected by this policy. Pediatr Pulmonol. 2017;52:458-466. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Dmitry Tumin
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio.,Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Susan S Li
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio.,Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio
| | - Benjamin T Kopp
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio.,Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Stephen E Kirkby
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio.,Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio.,Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Joseph D Tobias
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio.,Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, Ohio
| | - Wayne J Morgan
- Department of Pediatrics, University of Arizona, Tucson, Arizona
| | - Don Hayes
- Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio.,Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio
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