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Rosman L, Lampert R, Zhuo S, Li Q, Varma N, Burg M, Gaffey AE, Armbruster T, Gehi A. Wearable Devices, Health Care Use, and Psychological Well-Being in Patients With Atrial Fibrillation. J Am Heart Assoc 2024:e033750. [PMID: 39011944 DOI: 10.1161/jaha.123.033750] [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: 11/29/2023] [Accepted: 04/05/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND Wearables are increasingly used by patients with atrial fibrillation (AF) for symptom monitoring and health management, but their impact on patient health care use and psychological well-being is not well understood. METHODS AND RESULTS In this retrospective, propensity-matched study of patients with AF, survey and electronic health record data were merged to compare AF-specific health care use (outpatient/inpatient visits, rhythm-related testing, and procedures) and informal health care use (telephone calls and patient portal messages) over a 9-month period between wearable users and nonusers. We also examined the effects of wearable cardiac monitoring features (eg, heart rate alerts, irregular rhythm notification, and ECG) on patient behavior and well-being. Of 172 patients with AF in this analysis (age, 72.6±9.0 years; 42% women), 83 used a wearable. Compared with nonusers, wearable users reported higher rates of symptom monitoring and preoccupation (P=0.03) and more AF treatment concerns (P=0.02). Moreover, 20% of wearable users experienced anxiety and always contacted their doctors in response to irregular rhythm notifications. After matching, AF-specific health care use was significantly greater among wearable users compared with nonusers (P=0.04), including significantly higher rates of ECGs, echocardiograms/transesophageal echocardiogram, and ablation. Wearable users were also significantly more likely to use informal health care resources compared with nonusers (P=0.05). CONCLUSIONS Wearables were associated with higher rates of symptom monitoring and preoccupation, AF treatment concerns, AF-specific health care use, and use of informal health care resources. Prospective, randomized studies are needed to understand the net effects of wearables and their alerts on patients, providers, and the health care system.
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Affiliation(s)
- Lindsey Rosman
- Department of Medicine, Division of Cardiology University of North Carolina at Chapel Hill Chapel Hill NC USA
| | - Rachel Lampert
- Department of Internal Medicine (Section of Cardiovascular Medicine) Yale University School of Medicine New Haven CT USA
| | - Songcheng Zhuo
- Department of Biostatistics University of North Carolina at Chapel Hill Chapel Hill NC USA
| | - Quefeng Li
- Department of Biostatistics University of North Carolina at Chapel Hill Chapel Hill NC USA
| | - Niraj Varma
- Heart and Vascular Institute, Cleveland Clinic Cleveland OH USA
| | - Matthew Burg
- Department of Internal Medicine (Section of Cardiovascular Medicine) Yale University School of Medicine New Haven CT USA
- VA Connecticut Healthcare System West Haven CT USA
| | - Allison E Gaffey
- Department of Internal Medicine (Section of Cardiovascular Medicine) Yale University School of Medicine New Haven CT USA
- VA Connecticut Healthcare System West Haven CT USA
| | - Tiffany Armbruster
- Department of Medicine, Division of Cardiology University of North Carolina at Chapel Hill Chapel Hill NC USA
| | - Anil Gehi
- Department of Medicine, Division of Cardiology University of North Carolina at Chapel Hill Chapel Hill NC USA
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2
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Gustavson AM, Horstman MJ, Cogswell JA, Holland DE, Vanderboom CE, Mandrekar J, Harmsen WS, Kaufman BG, Ingram C, Griffin JM. Caregiver recruitment strategies for interventions designed to optimize transitions from hospital to home: lessons from a randomized trial. Trials 2024; 25:454. [PMID: 38965624 PMCID: PMC11223294 DOI: 10.1186/s13063-024-08288-2] [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: 03/06/2024] [Accepted: 06/24/2024] [Indexed: 07/06/2024] Open
Abstract
Challenges to recruitment of family caregivers exist and are amplified when consent must occur in the context of chaotic healthcare circumstances, such as the transition from hospital to home. The onset of the COVID-19 pandemic during our randomized controlled trial provided an opportunity for a natural experiment exploring and examining different consent processes for caregiver recruitment. The purpose of this publication is to describe different recruitment processes (in-person versus virtual) and compare diversity in recruitment rates in the context of a care recipient's hospitalization. We found rates of family caregiver recruitment for in-person versus virtual were 28% and 23%, respectively (p = 0.01). Differences existed across groups with family caregivers recruited virtually being more likely to be younger, white, have greater than high school education, and not be a spouse or significant other to the care recipient, such as a child. Future work is still needed to identify the modality and timing of family caregiver recruitment to maximize rates and enhance the representativeness of the population for equitable impact.
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Affiliation(s)
- Allison M Gustavson
- Veterans Affairs Health Services Research and Development Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, 55417, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Molly J Horstman
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, 77030, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Jodie A Cogswell
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Research, Rochester, MN, 55905, USA
| | - Diane E Holland
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Research, Rochester, MN, 55905, USA
| | - Catherine E Vanderboom
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Research, Rochester, MN, 55905, USA
| | - Jay Mandrekar
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, 55905, USA
| | - William S Harmsen
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, 55905, USA
| | - Brystana G Kaufman
- Department of Population Health Sciences, Duke University, Durham, NC, USA
- Duke-Margolis Institute for Health Policy, Duke University, Durham, NC, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, USA
| | - Cory Ingram
- Department of Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, Rochester, MN, 55905, USA
| | - Joan M Griffin
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Research, Rochester, MN, 55905, USA.
- Division of Health Care Delivery Research (HCDR), Mayo Clinic, Rochester, MN, 55905, USA.
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Foucher J, Azizi L, Öijerstedt L, Kläppe U, Ingre C. The usage of population and disease registries as pre-screening tools for clinical trials, a systematic review. Syst Rev 2024; 13:111. [PMID: 38654383 PMCID: PMC11040983 DOI: 10.1186/s13643-024-02533-0] [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: 01/29/2024] [Accepted: 04/12/2024] [Indexed: 04/25/2024] Open
Abstract
OBJECTIVE This systematic review aims to outline the use of population and disease registries for clinical trial pre-screening. MATERIALS AND METHODS The search was conducted in the time period of January 2014 to December 2022 in three databases: MEDLINE, Embase, and Web of Science Core Collection. References were screened using the Rayyan software, firstly based on titles and abstracts only, and secondly through full text review. Quality of the included studies was assessed using the List of Included Studies and quality Assurance in Review tool, enabling inclusion of publications of only moderate to high quality. RESULTS The search originally identified 1430 citations, but only 24 studies were included, reporting the use of population and/or disease registries for trial pre-screening. Nine disease domains were represented, with 54% of studies using registries based in the USA, and 62.5% of the studies using national registries. Half of the studies reported usage for drug trials, and over 478,679 patients were identified through registries in this review. Main advantages of the pre-screening methodology were reduced financial burden and time reduction. DISCUSSION AND CONCLUSION The use of registries for trial pre-screening increases reproducibility of the pre-screening process across trials and sites, allowing for implementation and improvement of a quality assurance process. Pre-screening strategies seem under-reported, and we encourage more trials to use and describe their pre-screening processes, as there is a need for standardized methodological guidelines.
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Affiliation(s)
- Juliette Foucher
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.
| | - Louisa Azizi
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Linn Öijerstedt
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Ulf Kläppe
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Caroline Ingre
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
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Goldstein KM, Kung LCY, Dailey SA, Kroll-Desrosiers A, Burke C, Shepherd-Banigan M, Lumsden R, Sims C, Schexnayder J, Patel D, Cantrell S, Sheahan KL, Gierisch JM. Strategies for enhancing the representation of women in clinical trials: an evidence map. Syst Rev 2024; 13:2. [PMID: 38166994 PMCID: PMC10759390 DOI: 10.1186/s13643-023-02408-w] [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: 04/21/2023] [Accepted: 12/03/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Equitable sex- and gender-based representation in clinical trials is an essential step to ensuring evidence-based care for women. While multi-institutional actions have led to significant improvements in the inclusion of women in trials, inequity persists in areas like sex-neutral cancers and cardiovascular disease. We sought to identify strategies described or evaluated to boost the inclusion of women in clinical trials. METHODS We used evidence mapping methodology to examine the breadth of relevant literature. We developed an a priori protocol and followed reporting guidance from the Preferred Reporting Items for Systematic Reviews and Meta-Analysis where applicable. We searched MEDLINE® (via PubMed) and EMBASE (via Elsevier) databases from inception through April 4, 2023, and used standardized procedures incorporating duplication and data verification. We included articles that described strategies to improve the recruitment and retention of women in clinical trials. RESULTS We identified 122 articles describing recruitment and retention strategies for 136 trials (377,595 women). Only one article distinguished between the sex and gender identity of participants, and none defined their use of the terms such as "women" or "female". The majority of articles (95%) described recruitment for only women, and 64% were conducted in the USA. Ninety-two articles (75%) described strategies in the context of sex-specific conditions (e.g., gynecologic diagnosis). The majority of included articles evaluated a behavioral intervention (52%), with 23% evaluating pharmacologic interventions and 4% invasive interventions. The most common trial phase for reported strategies was during outreach to potential participants (116 articles), followed by intervention delivery (76), enrollment (40), outcomes assessment (21), analysis and interpretation (3), and dissemination (4). We describe specific types of strategies within each of these phases. CONCLUSIONS Most of the existing literature describing strategies to improve the inclusion of women draws from trials for sex-specific conditions and is largely related to outreach to potential participants. There is little information about how and if studies have attempted to proportionally increase the inclusion of women in trials with both men and women or those focused on invasive and pharmacologic interventions. Future work in this area should focus on how to increase the participation of women in mixed-sex studies and on those areas with remaining inequities in trial participation.
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Affiliation(s)
- Karen M Goldstein
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC, 27705, USA.
- Division of General Internal Medicine, Duke University School of Medicine, 40 Duke Medicine Circle, Durham, NC, 27710, USA.
| | - Lindsay Chi Yan Kung
- Health Management & Policy, Graduate School of Public Health, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182-4162, USA
| | - Susan Alton Dailey
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC, 27705, USA
| | - Aimee Kroll-Desrosiers
- VA Central Western Massachusetts Healthcare System, 421 North Main Street, Leeds, MA, 01053, USA
- UMass Chan Medical School, 55 Lake Ave. N, Worcester, MA, 01655, USA
| | - Colleen Burke
- Department of Population Health Sciences, Duke University School of Medicine, 215 Morris Street, Durham, NC, 27701, USA
| | - Megan Shepherd-Banigan
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC, 27705, USA
- Department of Population Health Sciences, Duke University School of Medicine, 215 Morris Street, Durham, NC, 27701, USA
- Duke-Margolis Center for Health Policy, 100 Fuqua Drive, Box 90120, Durham, NC, 27708, USA
| | - Rebecca Lumsden
- Division of General Internal Medicine, Duke University School of Medicine, 40 Duke Medicine Circle, Durham, NC, 27710, USA
| | - Catherine Sims
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC, 27705, USA
- Duke Rheumatology Division, 40 Duke Medicine Circle Clinic 1j, Durham, NC, 27710, USA
| | - Julie Schexnayder
- University of Alabama at Birmingham School of Nursing, NB545 1720 2nd, Ave S, Birmingham, AL, 35294, USA
| | - Dhara Patel
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC, 27705, USA
| | - Sarah Cantrell
- Duke University Medical Center Library & Archives, Duke University School of Medicine 10 Searle Drive, Durham, NC, 27710, USA
| | | | - Jennifer M Gierisch
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC, 27705, USA
- Division of General Internal Medicine, Duke University School of Medicine, 40 Duke Medicine Circle, Durham, NC, 27710, USA
- Department of Population Health Sciences, Duke University School of Medicine, 215 Morris Street, Durham, NC, 27701, USA
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5
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Leuchter RK, Ma S, Bell DS, Hays RD, Vidorreta FJS, Binder SL, Sarkisian CA. Embedding research study recruitment within the patient portal preCheck-in. J Am Med Inform Assoc 2023; 30:2028-2035. [PMID: 37595575 PMCID: PMC10654868 DOI: 10.1093/jamia/ocad164] [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: 03/20/2023] [Accepted: 08/09/2023] [Indexed: 08/20/2023] Open
Abstract
OBJECTIVE Patient portals are increasingly used to recruit patients in research studies, but communication response rates remain low without tactics such as financial incentives or manual outreach. We evaluated a new method of study enrollment by embedding a study information sheet and HIPAA authorization form (HAF) into the patient portal preCheck-in (where patients report basic information like allergies). MATERIALS AND METHODS Eligible patients who enrolled received an after-visit patient-reported outcomes survey through the patient portal. No additional recruitment/messaging efforts were made. RESULTS A total of 386 of 843 patients completed preCheck-in, 308 of whom signed the HAF and enrolled in the study (37% enrollment rate). Of 93 patients who were eligible to receive the after-visit survey, 45 completed it (48% completion rate). CONCLUSION Enrollment and survey completion rates were higher than what is typically seen with recruitment by patient portal messaging, suggesting that preCheck-in recruitment can enhance research study recruitment and warrants further investigation.
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Affiliation(s)
- Richard K Leuchter
- Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, United States
| | - Suzette Ma
- UCLA Health Information Technology, UCLA Health, Los Angeles, CA 90095, United States
| | - Douglas S Bell
- Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, United States
- Clinical and Translational Science Institute, UCLA, Los Angeles, CA 90095, United States
| | - Ron D Hays
- Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, United States
- Department of Health Policy and Management, Fielding School of Public Health, UCLA, Los Angeles, CA 90095, United States
| | | | - Sandra L Binder
- Clinical and Translational Science Institute, UCLA, Los Angeles, CA 90095, United States
| | - Catherine A Sarkisian
- Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, United States
- VA Greater Los Angeles Healthcare System Geriatric Research Education and Clinical Center, Los Angeles, CA 90073, United States
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Leviton A, Loddenkemper T. Design, implementation, and inferential issues associated with clinical trials that rely on data in electronic medical records: a narrative review. BMC Med Res Methodol 2023; 23:271. [PMID: 37974111 PMCID: PMC10652539 DOI: 10.1186/s12874-023-02102-4] [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: 10/17/2022] [Accepted: 11/08/2023] [Indexed: 11/19/2023] Open
Abstract
Real world evidence is now accepted by authorities charged with assessing the benefits and harms of new therapies. Clinical trials based on real world evidence are much less expensive than randomized clinical trials that do not rely on "real world evidence" such as contained in electronic health records (EHR). Consequently, we can expect an increase in the number of reports of these types of trials, which we identify here as 'EHR-sourced trials.' 'In this selected literature review, we discuss the various designs and the ethical issues they raise. EHR-sourced trials have the potential to improve/increase common data elements and other aspects of the EHR and related systems. Caution is advised, however, in drawing causal inferences about the relationships among EHR variables. Nevertheless, we anticipate that EHR-CTs will play a central role in answering research and regulatory questions.
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Affiliation(s)
- Alan Leviton
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Tobias Loddenkemper
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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7
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Frisch EH, Mitchell J, Yao M, Llarena N, Omosigho UR, DeAngelo L, Arakelian M, Bradley L, Falcone T. The Impact of Fertility Goals on Long-term Quality of Life in Reproductive-aged Women Who Underwent Myomectomy versus Hysterectomy for Uterine Fibroids. J Minim Invasive Gynecol 2023; 30:642-651. [PMID: 37044261 DOI: 10.1016/j.jmig.2023.04.003] [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: 03/07/2023] [Revised: 03/31/2023] [Accepted: 04/05/2023] [Indexed: 04/14/2023]
Abstract
STUDY OBJECTIVE The objective of this study is to compare quality of life (QOL) for myomectomy with hysterectomy 1 to 5 years after surgical management for fibroids. This study evaluated the difference in QOL in a population of women of reproductive age, including those who desire fertility. DESIGN A retrospective cohort study. INTERVENTIONS Not applicable. SETTING A large academic hospital. PATIENTS A total of 142 women who underwent hysterectomy or myomectomy in 2015 to 2020. Included patients were women aged 18 years or older who underwent surgical intervention owing to uterine fibroids. MEASUREMENTS AND MAIN RESULTS The 36-Item Short Form Health Survey (SF-36) provides a total score as a single measure of health-related QOL. The Uterine Fibroid Symptom Quality of Life Questionnaire for Hysterectomy and Myomectomy (UFS-QOL) is a patient-reported outcome measure of fibroid symptoms and health-related QOL after hysterectomy and myomectomy. There was no significant difference in SF-36 QOL scores in women after myomectomy who desired fertility compared with those who did not desire fertility, except in the social functioning domain (p = .025). UFS-QOL scores in women after myomectomy who desired fertility were not significantly different compared with women after myomectomy who did not desire fertility (p = .37). There were no significant differences between women who underwent myomectomy and hysterectomy in overall QOL scores on the SF-36 (p = .13) and UFS-QOL scores (p = .16). CONCLUSION Myomectomy is not associated with significant differences in measures of general health and QOL compared with hysterectomy, making it a viable fibroid management option for women who desire fertility. Our study highlights the importance of discussing fertility goals and QOL when counseling patients for surgical fibroid treatment.
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Affiliation(s)
- Emily H Frisch
- ObGyn and Women's Health Institute (Drs. Frisch, Llarena, Omosigho, Bradley, and Falcone); and Quantitative Health Sciences (Mr. Yao), Cleveland Clinic Foundation, Cleveland, Ohio; Cleveland Clinic Lerner School of Medicine, Cleveland, Ohio (Mr. Mitchell, Ms. DeAngelo, and Ms. Arakelian); HRC Fertility, Pasadena, California (Dr. Llarena).
| | - Jameson Mitchell
- ObGyn and Women's Health Institute (Drs. Frisch, Llarena, Omosigho, Bradley, and Falcone); and Quantitative Health Sciences (Mr. Yao), Cleveland Clinic Foundation, Cleveland, Ohio; Cleveland Clinic Lerner School of Medicine, Cleveland, Ohio (Mr. Mitchell, Ms. DeAngelo, and Ms. Arakelian); HRC Fertility, Pasadena, California (Dr. Llarena)
| | - Meng Yao
- ObGyn and Women's Health Institute (Drs. Frisch, Llarena, Omosigho, Bradley, and Falcone); and Quantitative Health Sciences (Mr. Yao), Cleveland Clinic Foundation, Cleveland, Ohio; Cleveland Clinic Lerner School of Medicine, Cleveland, Ohio (Mr. Mitchell, Ms. DeAngelo, and Ms. Arakelian); HRC Fertility, Pasadena, California (Dr. Llarena)
| | - Natalia Llarena
- ObGyn and Women's Health Institute (Drs. Frisch, Llarena, Omosigho, Bradley, and Falcone); and Quantitative Health Sciences (Mr. Yao), Cleveland Clinic Foundation, Cleveland, Ohio; Cleveland Clinic Lerner School of Medicine, Cleveland, Ohio (Mr. Mitchell, Ms. DeAngelo, and Ms. Arakelian); HRC Fertility, Pasadena, California (Dr. Llarena)
| | - Ukpebo R Omosigho
- ObGyn and Women's Health Institute (Drs. Frisch, Llarena, Omosigho, Bradley, and Falcone); and Quantitative Health Sciences (Mr. Yao), Cleveland Clinic Foundation, Cleveland, Ohio; Cleveland Clinic Lerner School of Medicine, Cleveland, Ohio (Mr. Mitchell, Ms. DeAngelo, and Ms. Arakelian); HRC Fertility, Pasadena, California (Dr. Llarena)
| | - Lydia DeAngelo
- ObGyn and Women's Health Institute (Drs. Frisch, Llarena, Omosigho, Bradley, and Falcone); and Quantitative Health Sciences (Mr. Yao), Cleveland Clinic Foundation, Cleveland, Ohio; Cleveland Clinic Lerner School of Medicine, Cleveland, Ohio (Mr. Mitchell, Ms. DeAngelo, and Ms. Arakelian); HRC Fertility, Pasadena, California (Dr. Llarena)
| | - Miranda Arakelian
- ObGyn and Women's Health Institute (Drs. Frisch, Llarena, Omosigho, Bradley, and Falcone); and Quantitative Health Sciences (Mr. Yao), Cleveland Clinic Foundation, Cleveland, Ohio; Cleveland Clinic Lerner School of Medicine, Cleveland, Ohio (Mr. Mitchell, Ms. DeAngelo, and Ms. Arakelian); HRC Fertility, Pasadena, California (Dr. Llarena)
| | - Linda Bradley
- ObGyn and Women's Health Institute (Drs. Frisch, Llarena, Omosigho, Bradley, and Falcone); and Quantitative Health Sciences (Mr. Yao), Cleveland Clinic Foundation, Cleveland, Ohio; Cleveland Clinic Lerner School of Medicine, Cleveland, Ohio (Mr. Mitchell, Ms. DeAngelo, and Ms. Arakelian); HRC Fertility, Pasadena, California (Dr. Llarena)
| | - Tommaso Falcone
- ObGyn and Women's Health Institute (Drs. Frisch, Llarena, Omosigho, Bradley, and Falcone); and Quantitative Health Sciences (Mr. Yao), Cleveland Clinic Foundation, Cleveland, Ohio; Cleveland Clinic Lerner School of Medicine, Cleveland, Ohio (Mr. Mitchell, Ms. DeAngelo, and Ms. Arakelian); HRC Fertility, Pasadena, California (Dr. Llarena)
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8
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Yuh T, Srivastava T, Fiore D, Schmidt H, Frank I, Metzger D, Momplaisir F. Using a patient portal as a recruitment tool to diversify the pool of participants in COVID-19 vaccine clinical trials. JAMIA Open 2022; 5:ooac091. [PMID: 36380851 PMCID: PMC9642328 DOI: 10.1093/jamiaopen/ooac091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 08/26/2022] [Accepted: 10/26/2022] [Indexed: 08/20/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has disproportionately affected racial/ethnic minorities in the United States, who are underrepresented in clinical trials. We assessed the feasibility of using the University of Pennsylvania Health System electronic health record patient portal to diversify the pool of participants in COVID-19 vaccine clinical trials. The patient portal was used to send invitations to eligible individuals living in zip codes with high rates of racial/ethnic minorities. The 5614 invited consisted of 96.7% black, 1.3% Hispanic/Latinx, and 1.5% white. The overall response rate was 5.4%, with lower response rates among Black (3.8%) and Hispanic/Latinx (9.6%) as compared to white individuals (91.6%). Among respondents, black individuals had lower rates of interest in participating (26.7%), as compared to white (65.8%) and Hispanic/Latinx (71.4%) individuals. Of 115 respondents who expressed interest, 9 enrolled in the clinical trial, which included 6 black, 3 white, and 1 Hispanic/Latinx. During phone outreach to nonresponders and decliners, common reasons for declining included mistrust of the COVID-19 vaccine, underlying health conditions, and logistical barriers to trial participation. Because of low rates of patient portal account activation and use, compounded with vaccine hesitancy, this method yielded a small number of interested individuals.
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Affiliation(s)
- Tiffany Yuh
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Tuhina Srivastava
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Danielle Fiore
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Harald Schmidt
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Ian Frank
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - David Metzger
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Florence Momplaisir
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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9
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Mesa RA, Sullivan EM, Dubinski D, Carroll B, Slee VM, Jennings SV, Finnerty CC, Bohannon LS, Mathias SD, Lahue BJ, Castells MC. Patient-reported outcomes among patients with systemic mastocytosis in routine clinical practice: Results of the TouchStone SM Patient Survey. Cancer 2022; 128:3691-3699. [PMID: 35996873 PMCID: PMC9804682 DOI: 10.1002/cncr.34420] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 04/22/2022] [Accepted: 05/13/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Systemic mastocytosis (SM) is a rare clonal neoplasm driven by KIT D816V and other mutations. Data were collected from the patient perspective on disease burden and included an SM-specific symptom assessment tool. METHODS US adults aged 18 years and older with a self-reported SM diagnosis completed an online TouchStone SM Patient Survey of 100 items, including the 12-item Short-Form Health Survey, the Indolent Systemic Mastocytosis Symptom Assessment Form, and the Work Productivity and Activity Impairment Questionnaire, as well as questions about SM diagnosis, the impact of SM on daily activities, work impairment, and health care use. The results were analyzed using descriptive statistics. RESULTS Fifty-six individuals completed the survey (89% women; median age, 48 years; mean time since diagnosis, 6.7 years), reporting indolent SM (66%), aggressive SM (9%), smoldering SM (5%), and unknown SM subtype (18%). Over a 1-year recall, respondents reported seeking emergency care for anaphylaxis (30%) and taking three or more prescription medications (52%) for SM. Over one half of patients (54%) reduced their work hours because of SM, and 64% avoided leaving home because of symptoms. A majority of respondents (93%) had experienced ≥10 SM-related symptoms, noting that the most bothersome were anaphylactic episodes (18%), abdominal/stomach pain (16%), diarrhea/loose stools (13%), and fatigue (11%). Whereas an Indolent Systemic Mastocytosis Symptom Assessment Form-derived total symptom score of 28 is used to indicate moderate-to-severe symptoms, the mean total symptom score was 52.7. Mental and physical component summary scores from the 12-item Short-Form Health Survey were below population norms. CONCLUSIONS Patients who were surveyed reported substantial symptom burden and unmet needs because of SM, as evidenced by seeking emergency care and reporting bothersome symptoms, poor quality of life, and reduced work hours and productivity. LAY SUMMARY The objective of this research was to understand the burden and unmet needs in the rare disease of systemic mastocytosis (SM) to guide future care. Fifty-six patients completed an online survey containing questions about their diagnosis, medications, health care use, quality of life, and SM symptoms. The results demonstrated that SM is associated with severe and burdensome symptoms, anaphylactic events, emergency department visits, use of multiple medications, reduced ability to work, and poor physical and psychological quality of life. These findings suggest the need for future advances to address unmet needs in patients affected by SM.
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Affiliation(s)
- Ruben A. Mesa
- Mays Cancer Center at The University of Texas Health San Antonio MD Anderson Cancer CenterSan AntonioTexasUSA
| | | | - David Dubinski
- Blueprint Medicines CorporationCambridgeMassachusettsUSA
| | | | | | | | | | | | | | | | - Mariana C. Castells
- Division of Allergy and Clinical ImmunologyBrigham and Women's HospitalBostonMassachusettsUSA
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10
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Mangal S, Park L, Reading Turchioe M, Choi J, Niño de Rivera S, Myers A, Goyal P, Dugdale L, Masterson Creber R. Building trust in research through information and intent transparency with health information: representative cross-sectional survey of 502 US adults. J Am Med Inform Assoc 2022; 29:1535-1545. [PMID: 35699571 DOI: 10.1093/jamia/ocac084] [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: 01/03/2022] [Revised: 03/22/2022] [Accepted: 05/20/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Participation in healthcare research shapes health policy and practice; however, low trust is a barrier to participation. We evaluated whether returning health information (information transparency) and disclosing intent of data use (intent transparency) impacts trust in research. MATERIALS AND METHODS We conducted an online survey with a representative sample of 502 US adults. We assessed baseline trust and change in trust using 6 use cases representing the Social-Ecological Model. We assessed descriptive statistics and associations between trust and sociodemographic variables using logistic and multinomial regression. RESULTS Most participants (84%) want their health research information returned. Black/African American participants were more likely to increase trust in research with individual information transparency (odds ratio (OR) 2.06 [95% confidence interval (CI): 1.06-4.34]) and with intent transparency when sharing with chosen friends and family (3.66 [1.98-6.77]), doctors and nurses (1.96 [1.10-3.65]), or health tech companies (1.87 [1.02-3.40]). Asian, Native American or Alaska Native, Native Hawaiian or Pacific Islander, Multirace, and individuals with a race not listed, were more likely to increase trust when sharing with health policy makers (1.88 [1.09-3.30]). Women were less likely to increase trust when sharing with friends and family (0.55 [0.35-0.87]) or health tech companies (0.46 [0.31-0.70]). DISCUSSION Participants wanted their health information returned and would increase their trust in research with transparency when sharing health information. CONCLUSION Trust in research is influenced by interrelated factors. Future research should recruit diverse samples with lower baseline trust levels to explore changes in trust, with variation on the type of information shared.
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Affiliation(s)
- Sabrina Mangal
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Leslie Park
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | | | - Jacky Choi
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | | | - Annie Myers
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Parag Goyal
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Lydia Dugdale
- Department of Medicine, Columbia University, New York, New York, USA
| | - Ruth Masterson Creber
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
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11
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Gehtland LM, Paquin RS, Andrews SM, Lee AM, Gwaltney A, Duparc M, Pfaff ER, Bailey DB. Using a Patient Portal to Increase Enrollment in a Newborn Screening Research Study: Observational Study. JMIR Pediatr Parent 2022; 5:e30941. [PMID: 35142618 PMCID: PMC8874929 DOI: 10.2196/30941] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/12/2021] [Accepted: 12/11/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Many research studies fail to enroll enough research participants. Patient-facing electronic health record applications, known as patient portals, may be used to send research invitations to eligible patients. OBJECTIVE The first aim was to determine if receipt of a patient portal research recruitment invitation was associated with enrollment in a large ongoing study of newborns (Early Check). The second aim was to determine if there were differences in opening the patient portal research recruitment invitation and study enrollment by race and ethnicity, age, or rural/urban home address. METHODS We used a computable phenotype and queried the health care system's clinical data warehouse to identify women whose newborns would likely be eligible. Research recruitment invitations were sent through the women's patient portals. We conducted logistic regressions to test whether women enrolled their newborns after receipt of a patient portal invitation and whether there were differences by race and ethnicity, age, and rural/urban home address. RESULTS Research recruitment invitations were sent to 4510 women not yet enrolled through their patient portals between November 22, 2019, through March 5, 2020. Among women who received a patient portal invitation, 3.6% (161/4510) enrolled their newborns within 27 days. The odds of enrolling among women who opened the invitation was nearly 9 times the odds of enrolling among women who did not open their invitation (SE 3.24, OR 8.86, 95% CI 4.33-18.13; P<.001). On average, it took 3.92 days for women to enroll their newborn in the study, with 64% (97/161) enrolling their newborn within 1 day of opening the invitation. There were disparities by race and urbanicity in enrollment in the study after receipt of a patient portal research invitation but not by age. Black women were less likely to enroll their newborns than White women (SE 0.09, OR 0.29, 95% CI 0.16-0.55; P<.001), and women in urban zip codes were more likely to enroll their newborns than women in rural zip codes (SE 0.97, OR 3.03, 95% CI 1.62-5.67; P=.001). Black women (SE 0.05, OR 0.67, 95% CI 0.57-0.78; P<.001) and Hispanic women (SE 0.07, OR 0.73, 95% CI 0.60-0.89; P=.002) were less likely to open the research invitation compared to White women. CONCLUSIONS Patient portals are an effective way to recruit participants for research studies, but there are substantial racial and ethnic disparities and disparities by urban/rural status in the use of patient portals, the opening of a patient portal invitation, and enrollment in the study. TRIAL REGISTRATION ClinicalTrials.gov NCT03655223; https://clinicaltrials.gov/ct2/show/NCT03655223.
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Affiliation(s)
- Lisa M Gehtland
- RTI International, Research Triangle Park, NC, United States
| | - Ryan S Paquin
- RTI International, Research Triangle Park, NC, United States
| | - Sara M Andrews
- RTI International, Research Triangle Park, NC, United States
| | - Adam M Lee
- Department of Medicine, University of North Carolina Chapel Hill, Chapel Hill, NC, United States
| | - Angela Gwaltney
- RTI International, Research Triangle Park, NC, United States
| | - Martin Duparc
- RTI International, Research Triangle Park, NC, United States
| | - Emily R Pfaff
- Department of Medicine, University of North Carolina Chapel Hill, Chapel Hill, NC, United States
| | - Donald B Bailey
- RTI International, Research Triangle Park, NC, United States
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12
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Merone L, Tsey K, Russell D, Nagle C. Sex Inequalities in Medical Research: A Systematic Scoping Review of the Literature. WOMEN'S HEALTH REPORTS 2022; 3:49-59. [PMID: 35136877 PMCID: PMC8812498 DOI: 10.1089/whr.2021.0083] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/08/2021] [Indexed: 01/13/2023]
Abstract
Background: Historically, medical studies have excluded female participants and research data have been collected from males and generalized to females. The gender gap in medical research, alongside overarching misogyny, results in real-life disadvantages for female patients. This systematic scoping review of the literature aims to determine the extent of research into the medical research sex and gender gap and to assess the extent of misogyny, if any, in modern medical research. Methods: Initial literature searches were conducted using PubMed, Science Direct, PsychINFO and Google Scholar. Articles published between January 01, 2009, and December 31, 2019, were included. An article was deemed to display misogyny if it discussed the female aesthetic in terms of health, but did not measure health or could not be utilized to improve clinical practice. Results: Of the 17 included articles, 12 examined the gender gap in medical research and 5 demonstrated misogyny, assessing female attractiveness for alleged medical reasons. Females remain broadly under-represented in the medical literature, sex and gender are poorly reported and inadequately analyzed in research, and misogynistic perceptions continue to permeate the narrative. Conclusion: The gender gap and misogynistic studies remain present in the contemporary medical literature. Reasons and implications for practice are discussed.
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Affiliation(s)
- Lea Merone
- School of Health Sciences, James Cook University, Townsville, Queensland, Australia
| | - Komla Tsey
- School of Health Sciences, James Cook University, Townsville, Queensland, Australia
| | - Darren Russell
- School of Health Sciences, James Cook University, Townsville, Queensland, Australia
- Cairns Sexual Health Service, Cairns North, Queensland, Australia
| | - Cate Nagle
- College of Healthcare Sciences, James Cook University, Townsville, Queensland, Australia
- Townsville Hospital and Health Service, Townsville, Queensland, Australia
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13
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Salminen LE, Tubi MA, Bright J, Thomopoulos SI, Wieand A, Thompson PM. Sex is a defining feature of neuroimaging phenotypes in major brain disorders. Hum Brain Mapp 2022; 43:500-542. [PMID: 33949018 PMCID: PMC8805690 DOI: 10.1002/hbm.25438] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 12/12/2022] Open
Abstract
Sex is a biological variable that contributes to individual variability in brain structure and behavior. Neuroimaging studies of population-based samples have identified normative differences in brain structure between males and females, many of which are exacerbated in psychiatric and neurological conditions. Still, sex differences in MRI outcomes are understudied, particularly in clinical samples with known sex differences in disease risk, prevalence, and expression of clinical symptoms. Here we review the existing literature on sex differences in adult brain structure in normative samples and in 14 distinct psychiatric and neurological disorders. We discuss commonalities and sources of variance in study designs, analysis procedures, disease subtype effects, and the impact of these factors on MRI interpretation. Lastly, we identify key problems in the neuroimaging literature on sex differences and offer potential recommendations to address current barriers and optimize rigor and reproducibility. In particular, we emphasize the importance of large-scale neuroimaging initiatives such as the Enhancing NeuroImaging Genetics through Meta-Analyses consortium, the UK Biobank, Human Connectome Project, and others to provide unprecedented power to evaluate sex-specific phenotypes in major brain diseases.
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Affiliation(s)
- Lauren E. Salminen
- Imaging Genetics CenterMark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USCMarina del ReyCaliforniaUSA
| | - Meral A. Tubi
- Imaging Genetics CenterMark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USCMarina del ReyCaliforniaUSA
| | - Joanna Bright
- Imaging Genetics CenterMark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USCMarina del ReyCaliforniaUSA
| | - Sophia I. Thomopoulos
- Imaging Genetics CenterMark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USCMarina del ReyCaliforniaUSA
| | - Alyssa Wieand
- Imaging Genetics CenterMark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USCMarina del ReyCaliforniaUSA
| | - Paul M. Thompson
- Imaging Genetics CenterMark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USCMarina del ReyCaliforniaUSA
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14
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Wilfred SA, Lundgren JD. The Double Consciousness Body Image Scale: A body image assessment centering the experiences of Black women. Int J Eat Disord 2021; 54:1771-1781. [PMID: 34272899 DOI: 10.1002/eat.23581] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 07/02/2021] [Accepted: 07/03/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Body image among Black women is poorly understood; emerging research suggests that Black women experience pressures to adhere to a body type not currently captured in commonly used body image measures. This study assessed the psychometric properties and validity of the Double Consciousness Body Image Scale (DCBIS), a new culturally relevant body image assessment for Black women. METHOD Black women living in the United States (n = 198; 73.4% identified as African American; the remainder identified as African, Afro-Latina, Caribbean, Caribbean American, Black descent, or multiple racial identities) completed online surveys assessing behaviors used to modify physical features, pressures to adhere to certain physical features, and eating disorder symptomatology. RESULTS Exploratory factor analysis identified a unitary factor structure focused on pressures to adhere to physical characteristics, as well as behavior manifestation of those pressures. The DCBIS demonstrated good internal consistency (α = .96). The DCBIS demonstrated convergent validity with measures of body image and disordered eating behaviors and attitudes. DISCUSSION The DCBIS is a culturally relevant assessment of body image centering the experiences of Black women living in the context of U.S. culture. Future research is needed to confirm the factor structure of the DCBIS and evaluate its psychometric properties among a broader representation of Black women, globally.
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Affiliation(s)
- Salomé A Wilfred
- Department of Psychology, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Jennifer D Lundgren
- Department of Psychology, University of Missouri-Kansas City, Kansas City, Missouri, USA
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15
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Rosman L, Armbruster T, Kyazimzade S, Tugaoen Z, Mazzella AJ, Deyo Z, Walker J, Machineni S, Gehi A. Effect of a virtual self-management intervention for atrial fibrillation during the outbreak of COVID-19. Pacing Clin Electrophysiol 2021; 44:451-461. [PMID: 33565642 PMCID: PMC8014277 DOI: 10.1111/pace.14188] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/05/2021] [Accepted: 01/31/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND As the pandemic continues to unfold, effective, technology-based solutions are needed to help patients with atrial fibrillation (AF) maintain their health and well-being during the outbreak of COVID-19. METHODS This single-center, pilot study investigated the effects of a 4-week (eight sessions) virtual AF self-management program. Questionnaires were completed at baseline and 1 week after the intervention, and assessed AF knowledge, adherence to self-management behaviors, mental health, physical function, and disease-specific quality of life in patients with AF. Secondary outcomes included knowledge of COVID-19, intervention, acceptability, and satisfaction. RESULTS Of 68 patients who completed baseline questionnaires, 57 participated in the intervention and were included in the analysis (mean age of 73.4 ± 10.0 years, 60% male). Adherence to AF self-monitoring behaviors, including monitoring their heart rate (p < .001), heart rhythm (p = .003), and blood pressure (p = .013) were significantly improved at the end of the intervention compared with baseline. Symptom identification (p = .007) and management (p < .001) also improved. Reductions in sleep disturbance (p < .001), anxiety (p = .014), and depression (p = .046) were also observed. Misinformation and inaccurate beliefs about COVID-19 were significantly reduced at the end of the intervention compared with baseline. CONCLUSIONS This pilot study suggests that a virtual patient education program could have beneficial effects on adherence to guideline-recommend self-care of AF, emotional wellbeing, physical function, and knowledge of COVID-19 in patients with AF. Future randomized studies in larger samples are needed to determine the clinical benefits of the intervention.
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Affiliation(s)
- Lindsey Rosman
- Department of MedicineDivision of CardiologyUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Tiffany Armbruster
- Department of MedicineDivision of CardiologyUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Sayyad Kyazimzade
- Department of MedicineUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Zachary Tugaoen
- Department of MedicineUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Anthony J. Mazzella
- Department of MedicineDivision of CardiologyUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Zack Deyo
- Department of PharmacyUniversity of North Carolina HospitalsChapel HillNorth CarolinaUSA
- Division of Practice Advancement and Clinical EducationUniversity of North Carolina Eshelman School of PharmacyChapel HillNorth CarolinaUSA
| | - Jennifer Walker
- Department of MedicineDivision of CardiologyUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Sriram Machineni
- Department of MedicineDivision of Endocrinology & MetabolismUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Anil Gehi
- Department of MedicineDivision of CardiologyUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
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16
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Miller HN, Gleason KT, Juraschek SP, Plante TB, Lewis-Land C, Woods B, Appel LJ, Ford DE, Dennison Himmelfarb CR. Electronic medical record-based cohort selection and direct-to-patient, targeted recruitment: early efficacy and lessons learned. J Am Med Inform Assoc 2021; 26:1209-1217. [PMID: 31553434 DOI: 10.1093/jamia/ocz168] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 08/15/2019] [Accepted: 09/03/2019] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE The study sought to characterize institution-wide participation in secure messaging (SM) at a large academic health network, describe our experience with electronic medical record (EMR)-based cohort selection, and discuss the potential roles of SM for research recruitment. MATERIALS AND METHODS Study teams defined eligibility criteria to create a computable phenotype, structured EMR data, to identify and recruit participants. Patients with SM accounts matching this phenotype received recruitment messages. We compared demographic characteristics across SM users and the overall health system. We also tabulated SM activation and use, characteristics of individual studies, and efficacy of the recruitment methods. RESULTS Of the 1 308 820 patients in the health network, 40% had active SM accounts. SM users had a greater proportion of white and non-Hispanic patients than nonactive SM users id. Among the studies included (n = 13), 77% recruited participants with a specific disease or condition. All studies used demographic criteria for their phenotype, while 46% (n = 6) used demographic, disease, and healthcare utilization criteria. The average SM response rate was 2.9%, with higher rates among condition-specific (3.4%) vs general health (1.4%) studies. Those studies with a more inclusive comprehensive phenotype had a higher response rate. DISCUSSION Target population and EMR queries (computable phenotypes) affect recruitment efficacy and should be considered when designing an EMR-based recruitment strategy. CONCLUSIONS SM guided by EMR-based cohort selection is a promising approach to identify and enroll research participants. Efforts to increase the number of active SM users and response rate should be implemented to enhance the effectiveness of this recruitment strategy.
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Affiliation(s)
- Hailey N Miller
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA.,Institute for Clinical and Translational Research, Johns Hopkins University, Baltimore, Maryland, USA
| | - Kelly T Gleason
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA.,Institute for Clinical and Translational Research, Johns Hopkins University, Baltimore, Maryland, USA
| | - Stephen P Juraschek
- Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, USA
| | - Timothy B Plante
- Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Cassie Lewis-Land
- Institute for Clinical and Translational Research, Johns Hopkins University, Baltimore, Maryland, USA
| | - Bonnie Woods
- Institute for Clinical and Translational Research, Johns Hopkins University, Baltimore, Maryland, USA
| | - Lawrence J Appel
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Daniel E Ford
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Cheryl R Dennison Himmelfarb
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA.,Institute for Clinical and Translational Research, Johns Hopkins University, Baltimore, Maryland, USA
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17
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Carcel C, Reeves M. Under-Enrollment of Women in Stroke Clinical Trials: What Are the Causes and What Should Be Done About It? Stroke 2021; 52:452-457. [PMID: 33493049 DOI: 10.1161/strokeaha.120.033227] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The under-representation of women in clinical trials is a commonly recognized and seemingly intractable problem in many different areas of clinical medicine. Discrepancies in the enrollment of women in clinical trials raises concerns about the generalizability of trial evidence, as well as the potential for reduced access and utilization of new therapies in women. Recent studies confirm that the problem of under-enrollment of women continues to exist in stroke clinical trials, even after accounting for the sex ratio of stroke cases in the underlying population. The origins of these disparities are complex, and there remains a relative dearth of stroke studies that have examined the causes in detail. Although caution should be used when generalizing research findings from studies conducted in other medical conditions including cardiology trials, factors that contribute to lower enrollment in women include the use of specific trial eligibility criteria (eg, older age, presence of specific comorbidities), patient attitudes and beliefs (resulting in less interest and more refusals in women), and potentially implicit biases among study personnel. Beyond a general call to prioritize stroke research in this area, we also recommend the greater use of trial screening logs, the use of qualitative studies to understand patient attitudes and beliefs towards stroke research, avoiding the use of age-based exclusion criteria (eg, >80 years), and increasing the number of women who lead stroke clinical trials.
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Affiliation(s)
- Cheryl Carcel
- The George Institute for Global Health, University of New South Wales, Sydney, Australia (C.C.).,The University of Sydney, Sydney School of Public Health, Sydney Medical School, New South Wales, Australia (C.C.)
| | - Mathew Reeves
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing (M.R.)
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18
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Veinot TC, Ancker JS, Bakken S. Health informatics and health equity: improving our reach and impact. J Am Med Inform Assoc 2021; 26:689-695. [PMID: 31411692 DOI: 10.1093/jamia/ocz132] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Health informatics studies the use of information technology to improve human health. As informaticists, we seek to reduce the gaps between current healthcare practices and our societal goals for better health and healthcare quality, safety, or cost. It is time to recognize health equity as one of these societal goals-a point underscored by this Journal of the American Medical Informatics Association Special Focus Issue, "Health Informatics and Health Equity: Improving our Reach and Impact." This Special Issue highlights health informatics research that focuses on marginalized and underserved groups, health disparities, and health equity. In particular, this Special Issue intentionally showcases high-quality research and professional experiences that encompass a broad range of subdisciplines, methods, marginalized populations, and approaches to disparities. Building on this variety of submissions and other recent developments, we highlight contents of the Special Issue and offer an assessment of the state of research at the intersection of health informatics and health equity.
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Affiliation(s)
- Tiffany C Veinot
- School of Information, University of Michigan, Ann Arbor, Michigan, USA.,Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Jessica S Ancker
- Division of Health Informatics, Department of Healthcare Policy & Research, Weill Cornell Medical College, New York, New York, USA
| | - Suzanne Bakken
- School of Nursing, Columbia University, New York, New York, USA.,Department of Biomedical Informatics, Columbia University, New York, New York, USA.,Data Science Institute, Columbia University, New York, New York, USA
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19
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Hochheiser H, Valdez RS. Human-Computer Interaction, Ethics, and Biomedical Informatics. Yearb Med Inform 2020; 29:93-98. [PMID: 32823302 PMCID: PMC7442500 DOI: 10.1055/s-0040-1701990] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Objectives
: To provide an overview of recent work at the intersection of Biomedical Informatics, Human-Computer Interaction, and Ethics.
Methods
: Search terms for Human-Computer Interaction, Biomedical Informatics, and Ethics were used to identify relevant papers published between 2017 and 2019.Relevant papers were identified through multiple methods, including database searches, manual reviews of citations, recent publications, and special collections, as well as through peer recommendations. Identified articles were reviewed and organized into broad themes.
Results
: We identified relevant papers at the intersection of Biomedical Informatics, Human-Computer Interactions, and Ethics in over a dozen journals. The content of these papers was organized into three broad themes: ethical issues associated with systems in use, systems design, and responsible conduct of research.
Conclusions
: The results of this overview demonstrate an active interest in exploring the ethical implications of Human-Computer Interaction concerns in Biomedical Informatics. Papers emphasizing ethical concerns associated with patient-facing tools, mobile devices, social media, privacy, inclusivity, and e-consent reflect the growing prominence of these topics in biomedical informatics research. New questions in these areas will likely continue to arise with the growth of precision medicine and citizen science.
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Affiliation(s)
- Harry Hochheiser
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania USA
| | - Rupa S Valdez
- Public Health Sciences & Engineering Systems and Environment, University of Virginia, Charlottesville, Virginia USA
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