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Bradley KJ, Wros P, Bookman N, Mathews LR, Voss H, Ostrogorsky TL, LaForge K. The Interprofessional Care Access Network (I-CAN): achieving client health outcomes by addressing social determinants in the community. J Interprof Care 2023; 37:S45-S52. [PMID: 30585089 DOI: 10.1080/13561820.2018.1560246] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 11/26/2018] [Accepted: 11/28/2018] [Indexed: 01/17/2023]
Abstract
Four health professions schools at an academic health science university and a partner state university collaborated to develop the Interprofessional Care Access Network (I-CAN), a model of healthcare delivery and interprofessional education that addresses the Triple Aims for vulnerable populations in three underserved neighborhoods. Program goals were achieved through community-based partnerships and the development of a health-care workforce prepared for competent practice in emerging models of care. In the first three years, almost 600 nursing, medicine, dentistry, and pharmacy students worked with clients referred from community partners, providing interprofessional care coordination addressing life instability and social determinants of health. The evaluation has demonstrated substantial improvement of health-related outcomes for clients who began in the first three years of the program and specifically those who completed intake and follow-up documentation (N = 38). There were substantial reductions in the aggregate number of emergency department visits, emergency medical service calls, and hospitalizations when compared to the 6 months prior to starting I-CAN. Estimated cost savings for the 38 clients, based on minimal estimated costs for these indicators alone, were over $224,000. A three-year qualitative review of client progress notes indicated that as a result of interprofessional student team interventions, many clients improved access to health insurance and primary care, and stabilized housing. Since the evaluation was completed, three programs have been added in rural and urban communities, demonstrating the model is scalable and replicable.
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Affiliation(s)
| | - Peggy Wros
- OHSU School of Nursing, Portland, OR, USA
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Rountree LM, Mirzaei S, Brecht ML, Rosenfeld AG, Daya MR, Knight DNP E, Zègre-Hemsey JK, Frisch S, Dunn SL, Birchfield J, DeVon HA. There is little association between prehospital delay, persistent symptoms, and post-discharge healthcare utilization in patients evaluated for acute coronary syndrome. Appl Nurs Res 2022; 65:151588. [PMID: 35577486 PMCID: PMC9841768 DOI: 10.1016/j.apnr.2022.151588] [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: 09/24/2021] [Revised: 03/27/2022] [Accepted: 04/28/2022] [Indexed: 01/18/2023]
Abstract
AIMS Test for an association between prehospital delay for symptoms suggestive of acute coronary syndrome (ACS), persistent symptoms, and healthcare utilization (HCU) 30-days and 6-months post hospital discharge. BACKGROUND Delayed treatment for ACS increases patient morbidity and mortality. Prehospital delay is the largest factor in delayed treatment for ACS. METHODS Secondary analysis of data collected from a multi-center prospective study. Included were 722 patients presenting to the Emergency Department (ED) with symptoms that triggered a cardiac evaluation. Symptoms and HCU were measured using the 13-item ACS Symptom Checklist and the Froelicher's Health Services Utilization Questionnaire-Revised instrument. Logistic regression models were used to examine hypothesized associations. RESULTS For patients with ACS (n = 325), longer prehospital delay was associated with fewer MD/NP visits (OR, 0.986) at 30 days. Longer prehospital delay was associated with higher odds of calling 911 for any reason (OR, 1.015), and calling 911 for chest related symptoms (OR, 1.016) 6 months following discharge. For non-ACS patients (n = 397), longer prehospital delay was associated with higher odds of experiencing chest pressure (OR, 1.009) and chest discomfort (OR, 1.008) at 30 days. At 6 months, longer prehospital delay was associated with higher odds of upper back pain (OR, 1.013), palpitations (OR 1.014), indigestion (OR, 1.010), and calls to the MD/NP for chest symptoms (OR, 1.014). CONCLUSIONS There were few associations between prehospital delay and HCU for patients evaluated for ACS in the ED. Associations between prolonged delay and persistent symptoms may lead to increased HCU for those without ACS.
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Affiliation(s)
- Lauren M. Rountree
- University of California, Los Angeles, Factor Bldg., 700 Tiverton Dr, Los Angeles, CA 90095
| | - Sahereh Mirzaei
- University of California, Los Angeles, Factor Bldg., 700 Tiverton Dr, Los Angeles, CA 90095
| | - Mary-Lynn Brecht
- University of California, Los Angeles, Factor Bldg., 700 Tiverton Dr, Los Angeles, CA 90095
| | - Anne G. Rosenfeld
- University of Arizona, College of Nursing, 1305 N Martin Ave, Tucson, AZ 85721
| | - Mohamud R. Daya
- Oregon Health & Science University, School of Nursing, 3455 SW US Veterans Hospital Rd, Portland, OR 97239
| | - Elizabeth Knight DNP
- Oregon Health & Science University, School of Nursing, 3455 SW US Veterans Hospital Rd, Portland, OR 97239
| | - Jessica K. Zègre-Hemsey
- University of North Carolina, School of Nursing, Carrington Hall, S Columbia St, Chapel Hill, NC 27599
| | - Stephanie Frisch
- University of Pittsburgh, School of Nursing, 3500 Victoria St, Pittsburgh, PA 15213
| | - Susan L. Dunn
- University of Illinois Chicago, College of Nursing, 845 S Damen Ave, Chicago, IL 60612
| | - Jesse Birchfield
- University of California, Los Angeles, Factor Bldg., 700 Tiverton Dr, Los Angeles, CA 90095
| | - Holli A. DeVon
- University of California, Los Angeles, Factor Bldg., 700 Tiverton Dr, Los Angeles, CA 90095
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Berndt N, Bolman C, Lechner L, Max W, Mudde A, de Vries H, Evers S. Economic evaluation of a telephone- and face-to-face-delivered counseling intervention for smoking cessation in patients with coronary heart disease. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2016; 17:269-285. [PMID: 25796578 DOI: 10.1007/s10198-015-0677-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 02/23/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE This study examined the cost-effectiveness and cost-utility of two smoking cessation counseling interventions differing in their modality for patients diagnosed with coronary heart disease from a societal perspective. METHODS In a randomized controlled trial conducted in Dutch hospital wards, cardiac patients who smoked prior to admission were allocated to usual care (n = 245), telephone counseling (n = 223) or face-to-face counseling (n = 157). The counseling interventions lasted for 3 months and were complemented by nicotine patches. Baseline histories were obtained, and interviews took place 6 months after hospitalization to assess self-reported smoking status and quality adjusted life years (QALYs). Incremental cost-effectiveness ratios per quitter and cost-utility ratios per QALY were calculated and presented in acceptability curves. Uncertainty was accounted for by sensitivity analysis. RESULTS Using continued abstinence as the outcome measure showed that telephone counseling had the highest probability of being cost-effective. Face-to-to-face counseling was also more cost-effective than usual care. No significant improvements and differences in QALYs between the three conditions were found. Varying costs and effect estimations revealed that the results of the primary analyses were robust. CONCLUSIONS Assuming a willingness-to-pay of €20,000 per abstinent patient, telephone counseling would be a highly cost-effective smoking cessation intervention assisting cardiac patients to quit. However, the lack of consensus concerning the willingness-to-pay per quitter impedes drawing firm conclusions. Moreover, studies with extended follow-up periods are needed to capture late relapses and possible differences in QALYs.
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Affiliation(s)
- Nadine Berndt
- Faculty of Psychology and Educational Sciences, Open University of the Netherlands, POB 2960, 6401 DL, Heerlen, The Netherlands.
- Cellule d'expertise médicale, Inspection générale de la sécurité sociale, Le Gouvernement du Grand-Duché de Luxembourg, POB 1308, 1013, Luxembourg, Luxembourg.
| | - Catherine Bolman
- Faculty of Psychology and Educational Sciences, Open University of the Netherlands, POB 2960, 6401 DL, Heerlen, The Netherlands
| | - Lilian Lechner
- Faculty of Psychology and Educational Sciences, Open University of the Netherlands, POB 2960, 6401 DL, Heerlen, The Netherlands
| | - Wendy Max
- Institute for Health and Aging, Department of Social and Behavioral Sciences, University of California, San Francisco, 3333 California Street, Suite 340, San Francisco, CA, 94118, USA
| | - Aart Mudde
- Faculty of Psychology and Educational Sciences, Open University of the Netherlands, POB 2960, 6401 DL, Heerlen, The Netherlands
| | - Hein de Vries
- Department of Health Promotion, School for Public Health and Primary Care (CAPHRI), Maastricht University, POB 616, 6200 MD, Maastricht, The Netherlands
| | - Silvia Evers
- Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Maastricht University, POB 616, 6200 MD, Maastricht, The Netherlands
- Department of Public Mental Health, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, POB 725, 3500 AS, Utrecht, The Netherlands
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DeVon HA, Burke LA, Nelson H, Zerwic JJ, Riley B. Disparities in patients presenting to the emergency department with potential acute coronary syndrome: it matters if you are Black or White. Heart Lung 2014; 43:270-7. [PMID: 24992880 PMCID: PMC4082800 DOI: 10.1016/j.hrtlng.2014.04.019] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 04/22/2014] [Accepted: 04/23/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To explore disparities between non-Hispanic Blacks and non-Hispanic Whites presenting to the emergency department (ED) with potential acute coronary syndrome (ACS). BACKGROUND Individuals with fewer resources have worse health outcomes and these individuals are disproportionately those of color. METHODS This prospective study enrolled 663 patients in four EDs. Clinical presentation, treatment, and patient-reported outcome variables were measured at baseline, 1, and 6 months. RESULTS Blacks with confirmed ACS were younger; had lower income; less education; more risk factors; more symptoms, and longer prehospital delay at presentation compared to Whites. Blacks experiencing palpitations, unusual fatigue, and chest pain were more than 3 times as likely as Whites to have ACS confirmed. Blacks with ACS had more clinic visits and more symptoms 1 month following discharge. CONCLUSIONS Significant racial disparities remain in clinical presentation and outcomes for Blacks compared to Whites presenting to the ED with symptoms suggestive of ACS.
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Affiliation(s)
- Holli A DeVon
- University of Illinois at Chicago College of Nursing, Chicago, IL, USA.
| | - Larisa A Burke
- University of Illinois at Chicago College of Nursing, Chicago, IL, USA
| | | | - Julie J Zerwic
- University of Illinois at Chicago College of Nursing, Chicago, IL, USA
| | - Barth Riley
- University of Illinois at Chicago College of Nursing, Chicago, IL, USA
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Gleeson D, Crabbe DL. Emerging concepts in cardiovascular disease risk assessment: where do women fit in? ACTA ACUST UNITED AC 2011; 21:480-7. [PMID: 19845805 DOI: 10.1111/j.1745-7599.2009.00434.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To highlight the current limitations in the assessment of cardiovascular disease (CVD) risk for women. This article will offer the reader information on the current process for assessing CVD risk in women, the pitfalls associated with this current strategy, and the role of novel risk factors. DATA SOURCES Extensive review of the medical literature in the area of women's cardiovascular health. CONCLUSIONS The assessment of CVD risk for women is currently an evolving science. Limitations in the ability of the Framingham score to accurately estimate risk in women from diverse populations are increasingly recognized. Vastly different treatment goals between the genders for similar levels of risk factors have led to a re-evaluation of this strategy in women. While the Framingham score is still useful for guiding cholesterol treatment goals, the current preventive guidelines for women emphasize assessing a woman's risk throughout her lifetime. The future development of tools for improved risk stratification that incorporate novel risk factors may in fact improve our ability to appropriately risk stratify women to evidence-based therapies. IMPLICATIONS FOR PRACTICE Utilizing the Framingham Risk Assessment Tool and further CVD risk stratification using novel markers such as high sensitivity C-reactive protein, family history, and functional capacity may identify unique subsets of women at higher risk for CVD. Nurse practitioners can be instrumental in this assessment, education, and treatment of women at risk for CVD.
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Affiliation(s)
- Deborah Gleeson
- Department of Nursing, College of Health Professions, Temple University Hospital, Temple University, Philadelphia, PA 19140, USA.
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Li WW, Froelicher ES. Predictors of smoking relapse in women with cardiovascular disease in a 30-month study: extended analysis. Heart Lung 2008; 37:455-65. [PMID: 18992629 DOI: 10.1016/j.hrtlng.2008.07.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2007] [Revised: 07/18/2008] [Accepted: 07/22/2008] [Indexed: 11/18/2022]
Abstract
PURPOSE To identify predictors of long-term cessation after intervention for woman hospitalized with cardiovascular diseases (CVD). METHODS A randomized clinical trial (RCT) with a 30-month follow-up was conducted, recruiting 277 woman smokers with CVD from 10 hospitals. The intervention consisted of inpatient and outpatient counseling on smoking cessation and pharmacological protocol. Psychophysiological factors and time since quitting associated with relapse in the literature were assessed in our prediction model. RESULTS The nine independent variables for smoking relapse included time since quitting, group assignment, the interaction between time and group assignment, serious quit attempts and five and psychophysiological factors. Lower self-efficacy at baseline was a significant predictor of relapse (OR = 0.98, 95%CI = 0.97,0.99). Another predictor was the interaction between time and group assignment and the finding showed that for the usual care group, increase in time since quitting provided a significant protective factor (OR = 0.69, 95%CI = 0.60,0.79). CONCLUSIONS Cessation programs should include content on self-efficacy to help prevent relapse. The interaction between time and group warrants further investigation for its prediction for relapse.
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Affiliation(s)
- Wen-Wen Li
- School of Nursing, San Francisco State University, San Francisco, California 94132, USA
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Sohn M, Stotts NA, Benowitz N, Christopherson D, Kim KS, Jang YS, Ahn MS, Froelicher ES. Beliefs about health, smoking, and future smoking cessation among South Korean men hospitalized for cardiovascular disease. Heart Lung 2007; 36:339-47. [PMID: 17845880 DOI: 10.1016/j.hrtlng.2006.11.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2005] [Accepted: 11/13/2006] [Indexed: 11/28/2022]
Abstract
BACKGROUND A particularly high rate of smoking among South Korean men corresponds to high rates of cardiovascular disease. OBJECTIVES This study evaluated South Korean men hospitalized with cardiovascular disease to explore beliefs about the health benefits of smoking cessation, to determine smoking cessation intentions, and to identify factors associated with confidence in quitting smoking. METHODS This was a cross-sectional, descriptive study. RESULTS Of the study's 97 participants, only 78% believed that smoking cessation avoids or decreases the chance of developing heart disease; 93% reported their intention to quit; 74% had moderate to high confidence about quitting within the month after hospital discharge; and 88% preferred to quit by themselves without help. Significant predictors of low confidence in quitting were being married (odds ratio: 5.54, 95% confidence interval: 1.33-23.08); being alcohol dependent (odds ratio: 3.25, confidence interval: 1.20-8.80); and starting to smoke at or before 20 years of age (odds ratio: 2.96, confidence interval: 1.14-7.68). CONCLUSION The study's participants were motivated to quit smoking for their health, but they must be educated to understand that smoking is addictive and that special intervention is needed.
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Affiliation(s)
- Min Sohn
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California, USA
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Oka RK, Katapodi MC, Lim JW, Bacchetti P, Froelicher ES. Quantifying smoking cessation outcomes: from The Women's Initiative for Nonsmoking Study (X): methodological implications. Nurs Res 2006; 55:292-7. [PMID: 16849982 DOI: 10.1097/00006199-200607000-00010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Classification of smoking status has a major impact on the conclusions drawn from smoking cessation intervention research, yet few studies have addressed this critical issue. OBJECTIVES The aim of this study was to compare three classifications (naïve, optimistic, and pessimistic) of smoking cessation outcomes or smoking status from the Women's Initiative for Nonsmoking Study (WINS). METHODS This is a longitudinal prospective study nested within a randomized clinical trial (RCT) design of WINS, an RCT of 277 women over the age of 18 years who reported smoking cigarettes continuously for 1 month prior to a cardiovascular event requiring hospital admission. Women were randomized to either the usual care group (UC) or the intervention group (IG). Recruitment for WINS occurred between October 1996 and December 1998 in 10 hospitals in the San Francisco Bay area. Follow-up data on smoking status was obtained from the UC and the IG using a structured telephone interview at 6 and 12 months from baseline and was confirmed by family members and salivary cotinine levels. RESULTS Seven-day point prevalence(self-report of not smoking in the past 7 days; "not even a puff") using the naïve (the most liberal) classification yields a greater number of nonsmokers than the pessimistic or most conservative classification (cotinine level verification of smoking status). The classification of smoking status also affects time to continuous smoking. The pessimistic classification results in the shortest time to continuous smoking, whereas the opposite is observed with the naïve classification. DISCUSSION It is important to critically evaluate the underlying assumptions made by study investigators when measuring and reporting smoking status. The classification of smoking status and the selection of analysis, meaning point prevalence versus survival analysis, affect study results and contribute to the variability observed in the research findings of smoking cessation intervention trials and the challenges faced in making appropriate comparisons across studies.
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Affiliation(s)
- Roberta K Oka
- Department of Community Health Systems, University of California, San Francisco, CA 94143-0608, USA
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Doolan DM, Froelicher ES. Efficacy of smoking cessation intervention among special populations: review of the literature from 2000 to 2005. Nurs Res 2006; 55:S29-37. [PMID: 16829774 DOI: 10.1097/00006199-200607001-00005] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The United States Public Health Service acknowledges in the 2000 Clinical Practice Guideline for Treating Tobacco Use and Dependence that certain special populations have unique needs and considerations in regard to smoking cessation interventions. In a review of the current smoking cessation literature, the following special populations were identified: women; older adults; gay, lesbian, bisexual, and transgender smokers; smokers with psychiatric diagnoses; smokers addicted to illicit drugs, alcohol, or both; American Indians and Alaska Natives; African Americans; Hispanics; and Asian Americans. Existing smoking cessation research pertaining to these special populations was assessed, and an agenda for future research is proposed in this presentation. The available smoking cessation randomized clinical trials for efficacy and other research relevant to these groups is insufficient. Recent progress has been made in research in the areas of smoking cessation and women; smokers with psychiatric diagnoses; smokers addicted to illicit drugs, alcohol, or both; and African Americans. There is, however, a paucity of research evaluating smoking cessation interventions and older adults; gay, lesbian, bisexual, and transgender smokers; American Indians and Alaska Natives; Hispanics; and Asian Americans. Further research relevant to the smoking cessation needs of these special populations can enable nurses and other healthcare providers to administer culturally adequate and efficacious smoking cessation interventions to these groups.
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Affiliation(s)
- Daniel M Doolan
- Department of Physiological Nursing, University of California, San Francisco 94143-0610, USA
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Affiliation(s)
- Erika Sivarajan Froelicher
- Department of Physiological Nursing, School of Nursing, University of California at San Francisco, 94143, USA.
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