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Arora S, Brakey HR, Jones JL, Hood N, Fuentes JE, Cirolia L. Project ECHO for Cancer Care: a Scoping Review of Provider Outcome Evaluations. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:1509-1521. [PMID: 37002507 DOI: 10.1007/s13187-023-02292-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 06/19/2023]
Abstract
The Project ECHO model of telementoring has been used for the past 10 years to expand access to specialized cancer care. This scoping review identifies evidence for the model's ability to improve provider outcomes, synthesizing findings from existing studies within Moore et al.'s (2009) framework for continuing medical education outcomes. We search two large research databases and a collection maintained by Project ECHO staff for articles that focus on cancer ECHO programs, involve primary data collection, and were published between December 1, 2016, and November 30, 2021. We identified 25 articles for inclusion in our scoping review. Most articles reported results for outcomes related to program participation: attendance, satisfaction, and learning. Yet, just under half reported changes in provider practices. Results demonstrate widespread participation and improved learning resulting from ECHO programs focused on cancer care. There is also evidence of improved practices related to HCV vaccination and palliative care. We highlight examples of best practices as well as opportunities to improve provider outcome evaluations for cancer ECHO programs.
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Affiliation(s)
- Sanjeev Arora
- ECHO Institute, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Heidi Rishel Brakey
- Community Engagement and Research Core, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Jessica L Jones
- ECHO Institute, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
| | - Nancy Hood
- ECHO Institute, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Jesus E Fuentes
- Community Engagement and Research Core, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Lucca Cirolia
- ECHO Institute, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
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Godino JG, Samaniego JC, Sharp SP, Taren D, Zuber A, Armistad AJ, Dezan AM, Leyba AJ, Friedly JL, Bunnell AE, Matthews E, Miller MJ, Unger ER, Bertolli J, Hinckley A, Lin JMS, Scott JD, Struminger BB, Ramers C. A technology-enabled multi-disciplinary team-based care model for the management of Long COVID and other fatiguing illnesses within a federally qualified health center: protocol for a two-arm, single-blind, pragmatic, quality improvement professional cluster randomized controlled trial. Trials 2023; 24:524. [PMID: 37573421 PMCID: PMC10423413 DOI: 10.1186/s13063-023-07550-3] [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: 05/31/2023] [Accepted: 07/27/2023] [Indexed: 08/14/2023] Open
Abstract
BACKGROUND The clinical burden of Long COVID, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and other post-infectious fatiguing illnesses (PIFI) is increasing. There is a critical need to advance understanding of the effectiveness and sustainability of innovative approaches to clinical care of patients having these conditions. METHODS We aim to assess the effectiveness of a Long COVID and Fatiguing Illness Recovery Program (LC&FIRP) in a two-arm, single-blind, pragmatic, quality improvement, professional cluster, randomized controlled trial in which 20 consenting clinicians across primary care clinics in a Federally Qualified Health Center system in San Diego, CA, will be randomized at a ratio of 1:1 to either participate in (1) weekly multi-disciplinary team-based case consultation and peer-to-peer sharing of emerging best practices (i.e., teleECHO (Extension for Community Healthcare Outcomes)) with monthly interactive webinars and quarterly short courses or (2) monthly interactive webinars and quarterly short courses alone (a control group); 856 patients will be assigned to participating clinicians (42 patients per clinician). Patient outcomes will be evaluated according to the study arm of their respective clinicians. Quantitative and qualitative outcomes will be measured at 3- and 6-months post-baseline for clinicians and every 3-months post assignment to a participating clinician for patients. The primary patient outcome is change in physical function measured using the Patient-Reported Outcomes Measurement Information System (PROMIS)-29. Analyses of differences in outcomes at both the patient and clinician levels will include a linear mixed model to compare change in outcomes from baseline to each post-baseline assessment between the randomized study arms. A concurrent prospective cohort study will compare the LC&FIRP patient population to the population enrolled in a university health system. Longitudinal data analysis approaches will allow us to examine differences in outcomes between cohorts. DISCUSSION We hypothesize that weekly teleECHO sessions with monthly interactive webinars and quarterly short courses will significantly improve clinician- and patient-level outcomes compared to the control group. This study will provide much needed evidence on the effectiveness of a technology-enabled multi-disciplinary team-based care model for the management of Long COVID, ME/CFS, and other PIFI within a federally qualified health center. TRIAL REGISTRATION ClinicalTrials.gov, NCT05167227 . Registered on December 22, 2021.
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Affiliation(s)
- Job G Godino
- Laura Rodriguez Research Institute, Family Health Centers of San Diego, 1750 5Th Ave, San Diego, CA, 92101, USA.
- Center for Wireless and Population Health Systems, UC San Diego, 9500 Gilman Drive, Dept. 0811, La Jolla, CA, 92093, USA.
- Herbert Wertheim School of Public Health and Longevity Science, UC San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, USA.
- Exercise and Physical Activity Resource Center, UC San Diego, 9500 Gilman Drive, Dept. 0811, La Jolla, CA, 92093, USA.
| | - Jane C Samaniego
- Laura Rodriguez Research Institute, Family Health Centers of San Diego, 1750 5Th Ave, San Diego, CA, 92101, USA
| | - Sydney P Sharp
- Laura Rodriguez Research Institute, Family Health Centers of San Diego, 1750 5Th Ave, San Diego, CA, 92101, USA
- Exercise and Physical Activity Resource Center, UC San Diego, 9500 Gilman Drive, Dept. 0811, La Jolla, CA, 92093, USA
| | - Douglas Taren
- Department of Pediatrics and Nutrition, University of Colorado, 13001 East 17Th Place, Aurora, CO, 80045, USA
| | - Alexandra Zuber
- Ata Health Strategies, LLC, 1537 D Street NE, Washington, DC, 20002, USA
| | - Amy J Armistad
- Project ECHO, University of New Mexico Health Sciences Center, 1650 University Blvd NE, Albuquerque, NM, 87102, USA
| | - Amanda M Dezan
- Project ECHO, University of New Mexico Health Sciences Center, 1650 University Blvd NE, Albuquerque, NM, 87102, USA
| | - Azure J Leyba
- Project ECHO, University of New Mexico Health Sciences Center, 1650 University Blvd NE, Albuquerque, NM, 87102, USA
| | - Janna L Friedly
- Department of Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
- Rehabilitation Clinic, Harborview Medical Center, 410 9Th Ave, Seattle, WA, 98104, USA
| | - Aaron E Bunnell
- Department of Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
- Rehabilitation Clinic, Harborview Medical Center, 410 9Th Ave, Seattle, WA, 98104, USA
| | - Eva Matthews
- Laura Rodriguez Research Institute, Family Health Centers of San Diego, 1750 5Th Ave, San Diego, CA, 92101, USA
| | - Maureen J Miller
- National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, 30333, USA
| | - Elizabeth R Unger
- National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, 30333, USA
| | - Jeanne Bertolli
- National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, 30333, USA
| | - Alison Hinckley
- National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, 30333, USA
| | - Jin-Mann S Lin
- National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, 30333, USA
| | - John D Scott
- Department of Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
- Rehabilitation Clinic, Harborview Medical Center, 410 9Th Ave, Seattle, WA, 98104, USA
| | - Bruce B Struminger
- Project ECHO, University of New Mexico Health Sciences Center, 1650 University Blvd NE, Albuquerque, NM, 87102, USA
| | - Christian Ramers
- Laura Rodriguez Research Institute, Family Health Centers of San Diego, 1750 5Th Ave, San Diego, CA, 92101, USA
- School of Medicine, UC San Diego, 9500 Gilman Drive, Dept. 0606, La Jolla, CA, 92093, USA
- School of Public Health, San Diego State University, 5500 Campanile Dr, San Diego, CA, 92182, USA
- Global Hepatitis Program, Clinton Health Access Initiative, 383 Dorchester Ave, Boston, MA, 02127, USA
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Corcorran MA, Thornton K, Struminger B, Easterbrook P, Scott JD. Training the healthcare workforce: the global experience with telementorship for hepatitis B and hepatitis C. BMC Health Serv Res 2023; 23:824. [PMID: 37533025 PMCID: PMC10394928 DOI: 10.1186/s12913-023-09849-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 07/26/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Telementorship has emerged as an innovative strategy to decentralise medical knowledge and increase healthcare capacity across a wide range of disease processes. We report the global experience with telementorship to support healthcare workers delivering hepatitis B virus (HBV) and hepatitis C virus (HCV) care and treatment. METHODS In early 2020, we conducted a survey of HBV and HCV telementorship programmes, followed by an in-depth interview with programme leads. Programmes were eligible to participate if they were located outside of the United States (U.S.), focused on support to healthcare workers in management of HBV and/or HCV, and were affiliated with or maintained adherence to the Project ECHO model, a telementorship programme pioneered at the University of New Mexico. One programme in the U.S., focused on HCV treatment in the Native American community, was purposively sampled and invited to participate. Surveys were administered online, and all qualitative interviews were performed remotely. Descriptive statistics were calculated for survey responses, and qualitative interviews were assessed for major themes. RESULTS Eleven of 18 eligible programmes completed the survey and follow up interview. Sixty-four percent of programmes were located at regional academic medical centers. The majority of programmes (64%) were led by hepatologists. Most programmes (82%) addressed both HBV and HCV, and the remainder focused on HCV only. The median number of participating clinical spoke sites per programme was 22, and most spoke site participants were primary care providers. Most ECHO sessions were held monthly (36%) or bimonthly (27%), with sessions ranging from 45 min to 2 h in length. Programme leaders identified collective learning, empowerment and collaboration to be key strengths of their telementorship programme, while insufficient funding and a lack of protected time for telementorship leaders and participants were identified as major barriers to success. CONCLUSION The Project ECHO model for telementorship can be successfully implemented across high and low-and-middle-income countries to improve provider knowledge and experience in management of viral hepatitis. There is a tremendous opportunity to further expand upon the existing experience with telementorship to support non-specialist healthcare workers and promote elimination of viral hepatitis.
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Affiliation(s)
- Maria A Corcorran
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA.
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington School of Medicine, Harborview Medical Center, 325 9th Ave, Box 359782, Seattle, WA, 98104, USA.
| | - Karla Thornton
- Division of Infectious Diseases, Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
- Project ECHO, University of New Mexico, Albuquerque, NM, USA
| | - Bruce Struminger
- Division of Infectious Diseases, Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
- Project ECHO, University of New Mexico, Albuquerque, NM, USA
| | - Philippa Easterbrook
- Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - John D Scott
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
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Muftah AA, Banala C, Raasikh T, Jamali T, Bustamante G, Cholankeril G, Kanwal F, Flores A, Hernaez R. Telehealth interventions in patients with chronic liver diseases: A systematic review. Hepatology 2023; 78:179-194. [PMID: 36632994 DOI: 10.1097/hep.0000000000000265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 11/17/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND AIM Telehealth interventions may improve access to care, disease-specific, and quality outcomes in chronic liver diseases (CLDs). We aimed to systematically evaluate outcomes of telehealth interventions in CLDs. MATERIALS AND METHODS We used key terms and searched PubMed/EMBASE from inception to January 10, 2022. Two authors independently screened abstracts. Disagreements were resolved by a third reviewer. We included any type of CLD, including posttransplant patients, and extracted outcomes as defined by authors for each etiology of CLD (sustained virological response in HCV or weight loss in NAFLD). Meta-analysis was not performed because of the heterogeneity of data. Quality assessment was performed using the Newcastle-Ottawa Scale for observational studies and the Cochrane Risk of Bias tool for clinical trials. RESULTS Of 4250 studies screened, 43 met the inclusion criteria. Of these, 28 reported HCV treatment outcomes. All studies showed no statistically significant differences between sustained virological response rates in TH groups compared with control groups or historic cohorts. Eight studies evaluating liver transplant-related processes and outcomes demonstrated improved rates of transplant evaluation and referrals and decreased short-term readmission rates. Three randomized controlled trials and 1 observational study on NAFLD showed improved weight loss outcomes. One retrospective study showed reduced mortality risk in CLD patients with at least 1 TH encounter. CONCLUSIONS TH interventions in patients with CLDs consistently show equivalent or improved clinical outcomes compared with traditional encounters. TH in CLDs can bridge the gap in access while maintaining the quality of care for underserved populations.
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Affiliation(s)
- Abdullah A Muftah
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Chaitra Banala
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Taaj Raasikh
- Department of Gastroenterology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Taher Jamali
- Division of Gastroenterology, Henry Ford Hospital, Detroit, Michigan, USA
| | | | - George Cholankeril
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Fasiha Kanwal
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- Section of Gastroenterology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Avegail Flores
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- Section of Gastroenterology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Ruben Hernaez
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- Section of Gastroenterology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
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Mendizabal M, Thompson M, Gonzalez-Ballerga E, Anders M, Castro-Narro GE, Pessoa MG, Cheinquer H, Mezzano G, Palazzo A, Ridruejo E, Descalzi V, Velarde-Ruiz Velasco JA, Marciano S, Muñoz L, Schinoni MI, Poniachik J, Perazzo R, Cerda E, Fuster F, Varon A, Ruiz García S, Soza A, Cabrera C, Gomez-Aldana AJ, Beltrán FDM, Gerona S, Cocozzella D, Bessone F, Hernández N, Alonso C, Ferreiro M, Antinucci F, Torre A, Moutinho BD, Coelho Borges S, Gomez F, Murga MD, Piñero F, Sotera GF, Ocampo JA, Cortés Mollinedo VA, Simian D, Silva MO. Implementation of a re-linkage to care strategy in patients with chronic hepatitis C who were lost to follow-up in Latin America. J Viral Hepat 2023; 30:56-63. [PMID: 36197907 DOI: 10.1111/jvh.13758] [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: 07/18/2022] [Revised: 09/25/2022] [Accepted: 10/02/2022] [Indexed: 12/09/2022]
Abstract
To achieve WHO's goal of eliminating hepatitis C virus (HCV), innovative strategies must be designed to diagnose and treat more patients. Therefore, we aimed to describe an implementation strategy to identify patients with HCV who were lost to follow-up (LTFU) and offer them re-linkage to HCV care. We conducted an implementation study utilizing a strategy to contact patients with HCV who were not under regular follow-up in 13 countries from Latin America. Patients with HCV were identified by the international classification of diseases (ICD-9/10) or equivalent. Medical records were then reviewed to confirm the diagnosis of chronic HCV infection defined by anti-HCV+ and detectable HCV-RNA. Identified patients who were not under follow-up by a liver specialist were contacted by telephone or email, and offered a medical reevaluation. A total of 10,364 patients were classified to have HCV. After reviewing their medical charts, 1349 (13%) had undetectable HCV-RNA or were wrongly coded. Overall, 9015 (86.9%) individuals were identified with chronic HCV infection. A total of 5096 (56.5%) patients were under routine HCV care and 3919 (43.5%) had been LTFU. We were able to contact 1617 (41.3%) of the 3919 patients who were LTFU at the primary medical institution, of which 427 (26.4%) were cured at a different institutions or were dead. Of the remaining patients, 906 (76.1%) were candidates for retrieval. In our cohort, about one out of four patients with chronic HCV who were LTFU were candidates to receive treatment. This strategy has the potential to be effective, accessible and significantly impacts on the HCV care cascade.
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Affiliation(s)
- Manuel Mendizabal
- Unidad de Hígado y Trasplante Hepático, Hospital Universitario Austral, Pilar, Argentina
| | - Marcos Thompson
- Unidad de Hígado y Trasplante Hepático, Hospital Universitario Austral, Pilar, Argentina
| | - Esteban Gonzalez-Ballerga
- Sección Hepatología, Hospital de Clínicas "José de San Martín", Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Margarita Anders
- Unidad de Hepatología y Trasplante Hepático, Hospital Alemán, Buenos Aires, Argentina
| | - Graciela E Castro-Narro
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Ciudad de Mexico, Mexico
| | - Mario G Pessoa
- Divisão de Gastroenterologia e Hepatologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Hugo Cheinquer
- Departamento de Gastroenterología y Hepatología, Universidad Federal do Rio Grande do Sul e do Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Gabriel Mezzano
- Sección de Gastroenterología, Hospital El Salvador, Santiago, Chile
| | - Ana Palazzo
- Servicio de Gastroenterología, Sección de Hepatología, Hospital Padilla, Tucumán, Argentina
| | - Ezequiel Ridruejo
- Sección Hepatología, Departamento de Medicina, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno "CEMIC", Buenos Aires, Argentina
| | - Valeria Descalzi
- Unidad de Hígado y Trasplante Hepático, Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina
| | | | - Sebastian Marciano
- Sección Hepatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Linda Muñoz
- Hospital Universitario "Dr. José E. González", Monterrey, Mexico
| | - Maria I Schinoni
- Núcleo de Hepatología, Hospital Universitario Prof. Edgard Santos, Universidad Federal de Bahia, Salvador, Brazil
| | - Jaime Poniachik
- Sección de Gastroenterología, Departamento de Medicina, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - Rosalía Perazzo
- Unidad de Gastroenterología, Hospital Miguel Perez Carreño, Caracas, Venezuela
| | - Eira Cerda
- Hospital Central Militar, Escuela Militar de Graduados de Sanidad, Ciudad de México, Mexico
| | - Francisco Fuster
- Unidad de Hepatología, Hospital Gustavo Fricke, Viña del Mar, Chile
| | - Adriana Varon
- Fundación Cardioinfantil, Instituto de Cardiología, Bogotá, Colombia
| | | | - Alejandro Soza
- Departamento de Gastroenterología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cecilia Cabrera
- Unidad de Gastroenterología, Hospital Nacional Daniel A. Carrión, Callao, Peru
| | - Andres J Gomez-Aldana
- Unidad de Gastroenterología y Trasplante Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | | | - Solange Gerona
- Unidad de Hígado, Hospital de Fuerzas Armadas, Montevideo, Uruguay
| | | | - Fernando Bessone
- Departamento de Gastroenterología, Facultad de Medicina, Hospital Provincial del Centenario, University of Rosario School of Medicine, Rosario, Argentina
| | - Nelia Hernández
- Clínica de Gastroenterología, Hospital de Clínicas, Facultad de Medicina, UdelaR, Montevideo, Uruguay
| | - Cristina Alonso
- Unidad de Hígado y Trasplante Hepático, Hospital Universitario Austral, Pilar, Argentina
| | - Melina Ferreiro
- Sección Hepatología, Hospital de Clínicas "José de San Martín", Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Florencia Antinucci
- Unidad de Hepatología y Trasplante Hepático, Hospital Alemán, Buenos Aires, Argentina
| | - Aldo Torre
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Ciudad de Mexico, Mexico
| | - Bruna D Moutinho
- Divisão de Gastroenterologia e Hepatologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Fernando Gomez
- Sección de Gastroenterología, Hospital El Salvador, Santiago, Chile
| | - Maria Dolores Murga
- Servicio de Gastroenterología, Sección de Hepatología, Hospital Padilla, Tucumán, Argentina
| | - Federico Piñero
- Unidad de Hígado y Trasplante Hepático, Hospital Universitario Austral, Pilar, Argentina
| | - Gisela F Sotera
- Sección Hepatología, Hospital de Clínicas "José de San Martín", Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Jhonier A Ocampo
- Unidad de Hepatología y Trasplante Hepático, Hospital Alemán, Buenos Aires, Argentina
| | - Valeria A Cortés Mollinedo
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Ciudad de Mexico, Mexico
| | - Daniela Simian
- Sección de Gastroenterología, Departamento de Medicina, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - Marcelo O Silva
- Unidad de Hígado y Trasplante Hepático, Hospital Universitario Austral, Pilar, Argentina
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Facilitating Real-Time, Multidirectional Learning for Clinicians in a Low-Evidence Pandemic Response. Disaster Med Public Health Prep 2022; 17:e246. [PMID: 36128645 DOI: 10.1017/dmp.2022.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
As COVID-19 was declared a health emergency in March 2020, there was immense demand for information about the novel pathogen. This paper examines the clinician-reported impact of Project ECHO COVID-19 Clinical Rounds on clinician learning. Primary sources of study data were Continuing Medical Education (CME) Surveys for each session from the dates of March 24, 2020 to July 30, 2020 and impact surveys conducted in November 2020, which sought to understand participants' overall assessment of sessions. Quantitative analyses included descriptive statistics and Mann-Whitney testing. Qualitative data were analyzed through inductive thematic analysis. Clinicians rated their knowledge after each session as significantly higher than before that session. 75.8% of clinicians reported they would 'definitely' or 'probably' use content gleaned from each attended session and clinicians reported specific clinical and operational changes made as a direct result of sessions. 94.6% of respondents reported that COVID-19 Clinical Rounds helped them provide better care to patients. 89% of respondents indicated they 'strongly agree' that they would join ECHO calls again.COVID-19 Clinical Rounds offers a promising model for the establishment of dynamic peer-to-peer tele-mentoring communities for low or no-notice response where scientifically tested or clinically verified practice evidence is limited.
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Roblero JP, Arab JP, Mezzano G, Mendizabal M. Hepatitis C Virus Infection: What Are We Currently Doing in Latin America About WHO's Proposals for 2030? Clin Liver Dis (Hoboken) 2021; 18:72-75. [PMID: 34584671 PMCID: PMC8450463 DOI: 10.1002/cld.1084] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 12/02/2020] [Accepted: 12/04/2020] [Indexed: 02/04/2023] Open
Affiliation(s)
- Juan Pablo Roblero
- Departamento de Medicina, Sección Gastroenterología, Hospital ClínicoUniversidad de Chile, Escuela de MedicinaUniversidad de ChileSantiagoChile
| | - Juan Pablo Arab
- Departamento de GastroenterologíaEscuela de MedicinaPontificia Universidad Católica de ChileSantiagoChile
- Division of Gastroenterology and HepatologyMayo ClinicRochesterMN
| | - Gabriel Mezzano
- Departamento de Medicina, Sección Gastroenterología, Hospital del Salvador, Escuela de MedicinaUniversidad de Chile, Hospital Clínico Universidad de ChileSantiagoChile
| | - Manuel Mendizabal
- Hepatology and Liver Transplant UnitHospital Universitario AustralPilarArgentina
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Goldberg D, Ross-Driscoll K, Lynch R. County Differences in Liver Mortality in the United States: Impact of Sociodemographics, Disease Risk Factors, and Access to Care. Gastroenterology 2021; 160:1140-1150.e1. [PMID: 33220253 PMCID: PMC8650724 DOI: 10.1053/j.gastro.2020.11.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 11/05/2020] [Accepted: 11/10/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Data have demonstrated state-wide variability in mortality rates from liver disease (cirrhosis + hepatocellular carcinoma), but data are lacking at the local level (eg, county) to identify factors associated with variability in liver disease-related mortality and hotspots of liver disease mortality. METHODS We used Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research data from 2009 to 2018 to calculate county-level, age-adjusted liver disease-related death rates. We fit multivariable linear regression models to adjust for county-level covariates related to demographics (ie, race and ethnicity), medical comorbidities (eg, obesity), access to care (eg, uninsured rate), and geographic (eg, distance to closest liver transplant center) variables. We used optimized hotspot analysis to identify clusters of liver disease mortality hotspots based on the final multivariable models. RESULTS In multivariable models, 61% of the variability in among-county mortality was explained by county-level race/ethnicity, poverty, uninsured rates, distance to the closest transplant center, and local rates of obesity, diabetes, and alcohol use. Despite adjustment, significant within-state variability in county-level mortality rates was found. Of counties in the top fifth percentile (ie, highest mortality) of fully adjusted mortality, 60% were located in 3 states: Oklahoma, Texas, and New Mexico. Adjusted mortality rates were highly spatially correlated, representing 5 clusters: South Florida; Appalachia and the eastern part of the Midwest; Texas and Oklahoma; New Mexico, Arizona, California, and southern Oregon; and parts of Washington and Montana. CONCLUSIONS Our data demonstrate significant intrastate differences in liver disease-related mortality, with more than 60% of the variability explained by patient demographics, clinical risk factors for liver disease, and access to specialty liver care.
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Affiliation(s)
- David Goldberg
- Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida.
| | - Katherine Ross-Driscoll
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia; Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Raymond Lynch
- Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
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Physician awareness of hepatitis C virus among different departments. Clin Exp Hepatol 2021; 6:354-358. [PMID: 33511284 PMCID: PMC7816635 DOI: 10.5114/ceh.2020.102155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/19/2020] [Indexed: 02/02/2023] Open
Abstract
Aim of the study To determine the anti-hepatitis C virus (HCV) positivity in our region and to evaluate physician awareness of HCV among different inpatient and outpatient departments in a tertiary reference center in Turkey. Material and methods This retrospective study was conducted between January 2017 and January 2020. The patients tested for anti-HCV for any reason were enrolled from the data of all patients admitted to our hospital, which is the reference center of the region. Results A total of 121,492 anti-HCV assays were screened from the computerized database. Total number of patients with a positive anti-HCV result was 891 (0.81%). HCV RNA was positive in 147 (16.5%) of 891 patients and negative in 389 (43.7%) patients. Unfortunately HCV RNA was not tested in 355 (39.8%) patients. The percentages of the untested patients regarding the departments were 65.38% (n = 85/130) in medical inpatient clinics, 61.02% (n = 72/118) in surgical clinics, 16.67% (n = 88/528) medical outpatient departments, 96.8% (n = 91/94) in surgical outpatient departments, and 90.5% (n = 19/21) in the emergency department. Conclusions The prevalence of anti-HCV positivity was found to be 0.81% and was stable in Turkey. However, the level of physician awareness for HCV was unsatisfactory, and differed between departments. Because HCV is commonly asymptomatic, positive patients should not be overlooked and adequate treatment should be administered. Awareness of physicians should be increased to prevent delays in the diagnosis of hepatitis C and to reduce the number of untreated patients.
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Mendizabal M, Testa P, Rojas M, Colaci CS, Elías S, Nicolini P, Olguín S, Dunn C, Ronchi C, Barreiro M, Zirpoli M, Piñero F, Arora S, O Flaherty M, Rubinstein F, Silva MO. Pilot study using the ECHO model to enhance linkage to care for patients with hepatitis C in the custodial setting. J Viral Hepat 2020; 27:1430-1436. [PMID: 32813904 DOI: 10.1111/jvh.13374] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/10/2020] [Accepted: 08/11/2020] [Indexed: 12/14/2022]
Abstract
Prisoners in most countries have a higher prevalence of HCV than the general population, but their access to treatment is very limited. Our aim was to evaluate a pilot programme using the ECHO model to enhance linkage to care in patients with HCV in 3 Argentinean prisons between October 2018 and January 2020. All inmates were invited to participate, and data were collected through a personal interview. We then estimated HCV prevalence with dried blood spot and performed a logistic regression analysis to identify risk behaviours associated with HCV infection. Finally, HCV management was assessed and monitored through ECHO. Overall, 1141 inmates agreed to participate, representing 39.7% of the total prison population. Anti-HCV prevalence was estimated at 1.58% (CI 0.93; 2.48), being significantly higher in women 2.98% (CI 1.4;5.6) than in men 1.07% (CI 0.5; 2.0); P = .03. Patients with anti-HCV were significantly older than those who tested negative, 42.3 years (CI 37.6;47.1) vs 30.1 years (CI 30.6;31.2), P < .001, respectively. Multiple logistic regression analysis, identified age OR 1.07 (CI 1.03;1.12, P = .001), history of sexually transmitted disease OR 3.08 (CI 0.97;9.82, P = .057) and intravenous drug use OR 12.6 (CI 3.31;48.53, P < .001) as risk factors associated with anti-HCV. Treatment was initiated in all the patients with specialist physician support utilizing ECHO model. In conclusion, our pilot study reported a low prevalence of anti-HCV in the studied population. Incarceration provides an ideal opportunity for testing and treating HCV. ECHO model arises as a useful tool to support assessment and treatment for inmates with chronic HCV.
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Affiliation(s)
- Manuel Mendizabal
- Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Pilar, Argentina
| | - Pablo Testa
- Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Pilar, Argentina
| | - Mercedes Rojas
- Virology laboratory, Hospital Universitario Austral, Pilar, Argentina
| | - Carla S Colaci
- Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Pilar, Argentina
| | - Solana Elías
- Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Pilar, Argentina
| | - Paula Nicolini
- Servicio Penitenciario Bonaerense, Buenos Aires, Argentina
| | - Soledad Olguín
- Servicio Penitenciario Bonaerense, Buenos Aires, Argentina
| | | | | | - Mariano Barreiro
- Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Pilar, Argentina
| | - Mercedes Zirpoli
- Virology laboratory, Hospital Universitario Austral, Pilar, Argentina
| | - Federico Piñero
- Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Pilar, Argentina
| | - Sanjeev Arora
- Department of Internal Medicine, University of New Mexico, NM, USA
| | - Martín O Flaherty
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | | | - Marcelo O Silva
- Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Pilar, Argentina
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11
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Piñero F, Boin I, Chagas A, Quiñonez E, Marciano S, Vilatobá M, Santos L, Anders M, Hoyos Duque S, Soares Lima A, Menendez J, Padilla M, Poniachik J, Zapata R, Maraschio M, Chong Menéndez R, Muñoz L, Arufe D, Figueroa R, Mendizabal M, Hurtado Gomez S, Stucchi R, Maccali C, Vergara Sandoval R, Bermudez C, McCormack L, Varón A, Gadano A, Mattera J, Rubinstein F, Carrilho F, Silva M. Direct-Acting Antivirals and Hepatocellular Carcinoma: No Evidence of Higher Wait-List Progression or Posttransplant Recurrence. Liver Transpl 2020; 26:640-650. [PMID: 32133773 DOI: 10.1002/lt.25744] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 12/23/2019] [Accepted: 01/19/2020] [Indexed: 12/17/2022]
Abstract
The association between direct-acting antivirals (DAAs) and hepatocellular carcinoma (HCC) wait-list progression or its recurrence following liver transplantation (LT) remains uncertain. We evaluated the impact of DAAs on HCC wait-list progression and post-LT recurrence. This Latin American multicenter retrospective cohort study included HCC patients listed for LT between 2012 and 2018. Patients were grouped according to etiology of liver disease: hepatitis C virus (HCV) negative, HCV+ never treated with DAAs, and HCV+ treated with DAAs either before or after transplantation. Multivariate competing risks models were conducted for both HCC wait-list progression adjusted by a propensity score matching (pre-LT DAA effect) and for post-LT HCC recurrence (pre- or post-LT DAA effect). From 994 included patients, 50.6% were HCV-, 32.9% were HCV+ never treated with DAAs, and 16.5% were HCV+ treated with DAAs either before (n = 66) or after LT (n = 98). Patients treated with DAAs before LT presented similar cumulative incidence of wait-list tumor progression when compared with those patients who were HCV+ without DAAs (26.2% versus 26.9%; P = 0.47) and a similar HCC-related dropout rate (12.1% [95% CI, 0.4%-8.1%] versus 12.9% [95% CI, 3.8%-27.2%]), adjusted for baseline tumor burden, alpha-fetoprotein values, HCC diagnosis after listing, bridging therapies, and by the probability of having received or not received DAAs through propensity score matching (subhazard ratio [SHR], 0.9; 95% CI, 0.6-1.6; P = 0.95). A lower incidence of posttransplant HCC recurrence among HCV+ patients who were treated with pre- or post-LT DAAs was observed (SHR, 0.7%; 95% CI, 0.2%-4.0%). However, this effect was confounded by the time to DAA initiation after LT. In conclusion, in this multicenter cohort, HCV treatment with DAAs did not appear to be associated with an increased wait-list tumor progression and HCC recurrence after LT.
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Affiliation(s)
- Federico Piñero
- Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Buenos Aires, Argentina.,Latin American Liver Research Educational and Awareness Network, Pilar, Argentina
| | - Ilka Boin
- Hospital das Clínicas Universidade Estadual do Campiñas (UNICAMP), Sao Paulo, Brazil
| | - Aline Chagas
- Hospital das Clínicas University of São Paulo School of Medicine, Sao Paulo, Brazil
| | | | | | - Mario Vilatobá
- Instituto de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, México
| | | | | | - Sergio Hoyos Duque
- Hospital Tobón Uribe, Medellín, y Grupo de Gastrohepatología, Universidad de Antioquia, Antioquia, Colombia
| | | | | | | | | | - Rodrigo Zapata
- Clínica Alemana, Facultad de Medicina, Universidad del Desarrollo, Santiago, Chile
| | | | | | - Linda Muñoz
- Hospital Universitario "Dr. José E. González,", Monterrey, Mexico
| | - Diego Arufe
- Sanatorio Sagrado Corazón, Buenos Aires, Argentina
| | | | - Manuel Mendizabal
- Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Buenos Aires, Argentina.,Latin American Liver Research Educational and Awareness Network, Pilar, Argentina
| | - Sahara Hurtado Gomez
- Instituto de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, México
| | - Raquel Stucchi
- Hospital das Clínicas Universidade Estadual do Campiñas (UNICAMP), Sao Paulo, Brazil
| | - Claudia Maccali
- Hospital das Clínicas University of São Paulo School of Medicine, Sao Paulo, Brazil
| | | | - Carla Bermudez
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | | | - Adrián Gadano
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | | | - Flair Carrilho
- Hospital das Clínicas University of São Paulo School of Medicine, Sao Paulo, Brazil
| | - Marcelo Silva
- Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Buenos Aires, Argentina.,Latin American Liver Research Educational and Awareness Network, Pilar, Argentina
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