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C de Andrade JB, Quinn TJ, Carbonera LA, Montanaro VVA, Robles AC, Pádua Gomes R, Ribeiro S, Sampaio Silva G. An automated flowchart for the Modified Rankin Scale assessment: A multicenter inter-rater agreement analysis. Int J Stroke 2024:17474930241246157. [PMID: 38546172 DOI: 10.1177/17474930241246157] [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: 04/19/2024]
Abstract
BACKGROUND AND OBJECTIVE The Modified Rankin Scale (mRS) is a widely adopted scale for assessing stroke recovery. Despite limitations, the mRS has been adopted as primary outcome in most recent clinical acute stroke trials. Designed to be used by multidisciplinary clinical staff, the congruency of this scale is not consistent, which may lead to mistakes in clinical or research application. We aimed to develop and validate an interactive and automated digital tool for assessing the mRS-the iRankin. METHODS A panel of five board-certified and mRS-trained vascular neurologists developed an automated flowchart based on current mRS literature. Two international experts were consulted on content and provided feedback on the prototype platform. The platform contained five vignettes and five real video cases, representing mRS grades 0-5. For validation, we invited neurological staff from six comprehensive stroke centers to complete an online assessment. Participants were randomized into two equal groups usual practice versus iRankin. The participants were randomly allocated in pairs for the congruency analysis. Weighted kappa (kw) and proportions were used to describe agreement. RESULTS A total of 59 professionals completed the assessment. The kw was dramatically improved among nurses, 0.76 (95% confidence interval (CI) = 0.55-0.97) × 0.30 (0.07-0.67), and among vascular neurologists, 0.87 (0.72-1) × 0.82 (0.66-0.98). In the accuracy analysis, after the standard mRS values for the vignettes and videos were determined by a panel of experts, and considering each correct answer as equivalent to 1 point on a scale of 0-15, it revealed a higher mean of 10.6 (±2.2) in the iRankin group and 8.2 (±2.3) points in the control group (p = 0.02). In an adjusted analysis, the iRankin adoption was independently associated with the score of congruencies between reported and standard scores (beta coefficient = 2.22, 95% CI = 0.64-3.81, p = 0.007). CONCLUSION The iRankin adoption led to a substantial or near-perfect agreement in all analyzed professional categories. More trials are needed to generalize our findings. Our user-friendly and free platform is available at https://www.irankinscale.com/.
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Affiliation(s)
- Joao Brainer C de Andrade
- Departments of Health Informatics and Neurology, Universidade Federal de São Paulo, São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
- Bioengineering Laboratory, Aeronautics Institute of Technology (ITA), São Jose dos Campos, Brazil
- Centro Universitário São Camilo, São Paulo, Brazil
| | | | | | | | | | | | | | - Gisele Sampaio Silva
- Departments of Health Informatics and Neurology, Universidade Federal de São Paulo, São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
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Hernandez M, Guarino H, Kozlowski S, Srivastava A, Schenkel R, Tapia T, Seabrook TB, Nash D, Irvine MK. Addressing Mental Health Barriers in HIV Care Coordination Is Crucial to Providing Optimal HIV/AIDS Care. AIDS Patient Care STDS 2024; 38:107-114. [PMID: 38471091 DOI: 10.1089/apc.2023.0240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024] Open
Abstract
For people with HIV (PWH) who have psychological comorbidities, effective management of mental health issues is crucial to achieving and maintaining viral suppression. Care coordination programs (CCPs) have been shown to improve outcomes across the HIV care continuum, but little research has focused on the role of care coordination in supporting the mental health of PWH. This study reports qualitative findings from the Program Refinements to Optimize Model Impact and Scalability based on Evidence (PROMISE) study, which evaluated a revised version of an HIV CCP for Ryan White Part A clients in New York City. Semistructured interviews were conducted with 30 providers and 27 clients from 6 CCP-implementing agencies to elucidate barriers and facilitators of program engagement. Transcripts were analyzed for key themes related to clients' mental health needs and providers' successes and challenges in meeting these needs. Providers and clients agreed that insufficiently managed mental health issues are a common barrier to achieving and maintaining viral suppression. Although the CCP model calls for providers to address clients' unmet mental health needs primarily through screening and referrals to psychiatric and/or psychological care, both clients and providers reported that the routine provision of emotional support is a major part of providers' role that is highly valued by clients. Some concerns raised by providers included insufficient training to address clients' mental health needs and an inability to document the provision of emotional support as a delivered service. These findings suggest the potential value of formally integrating mental health services into HIV care coordination provision. ClinicalTrials.gov protocol number: NCT03628287.
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Affiliation(s)
- Miguel Hernandez
- Institute for Implementation Science in Population Health (ISPH), CUNY Graduate School of Public Health & Health Policy, New York, New York, USA
| | - Honoria Guarino
- Institute for Implementation Science in Population Health (ISPH), CUNY Graduate School of Public Health & Health Policy, New York, New York, USA
| | - Sarah Kozlowski
- Institute for Implementation Science in Population Health (ISPH), CUNY Graduate School of Public Health & Health Policy, New York, New York, USA
| | - Avantika Srivastava
- Institute for Implementation Science in Population Health (ISPH), CUNY Graduate School of Public Health & Health Policy, New York, New York, USA
| | - Rachel Schenkel
- Institute for Implementation Science in Population Health (ISPH), CUNY Graduate School of Public Health & Health Policy, New York, New York, USA
| | - Thamara Tapia
- Institute for Implementation Science in Population Health (ISPH), CUNY Graduate School of Public Health & Health Policy, New York, New York, USA
| | - Tyeirra B Seabrook
- Institute for Implementation Science in Population Health (ISPH), CUNY Graduate School of Public Health & Health Policy, New York, New York, USA
| | - Denis Nash
- Institute for Implementation Science in Population Health (ISPH), CUNY Graduate School of Public Health & Health Policy, New York, New York, USA
| | - Mary K Irvine
- Institute for Implementation Science in Population Health (ISPH), CUNY Graduate School of Public Health & Health Policy, New York, New York, USA
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Mody A, Sohn AH, Iwuji C, Tan RKJ, Venter F, Geng EH. HIV epidemiology, prevention, treatment, and implementation strategies for public health. Lancet 2024; 403:471-492. [PMID: 38043552 DOI: 10.1016/s0140-6736(23)01381-8] [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: 03/06/2023] [Revised: 05/28/2023] [Accepted: 06/29/2023] [Indexed: 12/05/2023]
Abstract
The global HIV response has made tremendous progress but is entering a new phase with additional challenges. Scientific innovations have led to multiple safe, effective, and durable options for treatment and prevention, and long-acting formulations for 2-monthly and 6-monthly dosing are becoming available with even longer dosing intervals possible on the horizon. The scientific agenda for HIV cure and remission strategies is moving forward but faces uncertain thresholds for success and acceptability. Nonetheless, innovations in prevention and treatment have often failed to reach large segments of the global population (eg, key and marginalised populations), and these major disparities in access and uptake at multiple levels have caused progress to fall short of their potential to affect public health. Moving forward, sharper epidemiologic tools based on longitudinal, person-centred data are needed to more accurately characterise remaining gaps and guide continued progress against the HIV epidemic. We should also increase prioritisation of strategies that address socio-behavioural challenges and can lead to effective and equitable implementation of existing interventions with high levels of quality that better match individual needs. We review HIV epidemiologic trends; advances in HIV prevention, treatment, and care delivery; and discuss emerging challenges for ending the HIV epidemic over the next decade that are relevant for general practitioners and others involved in HIV care.
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Affiliation(s)
- Aaloke Mody
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA.
| | - Annette H Sohn
- TREAT Asia, amfAR, The Foundation for AIDS Research, Bangkok, Thailand
| | - Collins Iwuji
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, UK; Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Rayner K J Tan
- University of North Carolina Project-China, Guangzhou, China; Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Francois Venter
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Elvin H Geng
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
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Conte M, Zimba R, Fong C, Carmona J, Gambone G, Robertson M, Kozlowski S, Abdelqader F, Nash D, Irvine M. Client preferences for HIV Care Coordination Program features in New York City: latent class analysis of a discrete choice experiment. J Int AIDS Soc 2023; 26:e26162. [PMID: 37643295 PMCID: PMC10465014 DOI: 10.1002/jia2.26162] [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: 11/23/2022] [Accepted: 08/22/2023] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION The PROMISE study, launched in 2018, evaluates the implementation of revisions to the HIV Care Coordination Program (CCP) designed to minimize persistent disparities in HIV outcomes among high-need persons living with HIV in New York City. We conducted a discrete choice experiment (DCE) assessing the preferences of CCP clients to inform improvements to the program's design. METHODS Clients chose between two hypothetical CCP options that varied across four program attributes: help with antiretroviral therapy (ART) adherence (directly observed therapy [DOT] vs. remind via phone/text vs. adherence assessment), help with primary care appointments (remind and accompany vs. remind and transport vs. remind only), help with issues other than primary care (coverage and benefits vs. housing and food vs. mental health vs. specialty medical care) and visit location (meet at home vs. via phone/video vs. program visit 30 or 60 minutes away). The latent class analysis identified different preference patterns. A choice simulation was performed to model client preferences for hypothetical CCPs as a whole. RESULTS One hundred and eighty-one CCP clients from six sites implementing the revised CCP completed the DCE January 2020-March 2021. Most clients had stable housing (68.5%), reported no problem substance use in the last 3 months (72.4%) and achieved viral suppression (78.5) with only 26.5% receiving DOT within a CCP. 77.3% of responses were obtained before the COVID-19 pandemic. Preferences clustered into three groups. Visit location and ART adherence support were the most important attributes. Group 1 (40%) endorsed telehealth for visit location; telehealth for ART adherence support; and help with securing housing/food; Group 2 (37%) endorsed telehealth for visit location; telehealth for ART adherence support; and staff reminding/arranging appointment transportation; Group 3 (23%) endorsed staff meeting clients at program location and staff working with clients for medication adherence. In the choice simulation, Basic and Medium hypothetical CCPs were endorsed more than Intensive CCPs. CONCLUSIONS This DCE revealed a strong preference for telehealth and a relatively low preference for intensive services, such as DOT and home visits; preferences were heterogeneous. The findings support differentiated care and remote service delivery options in the NYC CCP, and can inform improvements to CCP design.
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Affiliation(s)
- Madellena Conte
- Institute for Implementation Science in Population Health (ISPH)City University of New York (CUNY)New YorkNew YorkUSA
- Zucker School of Medicine at Hofstra/NorthwellHempsteadNew YorkUSA
| | - Rebecca Zimba
- Institute for Implementation Science in Population Health (ISPH)City University of New York (CUNY)New YorkNew YorkUSA
| | - Chunki Fong
- Institute for Implementation Science in Population Health (ISPH)City University of New York (CUNY)New YorkNew YorkUSA
| | - Jennifer Carmona
- New York City Department of Health and Mental Hygiene, Bureau of HepatitisHIV and Sexually Transmitted InfectionsNew YorkNew YorkUSA
| | - Gina Gambone
- New York City Department of Health and Mental Hygiene, Bureau of HepatitisHIV and Sexually Transmitted InfectionsNew YorkNew YorkUSA
| | - McKaylee Robertson
- Institute for Implementation Science in Population Health (ISPH)City University of New York (CUNY)New YorkNew YorkUSA
| | - Sarah Kozlowski
- New York City Department of Health and Mental Hygiene, Bureau of HepatitisHIV and Sexually Transmitted InfectionsNew YorkNew YorkUSA
| | - Faisal Abdelqader
- New York City Department of Health and Mental Hygiene, Bureau of HepatitisHIV and Sexually Transmitted InfectionsNew YorkNew YorkUSA
| | - Denis Nash
- Institute for Implementation Science in Population Health (ISPH)City University of New York (CUNY)New YorkNew YorkUSA
- Department of Epidemiology and BiostatisticsGraduate School of Public Health and Health PolicyCity University of New York (CUNY)New YorkNew YorkUSA
| | - Mary Irvine
- New York City Department of Health and Mental Hygiene, Bureau of HepatitisHIV and Sexually Transmitted InfectionsNew YorkNew YorkUSA
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Movement is Life-Optimizing Patient Access to Total Joint Arthroplasty: HIV and Hepatitis C Disparities. J Am Acad Orthop Surg 2022; 30:1011-1016. [PMID: 34723921 DOI: 10.5435/jaaos-d-21-00427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 09/29/2021] [Indexed: 02/01/2023] Open
Abstract
This article is one of a series focusing on how the preoperative optimization process, if designed for underserved communities, can improve access to care and reduce disparities. In this article, we specifically focus on methods to improve optimization for patients with HIV and hepatitis C to facilitate their access to total joint arthroplasty. 1.2 million Americans are currently living with HIV (people living with HIV). African Americans and Hispanics account for the largest proportion of new HIV diagnoses and make up the highest proportion of people living with HIV. HIV-positive patients, many of them with complex comorbidities, are at a high risk for postoperative complications. Optimization of this vulnerable cohort involves a multidisciplinary strategy focusing on optimizing treatment modalities to reduce viral loads, leading to lower complication rates and a safer environment for the surgical team. The rates of hepatitis C have been increasing in the United States, and more than half of individuals living with hepatitis C are unaware that they are infected. Hepatitis C infections are highest in African Americans, and the rates of chronic hepatitis C are highest in those born outside the United States. Patients with hepatitis C have an increased risk for surgical complications after total joint arthroplasty, and studies have demonstrated that these risks normalize when patients are preoperatively screened and treated. Optimization in these vulnerable groups includes working closely with psychosocial resources, the primary care team, and infectious disease specialists to ensure treatment access and compliance.
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Zimba R, Fong C, Conte M, Baim‐Lance A, Robertson M, Carmona J, Gambone G, Nash D, Irvine M. Provider preferences for delivery of HIV care coordination services: results from a discrete choice experiment. J Int AIDS Soc 2022; 25:e25887. [PMID: 35324055 PMCID: PMC8944220 DOI: 10.1002/jia2.25887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 01/18/2022] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION The PROMISE study was launched in 2018 to assess and document the implementation of changes to an existing HIV Care Coordination Programme (CCP) designed to address persistent disparities in care and treatment engagement among persons with HIV in New York City. We evaluated provider endorsement of features of the CCP to understand drivers of engagement with the programme. METHODS We used a discrete choice experiment to measure provider endorsement of four CCP attributes, including: (1) how CCP helps with medication adherence, (2) how CCP helps with primary care appointments, (3) how CCP helps with issues other than primary care and (4) where CCP visits take place (visit location). Each attribute had three to four levels. Our primary outcomes were relative importance and part-worth utilities, measures of preference for the levels of the four CCP program attributes, estimated using a hierarchical-Bayesian multinomial logit model. All non-medical providers in the core CCP positions of patient navigator, care coordinator and programme director or other administrator from each of the 25 revised CCP-implementing agencies were eligible to participate. RESULTS We received responses from 152 providers, 68% of whom identified as women, 49% identified as Latino/a, 34% identified as Black and 60% were 30-49 years old. Visit location (28.6%, 95% confidence interval [CI] 27.0-30.3%) had the highest relative importance, followed by how staff help with ART adherence (24.3%, 95% CI 22.4-26.1%), how staff help with issues other than primary care (24.2%, 95% CI 22.7-25.7%) and how staff help with primary care appointments (22.9%, 95% CI 21.7-24.1%). Within each of the above attributes, respectively, the levels with the highest part-worth utilities were home visits 60 minutes from the program or agency (utility 19.9, 95% CI 10.7-29.0), directly observed therapy (utility 26.1, 95% CI 19.1-33.1), help with non-HIV specialty medical care (utility 26.5, 95% CI 21.5-31.6) and reminding clients about and accompanying them to primary care appointments (utility 20.8, 95% CI 15.6-26.0). CONCLUSIONS Ongoing CCP refinements should account for how best to support and evaluate the intensive CCP components endorsed by providers in this study.
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Affiliation(s)
- Rebecca Zimba
- Institute for Implementation Science in Population Health (ISPH)City University of New York (CUNY)New YorkUSA
- Department of Epidemiology and BiostatisticsGraduate School of Public Health and Health PolicyCity University of New York (CUNY)New YorkUSA
| | - Chunki Fong
- Institute for Implementation Science in Population Health (ISPH)City University of New York (CUNY)New YorkUSA
| | - Madellena Conte
- Institute for Implementation Science in Population Health (ISPH)City University of New York (CUNY)New YorkUSA
| | - Abigail Baim‐Lance
- Institute for Implementation Science in Population Health (ISPH)City University of New York (CUNY)New YorkUSA
| | - McKaylee Robertson
- Department of Epidemiology and BiostatisticsInstitute for Implementation Science in Population Health (ISPH)City University of New York (CUNY)New YorkUSA
| | - Jennifer Carmona
- Bureau of Hepatitis, HIV and Sexually Transmitted InfectionsNew York City Department of Health and Mental HygieneNew YorkUSA
| | - Gina Gambone
- Bureau of Hepatitis, HIV and Sexually Transmitted InfectionsNew York City Department of Health and Mental HygieneNew YorkUSA
| | - Denis Nash
- Institute for Implementation Science in Population Health (ISPH)City University of New York (CUNY)New YorkUSA
- Department of Epidemiology and BiostatisticsGraduate School of Public Health and Health PolicyCity University of New York (CUNY)New YorkUSA
| | - Mary Irvine
- Bureau of Hepatitis, HIV and Sexually Transmitted InfectionsNew York City Department of Health and Mental HygieneNew YorkUSA
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