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Jepsen P, von Wowern N, Madsen LG, Klausen MK, Düring S, Benthien KS, Winther-Jensen M, Petersen J, Askgaard G. The LIVER CARE trial - screening for liver disease in individuals attending treatment for alcohol use disorder: a randomized controlled feasibility trial. Pilot Feasibility Stud 2024; 10:78. [PMID: 38755732 PMCID: PMC11097510 DOI: 10.1186/s40814-024-01504-5] [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: 02/02/2023] [Accepted: 04/30/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Alcohol-related liver disease is a preventable disease with high mortality. If individuals with alcohol-related liver disease were to be diagnosed earlier by screening and they reduced their alcohol consumption, lives lost to alcohol-related liver disease might be saved. A liver stiffness measurement (FibroScan©) is a key tool to screen for alcohol-related liver disease in asymptomatic individuals. No randomized controlled trials have been conducted to test if screening for liver disease reduces alcohol consumption in individuals with alcohol use disorders, in addition to what can be obtained by motivational interventions. We aimed to assess the feasibility of a randomized controlled trial of a screening for liver disease on the prevalence of alcohol abstinence or light consumption after 6 months in individuals attending outpatient treatment for alcohol use disorder. METHODS We used an interdisciplinary approach to develop the format of the randomized controlled trial. Individuals were recruited from one outpatient treatment facility for alcohol use disorders. Study participants were randomized 1:1 to receive a) a liver stiffness measurement in addition to usual care (intervention) or b) usual care (control). Follow-up on alcohol consumption was assessed by telephone interview after 6 months and corroborated by data from records from public hospitals and the alcohol treatment facility. Feasibility was assessed by probabilities of recruitment, retention, and completion and estimated by the exact binominal test, with success defined as > 50% participation for each endpoint. The study design was evaluated at interdisciplinary meetings with staff and researchers from the outpatient alcohol treatment facility and the hospital clinic. RESULTS Forty of 57 invited individuals agreed to participate in the study (recruitment = 70% (95% CI: 57-82)); 19 of 20 participants randomized to the intervention showed up for the screening (retention = 95% (95% CI: 75-100)). Follow-up telephone interviews succeeded for 33 of 39 reachable participants (completion = 85% (95% CI: 69-94)). Treatment records indicated that the 6 participants who were lost to follow-up for the telephone interview had not achieved alcohol abstinence or light consumption. There was no evidence that the intervention increased abstinence or light alcohol consumption at follow-up: 45% (95% CI: 23-68) in the intervention group and 65% (95% CI: 41-85) in the control group had a alcohol consumption below 10 standard drinks/week at 6 months. The main obstacle regarding study feasibility was to avoid disappointment in individuals randomized as controls. CONCLUSIONS This feasibility study developed a study design to test the influence of screening for liver disease on abstinence or light alcohol consumption in individuals attending treatment for alcohol use disorder. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT05244720; registered on February 17, 2022.
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Affiliation(s)
- Peter Jepsen
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Natasja von Wowern
- Department of Medicine, Section of Gastroenterology and Hepatology, Zealand University Hospital, Køge, Denmark
| | - Lone Galmstrup Madsen
- Department of Medicine, Section of Gastroenterology and Hepatology, Zealand University Hospital, Køge, Denmark
- Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mette Kruse Klausen
- Novavi Alcohol Treatment Center Køge, Køge, Denmark
- Psychiatric Center Copenhagen, Frederiksberg University Hospital, Copenhagen, Denmark
| | - Signe Düring
- Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Novavi Alcohol Treatment Center Køge, Køge, Denmark
| | | | - Matilde Winther-Jensen
- Department of Data, Biostatistics and Pharmacoepidemiology, Center for Clinical Research and Prevention, Frederiksberg University Hospital, Copenhagen, Denmark
| | - Janne Petersen
- Department of Data, Biostatistics and Pharmacoepidemiology, Center for Clinical Research and Prevention, Frederiksberg University Hospital, Copenhagen, Denmark
- Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Gro Askgaard
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.
- Department of Medicine, Section of Gastroenterology and Hepatology, Zealand University Hospital, Køge, Denmark.
- Department of Data, Biostatistics and Pharmacoepidemiology, Center for Clinical Research and Prevention, Frederiksberg University Hospital, Copenhagen, Denmark.
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Buczkowski A, Craig W, Holmes R, Allen D, Longnecker L, Kondrad M, Carr A, Turchi R, Gage S, Osorio SN, Cooperberg D, Mallory L. Factors Correlated With Successful Pediatric Post-Discharge Phone Call Attempt and Connection. Hosp Pediatr 2023; 13:47-54. [PMID: 36514893 DOI: 10.1542/hpeds.2022-006675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Postdischarge phone calls can identify discharge errors and gather information following hospital-to-home transitions. This study used the multisite Project IMPACT (Improving Pediatric Patient Centered Care Transitions) dataset to identify factors associated with postdischarge phone call attempt and connectivity. METHODS This study included 0- to 18-year-old patients discharged from 4 sites between January 2014 and December 2017. We compared demographic and clinical factors between postdischarge call attempt and no-attempt and connectivity and no-connectivity subgroups and used mixed model logistic regression to identify significant independent predictors of call attempt and connectivity. RESULTS Postdischarge calls were attempted for 5528 of 7725 (71.6%) discharges with successful connection for 3801 of 5528 (68.8%) calls. Connection rates varied significantly among sites (52% to 79%, P < .001). Age less than 30 days (P = .03; P = .01) and age 1 to 6 years (P = .04; P = .04) were independent positive predictors for both call attempt and connectivity, whereas English as preferred language (P < .001) and the chronic noncomplex clinical risk group (P = .02) were independent positive predictors for call attempt and connectivity, respectively. In contrast, readmission within 3 days (P = .004) and federal or state payor (P = .02) were negative independent predictors for call attempt and call connectivity, respectively. CONCLUSIONS This study suggests that targeted interventions may improve postdischarge call attempt rates, such as investment in a reliable call model or improvement in interpreter use, and connectivity, such as enhanced population-based communication.
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Affiliation(s)
- Amy Buczkowski
- Department of Pediatrics, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine
| | - Wendy Craig
- Maine Medical Center Research Institute, Scarborough, Maine
| | - Rebekah Holmes
- Midwestern University - Chicago College of Osteopathic Medicine, Downers Grove, Illinois
| | - Dannielle Allen
- University of New England College of Osteopathic Medicine, Biddeford, Maine
| | - Lee Longnecker
- Department of Pediatrics, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine
| | - Monica Kondrad
- Department of Pediatrics, Drexel University College of Medicine, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania
| | - Ann Carr
- Department of Pediatrics, Drexel University College of Medicine, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania
| | - Renee Turchi
- Department of Pediatrics, Drexel University College of Medicine, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania
| | - Sandra Gage
- Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix Children's Hospital, Phoenix, Arizona
| | - Snezana Nena Osorio
- Department of Pediatrics, Weill Cornell Medicine, Komansky Children's Hospital, New York Presbyterian Hospital, New York, New York
| | - David Cooperberg
- Department of Pediatrics, Drexel University College of Medicine, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania
| | - Leah Mallory
- Department of Pediatrics, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine
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Wells JM, Galarneau JM, Minich NM, Cohen DM, Clinton K, Taylor HG, Bigler ED, Bacevice A, Mihalov LK, Bangert BA, Zumberge NA, Yeates KO. Social determinants of participant recruitment and retention in a prospective cohort study of pediatric mild traumatic brain injury. Front Neurol 2022; 13:961024. [PMID: 36176559 PMCID: PMC9513452 DOI: 10.3389/fneur.2022.961024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/23/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPrior studies have shown poor recruitment and retention of minoritized groups in clinical trials.ObjectiveTo examine several social determinants as predictors of consent to participate and retention as part of a prospective, longitudinal cohort study of children 8–16 with either mild traumatic brain injury (mild TBI) or orthopedic injury (OI).MethodsChildren and families were recruited during acute visits to emergency departments (ED) in two large children's hospitals in the midwestern United States for a prospective, longitudinal cohort study of children 8–16 with either mild TBI or OI.ResultsA total of 588 (mild TBI = 307; OI = 281) eligible children were approached in the ED and 315 (mild TBI = 195; OI = 120) were consented. Children who consented did not differ significantly from those who did not consent in sex or age. Consent rates were higher among Black (60.9%) and multi-racial (76.3%) children than white (45.3%) children. Among the 315 children who consented, 217 returned for a post-acute assessment (mild TBI = 143; OI = 74), a retention rate of 68.9%. Participants who were multi-racial (96.6%) or white (79.8%) were more likely to return for the post-acute visit than those who were Black (54.3%).ConclusionsRacial differences exist in both recruitment and retention of participants in a prospective, longitudinal cohort of children with mild TBI or OI. Further work is needed to understand these differences to ensure equitable participation of minoritized groups in brain injury research.
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Affiliation(s)
- Jordee M. Wells
- Department of Pediatrics, Abigail Wexner Research Institute at Nationwide Children's Hospital, The Ohio State University, Columbus, OH, United States
- *Correspondence: Jordee M. Wells
| | - Jean-Michel Galarneau
- Department of Psychology, Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Nori M. Minich
- Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH, United States
| | - Daniel M. Cohen
- Department of Pediatrics, Abigail Wexner Research Institute at Nationwide Children's Hospital, The Ohio State University, Columbus, OH, United States
| | - Kameron Clinton
- Department of Pediatrics, Abigail Wexner Research Institute at Nationwide Children's Hospital, The Ohio State University, Columbus, OH, United States
| | - H. Gerry Taylor
- Department of Pediatrics, Abigail Wexner Research Institute at Nationwide Children's Hospital, The Ohio State University, Columbus, OH, United States
| | - Erin D. Bigler
- Department of Psychology and Neuroscience Center, Brigham Young University, Provo, UT, United States
| | - Ann Bacevice
- Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH, United States
| | - Leslie K. Mihalov
- Department of Pediatrics, Abigail Wexner Research Institute at Nationwide Children's Hospital, The Ohio State University, Columbus, OH, United States
| | - Barbara A. Bangert
- Departments of Radiology and Neurosurgery, University Hospitals Health System, Cleveland, OH, United States
| | - Nicholas A. Zumberge
- Department of Radiology, Nationwide Children's Hospital, Columbus, OH, United States
| | - Keith Owen Yeates
- Department of Psychology, Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
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Gray WN, Wagoner ST, Schaefer MR, Reed B, Morgan P, Holbrook E, Yacyshyn B, Mackner L, Young M, Maddux M, Saeed SA, Denson LA, Hommel K. Transition to Adult IBD Care: A Pilot Multi-Site, Telehealth Hybrid Intervention. J Pediatr Psychol 2021; 46:1-11. [PMID: 33236097 DOI: 10.1093/jpepsy/jsaa088] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 09/01/2020] [Accepted: 09/01/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Transition to adult IBD care continues to be a challenge. Efficacious models of improving transition to adult care in the United States are lacking. We present data from a pilot, prospective, non-randomized, intervention implemented at IBD centers in the Midwest and Southeast United States. DESIGN AND METHODS Adolescents and young adults (AYAs; 16-20 years) with IBD and their parents completed a 4- to 5-month transition program (1 in-person group session; 4 individual telehealth sessions). Primary outcomes were feasibility (i.e., recruitment, retention, fidelity) and acceptability (i.e., program satisfaction). Secondary outcomes were changes in transition readiness, self-management skill acquisition, perceived readiness to transfer to adult care, and disease knowledge. RESULTS The study exceeded goals for recruitment (target N = 20; actual: 36) and retention (target: 80%; actual: 86.11%). On average, it took participants 20.91 ± 3.15 weeks to complete our 4- to 5-month intervention and there were no deviations from the study protocol. Participant ratings for overall program satisfaction, perceived helpfulness, and program length and format were positive. Increases in transition readiness, t(30) = 8.30, d = 1.49, p < .001, self-management skill acquisition, t(30) = 3.93, d = 0.70, p < .001, and disease knowledge, t(30) = 8.20, d = 1.58, p < .001 were noted. AYA- and parent-perceived transfer readiness also improved (p's < .05; d's = 0.76-1.68). CONCLUSIONS This article presents feasibility and acceptability data for a 4- to 5-month transition intervention. Improvements in AYA transition readiness, self-management skill acquisition, IBD knowledge, and AYA/parent perceived transfer readiness were also observed.
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Affiliation(s)
- Wendy N Gray
- Department of Psychology, Auburn University.,Department of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center
| | | | | | - Bonney Reed
- Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine
| | - Pamela Morgan
- Department of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center
| | - Erin Holbrook
- Department of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center
| | - Bruce Yacyshyn
- Department of Internal Medicine, University of Cincinnati College of Medicine
| | - Laura Mackner
- Division of Pediatric Psychology and Neuropsychology, Nationwide Children's Hospital, Department of Pediatrics, Center for Biobehavioral Health, The Ohio State University
| | | | - Michele Maddux
- Division of Developmental and Behavioral Sciences/Division of Gastroenterology, Department of Pediatrics, Children's Mercy-Kansas City, University of Missouri-Kansas City School of Medicine
| | - Shehzad A Saeed
- Department of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center
| | - Lee A Denson
- Department of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center
| | - Kevin Hommel
- Department of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center
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Sood BG, Thomas R, Delaney-Black V, Xin Y, Sharma A, Chen X. Aerosolized Beractant in neonatal respiratory distress syndrome: A randomized fixed-dose parallel-arm phase II trial. Pulm Pharmacol Ther 2020; 66:101986. [PMID: 33338661 DOI: 10.1016/j.pupt.2020.101986] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 11/02/2020] [Accepted: 12/09/2020] [Indexed: 01/01/2023]
Abstract
PURPOSE There is increasing research into novel techniques of administering surfactant to preterm infants (PTIs) with respiratory distress syndrome (RDS) receiving non-invasive respiratory support (NIRS). Although aerosolized surfactant (AS) is promising in PTIs receiving NIRS, the optimal surfactant dose and formulation, drug-device combination and patient profile is not known. The objective of this randomized clinical trial was to investigate the feasibility, safety, efficacy and impact of four dosing schedules of AS using two nebulizers in PTIs with RDS stratified by gestational age (GA). METHODS PTIs with RDS receiving pre-defined NIRS for ≤8 h were assigned to 4 A S dosing schedules and 2 nebulizers within three GA strata (I = 240/7-286/7, II = 290/7-326/7, III = 330/7-366/7 weeks). There was no contemporaneous control group; at the recommendation of the Data Monitoring Committee, data was collected retrospectively for control infants. RESULTS Of 149 subjects that received AS, the median age at initiation of the 1st dose and duration was 5.5 and 2.4 h respectively. There were 29 infants in stratum I, and 60 each in strata II and III. Of infants <32 weeks GA, 94% received caffeine prior to AS. Fifteen infants (10%) required intubation within 72 h; the rates were not significantly different between GA strata, dosing schedules and nebulizers for infants who received aerosolized surfactant. Compared to retrospective controls, infants who received AS were less likely to need intubation within 72 h in both the intention-to-treat (32% vs. 11%) and the per-protocol (22% vs. 10%) analyses (p < 0.05) with GA stratum specific differences. AS was well tolerated by infants and clinical caregivers. Commonest adverse events included surfactant reflux from nose and mouth (18%), desaturations (11%), and increased secretions (7%). CONCLUSIONS We have demonstrated the feasibility, absence of serious adverse events and short-term efficacy of four dosing schedules of AS in the largest Phase II clinical trial of PTIs 24-36 weeks' GA with RDS receiving NIRS (ClinicalTrials.gov NCT02294630). The commonest adverse events noted were surfactant reflux and desaturations; no serious adverse effects were observed. Infants who received AS were less likely to receive intubation within 72 h compared to historical controls. AS is a promising new therapy for PTIs with RDS.
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Affiliation(s)
- Beena G Sood
- Department of Pediatrics, Wayne State University School of Medicine, 540 E Canfield St, Detroit, MI, 48201, USA.
| | - Ronald Thomas
- Department of Pediatrics, Wayne State University School of Medicine, 540 E Canfield St, Detroit, MI, 48201, USA
| | - Virginia Delaney-Black
- Department of Pediatrics, Wayne State University School of Medicine, 540 E Canfield St, Detroit, MI, 48201, USA
| | - Yuemin Xin
- Department of Pediatrics, Wayne State University School of Medicine, 540 E Canfield St, Detroit, MI, 48201, USA
| | - Amit Sharma
- Department of Pediatrics, Wayne State University School of Medicine, 540 E Canfield St, Detroit, MI, 48201, USA
| | - Xinguang Chen
- Department of Epidemiology, University of Florida College of Medicine, 665 W 8th Street, Jacksonville, FL, 32209, USA
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Lonhart JA, Edwards AR, Agarwal S, Lucas BP, Schroeder AR. Consent Rates Reported in Published Pediatric Randomized Controlled Trials. J Pediatr 2020; 227:281-287. [PMID: 32599033 DOI: 10.1016/j.jpeds.2020.06.058] [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: 03/18/2020] [Revised: 05/19/2020] [Accepted: 06/19/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To determine the average reported consent rate for published pediatric randomized controlled trials (RCTs) and whether this rate varies by trial characteristics. STUDY DESIGN A review of pediatric RCTs published in Medline in 2009, 2010, or 2015 was performed. Secondary analyses of prior trials, trials including adults, trials not requiring consent, or trials with missing or unclear consent data were excluded. Consent rate was defined as the number of patients enrolled divided by number of eligible patients where families were approached. Random effects meta-regression was conducted to determine the weighted average consent rate. RESULTS Of 2347 trials identified, 1651 were excluded. An additional 418 of 696 (60%) were excluded because the consent rate was missing or unclear. The average consent rate for 278 included RCTs was 82.6% (95% CI, 80.3%-84.8%) and was higher for vaccination compared with behavioral trials and for industry-funded compared with National Institutes of Health-funded or other government-funded trials. The average consent rate was <70% for 26% of included trials. Of these trials, US trials (28/77 [36.4%]) had a higher probability of a consent rate of <70% than non-US studies (35/64 [21.3%]) and multinational (9/37 [24.3%]) studies. There was slight variation by funding category. CONCLUSIONS Although the average consent rate for published trials was reasonably high, approximately one-quarter of trials had consent rates of <70%. Consent rates reporting has improved over time, but remains suboptimal. Our findings should assist with the planning of future pediatric RCTs, although consent data from unpublished trials are also needed.
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Affiliation(s)
| | | | - Swati Agarwal
- Department of Pediatrics, Inova Children's Hospital, Falls Church, VA
| | - Brian P Lucas
- The Dartmouth Institute of Health Policy & Clinical Practice, Hanover, NH
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Bhatnagar S, Hoberman A, Kurs-Lasky M, Kearney DH, Haralam MA, Nagg J, Shaikh N. An innovative recruitment strategy in a pediatric clinical trial. Clin Trials 2020; 17:338-340. [PMID: 32114798 DOI: 10.1177/1740774520910396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sonika Bhatnagar
- Department of Pediatrics, Division of General Academic Pediatrics, UPMC Children's Hospital of Pittsburgh, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Alejandro Hoberman
- Department of Pediatrics, Division of General Academic Pediatrics, UPMC Children's Hospital of Pittsburgh, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Marcia Kurs-Lasky
- Department of Pediatrics, Division of General Academic Pediatrics, UPMC Children's Hospital of Pittsburgh, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Diana H Kearney
- Department of Pediatrics, Division of General Academic Pediatrics, UPMC Children's Hospital of Pittsburgh, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mary Ann Haralam
- Department of Pediatrics, Division of General Academic Pediatrics, UPMC Children's Hospital of Pittsburgh, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jennifer Nagg
- Department of Pediatrics, Division of General Academic Pediatrics, UPMC Children's Hospital of Pittsburgh, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nader Shaikh
- Department of Pediatrics, Division of General Academic Pediatrics, UPMC Children's Hospital of Pittsburgh, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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Devoe C, Gabbidon H, Schussler N, Cortese L, Caplan E, Gorman C, Jethwani K, Kvedar J, Agboola S. Use of Electronic Health Records to Develop and Implement a Silent Best Practice Alert Notification System for Patient Recruitment in Clinical Research: Quality Improvement Initiative. JMIR Med Inform 2019; 7:e10020. [PMID: 31025947 PMCID: PMC6658304 DOI: 10.2196/10020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 09/04/2018] [Accepted: 12/31/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Participant recruitment, especially for frail, elderly, hospitalized patients, remains one of the greatest challenges for many research groups. Traditional recruitment methods such as chart reviews are often inefficient, low-yielding, time consuming, and expensive. Best Practice Alert (BPA) systems have previously been used to improve clinical care and inform provider decision making, but the system has not been widely used in the setting of clinical research. OBJECTIVE The primary objective of this quality-improvement initiative was to develop, implement, and refine a silent Best Practice Alert (sBPA) system that could maximize recruitment efficiency. METHODS The captured duration of the screening sessions for both methods combined with the allotted research coordinator hours in the Emerald-COPD (chronic obstructive pulmonary disease) study budget enabled research coordinators to estimate the cost-efficiency. RESULTS Prior to implementation, the sBPA system underwent three primary stages of development. Ultimately, the final iteration produced a system that provided similar results as the manual Epic Reporting Workbench method of screening. A total of 559 potential participants who met the basic prescreen criteria were identified through the two screening methods. Of those, 418 potential participants were identified by both methods simultaneously, 99 were identified only by the Epic Reporting Workbench Method, and 42 were identified only by the sBPA method. Of those identified by the Epic Reporting Workbench, only 12 (of 99, 12.12%) were considered eligible. Of those identified by the sBPA method, 30 (of 42, 71.43%) were considered eligible. Using a side-by-side comparison of the sBPA and the traditional Epic Reporting Workbench method of screening, the sBPA screening method was shown to be approximately four times faster than our previous screening method and estimated a projected 442.5 hours saved over the duration of the study. Additionally, since implementation, the sBPA system identified the equivalent of three additional potential participants per week. CONCLUSIONS Automation of the recruitment process allowed us to identify potential participants in real time and find more potential participants who meet basic eligibility criteria. sBPA screening is a considerably faster method that allows for more efficient use of resources. This innovative and instrumental functionality can be modified to the needs of other research studies aiming to use the electronic medical records system for participant recruitment.
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Affiliation(s)
- Connor Devoe
- Partners HealthCare Pivot Labs, Partners HealthCare, Boston, MA, United States
| | - Harriett Gabbidon
- Partners HealthCare Pivot Labs, Partners HealthCare, Boston, MA, United States
| | - Nina Schussler
- Partners HealthCare Pivot Labs, Partners HealthCare, Boston, MA, United States
| | - Lauren Cortese
- Partners HealthCare Pivot Labs, Partners HealthCare, Boston, MA, United States
| | - Emily Caplan
- Partners HealthCare Pivot Labs, Partners HealthCare, Boston, MA, United States
| | - Colin Gorman
- Partners HealthCare Pivot Labs, Partners HealthCare, Boston, MA, United States
| | - Kamal Jethwani
- Partners HealthCare Pivot Labs, Partners HealthCare, Boston, MA, United States.,Harvard Medical School, Harvard University, Boston, MA, United States.,Massachusetts General Hospital, Boston, MA, United States
| | - Joseph Kvedar
- Partners HealthCare Pivot Labs, Partners HealthCare, Boston, MA, United States.,Harvard Medical School, Harvard University, Boston, MA, United States.,Massachusetts General Hospital, Boston, MA, United States
| | - Stephen Agboola
- Partners HealthCare Pivot Labs, Partners HealthCare, Boston, MA, United States.,Harvard Medical School, Harvard University, Boston, MA, United States.,Massachusetts General Hospital, Boston, MA, United States
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Chan S, Babcock L, Geis G, Frey M, Robinson V, Kerrey B. In Situ Simulation to Mitigate Threats to Participation in a Multicenter Clinical Trial in High-Acuity, Low-Frequency Setting. Simul Healthc 2019; 14:1-9. [PMID: 30216275 PMCID: PMC6358461 DOI: 10.1097/sih.0000000000000328] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Multicenter clinical trials of high-acuity, low-frequency emergencies are expensive and resource intensive. Current standards for trial preparation have significant limitations. Our objective is to describe our use of in situ simulation (ISS) to identify and mitigate threats to enrollment, protocol adherence, and patient safety in preparation for a multicenter clinical trial of antiepileptics for status epilepticus in the emergency department. METHODS This is a descriptive study of ISS conducted in the emergency department at a free-standing, academic pediatric institution. We designed two scenarios, one for an eligible and ineligible patient, to allow care teams to complete all study procedures. All study training was completed before the first ISS. Participants included physicians, nurses, patient care assistants, paramedics, research coordinators, and pharmacists. Ten-minute simulations were followed by 10-minute debriefings, led by trained facilitators using a standard template. Data on threats to enrollment, protocol adherence, and patient safety were recorded. Mitigation strategies were developed by the study team and local experts in ISS. RESULTS Ten of 18 planned simulations were conducted. Seven of 10 completed simulations were study eligible patients, with 73 total participants. Nine threats to enrollment and five to protocol adherence were identified. Five of 14 were also threats to patient safety. Mitigation strategies included creation of decision aid tools, targeted education during debriefings, adapting study material for use, and revision of status epilepticus treatment algorithm. CONCLUSIONS The addition of ISS to standard preparation for a multicenter clinical trial facilitated the identification and mitigation of threats to study participation and patient safety.
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Affiliation(s)
- Steven Chan
- From the Division of Emergency Medicine, University of Cincinnati, College of Medicine (S.C., L.B., G.G., M.F., B.K.), Cincinnati Children's Hospital Medical Center, Cincinnati; and Quality Improvement Services (V.R.), Nationwide Children's Hospital, Columbus, OH
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Auger KA, Shah SS, Tubbs-Cooley HL, Sucharew HJ, Gold JM, Wade-Murphy S, Statile AM, Bell KD, Khoury JC, Mangeot C, Simmons JM. Effects of a 1-Time Nurse-Led Telephone Call After Pediatric Discharge: The H2O II Randomized Clinical Trial. JAMA Pediatr 2018; 172:e181482. [PMID: 30039161 PMCID: PMC6143054 DOI: 10.1001/jamapediatrics.2018.1482] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 04/21/2018] [Indexed: 11/14/2022]
Abstract
Importance Families often struggle after discharge of a child from the hospital. Postdischarge challenges can lead to increased use of urgent health care services. Objective To determine whether a single nurse-led telephone call after pediatric discharge decreased the 30-day reutilization rate for urgent care services and enhanced overall transition success. Design, Setting, and Participants This Hospital-to-Home Outcomes (H2O) randomized clinical trial included 966 children and adolescents younger than 18 years (hereinafter referred to as children) admitted to general medicine services at a free-standing tertiary care children's hospital from May 11 through October 31, 2016. Data were analyzed as intention to treat and per protocol. Interventions A postdischarge telephone call within 4 days of discharge compared with standard discharge. Main Outcomes and Measures The primary outcome was the 30-day reutilization rate for urgent health care services (ie, unplanned readmission, emergency department visit, or urgent care visit). Secondary outcomes included additional utilization measures, as well as parent coping, return to normalcy, and understanding of clinical warning signs measured at 14 days. Results A total of 966 children were enrolled and randomized (52.3% boys; median age [interquartile range], 2.4 years [0.5-7.8 years]). Of 483 children randomized to the intervention, the nurse telephone call was completed for 442 (91.5%). Children in the intervention and control arms had similar reutilization rates for 30-day urgent health care services (intervention group, 77 [15.9%]; control group, 63 [13.1%]; P = .21). Parents of children in the intervention group recalled more clinical warning signs at 14 days (mean, 1.8 [95% CI, 1.7-2.0] in the intervention group; 1.5 [95% CI, 1.4-1.6] in the control group; ratio of intervention to control, 1.2 [95% CI, 1.1-1.3]). Conclusions and Relevance Although postdischarge nurse contact did not decrease the reutilization rate of postdischarge urgent health care services, this method shows promise to bolster postdischarge education. Trial Registration ClinicalTrials.gov Identifier: NCT02081846.
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Affiliation(s)
- Katherine A. Auger
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- James M. Anderson Center for Health System Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
| | - Samir S. Shah
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- James M. Anderson Center for Health System Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
| | - Heather L. Tubbs-Cooley
- Department of Patient Services, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- College of Nursing, Ohio State University, Columbus
| | - Heidi J. Sucharew
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Jennifer M. Gold
- Department of Patient Services, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Susan Wade-Murphy
- Department of Patient Services, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Angela M. Statile
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
| | - Kathleen D. Bell
- Northeast Node of the National Drug Abuse Clinical Trials Network, Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire
| | - Jane C. Khoury
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Colleen Mangeot
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Jeffrey M. Simmons
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- James M. Anderson Center for Health System Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
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Auger KA, Simmons JM, Tubbs-Cooley HL, Sucharew HJ, Statile AM, Pickler RH, Sauers-Ford HS, Gold JM, Khoury JC, Beck AF, Wade-Murphy S, Kuhnell P, Shah SS. Postdischarge Nurse Home Visits and Reuse: The Hospital to Home Outcomes (H2O) Trial. Pediatrics 2018; 142:peds.2017-3919. [PMID: 29934295 DOI: 10.1542/peds.2017-3919] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/03/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Hospital discharge is stressful for children and families. Poor transitional care is linked to unplanned health care reuse. We evaluated the effects of a pediatric transition intervention, specifically a single nurse home visit, on postdischarge outcomes in a randomized controlled trial. METHODS We randomly assigned 1500 children hospitalized on hospital medicine, neurology services, or neurosurgery services to receive either a single postdischarge nurse-led home visit or no visit. We excluded children discharged with skilled home nursing services. Primary outcomes included 30-day unplanned, urgent health care reuse (composite measure of unplanned readmission, emergency department, or urgent care visit). Secondary outcomes, measured at 14 days, included postdischarge parental coping, number of days until parent-reported return to normal routine, and number of "red flags" or clinical warning signs a parent or caregiver could recall. RESULTS The 30-day reuse rate was 17.8% in the intervention group and 14.0% in the control group. In the intention-to-treat analysis, children randomly assigned to the intervention group had higher odds of 30-day health care use (odds ratio: 1.33; 95% confidence interval: 1.003-1.76). In the per protocol analysis, there were no differences in 30-day health care use (odds ratio: 1.14; confidence interval: 0.84-1.55). Postdischarge coping scores and number of days until returning to a normal routine were similar between groups. Parents in the intervention group recalled more red flags at 14 days (mean: 1.9 vs 1.6; P < .01). CONCLUSIONS Children randomly assigned to the intervention had higher rates of 30-day postdischarge unplanned health care reuse. Parents in the intervention group recalled more clinical warning signs 2 weeks after discharge.
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Affiliation(s)
- Katherine A Auger
- Divisions of Hospital Medicine.,James M. Anderson Center for Health System Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jeffrey M Simmons
- Divisions of Hospital Medicine.,James M. Anderson Center for Health System Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Heidi J Sucharew
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Biostatistics and Epidemiology, and
| | - Angela M Statile
- Divisions of Hospital Medicine.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Hadley S Sauers-Ford
- Department of Pediatrics, University of California Davis Health, Sacramento, California
| | | | - Jane C Khoury
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Biostatistics and Epidemiology, and
| | - Andrew F Beck
- Divisions of Hospital Medicine.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.,General Pediatrics
| | | | | | - Samir S Shah
- Divisions of Hospital Medicine.,James M. Anderson Center for Health System Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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