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Reeve BK, Dennis BB, Dechert W, Longo B, Heels-Ansdell D, Scholes A, Clarke FJ, Arthur JRK, Cook DJ. Community implementation of the 3 Wishes Project: an observational study of a compassionate end-of-life care initiative for critically ill patients. CMAJ Open 2021; 9:E757-E764. [PMID: 34285055 PMCID: PMC8313093 DOI: 10.9778/cmajo.20200273] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The 3 Wishes Project (3WP) promotes a personalized dying experience by eliciting and facilitating individualized terminal wishes for patients, families and the clinicians caring for them. We aimed to evaluate the adaptability of the 3WP to a community intensive care unit (ICU), and to describe the patients cared for with this palliative approach, as well as local implementation strategies. METHODS The 3WP was implemented in a 15-bed community hospital ICU in southern Ontario from 2017 to 2019. In this observational, descriptive study, we invited adult patients (≥ 18 yr) whose risk of death was deemed to be 95% or greater by the attending physician, or patients undergoing withdrawal of life-support to participate. We abstracted patient data from medical records, as well as the type, timing and cost of each wish, which person or service made and facilitated each wish, and if and why wishes were completed or not. We summarized data both narratively and quantitatively. RESULTS The 3WP helped to realize 479 (99.2%) of 483 terminal wishes for 101 dying patients. This initiative was introduced as an interprofessional intervention and championed by nursing staff who were responsible for most patient enrolment and wish facilitation. Wishes included humanizing the ICU environment for the patient with belongings and blankets, musical performances, smudging and bathing ceremonies, and keepsakes. The cost was $5.39 per patient (standard deviation $22.40), with 430 (89.8%) wishes incurring no cost. Wishes made directly by patients accounted for 30 (6.2%) of wishes; those from family members and ICU staff accounted for 236 (48.9%) and 238 (49.3%) of wishes, respectively. The program comforted patients and their loved ones, motivating clinicians to sustain this end-of-life intervention. INTERPRETATION We documented successful implementation of the 3WP in a community hospital, showing program adaptability and uptake outside of academic centres at relatively low cost. The lack of strict protocolization and personalized design of this intervention underscores its inherent flexibility, with potential to promote individualized end-of-life care in nonacademic hospital wards, homes or hospice.
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Affiliation(s)
- Brenda K Reeve
- Department of Critical Care (Reeve, Dechert, Longo, Scholes, Arthur), Brantford General Hospital, Brantford, Ont.; Department of Medicine (Dennis, Cook), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evaluation, and Impact (Dennis, Heels-Ansdell, Clarke, Cook), McMaster University, Hamilton, Ont.; Department of Critical Care (Dechert, Clarke, Cook), St. Joseph's Healthcare Hamilton, Ont
| | - Brittany B Dennis
- Department of Critical Care (Reeve, Dechert, Longo, Scholes, Arthur), Brantford General Hospital, Brantford, Ont.; Department of Medicine (Dennis, Cook), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evaluation, and Impact (Dennis, Heels-Ansdell, Clarke, Cook), McMaster University, Hamilton, Ont.; Department of Critical Care (Dechert, Clarke, Cook), St. Joseph's Healthcare Hamilton, Ont
| | - William Dechert
- Department of Critical Care (Reeve, Dechert, Longo, Scholes, Arthur), Brantford General Hospital, Brantford, Ont.; Department of Medicine (Dennis, Cook), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evaluation, and Impact (Dennis, Heels-Ansdell, Clarke, Cook), McMaster University, Hamilton, Ont.; Department of Critical Care (Dechert, Clarke, Cook), St. Joseph's Healthcare Hamilton, Ont
| | - Barbara Longo
- Department of Critical Care (Reeve, Dechert, Longo, Scholes, Arthur), Brantford General Hospital, Brantford, Ont.; Department of Medicine (Dennis, Cook), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evaluation, and Impact (Dennis, Heels-Ansdell, Clarke, Cook), McMaster University, Hamilton, Ont.; Department of Critical Care (Dechert, Clarke, Cook), St. Joseph's Healthcare Hamilton, Ont
| | - Diane Heels-Ansdell
- Department of Critical Care (Reeve, Dechert, Longo, Scholes, Arthur), Brantford General Hospital, Brantford, Ont.; Department of Medicine (Dennis, Cook), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evaluation, and Impact (Dennis, Heels-Ansdell, Clarke, Cook), McMaster University, Hamilton, Ont.; Department of Critical Care (Dechert, Clarke, Cook), St. Joseph's Healthcare Hamilton, Ont
| | - Alison Scholes
- Department of Critical Care (Reeve, Dechert, Longo, Scholes, Arthur), Brantford General Hospital, Brantford, Ont.; Department of Medicine (Dennis, Cook), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evaluation, and Impact (Dennis, Heels-Ansdell, Clarke, Cook), McMaster University, Hamilton, Ont.; Department of Critical Care (Dechert, Clarke, Cook), St. Joseph's Healthcare Hamilton, Ont
| | - France J Clarke
- Department of Critical Care (Reeve, Dechert, Longo, Scholes, Arthur), Brantford General Hospital, Brantford, Ont.; Department of Medicine (Dennis, Cook), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evaluation, and Impact (Dennis, Heels-Ansdell, Clarke, Cook), McMaster University, Hamilton, Ont.; Department of Critical Care (Dechert, Clarke, Cook), St. Joseph's Healthcare Hamilton, Ont
| | - John R K Arthur
- Department of Critical Care (Reeve, Dechert, Longo, Scholes, Arthur), Brantford General Hospital, Brantford, Ont.; Department of Medicine (Dennis, Cook), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evaluation, and Impact (Dennis, Heels-Ansdell, Clarke, Cook), McMaster University, Hamilton, Ont.; Department of Critical Care (Dechert, Clarke, Cook), St. Joseph's Healthcare Hamilton, Ont
| | - Deborah J Cook
- Department of Critical Care (Reeve, Dechert, Longo, Scholes, Arthur), Brantford General Hospital, Brantford, Ont.; Department of Medicine (Dennis, Cook), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evaluation, and Impact (Dennis, Heels-Ansdell, Clarke, Cook), McMaster University, Hamilton, Ont.; Department of Critical Care (Dechert, Clarke, Cook), St. Joseph's Healthcare Hamilton, Ont.
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Liu J, Gutierrez E, Tiwari A, Padam S, Li D, Dale W, Pal SK, Stewart D, Subbiah S, Bosserman LD, Presant C, Phillips T, Yap K, Hill A, Bhatt G, Yeon C, Cianfrocca M, Yuan Y, Mortimer J, Sedrak MS. Strategies to Improve Participation of Older Adults in Cancer Research. J Clin Med 2020; 9:jcm9051571. [PMID: 32455877 PMCID: PMC7291007 DOI: 10.3390/jcm9051571] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/15/2020] [Accepted: 05/19/2020] [Indexed: 02/02/2023] Open
Abstract
Cancer is a disease associated with aging. As the US population ages, the number of older adults with cancer is projected to dramatically increase. Despite this, older adults remain vastly underrepresented in research that sets the standards for cancer treatments and, consequently, clinicians struggle with how to interpret data from clinical trials and apply them to older adults in practice. A combination of system, clinician, and patient barriers bar opportunities for trial participation for many older patients, and strategies are needed to address these barriers at multiple fronts, five of which are offered here. This review highlights the need to (1) broaden eligibility criteria, (2) measure relevant end points, (3) expand standard trial designs, (4) increase resources (e.g., institutional support, interdisciplinary care, and telehealth), and (5) develop targeted interventions (e.g., behavioral interventions to promote patient enrollment). Implementing these solutions requires a substantial investment in engaging and collaborating with community-based practices, where the majority of older patients with cancer receive their care. Multifaceted strategies are needed to ensure that older patients with cancer, across diverse healthcare settings, receive the highest-quality, evidence-based care.
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Affiliation(s)
- Jennifer Liu
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Eutiquio Gutierrez
- Department of Internal Medicine, Harbor-UCLA Medical Center, Los Angeles, CA 90502, USA;
| | - Abhay Tiwari
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Simran Padam
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Daneng Li
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - William Dale
- Department of Supportive Care Medicine, City of Hope, Duarte, CA 91010, USA;
| | - Sumanta K. Pal
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Daphne Stewart
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Shanmugga Subbiah
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Linda D. Bosserman
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Cary Presant
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Tanyanika Phillips
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Kelly Yap
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Addie Hill
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Geetika Bhatt
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Christina Yeon
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Mary Cianfrocca
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Yuan Yuan
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Joanne Mortimer
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Mina S. Sedrak
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
- Correspondence:
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Gehrke P, Binnie A, Chan SPT, Cook DJ, Burns KEA, Rewa OG, Herridge M, Tsang JLY. Fostering community hospital research. CMAJ 2020; 191:E962-E966. [PMID: 31481424 DOI: 10.1503/cmaj.190055] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Paige Gehrke
- Niagara Health (Gehrke, Tsang), St. Catharines, Ont.; Niagara Regional Campus (Chan, Tsang), Michael G. DeGroote School of Medicine, McMaster University, St. Catharines, Ont.; William Osler Health System (Binnie), Brampton, Ont.; Sturgeon Community Hospital (Rewa), St. Albert, Alta.; University of Alberta Hospital (Rewa), Edmonton, Alta.; Department of Critical Care Medicine (Rewa), University of Alberta, Edmonton, Alta.; University Health Network (Herridge); Department of Medicine (Herridge, Burns), University of Toronto, Toronto, Ont.; St. Joseph's Health Care (Cook), Hamilton, Ont.; Departments of Medicine (Cook, Tsang), and Clinical Epidemiology & Biostatistics (Cook), McMaster University, Hamilton, Ont.; St. Michael's Hospital (Burns), Toronto, Ont
| | - Alexandra Binnie
- Niagara Health (Gehrke, Tsang), St. Catharines, Ont.; Niagara Regional Campus (Chan, Tsang), Michael G. DeGroote School of Medicine, McMaster University, St. Catharines, Ont.; William Osler Health System (Binnie), Brampton, Ont.; Sturgeon Community Hospital (Rewa), St. Albert, Alta.; University of Alberta Hospital (Rewa), Edmonton, Alta.; Department of Critical Care Medicine (Rewa), University of Alberta, Edmonton, Alta.; University Health Network (Herridge); Department of Medicine (Herridge, Burns), University of Toronto, Toronto, Ont.; St. Joseph's Health Care (Cook), Hamilton, Ont.; Departments of Medicine (Cook, Tsang), and Clinical Epidemiology & Biostatistics (Cook), McMaster University, Hamilton, Ont.; St. Michael's Hospital (Burns), Toronto, Ont
| | - Stephanie P T Chan
- Niagara Health (Gehrke, Tsang), St. Catharines, Ont.; Niagara Regional Campus (Chan, Tsang), Michael G. DeGroote School of Medicine, McMaster University, St. Catharines, Ont.; William Osler Health System (Binnie), Brampton, Ont.; Sturgeon Community Hospital (Rewa), St. Albert, Alta.; University of Alberta Hospital (Rewa), Edmonton, Alta.; Department of Critical Care Medicine (Rewa), University of Alberta, Edmonton, Alta.; University Health Network (Herridge); Department of Medicine (Herridge, Burns), University of Toronto, Toronto, Ont.; St. Joseph's Health Care (Cook), Hamilton, Ont.; Departments of Medicine (Cook, Tsang), and Clinical Epidemiology & Biostatistics (Cook), McMaster University, Hamilton, Ont.; St. Michael's Hospital (Burns), Toronto, Ont
| | - Deborah J Cook
- Niagara Health (Gehrke, Tsang), St. Catharines, Ont.; Niagara Regional Campus (Chan, Tsang), Michael G. DeGroote School of Medicine, McMaster University, St. Catharines, Ont.; William Osler Health System (Binnie), Brampton, Ont.; Sturgeon Community Hospital (Rewa), St. Albert, Alta.; University of Alberta Hospital (Rewa), Edmonton, Alta.; Department of Critical Care Medicine (Rewa), University of Alberta, Edmonton, Alta.; University Health Network (Herridge); Department of Medicine (Herridge, Burns), University of Toronto, Toronto, Ont.; St. Joseph's Health Care (Cook), Hamilton, Ont.; Departments of Medicine (Cook, Tsang), and Clinical Epidemiology & Biostatistics (Cook), McMaster University, Hamilton, Ont.; St. Michael's Hospital (Burns), Toronto, Ont
| | - Karen E A Burns
- Niagara Health (Gehrke, Tsang), St. Catharines, Ont.; Niagara Regional Campus (Chan, Tsang), Michael G. DeGroote School of Medicine, McMaster University, St. Catharines, Ont.; William Osler Health System (Binnie), Brampton, Ont.; Sturgeon Community Hospital (Rewa), St. Albert, Alta.; University of Alberta Hospital (Rewa), Edmonton, Alta.; Department of Critical Care Medicine (Rewa), University of Alberta, Edmonton, Alta.; University Health Network (Herridge); Department of Medicine (Herridge, Burns), University of Toronto, Toronto, Ont.; St. Joseph's Health Care (Cook), Hamilton, Ont.; Departments of Medicine (Cook, Tsang), and Clinical Epidemiology & Biostatistics (Cook), McMaster University, Hamilton, Ont.; St. Michael's Hospital (Burns), Toronto, Ont
| | - Oleksa G Rewa
- Niagara Health (Gehrke, Tsang), St. Catharines, Ont.; Niagara Regional Campus (Chan, Tsang), Michael G. DeGroote School of Medicine, McMaster University, St. Catharines, Ont.; William Osler Health System (Binnie), Brampton, Ont.; Sturgeon Community Hospital (Rewa), St. Albert, Alta.; University of Alberta Hospital (Rewa), Edmonton, Alta.; Department of Critical Care Medicine (Rewa), University of Alberta, Edmonton, Alta.; University Health Network (Herridge); Department of Medicine (Herridge, Burns), University of Toronto, Toronto, Ont.; St. Joseph's Health Care (Cook), Hamilton, Ont.; Departments of Medicine (Cook, Tsang), and Clinical Epidemiology & Biostatistics (Cook), McMaster University, Hamilton, Ont.; St. Michael's Hospital (Burns), Toronto, Ont
| | - Margaret Herridge
- Niagara Health (Gehrke, Tsang), St. Catharines, Ont.; Niagara Regional Campus (Chan, Tsang), Michael G. DeGroote School of Medicine, McMaster University, St. Catharines, Ont.; William Osler Health System (Binnie), Brampton, Ont.; Sturgeon Community Hospital (Rewa), St. Albert, Alta.; University of Alberta Hospital (Rewa), Edmonton, Alta.; Department of Critical Care Medicine (Rewa), University of Alberta, Edmonton, Alta.; University Health Network (Herridge); Department of Medicine (Herridge, Burns), University of Toronto, Toronto, Ont.; St. Joseph's Health Care (Cook), Hamilton, Ont.; Departments of Medicine (Cook, Tsang), and Clinical Epidemiology & Biostatistics (Cook), McMaster University, Hamilton, Ont.; St. Michael's Hospital (Burns), Toronto, Ont
| | - Jennifer L Y Tsang
- Niagara Health (Gehrke, Tsang), St. Catharines, Ont.; Niagara Regional Campus (Chan, Tsang), Michael G. DeGroote School of Medicine, McMaster University, St. Catharines, Ont.; William Osler Health System (Binnie), Brampton, Ont.; Sturgeon Community Hospital (Rewa), St. Albert, Alta.; University of Alberta Hospital (Rewa), Edmonton, Alta.; Department of Critical Care Medicine (Rewa), University of Alberta, Edmonton, Alta.; University Health Network (Herridge); Department of Medicine (Herridge, Burns), University of Toronto, Toronto, Ont.; St. Joseph's Health Care (Cook), Hamilton, Ont.; Departments of Medicine (Cook, Tsang), and Clinical Epidemiology & Biostatistics (Cook), McMaster University, Hamilton, Ont.; St. Michael's Hospital (Burns), Toronto, Ont.
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Wong AR, Sun V, George K, Liu J, Padam S, Chen BA, George T, Amini A, Li D, Sedrak MS. Barriers to Participation in Therapeutic Clinical Trials as Perceived by Community Oncologists. JCO Oncol Pract 2020; 16:e849-e858. [PMID: 32240068 DOI: 10.1200/jop.19.00662] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Despite considerable research on the barriers to enrollment in cancer therapeutic trials, few studies have elicited barriers from the perspective of community physicians, who provide the majority of cancer care. The purpose of this study was to characterize barriers to and facilitators of cancer therapeutic trials as perceived by oncologists in community practices. METHODS Twenty semistructured interviews were conducted with oncologists at six community sites affiliated with City of Hope National Medical Center from March to June 2018. Responses were recorded digitally and transcribed. Data were analyzed using qualitative content analysis. RESULTS Of the 20 participants, 4 (20%) were women, 13 (65%) had > 10 years of practice experience, and 16 (80%) reported that < 5% of their patients were enrolled in a therapeutic trial. Participants identified four system-level barriers: lack of appropriate trials for community-based settings, insufficient infrastructure support, restrictive eligibility criteria, and financial limitations; three physician-level barriers: lack of awareness of available trials, lack of knowledge of trial details, and lack of time; and two patient-level barriers: patient burden and negative beliefs/attitudes toward research. Efforts aimed to increase trial availability, clinical trial support personnel, and physician knowledge were identified as major facilitators. CONCLUSION Community oncologists face numerous complex, multifaceted barriers to cancer therapeutic trial enrollment. Although expanding clinical research beyond the academic setting allows access to a larger and more diverse patient population, increasing generalizability and relevance of trial findings, there remains a substantial need for new strategies to improve cancer research delivery in the community.
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Affiliation(s)
- Andrew R Wong
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA
| | - Virginia Sun
- Department of Population Science, City of Hope, Duarte, CA
| | - Kevin George
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA
| | - Jennifer Liu
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA
| | - Simran Padam
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA
| | - Brandon A Chen
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA
| | - Thomas George
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA
| | - Arya Amini
- Department of Radiation Oncology, City of Hope, Duarte, CA
| | - Daneng Li
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA
| | - Mina S Sedrak
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA
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Fortmann SP, Bailey SR, Brooks NB, Hitsman B, Rittner SS, Gillespie SE, Hill CN, Leo MC, Crawford PM, Hu W, King DS, O'Cleirigh C, Puro J, Ann McBurnie M. Trends in smoking documentation rates in safety net clinics. Health Serv Res 2020; 55:170-177. [PMID: 31930738 PMCID: PMC7080378 DOI: 10.1111/1475-6773.13259] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To assess the impact of provider incentive policy on smoking status documentation. DATA SOURCES Primary data were extracted from structured electronic medical records (EMRs) from 15 community health centers (CHCs). STUDY DESIGN This was an observational study of data from 2006 to 2013, assessing changes in documentation of smoking status over time. DATA EXTRACTION METHODS We extracted structured EMR data for patients age 18 and older with at least one primary care visit. PRINCIPAL FINDINGS Rates of documented smoking status rose from 30 percent in 2006 to 90 percent in 2013; the largest increase occurred from 2011 to 2012 following policy changes (21.3% [95% CI, 8.2%, 34.4%] from the overall trend). Rates varied by clinic and across patient subgroups. CONCLUSIONS Documentation of smoking status improved markedly after introduction of new federal standards. Further improvement in documentation is still needed, especially for males, nonwhite patients, those using opioids, and HIV + patients. More research is needed to study whether changes in documentation lead to improvements in counseling, cessation, and patient outcomes.
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Affiliation(s)
| | - Steffani R. Bailey
- Department of Family MedicineOregon Health and Science UniversityPortlandOregon
| | - Neon B. Brooks
- Kaiser Permanente Center for Health ResearchPortlandOregon
| | - Brian Hitsman
- Department of Preventive MedicineNorthwestern University Feinberg School of MedicineChicagoIllinois
| | - Sarah Stuart Rittner
- AllianceChicagoChicagoIllinois
- Present address:
SASU Project ManagementChicagoIllinois
| | | | | | - Michael C. Leo
- Kaiser Permanente Center for Health ResearchPortlandOregon
| | | | - Weiming Hu
- Kaiser Permanente Center for Health ResearchPortlandOregon
| | | | - Conall O'Cleirigh
- The Fenway InstituteBostonMassachusetts
- Massachusetts General HospitalBostonMassachusetts
- Harvard Medical SchoolBostonMassachusetts
| | - Jon Puro
- Research Informatics and AnalyticsOCHIN, Inc.PortlandOregon
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Sedrak MS, Mohile SG, Sun V, Sun CL, Chen BT, Li D, Wong AR, George K, Padam S, Liu J, Katheria V, Dale W. Barriers to clinical trial enrollment of older adults with cancer: A qualitative study of the perceptions of community and academic oncologists. J Geriatr Oncol 2020; 11:327-334. [DOI: 10.1016/j.jgo.2019.07.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 07/15/2019] [Accepted: 07/16/2019] [Indexed: 12/27/2022]
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O'Regan A, Hayes P, O'Connor R, Casey M, O'Dwyer P, Culhane A, O'Donnell P, Stack G, Cuddihy J, O'Connell B, O'Flynn J, Cullen W, O'Doherty J, O'Connell M, Glynn L. The University of Limerick Education and Research Network for General Practice (ULEARN-GP): practice characteristics and general practitioner perspectives. BMC FAMILY PRACTICE 2020; 21:25. [PMID: 32024480 PMCID: PMC7003418 DOI: 10.1186/s12875-020-1100-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 01/29/2020] [Indexed: 11/17/2022]
Abstract
Background A well-functioning general practice sector that has a strong research component is recognised as a key foundation of any modern health system. General practitioners (GPs) are more likely to collaborate in research if they are part of an established research network. The primary aims of this study are to describe Ireland’s newest general practice-based research network and to analyse the perspectives of the network’s members on research engagement. Method A survey was sent to all GPs participating in the network in order to document practice characteristics so that this research network’s profile could be compared to other national profiles of Irish general practice. In depth interviews were then conducted and analysed thematically to explore the experiences and views of a selection of these GPs on research engagement. Results All 134 GPs responded to the survey. Practices have similar characteristics to the national profile in terms of location, size, computerisation, type of premises and out of hours arrangements. Twenty-two GPs were interviewed and the resulting data was categorised into subthemes and four related overarching themes: GPs described catalysts for research in their practices, the need for coherence in how research is understood in this context, systems failures, whereby the current health system design is prohibitive of GP participation and aspirations for a better future. Conclusion This study has demonstrated that the research network under examination is representative of current trends in Irish general practice. It has elucidated a better understanding of factors that need to be addressed in order to encourage more GPs to engage in the research process.
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Affiliation(s)
- Andrew O'Regan
- Graduate Entry Medical School, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland. .,Health Research Institute, University of Limerick, Limerick, Ireland.
| | - Peter Hayes
- Graduate Entry Medical School, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland
| | - Ray O'Connor
- Graduate Entry Medical School, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Monica Casey
- Graduate Entry Medical School, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Pat O'Dwyer
- Graduate Entry Medical School, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Aidan Culhane
- Graduate Entry Medical School, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Patrick O'Donnell
- Graduate Entry Medical School, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland
| | - Gary Stack
- Graduate Entry Medical School, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - John Cuddihy
- Graduate Entry Medical School, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Billy O'Connell
- Graduate Entry Medical School, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Jerry O'Flynn
- Graduate Entry Medical School, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Walter Cullen
- School of Medicine, Health Sciences Centre, University College Dublin, Belfield, Dublin, Ireland
| | - Jane O'Doherty
- Graduate Entry Medical School, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Maurice O'Connell
- Graduate Entry Medical School, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Liam Glynn
- Graduate Entry Medical School, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland
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8
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Cottrell EK, Gold R, Likumahuwa S, Angier H, Huguet N, Cohen DJ, Clark KD, Gottlieb LM, DeVoe JE. Using Health Information Technology to Bring Social Determinants of Health into Primary Care: A Conceptual Framework to Guide Research. J Health Care Poor Underserved 2019; 29:949-963. [PMID: 30122675 DOI: 10.1353/hpu.2018.0071] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Several recent national initiatives have called for increased efforts to integrate social determinants of health (SDH) into health care settings using health information technology (HIT). However, there is limited evidence to guide the implementation of these recommendations in practice. Research is needed to understand what SDH information is most important to collect, how SDH information can be used to inform clinical care and referrals, and ultimately, whether and how integrating SDH screening and action into primary care affects individual and population health. We recently proposed a conceptual framework to illustrate how HIT can be used to bring SDH information into primary care. In this paper, we describe how we are putting this conceptual model into practice within the OCHIN network of community health centers by highlighting examples of ongoing research, identifying knowledge gaps, and outlining a roadmap of future research to move the field forward.
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9
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Gustavson AM, Boxer RS, Nordon-Craft A, Marcus RL, Daddato A, Stevens-Lapsley JE. Advancing Innovation in Skilled Nursing Facilities through Academic Collaborations. PHYSICAL THERAPY JOURNAL OF POLICY, ADMINISTRATION, AND LEADERSHIP 2018; 18:5-16. [PMID: 35747320 PMCID: PMC9217103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
There is growing recognition that acute hospitalization contributes to marked functional decline in older adult populations. Nearly 20% of all hospitalized older adults in the United States are discharged to skilled nursing facilities (SNFs) to address these functional deficits. However, current approaches to care in SNFs may not adequately restore function, which may contribute to low community discharge rates and high hospital readmission rates. Barriers to rehabilitation innovation in SNFs include management, staff, patient, and researcher-level factors. This clinical commentary builds upon clinical innovation strategies in other health care settings by describing barriers in the context of the SNF environment. Fostering collaboration between academic clinical researchers and SNFs may be the answer to advancing rehabilitation practices and care delivery, thereby improving outcomes in this vulnerable population.
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Affiliation(s)
- Allison M. Gustavson
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO
| | - Rebecca S. Boxer
- Division of Geriatric Medicine, Department of Medicine, University of Colorado, Aurora, CO
- Veterans Affairs Geriatric Research, Education and Clinical Center, Denver, CO
| | - Amy Nordon-Craft
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO
| | - Robin L. Marcus
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT
| | - Andrea Daddato
- Division of Geriatric Medicine, Department of Medicine, University of Colorado, Aurora, CO
| | - Jennifer E. Stevens-Lapsley
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO
- Veterans Affairs Geriatric Research, Education and Clinical Center, Denver, CO
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10
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Impacts of the Affordable Care Act on Community Health Centers: Characteristics of New Patients and Early Changes in Delivery of Care. J Ambul Care Manage 2018; 41:250-261. [PMID: 29771741 DOI: 10.1097/jac.0000000000000244] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The aim of this study was to assess the impact of the Affordable Care Act (ACA) on community health centers (CHCs). Using electronic health records from the Community Health Applied Research Network, we assessed new patient characteristics, office visit volume, and payer distribution among CHC patients before and after ACA implementation, 2011-2014 (n = 442 455). New patients post-ACA were younger, more likely to be female and have chronic health conditions, and utilized more primary care (P < .05 for each). Post-ACA, clinics delivered 19% more office visits and more visits were reimbursed by Medicaid. The support of CHCs is needed to meet increased demand post-ACA.
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11
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Rieckmann T, Muench J, McBurnie MA, Leo MC, Crawford P, Ford D, Stubbs J, O'Cleirigh C, Mayer KH, Fiscella K, Wright N, Doe-Simkins M, Cuddeback M, Salisbury-Afshar E, Nelson C. Medication-assisted treatment for substance use disorders within a national community health center research network. Subst Abus 2018; 37:625-634. [PMID: 27218678 DOI: 10.1080/08897077.2016.1189477] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND The Affordable Care Act increases access to treatment services for people who suffer from substance use disorders (SUDs), including alcohol use disorders (AUDs) and opioid use disorders (OUDs). This increased access to treatment has broad implications for delivering health services and creates a dramatic need for transformation in clinical care, service lines, and collaborative care models. Medication-assisted treatments (MAT) are effective for helping SUD patients reach better outcomes. This article uses electronic health record (EHR) data to examine the prevalence of EHR-documented SUDs, patient characteristics, and patterns of MAT prescribing and screening for patients within the Community Health Applied Research Network (CHARN), a national network of 17 community health centers that facilitates patient-centered outcomes research among underserved populations. METHODS Hierarchical generalized linear models examined patient characteristics, SUD occurrence rates, MAT prescription, and human immunodeficiency virus (HIV) and hepatitis virus C screening for patients with AUDs or OUDs. Results: Among 572,582 CHARN adult patients, 16,947 (3.0%) had a documented AUD diagnosis and 6,080 (1.1%) an OUD diagnosis. Alcohol MAT prescriptions were documented for 547 AUD patients (3.2%) and opioid MAT for 1,764 OUD patients (29.0%). Among OUD patients, opioid MAT was significantly associated with HIV screening (odds ratio [OR] = 1.31, P < .001) in OUD patients, as was alcohol MAT among AUD patients (OR = 1.30, P = .013). CONCLUSIONS These findings suggest that effective opioid and alcohol MAT may be substantially underprescribed among safety-net patients identified as having OUDs or AUDs.
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Affiliation(s)
- Traci Rieckmann
- a School of Medicine, Oregon Health and Science University (OHSU) , Portland , Oregon , USA.,b School of Public Health, Oregon Health and Science University (OHSU) , Portland , Oregon , USA
| | - John Muench
- c Department of Family Medicine , Oregon Health and Science University Richmond Clinic , Portland , Oregon , USA
| | - Mary Ann McBurnie
- d Oregon Community Health Information Network (OCHIN) , Portland , Oregon , USA
| | - Michael C Leo
- e Community Health Applied Research Network (CHARN) Data Coordinating Center , Portland , Oregon , USA
| | - Phillip Crawford
- e Community Health Applied Research Network (CHARN) Data Coordinating Center , Portland , Oregon , USA
| | - Daren Ford
- b School of Public Health, Oregon Health and Science University (OHSU) , Portland , Oregon , USA
| | - Jennifer Stubbs
- b School of Public Health, Oregon Health and Science University (OHSU) , Portland , Oregon , USA
| | - Conall O'Cleirigh
- f Fenway Health, Harvard Medical School, and Massachusetts General Hospital , Boston , Massachusetts , USA
| | - Kenneth H Mayer
- f Fenway Health, Harvard Medical School, and Massachusetts General Hospital , Boston , Massachusetts , USA
| | - Kevin Fiscella
- g Departments of Family Medicine and Public Health Sciences , University of Rochester Medical Center , Rochester , New York , USA
| | - Nicole Wright
- h Association of Asian Pacific Community Health Organizations , Oakland , California , USA
| | - Maya Doe-Simkins
- i Alliance of Chicago Community Health Services , Chicago , Illinois , USA
| | - Matthew Cuddeback
- i Alliance of Chicago Community Health Services , Chicago , Illinois , USA
| | | | - Christine Nelson
- d Oregon Community Health Information Network (OCHIN) , Portland , Oregon , USA
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12
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Akhabue E, Rittner SS, Carroll JE, Crawford PM, Dant L, Laws R, Leo MC, Puro J, Persell SD. Implications of American College of Cardiology/American Heart Association (ACC/AHA) Cholesterol Guidelines on Statin Underutilization for Prevention of Cardiovascular Disease in Diabetes Mellitus Among Several US Networks of Community Health Centers. J Am Heart Assoc 2017; 6:JAHA.117.005627. [PMID: 28673901 PMCID: PMC5586289 DOI: 10.1161/jaha.117.005627] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background Little is known about statin underutilization among diabetes mellitus patients cared for in community health centers, which tend to serve socioeconomically disadvantaged populations. Implications of the American College of Cardiology/American Heart Association (ACC/AHA) guidelines on preexisting gaps in statin treatment in this population are unclear. Methods and Results We included 32 440 adults (45% male, 63% nonwhite, 29% uninsured/Medicaid) aged 40 to 75 years with diabetes mellitus who received care within 16 community health center groups in 11 states in the Community Health Applied Research Network during 2013. Statin prescribing was analyzed as a function of concordance with the National Cholesterol Education Program Adult Treatment Panel 2001 and ACC/AHA 2013 guidelines. More patients’ treatments were concordant with the ACC/AHA (52.8%) versus the National Cholesterol Education Program Adult Treatment Panel (36.2%) guideline. Female sex was associated with lower concordance for both (odds ratio [OR] 0.90, CI 0.85‐0.94; and OR 0.84, CI 0.80‐0.88, respectively). Being insured, an Asian/Pacific Islander, or primarily Spanish speaking were associated with greater concordance for both guidelines: 35.5% (11 526/32 440) were concordant with neither guideline, the majority (79.7%) having no statin prescribed; 28.2% (9168/32 440) were concordant with ACC/AHA but not the National Cholesterol Education Program Adult Treatment Panel. 8.7% of these patients had a low‐density lipoprotein cholesterol >160 mg/dL despite having a moderate‐ or high‐intensity statin prescribed. And 11.6% (3772/32 440) were concordant with the National Cholesterol Education Program Adult Treatment Panel but not with ACC/AHA. Most of these patients had a low‐density lipoprotein cholesterol between 70 and 99 mg/dL with no or a low‐intensity statin prescribed. Conclusions Opportunities exist to improve cholesterol management in diabetes mellitus patients in community health centers. Addressing care gaps could improve cardiovascular disease prevention in this high‐risk population.
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Affiliation(s)
- Ehimare Akhabue
- Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | | | | | | | - Reesa Laws
- Kaiser Permanente Center for Health Research, Portland, OR
| | - Michael C Leo
- Kaiser Permanente Center for Health Research, Portland, OR
| | | | - Stephen D Persell
- Division of General Internal Medicine and Geriatrics, Center for Primary Care Innovation, Feinberg School of Medicine, Northwestern University, Chicago, IL
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13
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Huguet N, Angier H, Marino M, McConnell KJ, Hoopes MJ, O'Malley JP, Raynor LA, Likumahuwa-Ackman S, Holderness H, DeVoe JE. Protocol for the analysis of a natural experiment on the impact of the Affordable Care Act on diabetes care in community health centers. Implement Sci 2017; 12:14. [PMID: 28183354 PMCID: PMC5301438 DOI: 10.1186/s13012-017-0543-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 01/27/2017] [Indexed: 11/28/2022] Open
Abstract
Background It is hypothesized that Affordable Care Act (ACA) Medicaid expansions could substantially improve access to health insurance and healthcare services for patients at risk for diabetes mellitus (DM), with pre-DM, or already diagnosed with DM. The ACA called for every state to expand Medicaid coverage by 2014. In a 2012 legal challenge, the US Supreme Court ruled that states were not required to implement Medicaid expansions. This 'natural experiment' presents a unique opportunity to learn whether and to what extent Medicaid expansion can affect healthcare access and services for patients with DM risk, pre-DM, or DM. Methods/design Data from electronic health records (EHRs) from the Accelerating Data Value Across a National Community Health Center Network (ADVANCE) clinical data research network, which has data from >700 community health centers (CHCs), was included in the study. EHR data will be linked to Oregon Medicaid claims data. Data collection will include information on changes in health insurance, service receipt, and health outcomes, spanning 9 years (pre- and post-expansion), comparing states that expanded Medicaid, and those that did not. Patients included in this study will be diagnosed with DM, be at risk for DM, or have pre-DM, between the ages of 19 and 64, with ≥1 ambulatory visit. Sample size is estimated to be roughly 275,000 patients. Biostatistical analyses will include the difference-in-differences (DID) methodology and a generalized linear mixed model. Econometric analyses will include a DID two-part method to calculate the difference in Medicaid expenditures in Oregon among newly insured CHC patients. Discussion Findings will have national relevance on DM health services and outcomes and will be shared through national conferences and publications. The findings will provide information needed to impact the policy as it is related to access to health insurance and receipt of healthcare among a vulnerable population. Trial registration This project is registered with ClinicalTrials.gov (NCT02685384). Registered 18 May 2016.
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Affiliation(s)
- Nathalie Huguet
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - Heather Angier
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - Miguel Marino
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - K John McConnell
- Department of Emergency Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - Megan J Hoopes
- Research Department, OCHIN Inc., 1881 SW Naito Pkwy, Portland, OR, 97201, USA
| | - Jean P O'Malley
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - Lewis A Raynor
- Research Department, OCHIN Inc., 1881 SW Naito Pkwy, Portland, OR, 97201, USA
| | - Sonja Likumahuwa-Ackman
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - Heather Holderness
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA.
| | - Jennifer E DeVoe
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
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14
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Supporting Integrative Medicine research through an Australasian practice-based research network. ADVANCES IN INTEGRATIVE MEDICINE 2016. [DOI: 10.1016/j.aimed.2016.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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15
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Wong PD, Dave MG, Tulloch T, Feldman ML, Ford-Jones EL, Parkin PC, Tetley A, Moodie RG. Community health centres: Potential opportunities for community paediatrics. From interprofessional clinical care to board governance. Paediatr Child Health 2015; 20:12-4. [PMID: 25722635 DOI: 10.1093/pch/20.1.12] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2014] [Indexed: 11/13/2022] Open
Affiliation(s)
- Peter D Wong
- Rexdale Community Health Centre; ; Community Paediatrics, Division of Paediatric Medicine, Department of Paediatrics, University of Toronto
| | - Malini G Dave
- Black Creek Community Health Centre; ; Emergency Medicine, The Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto
| | - Trisha Tulloch
- Barbara Black Community Health Centre, Ajax; ; Concurrent Youth Unit, Centre for Addiction and Mental Health, Department of Paediatrics, University of Toronto
| | - Mark L Feldman
- Continuing Education, Department of Paediatrics; ; Community Paediatrics and Integrated Medical Education; ; Faculty of Medicine, University of Toronto, The Hospital for Sick Children & Saint Joseph's Health Centre
| | | | - Patricia C Parkin
- The Applied Research Group for Kids (TARGetKids!); ; Paediatric Outcomes Research Team, Department of Paediatrics, Hospital for Sick Children
| | | | - Rosemary G Moodie
- Division of Neonatology, Department of Paediatrics, University of Toronto, Toronto, Ontario
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16
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Community-engagement strategies of the developmental disabilities practice-based research network (DD-PBRN). J Am Board Fam Med 2014; 27:831-8. [PMID: 25381081 PMCID: PMC4822831 DOI: 10.3122/jabfm.2014.06.140022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
There is often a rich but untold history of events that occur and relationships that form before a practice-based research network (PBRN) is launched. This is particularly the case in PBRNs that are community based and comprise partnerships outside of the health care system. In this article we summarize an organizational "prenatal history" before the birth of a PBRN devoted to people with developmental disabilities. Using a case study approach, this article describes the historic events that preceded and fostered the evolution of this PBRN and contrasts how the processes leading to the creation of this multistakeholder, community-based PBRN differ from those of typical academic/clinical practice PBRNs. We propose potential advantages and complexities inherent to this newest iteration of PBRNs.
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17
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DeVoe JE, Gold R, Cottrell E, Bauer V, Brickman A, Puro J, Nelson C, Mayer KH, Sears A, Burdick T, Merrell J, Matthews P, Fields S. The ADVANCE network: accelerating data value across a national community health center network. J Am Med Inform Assoc 2014; 21:591-5. [PMID: 24821740 PMCID: PMC4078289 DOI: 10.1136/amiajnl-2014-002744] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The ADVANCE (Accelerating Data Value Across a National Community Health Center Network) clinical data research network (CDRN) is led by the OCHIN Community Health Information Network in partnership with Health Choice Network and Fenway Health. The ADVANCE CDRN will ‘horizontally’ integrate outpatient electronic health record data for over one million federally qualified health center patients, and ‘vertically’ integrate hospital, health plan, and community data for these patients, often under-represented in research studies. Patient investigators, community investigators, and academic investigators with diverse expertise will work together to meet project goals related to data integration, patient engagement and recruitment, and the development of streamlined regulatory policies. By enhancing the data and research infrastructure of participating organizations, the ADVANCE CDRN will serve as a ‘community laboratory’ for including disadvantaged and vulnerable patients in patient-centered outcomes research that is aligned with the priorities of patients, clinics, and communities in our network.
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Affiliation(s)
- Jennifer E DeVoe
- OCHIN, Inc, Portland, Oregon, USA Department of Family Medicine, Oregon Health and Science University, Portland, Oregon, USA Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, USA
| | - Rachel Gold
- OCHIN, Inc, Portland, Oregon, USA Kaiser Permanente Northwest Center for Health Research, Portland, Oregon, USA
| | - Erika Cottrell
- OCHIN, Inc, Portland, Oregon, USA Health Choice Network, Miami, Florida, USA
| | | | | | - Jon Puro
- OCHIN, Inc, Portland, Oregon, USA
| | | | - Kenneth H Mayer
- The Fenway Institute, Boston, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA HIV Prevention Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | | - Tim Burdick
- OCHIN, Inc, Portland, Oregon, USA Department of Family Medicine, Oregon Health and Science University, Portland, Oregon, USA Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, USA
| | | | | | - Scott Fields
- OCHIN, Inc, Portland, Oregon, USA Department of Family Medicine, Oregon Health and Science University, Portland, Oregon, USA
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