1
|
Chang HC, Chang TH, Kang HY, Chen YW, Chen SP, Wang MC, Liang J. Retention in Community Health Screening among Taiwanese Adults: A 9-Year Prospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116813. [PMID: 35682395 PMCID: PMC9180367 DOI: 10.3390/ijerph19116813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 05/27/2022] [Accepted: 05/31/2022] [Indexed: 02/04/2023]
Abstract
Largely conducted in Western developed nations, research on community health screening has mainly been of limited duration. This study aims to ascertain the predictors of retention in a community health screening program, involving multiple admission cohorts over a 9-year period in Taiwan. Retention is defined as the participation in subsequent waves of health screening after being recruited for an initial screening. Data came from a prospective cohort study, named "Landseed Integrated Outreaching Neighborhood Screening (LIONS)", in Taiwan. This research retrieved 5901 community-dwelling Taiwanese adults aged 30 and over from LIONS and examined their retention in three follow-ups during 2006-2014. Generalized estimating equations were employed to evaluate retention over time as a function of social determinants, health behaviors, and health conditions. Being middle-aged, higher education, and regular exercise were positively associated with retention. Conversely, smoking, betel-nut chewing, psychiatric disorder, hypertension, type 2 diabetes mellitus, stroke, and a longer time interval since enrollment were negatively associated with retention. Furthermore, retention rates varied substantially across admission cohorts with more recent cohorts having a lower rate of retention (aOR = 0.33-0.83). Greater attention needs to be directed to retention over time and variations across admission cohorts. Additionally, those who are in either younger or older age groups and have chronic diseases or unhealthy behaviors should be targeted with greater efforts.
Collapse
Affiliation(s)
- Huan-Cheng Chang
- Division of Family Medicine, Department of Community Medicine, Landseed International Hospital, Taoyuan 324609, Taiwan; (H.-C.C.); (H.-Y.K.); (S.-P.C.)
| | - Ting-Huan Chang
- Department of Medical Education, Research and Quality Management, Landseed International Hospital, Taoyuan 324609, Taiwan;
| | - Hsiao-Yen Kang
- Division of Family Medicine, Department of Community Medicine, Landseed International Hospital, Taoyuan 324609, Taiwan; (H.-C.C.); (H.-Y.K.); (S.-P.C.)
| | - Yu-Wei Chen
- Department of Neurology, Landseed International Hospital, Taoyuan 324609, Taiwan;
| | - Sheng-Pyng Chen
- Division of Family Medicine, Department of Community Medicine, Landseed International Hospital, Taoyuan 324609, Taiwan; (H.-C.C.); (H.-Y.K.); (S.-P.C.)
| | - Mei-Chin Wang
- Community Health Development Center, Department of Community Medicine, Landseed International Hospital, Taoyuan 324609, Taiwan;
| | - Jersey Liang
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI 48109-2029, USA
- Correspondence: ; Tel.: +1-734-936-1303; Fax: +1-734-764-4338
| |
Collapse
|
2
|
Eisenberg D, LaVela SL, Frayne SM, Chen R, Barreto NB, Wu J, Nevedal AL, Davis K, Arnow KD, Harris AH. Rates, Variability, and Predictors of Screening for Obesity: Are Individuals with Spinal Cord Injury Being Overlooked? Obes Facts 2022; 15:451-457. [PMID: 35263742 PMCID: PMC9209967 DOI: 10.1159/000523917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 02/24/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Individuals with spinal cord injury (SCI) are vulnerable to obesity. Annual obesity screening using body mass index (BMI) is the standard of care mandated by US Veterans Health Administration (VHA) guidelines. Our objective was to determine the rates, variability, and predictors of guideline-concordant annual screening for obesity, given potential challenges of height and weight measurements in individuals with SCI. METHODS This is a cross-sectional retrospective study using US national VA databases. We identified all VHA patients with chronic SCI in the fiscal year (FY) 2019, their treating facility and frequency of recorded height and weight. We applied mixed-effects logistic regression models to assess associations between annual BMI screening and patient- and facility-level characteristics. RESULTS Of 20,978 individuals with chronic SCI in VHA in FY19, guideline-concordant annual BMI screening was lacking in 37.9%. Accounting for facility-level factors (geographic region, SCI facility type, volume of patients with SCI treated at the facility), a mixed-effects logistic regression model demonstrated that lack of annual obesity screening was significantly associated with older patient age (p < 0.001) and fewer outpatient encounters (p < 0.001) but not other patient-level factors such as sex, race, level of injury, or rurality. The rate of obesity screening among different facilities within VHA varied widely from 11.1% to 75.7%. CONCLUSION A large proportion of persons with SCI receiving care in VHA do not receive guideline-concordant annual obesity screening, an especially acute problem in some facilities. Older patients with fewer outpatient encounters are more likely to be missed. To inform the design of interventions to improve identification and documentation of obesity, further study is needed to assess potential barriers to obesity screening in the population with SCI.
Collapse
Affiliation(s)
- Dan Eisenberg
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, USA
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford School of Medicine, Stanford, California, USA
- *Dan Eisenberg,
| | - Sherri L. LaVela
- Center of Innovation for Complex Chronic Care, VA Edward Hines Jr., Hines, Illinois, USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Susan M. Frayne
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, USA
- Department of Medicine, Stanford School of Medicine, Stanford, California, USA
| | - Rui Chen
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford School of Medicine, Stanford, California, USA
| | - Nicolas B. Barreto
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford School of Medicine, Stanford, California, USA
| | - Justina Wu
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Andrea L. Nevedal
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Kristen Davis
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford School of Medicine, Stanford, California, USA
| | - Katherine D. Arnow
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford School of Medicine, Stanford, California, USA
| | - Alex H.S. Harris
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, USA
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford School of Medicine, Stanford, California, USA
| |
Collapse
|