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Bartels CM, Johnson L, Ramly E, Panyard DJ, Gilmore-Bykovskyi A, Johnson HM, McBride P, Li Z, Sampene E, Lauver DR, Lewicki K, Piper ME. Impact of a Rheumatology Clinic Protocol on Tobacco Cessation Quit Line Referrals. Arthritis Care Res (Hoboken) 2022; 74:1421-1429. [PMID: 33825349 PMCID: PMC8492788 DOI: 10.1002/acr.24589] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 12/23/2020] [Accepted: 03/02/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Smoking increases cardiopulmonary and rheumatic disease risk, yet tobacco cessation intervention is rare in rheumatology clinics. This study aimed to implement a rheumatology staff-driven protocol, Quit Connect, to increase the rate of electronic referrals (e-referrals) to free, state-run tobacco quit lines. METHODS We conducted a quasi-experimental cohort study of Quit Connect at 3 rheumatology clinics comparing tobacco quit line referrals from 4 baseline years to referrals during a 6-month intervention period. Nurses and medical assistants were trained to use 2 standardized electronic health record (EHR) prompts to check readiness to quit smoking within 30 days, advise cessation, and connect patients using tobacco quit line e-referral orders. Our objective was to use EHR data to examine the primary outcome of tobacco quit line referrals using pre/post design. RESULTS Across 54,090 pre- and post-protocol rheumatology clinic visits, 4,601 were with current smokers. We compared outcomes between 4,078 eligible pre-implementation visits and 523 intervention period visits. Post-implementation, the odds of tobacco quit line referral were 26-fold higher compared to our pre-implementation rate (unadjusted odds ratio [OR] 26 [95% confidence interval (95% CI) 6-106]). Adjusted odds of checking readiness to quit in the next 30 days increased over 100-fold compared to pre-implementation (adjusted OR 132 [95% CI 99-177]). Intervention led to e-referrals for 71% of quit-ready patients in <90 seconds; 24% of referred patients reported a quit attempt. CONCLUSION Implementing Quit Connect in rheumatology clinics was feasible and improved referrals to a state-run tobacco quit line. Given the importance of smoking cessation to reduce cardiopulmonary and rheumatic disease risk, future studies should investigate disseminating cessation protocols like Quit Connect that leverage tobacco quit lines.
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Affiliation(s)
| | - Lauren Johnson
- University of Wisconsin School of Medicine and Public Health, Madison
| | - Edmond Ramly
- University of Wisconsin School of Medicine and Public Health, Madison
| | - Daniel J Panyard
- University of Wisconsin School of Medicine and Public Health, Madison
| | | | - Heather M Johnson
- Charles E. Schmidt College of Medicine, Florida Atlantic University and Boca Raton Regional Hospital/Baptist Health South Florida, Boca Raton
| | - Patrick McBride
- University of Wisconsin School of Medicine and Public Health, Madison
| | - Zhanhai Li
- University of Wisconsin School of Medicine and Public Health, Madison
| | - Emmanuel Sampene
- University of Wisconsin School of Medicine and Public Health, Madison
| | | | - Kristin Lewicki
- University of Wisconsin School of Medicine and Public Health, Madison
| | - Megan E Piper
- University of Wisconsin School of Medicine and Public Health, Madison
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2
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Sparks JB, Klamerus ML, Caverly TJ, Skurla SE, Hofer TP, Kerr EA, Bernstein SJ, Damschroder LJ. Planning and Reporting Effective Web-Based RAND/UCLA Appropriateness Method Panels: Literature Review and Preliminary Recommendations. J Med Internet Res 2022; 24:e33898. [PMID: 36018626 PMCID: PMC9463617 DOI: 10.2196/33898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 06/28/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The RAND/UCLA Appropriateness Method (RAM), a variant of the Delphi Method, was developed to synthesize existing evidence and elicit the clinical judgement of medical experts on the appropriate treatment of specific clinical presentations. Technological advances now allow researchers to conduct expert panels on the internet, offering a cost-effective and convenient alternative to the traditional RAM. For example, the Department of Veterans Affairs recently used a web-based RAM to validate clinical recommendations for de-intensifying routine primary care services. A substantial literature describes and tests various aspects of the traditional RAM in health research; yet we know comparatively less about how researchers implement web-based expert panels. OBJECTIVE The objectives of this study are twofold: (1) to understand how the web-based RAM process is currently used and reported in health research and (2) to provide preliminary reporting guidance for researchers to improve the transparency and reproducibility of reporting practices. METHODS The PubMed database was searched to identify studies published between 2009 and 2019 that used a web-based RAM to measure the appropriateness of medical care. Methodological data from each article were abstracted. The following categories were assessed: composition and characteristics of the web-based expert panels, characteristics of panel procedures, results, and panel satisfaction and engagement. RESULTS Of the 12 studies meeting the eligibility criteria and reviewed, only 42% (5/12) implemented the full RAM process with the remaining studies opting for a partial approach. Among those studies reporting, the median number of participants at first rating was 42. While 92% (11/12) of studies involved clinicians, 50% (6/12) involved multiple stakeholder types. Our review revealed that the studies failed to report on critical aspects of the RAM process. For example, no studies reported response rates with the denominator of previous rounds, 42% (5/12) did not provide panelists with feedback between rating periods, 50% (6/12) either did not have or did not report on the panel discussion period, and 25% (3/12) did not report on quality measures to assess aspects of the panel process (eg, satisfaction with the process). CONCLUSIONS Conducting web-based RAM panels will continue to be an appealing option for researchers seeking a safe, efficient, and democratic process of expert agreement. Our literature review uncovered inconsistent reporting frameworks and insufficient detail to evaluate study outcomes. We provide preliminary recommendations for reporting that are both timely and important for producing replicable, high-quality findings. The need for reporting standards is especially critical given that more people may prefer to participate in web-based rather than in-person panels due to the ongoing COVID-19 pandemic.
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Affiliation(s)
- Jordan B Sparks
- VA Center for Clinical Management Research, Ann Arbor, MI, United States
| | - Mandi L Klamerus
- VA Center for Clinical Management Research, Ann Arbor, MI, United States
| | - Tanner J Caverly
- VA Center for Clinical Management Research, Ann Arbor, MI, United States.,Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States.,Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, United States
| | - Sarah E Skurla
- VA Center for Clinical Management Research, Ann Arbor, MI, United States
| | - Timothy P Hofer
- VA Center for Clinical Management Research, Ann Arbor, MI, United States.,Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States
| | - Eve A Kerr
- VA Center for Clinical Management Research, Ann Arbor, MI, United States.,Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States
| | - Steven J Bernstein
- VA Center for Clinical Management Research, Ann Arbor, MI, United States.,Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States
| | - Laura J Damschroder
- VA Center for Clinical Management Research, Ann Arbor, MI, United States.,VA Quality Enhancement Research Initiative (QUERI) Personalizing Options through Veteran Engagement (PROVE) Program, Ann Arbor, MI, United States
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3
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Shearer AL, Bromley E, Bonds C, Draxler C, Khodyakov D. Improving Mental Health Guardianship: From Prevention to Treatment. Psychiatr Serv 2022; 73:642-649. [PMID: 34839674 DOI: 10.1176/appi.ps.202100020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The authors sought to identify the most promising strategies for improving the mental health guardianship process in Los Angeles County for adults with mental illness who are gravely disabled. METHODS In May and June 2019, 56 experts, working in hospitals or outpatient facilities or representing legal, advocacy, policy, or forensic organizations, participated in an online modified-Delphi panel, rating the ethical appropriateness, impact on care quality, efficiency, and feasibility of nine strategies for improvement of mental health guardianship. Agreement was determined with the RAND/UCLA appropriateness method, and comments were thematically analyzed. RESULTS The strategy ranked highest by the participating experts was improving the administrative functioning and judicial processes of entities involved in mental health guardianship proceedings-it was the only strategy that achieved agreement among panelists and was rated highly on all four criteria. Other preferred strategies were enhancing the ability of assertive outpatient mental health teams to serve individuals before they experience a crisis and expanding the continuum of unlocked residential treatment settings. CONCLUSIONS Opportunities exist to improve all stages of the mental health guardianship process. Experts favored strategies that streamline administrative processes, facilitate community integration into treatment, and ensure fidelity to best practices. Improving the mental health guardianship process has the potential to speed up delivery of services, better manage resources, and increase access to treatment for individuals with mental illness who are gravely disabled.
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Affiliation(s)
- Amy L Shearer
- Behavioral and Policy Sciences, RAND Corporation, Santa Monica, California (Shearer, Khodyakov);DMH+UCLA Public Mental Health Partnership, University of California, Los Angeles (Bromley);Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles (Bromley);Los Angeles County Department of Mental Health, Los Angeles (Bonds, Draxler);California Department of Psychiatry and Human Behavior, Charles Drew University of Medicine and Science, Willowbrook (Bonds)
| | - Elizabeth Bromley
- Behavioral and Policy Sciences, RAND Corporation, Santa Monica, California (Shearer, Khodyakov);DMH+UCLA Public Mental Health Partnership, University of California, Los Angeles (Bromley);Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles (Bromley);Los Angeles County Department of Mental Health, Los Angeles (Bonds, Draxler);California Department of Psychiatry and Human Behavior, Charles Drew University of Medicine and Science, Willowbrook (Bonds)
| | - Curley Bonds
- Behavioral and Policy Sciences, RAND Corporation, Santa Monica, California (Shearer, Khodyakov);DMH+UCLA Public Mental Health Partnership, University of California, Los Angeles (Bromley);Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles (Bromley);Los Angeles County Department of Mental Health, Los Angeles (Bonds, Draxler);California Department of Psychiatry and Human Behavior, Charles Drew University of Medicine and Science, Willowbrook (Bonds)
| | - Connie Draxler
- Behavioral and Policy Sciences, RAND Corporation, Santa Monica, California (Shearer, Khodyakov);DMH+UCLA Public Mental Health Partnership, University of California, Los Angeles (Bromley);Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles (Bromley);Los Angeles County Department of Mental Health, Los Angeles (Bonds, Draxler);California Department of Psychiatry and Human Behavior, Charles Drew University of Medicine and Science, Willowbrook (Bonds)
| | - Dmitry Khodyakov
- Behavioral and Policy Sciences, RAND Corporation, Santa Monica, California (Shearer, Khodyakov);DMH+UCLA Public Mental Health Partnership, University of California, Los Angeles (Bromley);Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles (Bromley);Los Angeles County Department of Mental Health, Los Angeles (Bonds, Draxler);California Department of Psychiatry and Human Behavior, Charles Drew University of Medicine and Science, Willowbrook (Bonds)
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Appleton CT, Hegele RA. Preventing cardiovascular events in patients with inflammatory arthritis: are we missing the mark? Can J Cardiol 2022; 38:1138-1140. [DOI: 10.1016/j.cjca.2022.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/14/2022] [Accepted: 05/16/2022] [Indexed: 11/02/2022] Open
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5
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Jilani SM, Jones HE, Grossman M, Jansson LM, Terplan M, Faherty LJ, Khodyakov D, Patrick SW, Davis JM. Standardizing the Clinical Definition of Opioid Withdrawal in the Neonate. J Pediatr 2022; 243:33-39.e1. [PMID: 34942181 DOI: 10.1016/j.jpeds.2021.12.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/22/2021] [Accepted: 12/05/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To standardize the clinical definition of opioid withdrawal in neonates to address challenges in clinical care, quality improvement, research, and public policy for this patient population. STUDY DESIGN Between October and December 2020, we conducted 2 modified-Delphi panels using ExpertLens, a virtual platform for performing iterative expert engagement panels. Twenty clinical experts specializing in care for the substance-exposed mother-neonate dyad explored the necessity of key evidence-based clinical elements in defining opioid withdrawal in the neonate leading to a diagnosis of neonatal abstinence syndrome (NAS)/neonatal opioid withdrawal syndrome (NOWS). Expert consensus was assessed using descriptive statistics, the RAND/UCLA Appropriateness Method, and thematic analysis of participants' comments. RESULTS Expert panels concluded the following were required for diagnosis: in utero exposure (known by history, not necessarily by toxicology testing) to opioids with or without the presence of other psychotropic substances, and the presence of at least two of the most common clinical signs characteristic of withdrawal (excessive crying, fragmented sleep, tremors, increased muscle tone, gastrointestinal dysfunction). CONCLUSIONS Results indicate that both a known history of in utero opioid exposure and a distinct set of withdrawal signs are necessary to standardize a definition of neonatal withdrawal. Implementation of a standardized definition requires both patient engagement and a mother-neonate dyadic approach mindful of program and policy implications.
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Affiliation(s)
- Shahla M Jilani
- Office of the Assistant Secretary for Health, US Department of Health and Human Services, Washington, DC
| | - Hendrée E Jones
- Department of Obstetrics and Gynecology, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Matthew Grossman
- Department of Pediatrics, Yale School of Medicine, New Haven, CT
| | - Lauren M Jansson
- Department of Pediatrics, Center for Addiction and Pregnancy, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Laura J Faherty
- Pardee RAND Graduate School, Santa Monica, CA; Department of Pediatrics, Boston University School of Medicine, Boston, MA
| | | | - Stephen W Patrick
- Division of Neonatology, Department of Pediatrics and Department of Health Policy, Vanderbilt Center for Child Health Policy, Vanderbilt University Medical Center, Nashville, TN
| | - Jonathan M Davis
- Division of Newborn Medicine, Tufts Children's Hospital and the Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA
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Seijo M, Spira C, Chaparro M, Elorriaga N, Rubinstein A, García-Elorrio E, Irazola V. Development of physical activity and food built environment quality indicators for chronic diseases in Argentina. Health Promot Int 2021; 36:1554-1565. [PMID: 33608705 DOI: 10.1093/heapro/daaa138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Although obesity and non-communicable disease (NCD) prevention efforts to-date have focused mainly on individual level factors, the social and physical environments in which people live are now widely recognized as important social determinants of health. Obesogenic environments promote higher dietary energy intakes and sedentary behaviors, thus contributing to the obesity/NCD burden. To develop quality indicators (QIs) for measuring food and physical activity (PA)-built environments in municipalities. A literature review was conducted. Based on the best practices identified from this review, a draft set of candidate QI was retrieved. The initial 67 QIs were then evaluated by a modified Delphi panel of multidisciplinary health professionals (n = 40) to determine their relevance, validity, and feasibility in 3 rounds of voting and threaded discussion using a modified RAND/University of California, Los Angeles Appropriateness Methodology. Response rate for the panel was 89.4%. All final 42 QIs were rated as highly relevant, valid, and feasible (median rating ≥ 7 on a 1-9 scale), with no significant disagreement. The final QI set addresses for the PA domain: (i) promotion of PA; and (ii) improvements in the environment to strengthen the practice of PA; and for Food environment domain: (i) promotion of healthy eating; (ii) access to healthy foods; and (iii) promotion of responsible advertising. We generated a set of indicators to evaluate the PA and food built environment, which can be adapted for use in Latin American and other low- and middle-income countries.
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Affiliation(s)
- Mariana Seijo
- Metabolic Bone Diseases Laboratory, Immunology, Genetic and Metabolism Institute (INIGEM)
- School of Pharmacy and Biochemistry, Clinical Hospital "José de San Martín"
- National Council for Scientific and Technologic Research (CONICET)/Buenos Aires University (UBA), Buenos Aires, Argentina
| | - Cintia Spira
- Department of Health Care Quality and Patient Safety, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Martín Chaparro
- South American Center of Excellence for Cardiovascular Health (CESCAS), Department of Research in Chronic Diseases, Institute for Clinical Effectiveness and Health Policy (IECS)
| | - Natalia Elorriaga
- South American Center of Excellence for Cardiovascular Health (CESCAS), Department of Research in Chronic Diseases, Institute for Clinical Effectiveness and Health Policy (IECS)
- Center for Research in Epidemiology and Public Health (CIESP-IECS), National Scientific and Technical Research Council (CONICET)
| | - Adolfo Rubinstein
- South American Center of Excellence for Cardiovascular Health (CESCAS), Department of Research in Chronic Diseases, Institute for Clinical Effectiveness and Health Policy (IECS)
- Center for Research in Epidemiology and Public Health (CIESP-IECS), National Scientific and Technical Research Council (CONICET)
| | - Ezequiel García-Elorrio
- Department of Health Care Quality and Patient Safety, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Vilma Irazola
- South American Center of Excellence for Cardiovascular Health (CESCAS), Department of Research in Chronic Diseases, Institute for Clinical Effectiveness and Health Policy (IECS)
- Center for Research in Epidemiology and Public Health (CIESP-IECS), National Scientific and Technical Research Council (CONICET)
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7
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Khodyakov D, Jilani SM, Dellva S, Faherty LJ. Informing the Development of a Standardized Clinical Definition of Neonatal Abstinence Syndrome: Protocol for a Modified-Delphi Expert Panel. JMIR Res Protoc 2021; 10:e25387. [PMID: 34491203 PMCID: PMC8456327 DOI: 10.2196/25387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 07/09/2021] [Accepted: 07/10/2021] [Indexed: 11/18/2022] Open
Abstract
Background Neonatal abstinence syndrome (NAS) is a postnatal withdrawal syndrome that most commonly results from prenatal opioid exposure. Every 15 minutes, an infant is born in the United States with signs of NAS. The field lacks a standardized clinical definition of NAS, complicating discussions on programmatic and policy development to support opioid-exposed mothers and infants. Objective The goal of this paper is to describe a protocol for a systematic expert panel process to inform the development of a clinical definition of NAS. Methods We will conduct two three-round online modified-Delphi panels using the ExpertLens system and will follow the recommendations for Conducting and REporting of DElphi Studies (CREDES). One panel will focus on developing key components of a clinical definition of NAS, and the second panel will focus on neonatal opioid withdrawal syndrome (NOWS), which is a term that has come into use to differentiate opioid-exposed infants from infants exposed to other substances in utero. However, there is lack of agreement on the precise clinical definition of NOWS and how it is distinct from or overlaps with NAS. Each panel will complete two rating rounds and a discussion round using a similar protocol. We will analyze all rating data descriptively and determine the presence of agreement within and between the two panels. We will also perform thematic analysis of the qualitative comments to contextualize the panel findings. Results The panels were convened between October 29 and December 17, 2020. Their results were disseminated and discussed at a national conference on NAS that took place on March 17-18, 2021. Conclusions A standardized clinical definition of NAS will help to better characterize NAS incidence and to design effective clinical, public health, and policy interventions to support opioid-exposed mother-infant dyads. International Registered Report Identifier (IRRID) DERR1-10.2196/25387
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Affiliation(s)
- Dmitry Khodyakov
- RAND Corporation, Santa Monica, CA, United States.,Pardee RAND Graduate School, Santa Monica, CA, United States
| | - Shahla M Jilani
- Office of the Assistant Secretary for Health, US Department of Health & Human Services, Washington, DC, United States
| | | | - Laura J Faherty
- Pardee RAND Graduate School, Santa Monica, CA, United States.,RAND Corporation, Boston, MA, United States.,Boston University School of Medicine, Boston, MA, United States
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Bodnar LM, Khodyakov D, Parisi SM, Himes KP, Burke JG, Hutcheon JA. Rating the seriousness of maternal and child health outcomes linked with pregnancy weight gain. Paediatr Perinat Epidemiol 2021; 35:459-468. [PMID: 33216402 PMCID: PMC8134513 DOI: 10.1111/ppe.12741] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/18/2020] [Accepted: 10/23/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Current pregnancy weight gain guidelines were developed based on implicit assumptions of a small group of experts about the relative seriousness of adverse health outcomes. Therefore, they will not necessarily reflect the values of women. OBJECTIVE To estimate the seriousness of 11 maternal and child health outcomes that have been consistently associated with pregnancy weight gain by engaging patients and health professionals. METHODS We collected data using an online panel approach with a modified Delphi structure. We selected a purposeful sample of maternal and child health professionals (n = 84) and women who were pregnant or recently postpartum (patients) (n = 82) in the United States as panellists. We conducted three concurrent panels: professionals only, patients only, and patients and professionals. During a 3-round online modified Delphi process, participants rated the seriousness of health outcomes (Round 1), reviewed and discussed the initial results (Round 2), and revised their original ratings (Round 3). Panellists assigned seriousness ratings (0, [not serious] to 100 [most serious]) for infant death, stillbirth, preterm birth, gestational diabetes, preeclampsia, small-for-gestational-age (SGA) birth, large-for-gestational-age (LGA) birth, unplanned caesarean delivery, maternal obesity, childhood obesity, and maternal metabolic syndrome. RESULTS Each panel individually came to a consensus on all seriousness ratings. The final median seriousness ratings combined across all panels were highest for infant death (100), stillbirth (95), preterm birth (80), and preeclampsia (80). Obesity in children, metabolic syndrome in women, obesity in women, and gestational diabetes had median seriousness ratings ranging from 55 to 65. The lowest seriousness ratings were for SGA birth, LGA birth, and unplanned caesarean delivery (30-40). CONCLUSION Professionals and women rate some adverse outcomes as being more serious than others. These ratings can be used to establish the range of pregnancy weight gain associated with the lowest risk of a broad range of maternal and child health outcomes.
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Affiliation(s)
- Lisa M. Bodnar
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States,Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | | | - Sara M. Parisi
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Katherine P. Himes
- Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Jessica G. Burke
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, PA, United States
| | - Jennifer A. Hutcheon
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
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Seo MR, Kim G, Moon KW, Sung YK, Yoo JJ, Yoon CH, Lee EB, Lee J, Kang EH, Kim H, Park EJ, Uhm WS, Lee MS, Lee SW, Choi BY, Hong SJ, Baek HJ. Quality Indicators for Evaluating the Health Care of Patients with Rheumatoid Arthritis: a Korean Expert Consensus. J Korean Med Sci 2021; 36:e109. [PMID: 33942576 PMCID: PMC8093604 DOI: 10.3346/jkms.2021.36.e109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/22/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND There is increasing interest in the quality of health care and considerable efforts are being made to improve it. Rheumatoid arthritis (RA) is a disease that can result in favorable outcomes when appropriate diagnosis and treatment are provided. However, several studies have shown that RA is often managed inappropriately. Therefore, the Korean College of Rheumatology aimed to develop quality indicators (QIs) to evaluate and improve the health care of patients with RA. METHODS Preliminary QIs were derived based on the existing guidelines and QIs for RA. The final QIs were determined through two separate consensus meetings of experts. The consensus was achieved through a panel of experts who voted using the modified Delphi method. RESULTS Fourteen final QIs were selected among 70 preliminary QIs. These included early referral to and regular follow-up with a rheumatologist, radiographs of the hands and feet, early initiation and maintenance of disease-modifying anti-rheumatic drug (DMARD) therapy, periodic assessment of disease activity, screening for drug safety and comorbidities, including viral hepatitis and tuberculosis before biologic DMARD therapy, periodic laboratory testing, supplementation with folic acid, assessment of the risk for cervical spine instability before general anesthesia, patient education, and specialized nurse. CONCLUSION These QIs can be used to assess and improve the quality of health care for patients with RA.
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Affiliation(s)
- Mi Ryoung Seo
- Division of Rheumatology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Gunwoo Kim
- Division of Rheumatology, Department of Internal Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Ki Won Moon
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Yoon Kyoung Sung
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Jong Jin Yoo
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Chong Hyeon Yoon
- Division of Rheumatology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Eun Bong Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jisoo Lee
- Division of Rheumatology, Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Eun Ha Kang
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyungjin Kim
- Department of Medical Humanities, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Jung Park
- Division of Rheumatology, Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Wan Sik Uhm
- Uhm's Hanyang Rheumatism Clinic, Seoul, Korea
| | - Myeung Su Lee
- Division of Rheumatology, Department of Internal Medicine, Wonkwang University Hospital, Iksan, Korea
| | | | - Byoong Yong Choi
- Department of Internal Medicine, Seoul Medical Center, Seoul Metropolitan Government, Seoul, Korea
| | - Seung Jae Hong
- Division of Rheumatology, Department of Internal Medicine, Kyung Hee University Medical Center, Kyung Hee University, Seoul, Korea
| | - Han Joo Baek
- Division of Rheumatology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea.
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Taylor E. We Agree, Don't We? The Delphi Method for Health Environments Research. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2021; 13:11-23. [PMID: 31887097 DOI: 10.1177/1937586719887709] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE This overview is intended to provide the process framework for built environment researchers to use the Delphi method. The article outlines the methodological criteria originally established for the Delphi method, as well as commonly accepted modifications, to advance guidance for evidence-based built environment considerations. BACKGROUND Increasingly used in healthcare research, the Delphi method is a process for gaining consensus through controlled feedback from a panel-a group made up of experts or individuals knowledgeable on the subject. The method is often used where there is limited or conflicting evidence, where participants may be geographically dispersed, and where anonymity is desired to control for dominant individuals. The Delphi method consists of panel selection, development of content surveys, and iterative stages of anonymous responses to gain consensus. Panelists receive feedback after each round in the form of a statistical representation of the overall group's response. The goal of multiple iterations in the Delphi method is to reduce the range of responses and gain expert consensus, which is often seen as more credible than conjecture or individual opinion. CONCLUSION With a geographic diversity of healthcare design expertise, and with so many aspects of healthcare design lacking a robust body of supporting empirical research, the Delphi method is well-suited to developing evidence-based design recommendations and considerations for healthcare built environments.
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Lapane KL, Dubé C, Hume AL, Tjia J, Jesdale BM, Pawasauskas J, Khodyakov D. Priority-Setting to Address the Geriatric Pharmacoparadox for Pain Management: A Nursing Home Stakeholder Delphi Study. Drugs Aging 2021; 38:327-340. [PMID: 33624228 DOI: 10.1007/s40266-021-00836-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Evidence to guide clinical decision making for pain management in nursing home residents is scant. OBJECTIVE Our objective was to explore the extent of consensus among expert stakeholders regarding what analgesic issues should be prioritized for comparative-effectiveness studies of beneficial and adverse effects of analgesic regimens in nursing home residents. METHODS Two stakeholder panels (nurses only and a mix of clinicians/researchers) were engaged (n = 83). During a three-round online modified Delphi process, participants rated and commented on the need for new evidence on nonopioid analgesic regimens and opioid regimens, short-term adverse effects, long-term adverse effects, comorbid conditions, and other factors in the nursing home setting (9-point scale; 1 = not essential to 9 = very essential to obtain new evidence). The quantitative data were analyzed to determine the existence of consensus using an approach from the RAND/UCLA Appropriateness Method User's Manual. The qualitative data, consisting of participant explanations of their numeric ratings, were thematically analyzed by an experienced qualitative researcher. RESULTS For nursing home residents, evidence generation was deemed essential for opioids, gabapentin (alone or with serotonin norepinephrine reuptake inhibitors [SNRIs]), and nonsteroid anti-inflammatory drugs with SNRIs. Experts prioritized the following outcomes as essential: long-term adverse effects, including delirium, cognitive decline, and decline in activities of daily living (ADLs). Kidney disease and depression were deemed essential conditions to consider in studies of pain medications. Coprescribing analgesic regimens with benzodiazepines, sedating medications, serotonergic medications, and non-SNRI antidepressants were considered essential areas of study. Experts noted that additional study was essential in residents with moderate/severe cognitive impairment and limitations in ADLs. CONCLUSIONS Stakeholder priorities for more evidence reflect concerns related to treating medically complex residents with complex drug regimens and included long-term adverse effects, coprescribing, and sedating medications. Carefully conducted observational studies are needed to address the vast evidence gap for nursing home residents.
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Affiliation(s)
- Kate L Lapane
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA.
| | - Catherine Dubé
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Anne L Hume
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, RI, USA
| | - Jennifer Tjia
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Bill M Jesdale
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Jayne Pawasauskas
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, RI, USA
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12
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Wattiaux A, Bettendorf B, Block L, Gilmore-Bykovskyi A, Ramly E, Piper ME, Rosenthal A, Sadusky J, Cox E, Chewning B, Bartels CM. Patient Perspectives on Smoking Cessation and Interventions in Rheumatology Clinics. Arthritis Care Res (Hoboken) 2020; 72:369-377. [PMID: 30768768 DOI: 10.1002/acr.23858] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 02/12/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Although smoking is a risk factor for cardiovascular and rheumatic disease severity, only 10% of rheumatology visits document cessation counseling. After implementing a rheumatology clinic protocol that increased tobacco quitline referrals 20-fold, we undertook this study to examine patients' barriers and facilitators to smoking cessation based on prior rheumatology experiences, to solicit reactions to the new cessation protocol, and to identify patient-centered outcomes or signs of cessation progress following improved care. METHODS We recruited 19 patients who smoke (12 with rheumatoid arthritis [RA] and 7 with systemic lupus erythematosus [SLE]) to participate in 1 of 3 semistructured focus groups. Transcripts of the focus group discussions were analyzed using thematic analysis to classify barriers, facilitators, and signs of cessation progress. RESULTS Participant-reported barriers and facilitators to cessation involved psychological, health-related, and social and economic factors, as well as health care messaging and resources. Commonly discussed barriers included viewing smoking as a crutch amid rheumatic disease, rarely receiving cessation counseling in rheumatology clinics, and very limited awareness that smoking can worsen rheumatic diseases or reduce efficacy of some rheumatic disease medications. Participants endorsed our cessation protocol with rheumatology-specific education and accessible resources, such as a quitline. Beyond quitting, participants prioritized knowing why and how to quit as signs of progress outcomes. CONCLUSION Focus groups identified themes and categories of facilitators/barriers to smoking cessation at the levels of patient and health system. Two key outcomes of improving cessation care for patients with RA and SLE were knowing why and how to quit. Emphasizing rheumatologic health benefits and cessation resources is essential when designing and evaluating rheumatology smoking cessation interventions.
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Affiliation(s)
| | | | | | | | | | - Megan E Piper
- University of Wisconsin, Center for Tobacco Research and Intervention, Madison
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13
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Solomon A, Stanwix AE, Castañeda S, Llorca J, Gonzalez-Juanatey C, Hodkinson B, Romela B, Ally MMTM, Maharaj AB, Van Duuren EM, Ziki JJ, Seboka M, Mohapi M, Jansen Van Rensburg BJ, Tarr GS, Makan K, Balton C, Gogakis A, González-Gay MA, Dessein PH. Points to consider in cardiovascular disease risk management among patients with rheumatoid arthritis living in South Africa, an unequal middle income country. BMC Rheumatol 2020; 4:42. [PMID: 32550295 PMCID: PMC7296622 DOI: 10.1186/s41927-020-00139-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 05/07/2020] [Indexed: 12/21/2022] Open
Abstract
Background It is plausible that optimal cardiovascular disease (CVD) risk management differs in patients with rheumatoid arthritis (RA) from low or middle income compared to high income populations. This study aimed at producing evidence-based points to consider for CVD prevention in South African RA patients. Methods Five rheumatologists, one cardiologist and one epidemiologist with experience in CVD risk management in RA patients, as well as two patient representatives, two health professionals and one radiologist, one rheumatology fellow and 11 rheumatologists that treat RA patients regularly contributed. Systematic literature searches were performed and the level of evidence was determined according to standard guidelines. Results Eighteen points to consider were formulated. These were grouped into 6 categories that comprised overall CVD risk assessment and management (n = 4), and specific interventions aimed at reducing CVD risk including RA control with disease modifying anti-rheumatic drugs, glucocorticoids and non-steroidal anti-inflammatory drugs (n = 3), lipid lowering agents (n = 8), antihypertensive drugs (n = 1), low dose aspirin (n = 1) and lifestyle modification (n = 1). Each point to consider differs partially or completely from recommendations previously reported for CVD risk management in RA patients from high income populations. Currently recommended CVD risk calculators do not reliably identify South African black RA patients with very high-risk atherosclerosis as represented by carotid artery plaque presence on ultrasound. Conclusions Our findings indicate that optimal cardiovascular risk management likely differs substantially in RA patients from low or middle income compared to high income populations. There is an urgent need for future multicentre longitudinal studies on CVD risk in black African patients with RA.
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Affiliation(s)
- Ahmed Solomon
- Rheumatology Department, Charlotte Maxeke Johannesburg Academic Hospital, Faculty of Health Sciences, University of Witwatersrand, 80 Scholtz Road, Norwood, Johannesburg, 2190 South Africa
| | - Anne E Stanwix
- Rheumatology Department, Charlotte Maxeke Johannesburg Academic Hospital, Faculty of Health Sciences, University of Witwatersrand, 80 Scholtz Road, Norwood, Johannesburg, 2190 South Africa
| | - Santos Castañeda
- Rheumatology Department, Hospital de la Princesa, IIS-Princesa, Cátedra UAM-ROCHE, EPID-Future, Department of Medicine, Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Javier Llorca
- Universidad de Cantabria - IDIVAL, CIBER Epidemiologia y Salud Pública (CIBERESP), Santander, Spain
| | | | - Bridget Hodkinson
- Rheumatology Department, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Benitha Romela
- Rheumatology Unit, Wilgeheuwel Hospital, Johannesburg, South Africa
| | - Mahmood M T M Ally
- Rheumatology Department, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | - Ajesh B Maharaj
- Rheumatology Unit, Westville Hospital and University of KwaZulu-Natal, Durban, South Africa
| | - Elsa M Van Duuren
- Rheumatology Division, Department of Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Joyce J Ziki
- Rheumatology Department, Charlotte Maxeke Johannesburg Academic Hospital, Faculty of Health Sciences, University of Witwatersrand, 80 Scholtz Road, Norwood, Johannesburg, 2190 South Africa
| | - Mpoti Seboka
- Rheumatology Department, Charlotte Maxeke Johannesburg Academic Hospital, Faculty of Health Sciences, University of Witwatersrand, 80 Scholtz Road, Norwood, Johannesburg, 2190 South Africa
| | - Makgotso Mohapi
- Rheumatology Department, Charlotte Maxeke Johannesburg Academic Hospital, Faculty of Health Sciences, University of Witwatersrand, 80 Scholtz Road, Norwood, Johannesburg, 2190 South Africa
| | | | - Gareth S Tarr
- Rheumatology Department, Tygerberg Hospital, Faculty of Health Sciences, Physiological Sciences Department, Stellenbosch University, Stellenbosch, Western Cape South Africa
| | - Kavita Makan
- Rheumatology Department, Chris Hani Baragwanath Hospital, Johannesburg, South Africa
| | - Charlene Balton
- Rheumatology Department, Charlotte Maxeke Johannesburg Academic Hospital, Faculty of Health Sciences, University of Witwatersrand, 80 Scholtz Road, Norwood, Johannesburg, 2190 South Africa
| | - Aphrodite Gogakis
- Radiology Unit, Rivonia Road Medical Centre, Morningside, Johannesburg, South Africa
| | - Miguel A González-Gay
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.,Division of Rheumatology and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla (IDIVAL), Spain; University of Cantabria, Santander, Spain
| | - Patrick H Dessein
- Rheumatology Department, Charlotte Maxeke Johannesburg Academic Hospital, Faculty of Health Sciences, University of Witwatersrand, 80 Scholtz Road, Norwood, Johannesburg, 2190 South Africa.,School of Physiology and School of Clinical Medicine, Faculty Health Sciences, University of Witwatersrand, Johannesburg, South Africa.,Free University and University Hospital, Brussels, Belgium
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14
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Bodnar LM, Khodyakov D, Himes KP, Burke JG, Parisi S, Hutcheon JA. Engaging Patients and Professionals to Evaluate the Seriousness of Maternal and Child Health Outcomes: Protocol for a Modified Delphi Study. JMIR Res Protoc 2020; 9:e16478. [PMID: 32222699 PMCID: PMC7298634 DOI: 10.2196/16478] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 02/19/2020] [Accepted: 03/21/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Maternal weight gain during pregnancy is one of the few potentially modifiable risk factors for many adverse maternal and child health outcomes. Defining the optimal pregnancy weight gain range is difficult because, while lower weight gain may prevent some outcomes, such as maternal and child obesity, it may increase the risk of others such as fetal growth restriction and infant death. These health outcomes vary in their seriousness to mothers and their health care providers, and these differences in seriousness should be taken into account when determining optimal weight gain ranges. However, the relative seriousness that women and their care providers place on different health outcomes is unknown. OBJECTIVE We will determine the seriousness of 11 maternal and child health outcomes that have been consistently associated with pregnancy weight gain. We will achieve this by engaging patients and maternal and child health professionals using an online modified Delphi panel process. METHODS We aim to recruit a racially/ethnically and geographically diverse group of 90 US maternal and child health professionals and 90 women who are pregnant or less than 2 years postpartum. We will conduct 3 concurrent panels using the ExpertLens system, a previously evaluated online modified Delphi system that combines 2 rounds of rating with 1 round of feedback and moderated online discussion. In Round 1, panelists are asked to rate the seriousness of each health outcome on a scale of 0-100 and to provide a rationale for their scores. In Round 2, panelists will review their responses relative to those of other panelists. They will discuss their seriousness ratings anonymously using a moderated online discussion board. In Round 3, participants will revise their Round 1 responses based on group feedback and discussion. Each round will be open for 1-2 weeks. RESULTS The study protocol was reviewed by our ethics boards and did not require approval as human research. A pilot study of 6 professionals and 7 patients was completed in December 2019. CONCLUSIONS Our numeric estimates of the seriousness of maternal and child health outcomes will enable future studies to determine pregnancy weight gain ranges that balance the risks of low and high weight gain for mothers and children. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/16478.
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Affiliation(s)
- Lisa M Bodnar
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, United States
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
- Magee-Womens Research Institute, Pittsburgh, PA, United States
| | | | - Katherine P Himes
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
- Magee-Womens Research Institute, Pittsburgh, PA, United States
| | - Jessica G Burke
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, United States
| | - Sara Parisi
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, United States
| | - Jennifer A Hutcheon
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
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15
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Joshi GP, Benzon HT, Gan TJ, Vetter TR. Consistent Definitions of Clinical Practice Guidelines, Consensus Statements, Position Statements, and Practice Alerts. Anesth Analg 2019; 129:1767-1770. [PMID: 31743199 DOI: 10.1213/ane.0000000000004236] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
An evidence-based approach to clinical decision-making for optimizing patient care is desirable because it promotes quality of care, improves patient safety, decreases medical errors, and reduces health care costs. Clinical practice recommendations are systematically developed documents regarding best practice for specific clinical management issues, which can assist care providers in their clinical decision-making. However, there is currently wide variation in the terminology used for such clinical practice recommendations. The aim of this article is to provide guidance to authors, reviewers, and editors on the definitions of terms commonly used for clinical practice recommendations. This is intended to improve transparency and clarity regarding the definitions of these terminologies.
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Affiliation(s)
- Girish P Joshi
- From the Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Honorio T Benzon
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Tong J Gan
- Department of Anesthesiology, Stony Brook University, Stony Brook, New York
| | - Thomas R Vetter
- Department of Surgery and Perioperative Care, Dell Medical School at University of Texas, Austin, Texas
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16
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Ramalho A, Castro P, Gonçalves-Pinho M, Teixeira J, Santos JV, Viana J, Lobo M, Santos P, Freitas A. Primary health care quality indicators: An umbrella review. PLoS One 2019; 14:e0220888. [PMID: 31419235 PMCID: PMC6697344 DOI: 10.1371/journal.pone.0220888] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 07/22/2019] [Indexed: 01/08/2023] Open
Abstract
Nowadays, evaluating the quality of health services, especially in primary health care (PHC), is increasingly important. In a historical perspective, the Department of Health (United Kingdom) developed and proposed a range of indicators in 1998, and lately several health, social and political organizations have defined and implemented different sets of PHC quality indicators. Some systematic reviews in PHC quality indicators are reported but only in specific contexts and conditions. The aim of this study is to characterize and provide a list of indicators discussed in the literature to support managers and clinicians in decision-making processes, through an umbrella review on PHC quality indicators. The methodology was performed according to PRISMA Statement. Indicators from 33 eligible systematic reviews were categorized according to the dimensions of care, function, type of care, domains and condition contexts. Of a total of 727 indicators or groups of indicators, 74.5% (n = 542) were classified in process category and 89.5% (n = 537) with chronic type of care (n = 428; 58.8%) and effective domain (n = 423; 58.1%) with the most frequent values in categorizations by dimensions. The results of this overview of reviews are valuable and imply the need for future research and practice regarding primary health care quality indicators in the most varied conditions and contexts to generate new discussions about their use, comparison and implementation.
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Affiliation(s)
- André Ramalho
- MEDCIDS–Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS–Centre for Health Technology and Services Research, Porto, Portugal
| | - Pedro Castro
- USF Camélias, ACeS Grande Porto VII (ARS Norte)–Vila Nova de Gaia, Portugal
| | - Manuel Gonçalves-Pinho
- MEDCIDS–Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS–Centre for Health Technology and Services Research, Porto, Portugal
| | - Juliana Teixeira
- MEDCIDS–Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
| | - João Vasco Santos
- MEDCIDS–Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS–Centre for Health Technology and Services Research, Porto, Portugal
- Public Health Unit, ACeS Grande Porto VIII (ARS Norte)–Espinho/Gaia, Portugal
| | - João Viana
- MEDCIDS–Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS–Centre for Health Technology and Services Research, Porto, Portugal
| | - Mariana Lobo
- MEDCIDS–Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS–Centre for Health Technology and Services Research, Porto, Portugal
| | - Paulo Santos
- MEDCIDS–Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS–Centre for Health Technology and Services Research, Porto, Portugal
| | - Alberto Freitas
- MEDCIDS–Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS–Centre for Health Technology and Services Research, Porto, Portugal
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17
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Butler EA, Baron M, Fogo AB, Frech T, Ghossein C, Hachulla E, Hoa S, Johnson SR, Khanna D, Mouthon L, Nikpour M, Proudman S, Steen V, Stern E, Varga J, Denton C, Hudson M. Generation of a Core Set of Items to Develop Classification Criteria for Scleroderma Renal Crisis Using Consensus Methodology. Arthritis Rheumatol 2019; 71:964-971. [PMID: 30614663 DOI: 10.1002/art.40809] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 12/13/2018] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To generate a core set of items to develop classification criteria for scleroderma renal crisis (SRC) using consensus methodology. METHODS An international, multidisciplinary panel of experts was invited to participate in a 3-round Delphi exercise developed using a survey based on items identified by a scoping review. In round 1, participants were asked to identify omissions and clarify ambiguities regarding the items in the survey. In round 2, participants were asked to rate the validity and feasibility of the items using Likert-type scales ranging from 1 to 9 (where 1 = very invalid/unfeasible, 5 = uncertain, and 9 = very valid/feasible). In round 3, participants reviewed the results and comments from round 2 and were asked to provide final ratings. Items rated as highly valid and feasible (median scores ≥7 for each) in round 3 were selected as the provisional core set of items. A consensus meeting using a nominal group technique was conducted to further reduce the core set of items. RESULTS Ninety-nine experts from 16 countries participated in the Delphi exercise. Of the 31 items in the survey, consensus was achieved on 13, in the categories hypertension, renal insufficiency, proteinuria, and hemolysis. Eleven experts took part in the nominal group technique discussion, where consensus was achieved in 5 domains: blood pressure, acute kidney injury, microangiopathic hemolytic anemia, target organ dysfunction, and renal histopathology. CONCLUSION A core set of items that characterize SRC was identified using consensus methodology. This core set will be used in future data-driven phases of this project to develop classification criteria for SRC.
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Affiliation(s)
| | - Murray Baron
- Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Agnes B Fogo
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Cybele Ghossein
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Eric Hachulla
- University of Lille and Hôpital Claude Huriez, Lille, France
| | - Sabrina Hoa
- McGill University and Lady Davis Institute, Montreal, Quebec, Canada
| | - Sindhu R Johnson
- Toronto Western Hospital, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
| | | | - Luc Mouthon
- Cochin Hospital, Paris-Descartes University, Paris, France
| | - Mandana Nikpour
- University of Melbourne at St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Susanna Proudman
- Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia
| | | | | | - John Varga
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Marie Hudson
- Jewish General Hospital, McGill University and Lady Davis Institute, Montreal, Quebec, Canada
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18
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Awareness and perceived risk of cardiovascular disease among individuals living with rheumatoid arthritis is low: results of a systematic literature review. Arthritis Res Ther 2019; 21:33. [PMID: 30670075 PMCID: PMC6341634 DOI: 10.1186/s13075-019-1817-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 01/08/2019] [Indexed: 12/22/2022] Open
Abstract
Background Individuals with rheumatoid arthritis (RA) are at risk of developing cardiovascular disease (CVD), but patient perceptions of CVD are not routinely assessed. We performed a systematic literature review to evaluate awareness of the association between RA and CVD, and perceived risk of CVD among individuals with RA. Methods Three electronic databases (MEDLINE, EMBASE, and PubMed) were searched for English language articles between the years of 1990–2018. Search terms pertained to RA, CVD, knowledge, awareness, or perceptions of CVD risk. Abstracts were screened for inclusion/exclusion by two independent reviewers. Results A total of 33 abstracts were screened and 6 underwent full review. The overall sample size was 478 subjects and included patients with established RA who were predominantly female with a mean age range of 53 to 64 years. RA disease characteristics relevant to CVD were not uniformly reported, including the use of DMARDs, corticosteroids, or NSAIDs. A high proportion of subjects (range 73 to 97%) were unaware of an increased risk of developing CVD in relation to their RA, and this frequently occurred in those with a greater number of traditional CVD risk factors. Misperceptions about CVD were common, and the majority of subjects misestimated their actual CVD risk. Conclusion Individuals with RA at highest risk for CVD report low awareness and perceived risk of this comorbidity. This represents a knowledge gap in need of intervention but must be tailored to patients’ needs. An understanding of the system- and individual-level barriers preventing CVD awareness is needed. Only then will approaches to improve CVD screening and management in RA be successful. Electronic supplementary material The online version of this article (10.1186/s13075-019-1817-y) contains supplementary material, which is available to authorized users.
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19
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Righolt AJ, Sidorenkov G, Faggion CM, Listl S, Duijster D. Quality measures for dental care: A systematic review. Community Dent Oral Epidemiol 2018; 47:12-23. [PMID: 30375669 PMCID: PMC7379624 DOI: 10.1111/cdoe.12429] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 09/23/2018] [Accepted: 09/30/2018] [Indexed: 01/26/2023]
Abstract
Objectives This systematic review aimed to (a) provide an overview of existing quality measures in the field of oral health care, and to (b) evaluate the scientific soundness and applicability of these quality measures. Methods A systematic search was conducted in three electronic databases MEDLINE (via PubMed), EMBASE (via OVID) and LILACS (via BIREME). The search was restricted to articles published between 2002 and 2018. Publications reporting on the development process or clinimetric properties of oral health care quality measures for outpatient oral health care in dental practices were included. The identified publications reporting on oral health care quality measures were critically appraised with the Appraisal of Indicators through Research and Evaluation 2.0 (AIRE 2.0) instrument to evaluate the soundness and applicability of the measures. Results The search strategy resulted in 2541 unique and potentially relevant articles. In total, 24 publications were included yielding 215 quality measures. The critical appraisal showed a large variation in the quality of the included publications (AIRE scores ranging from 38 to 78 out of 80 possible points). The majority of measures (n = 71) referred to treatment and preventive services. Comparably, few measures referred to the domain patient safety (n = 3). The development process of measures often exhibited a lack of involvement of patients and dental professionals. Few projects reported on the validity (n = 2) and reliability (n = 3) of the measures. Four projects piloted the measures for implementation in practice. Conclusions This systematic review provides an overview of the status quo with respect to existing quality measures in oral health care. Potential opportunities include the piloting and testing of quality measures and the establishment of suitable information systems that allow the provision of transparent routine feedback on the quality of oral health care.
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Affiliation(s)
- Amy Joyce Righolt
- Department of Dentistry - Quality and Safety of Oral Healthcare, Radboud University Medical Center, Radboud University, Nijmegen, The Netherlands
| | - Grigory Sidorenkov
- Department of Dentistry - Quality and Safety of Oral Healthcare, Radboud University Medical Center, Radboud University, Nijmegen, The Netherlands.,Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Clovis Mariano Faggion
- Department of Periodontology and Operative Dentistry, Faculty of Dentistry, University of Münster, Münster, Germany
| | - Stefan Listl
- Department of Dentistry - Quality and Safety of Oral Healthcare, Radboud University Medical Center, Radboud University, Nijmegen, The Netherlands.,Section for Translational Health Economics, Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Denise Duijster
- Department of Social Dentistry, Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, The Netherlands
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20
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Abstract
OBJECTIVE All healthcare systems require valid ways to evaluate service delivery. The objective of this study was to identify existing content validated quality indicators (QIs) for responsible use of medicines (RUM) and classify them using multiple frameworks to identify gaps in current quality measurements. DESIGN Systematic review without meta-analysis. SETTING All care settings. SEARCH STRATEGY CINAHL, Embase, Global Health, International Pharmaceutical Abstract, MEDLINE, PubMed and Web of Science databases were searched up to April 2018. An internet search was also conducted. Articles were included if they described medication-related QIs developed using consensus methods. Government agency websites listing QIs for RUM were also included. ANALYSIS Several multidimensional frameworks were selected to assess the scope of QI coverage. These included Donabedian's framework (structure, process and outcome), the Anatomical Therapeutic Chemical (ATC) classification system and a validated classification for causes of drug-related problems (c-DRPs; drug selection, drug form, dose selection, treatment duration, drug use process, logistics, monitoring, adverse drug reactions and others). RESULTS 2431 content validated QIs were identified from 131 articles and 5 websites. Using Donabedian's framework, the majority of QIs were process indicators. Based on the ATC code, the largest number of QIs pertained to medicines for nervous system (ATC code: N), followed by anti-infectives for systemic use (J) and cardiovascular system (C). The most common c-DRPs pertained to 'drug selection', followed by 'monitoring' and 'drug use process'. CONCLUSIONS This study was the first systematic review classifying QIs for RUM using multiple frameworks. The list of the identified QIs can be used as a database for evaluating the achievement of RUM. Although many QIs were identified, this approach allowed for the identification of gaps in quality measurement of RUM. In order to more effectively evaluate the extent to which RUM has been achieved, further development of QIs may be required.
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Affiliation(s)
- Kenji Fujita
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Rebekah J Moles
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Timothy F Chen
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Schmidt TJ, Aviña-Zubieta JA, Sayre EC, Abrahamowicz M, Esdaile JM, Lacaille D. Cardiovascular Disease Prevention in Rheumatoid Arthritis: Compliance with Diabetes Screening Guidelines. J Rheumatol 2018; 45:1367-1374. [DOI: 10.3899/jrheum.170973] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2018] [Indexed: 12/16/2022]
Abstract
Objective.To evaluate compliance with diabetes screening guidelines for cardiovascular disease (CVD) prevention in rheumatoid arthritis (RA) compared to the general population.Methods.We conducted the first longitudinal study of a population-based RA cohort including all prevalent RA cases in British Columbia between 1996 and 2006 and followed until 2010, with matched general population comparators. Using administrative data, we measured compliance with general population guidelines [i.e., testing plasma glucose (PG) at least once every 3 years after age 45] after excluding individuals with previous diabetes. Followup was divided into 3-year eligibility periods. Compliance was measured as the proportion of periods with ≥ 1 PG test performed. OR (95% CI) of compliance in RA (vs general population) was calculated using generalized estimating equation models, adjusting for age and sex. Mean compliance rate per patient was also calculated and compared using the Mann-Whitney U test.Results.Analysis included 22,624 individuals with RA, contributing 48,724 three-year eligibility periods; and 22,579 people in a general population group, contributing 51,081 three-year eligibility periods. PG was measured in 72.3% (SD 37%) of the eligible time periods in the RA sample and in 70.4% (SD 38%) for the general population (OR 1.05, 95% CI 1.02–1.09, p < 0.0001). RA individuals met recommended screening guidelines in 71.4% of their eligible periods, compared to 70.6% (p < 0.001). Screening improved over time in RA relative to the general population. Family physicians ordered nearly all the PG tests.Conclusion.Compliance with general population guidelines for diabetes screening in RA was suboptimal, with little difference relative to the general population, despite a higher risk of CVD and diabetes.
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Schmidt TJ, Aviña-Zubieta JA, Sayre EC, Abrahamowicz M, Esdaile JM, Lacaille D. Quality of care for cardiovascular disease prevention in rheumatoid arthritis: compliance with hyperlipidemia screening guidelines. Rheumatology (Oxford) 2018; 57:1789-1794. [DOI: 10.1093/rheumatology/key164] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Indexed: 12/11/2022] Open
Affiliation(s)
- Timothy J Schmidt
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Arthritis Research Canada, Milan Ilich Arthritis Research Centre, Richmond, Canada
| | - J Antonio Aviña-Zubieta
- Arthritis Research Canada, Milan Ilich Arthritis Research Centre, Richmond, Canada
- Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eric C Sayre
- Arthritis Research Canada, Milan Ilich Arthritis Research Centre, Richmond, Canada
| | - Michal Abrahamowicz
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada, Canada
| | - John M Esdaile
- Arthritis Research Canada, Milan Ilich Arthritis Research Centre, Richmond, Canada
- Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Diane Lacaille
- Arthritis Research Canada, Milan Ilich Arthritis Research Centre, Richmond, Canada
- Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Bartels CM, Johnson H, Alcaraz Voelker K, Ogdie A, McBride P, Jacobs EA, Zhao YQ, Smith M. Frequency and Predictors of Communication About High Blood Pressure in Rheumatoid Arthritis Visits. J Clin Rheumatol 2018; 24:210-217. [PMID: 29688897 PMCID: PMC5962363 DOI: 10.1097/rhu.0000000000000726] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND/OBJECTIVE Given heightened cardiovascular disease (CVD) risk in rheumatoid arthritis (RA) and that higher blood pressure (BP) represents greater CVD risk, we hypothesized that higher BP would predict more BP-related communication in rheumatology visits. We examined predictors of documented BP communication during RA clinic visits. METHODS This was a retrospective cohort study of RA patients identified in electronic health record records with uncontrolled hypertension (HTN) receiving both primary and rheumatology care. Trained abstractors reviewed RA visit notes for "BP communication" using a standardized tool to elicit documentation about BP or HTN beyond recording vital signs. We used multivariate logistic regression to examine the impact of BP category (American Heart Association: ideal normotension, pre-HTN, and stages I and II HTN) on odds ratios (95% confidence intervals) of BP communication. RESULTS Among 1267 RA patients, 40% experienced BP elevations meeting the definition of uncontrolled HTN. Of 2677 eligible RA visits, 22% contained any documented BP communication. After adjustment, models predicted only 31% of visits with markedly high BPs 160/100 mm Hg or greater would contain BP communication. Compared with stage I, stage II elevation did not significantly increase communication (odds ratio, 2.0 [95% confidence interval, 1.4-2.8] vs. 1.5 [1.2-2.2]), although both groups' odds exceeded pre-HTN and normotension. Less than 10% of eligible visits resulted in documented action steps recommending follow-up of high BP. CONCLUSIONS Regardless of BP magnitude, most RA clinic visits lacked documented communication about BP despite compounded CVD risk. Future work should study how rheumatology clinics can facilitate follow-up of high BPs to address HTN as the most common and reversible CVD risk factor.
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Affiliation(s)
| | | | | | - Alexis Ogdie
- Division of Rheumatology, Center for Clinical Epidemiology and Biostatistics, Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | | | | | - Ying-Qi Zhao
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
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24
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Legge A, Hanly JG. Managing premature atherosclerosis in patients with chronic inflammatory diseases. CMAJ 2018; 190:E430-E439. [PMID: 29632038 PMCID: PMC5893318 DOI: 10.1503/cmaj.170776] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Alexandra Legge
- Department of Medicine (Legge); Division of Rheumatology, Department of Medicine, and Department of Pathology (Hanly), Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, NS
| | - John G Hanly
- Department of Medicine (Legge); Division of Rheumatology, Department of Medicine, and Department of Pathology (Hanly), Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, NS
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25
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Cooper M, Rouhi A, Barber CEH. A Systematic Review of Quality Measures for Inflammatory Arthritis. J Rheumatol 2017; 45:274-283. [PMID: 29142026 DOI: 10.3899/jrheum.170157] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To conduct a systematic review and quality appraisal of quality measures for inflammatory arthritis, including rheumatoid arthritis (RA), spondyloarthritis, psoriatic arthritis (PsA), and juvenile idiopathic arthritis (JIA). METHODS Embase, MEDLINE, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched from January 1, 2000, to October 23, 2016, using Medical Subject Headings terms for inflammatory arthritis and quality measures. A "grey literature" search of international arthritis organizations and quality measure libraries was also conducted. Two reviewers independently considered the papers for inclusion, with disagreements resolved by consensus. A modified guideline appraisal tool (AGREE II) was used to appraise the measure development process, which determined final inclusion. Measures were abstracted in duplicate and categorized into themes, measure type, and domains of quality. RESULTS Thirteen measurement sets were included from 4 countries (United States, Canada, United Kingdom, Netherlands) and 1 European consortium. They included 10 sets on RA and 1 each for PsA, inflammatory arthritis, and JIA. There were 161 unique individual measures (136 process, 20 structure, and 5 outcome). Major themes included assessment, medications, and comorbidities. Measure development methods were varied, including RAND/University of California, Los Angeles appropriateness methodology, prioritization exercises, or other modified-Delphi methods. Inclusion of patients occurred in 77% of development groups. Discussion of barriers to measurement was infrequent. CONCLUSION Inflammatory arthritis quality measures cover a diversity of themes encompassing process, structure, and outcomes of care across the 6 domains of quality. However, between organizations, measure development is not standardized. Local assessment of measurement feasibility before use outside the original development context is recommended.
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Affiliation(s)
- Matthew Cooper
- From the Department of Medicine, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary; Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta; Arthritis Research Canada, Richmond, British Columbia, Canada.,M. Cooper, MD, FRCPC, Rheumatology Resident, Department of Medicine, Cumming School of Medicine, University of Calgary; A. Rouhi, BHSc, MD program student, Faculty of Medicine and Dentistry, University of Alberta; C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, and Scientist, Arthritis Research Canada
| | - Azin Rouhi
- From the Department of Medicine, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary; Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta; Arthritis Research Canada, Richmond, British Columbia, Canada.,M. Cooper, MD, FRCPC, Rheumatology Resident, Department of Medicine, Cumming School of Medicine, University of Calgary; A. Rouhi, BHSc, MD program student, Faculty of Medicine and Dentistry, University of Alberta; C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, and Scientist, Arthritis Research Canada
| | - Claire E H Barber
- From the Department of Medicine, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary; Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta; Arthritis Research Canada, Richmond, British Columbia, Canada. .,M. Cooper, MD, FRCPC, Rheumatology Resident, Department of Medicine, Cumming School of Medicine, University of Calgary; A. Rouhi, BHSc, MD program student, Faculty of Medicine and Dentistry, University of Alberta; C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, and Scientist, Arthritis Research Canada.
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Chodara AM, Wattiaux A, Bartels CM. Managing Cardiovascular Disease Risk in Rheumatoid Arthritis: Clinical Updates and Three Strategic Approaches. Curr Rheumatol Rep 2017; 19:16. [PMID: 28361332 DOI: 10.1007/s11926-017-0643-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
ᅟ: The increase in cardiovascular disease (CVD) risk in rheumatoid arthritis (RA) is well known; however, appropriate management of this elevated risk in rheumatology clinics is less clear. PURPOSE OF REVIEW By critically reviewing literature published within the past 5 years, we aim to clarify current knowledge and gaps regarding CVD risk management in RA. RECENT FINDINGS We examine recent guidelines, recommendations, and evidence and discuss three approaches: (1) RA-specific management including treat-to-target and medication management, (2) assessment of comprehensive individual risk, and (3) targeting traditional CVD risk factors (hypertension, smoking, hyperlipidemia, diabetes, obesity, and physical inactivity) at a population level. Considering that 75% of US RA visits occur in specialty clinics, further research is needed regarding evidence-based strategies to manage and reduce CVD risk in RA. This review highlights clinical updates including US cardiology and international professional society guidelines, successful evidence-based population approaches from primary care, and novel opportunities in rheumatology care to reduce CVD risk in RA.
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Affiliation(s)
- Ann M Chodara
- Department of Medicine, University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - Aimée Wattiaux
- Rheumatology Division, Department of Medicine, University of Wisconsin (UW) School of Medicine and Public Health (SMPH), 1685 Highland Ave, Rm 4132, 53705-2281, Madison, WI, USA
| | - Christie M Bartels
- Rheumatology Division, Department of Medicine, University of Wisconsin (UW) School of Medicine and Public Health (SMPH), 1685 Highland Ave, Rm 4132, 53705-2281, Madison, WI, USA.
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Barber CEH, Mosher DP, Ahluwalia V, Zummer M, Marshall DA, Choquette D, Lacaille D, Bombardier C, Lyddiatt A, Chandran V, Khodyakov D, Dao E, Barnabe C. Development of a Canadian Core Clinical Dataset to Support High-quality Care for Canadian Patients with Rheumatoid Arthritis. J Rheumatol 2017; 44:1813-1822. [PMID: 28966205 DOI: 10.3899/jrheum.170421] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To develop a Canadian Rheumatoid Arthritis Core Clinical Dataset (CAN-RACCD) to standardize documentation encouraging high-quality care. METHODS A set of candidate elements was drafted through meetings with 27 rheumatologists, researchers, and patients, and supplemented with focused literature reviews. A 3-round online-modified Delphi consensus process was held with rheumatologists (n = 26), allied health professionals (n = 7), and patients (n = 4); for the remainder there was no demographic information. Participants rated both the importance and feasibility of documenting candidate elements on a Likert scale of 1-9, contributed to an online moderated discussion, and re-rated the elements for inclusion in the CAN-RACCD. Elements were included in the final set if importance and feasibility ratings had a median score of ≥ 6.5 and there was no disagreement among participants. RESULTS Fifty-five individual elements in 10 subgroups were proposed to the Delphi participants: measures of RA disease activity; dates to calculate waiting times, disease duration, and disease-modifying antirheumatic drug start; comorbidities; smoking status; patient-reported pain and fatigue; physical function; laboratory and radiographic investigations; medications; clinical characteristics; and vaccines. All groups were included in the final set, with the exception of vaccination status. Additionally, 3 individual elements from the smoking subgroup were eliminated with a recommendation to record smoking status as never/ever/current, and 2 elements relating to coping and effect of fatigue were eliminated due to low feasibility and importance ratings. CONCLUSION The CAN-RACCD stands as a national recommendation on which data elements should be routinely collected in clinical practice to monitor and support high-quality RA care.
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Affiliation(s)
- Claire E H Barber
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences of the Cumming School of Medicine, and the McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Division of Rheumatology, and the Department of Medicine and Laboratory Medicine and Pathobiology, and the Institute of Medical Science, and the Krembil Research Institute, University of Toronto, Toronto; Arthritis Alliance of Canada (AAC) Inflammatory Arthritis Models of Care, Toronto; William Osler Health System, Brampton; Canadian Institute of Health Research (CIHR) National Steering Committee, Ottawa; Outcome Measures in Rheumatology (OMERACT), Ottawa, Ontario; Hôpital Maisonneuve-Rosemont, and the Institut de Recherche en Rhumatologie de Montréal, Université de Montréal, Montreal, Quebec, Canada; RAND Corp., Santa Monica, California, USA. .,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, departments of Medicine and Community Health Sciences, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, Research Scientist, Arthritis Research Canada; D.P. Mosher, MD, FRCPC, Professor, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, Associate Professor, Université de Montréal; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health, and Arthritis Research Canada; D. Choquette, MD, FRCPC, Institut de Recherche en Rhumatologie de Montréal, Scientific Director, Rhumadata, Université de Montréal; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, Senior Scientist, Arthritis Research Canada; C. Bombardier, MD, FRCPC, Professor, Division of Rheumatology, University of Toronto; A. Lyddiatt, member, CIHR National Steering Committee, OMERACT patient research partner, AAC Inflammatory Arthritis Models of Care Executive Member; V. Chandran, MBBS, MD, DM, PhD, Assistant Professor, Department of Medicine and Laboratory Medicine and Pathobiology, Institute of Medical Science, Krembil Research Institute; D. Khodyakov, PhD, MA, BA, Senior Behavioral/Social Scientist, RAND Corp.; E. Dao, BS, RAND Corp.; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary.
| | - Dianne P Mosher
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences of the Cumming School of Medicine, and the McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Division of Rheumatology, and the Department of Medicine and Laboratory Medicine and Pathobiology, and the Institute of Medical Science, and the Krembil Research Institute, University of Toronto, Toronto; Arthritis Alliance of Canada (AAC) Inflammatory Arthritis Models of Care, Toronto; William Osler Health System, Brampton; Canadian Institute of Health Research (CIHR) National Steering Committee, Ottawa; Outcome Measures in Rheumatology (OMERACT), Ottawa, Ontario; Hôpital Maisonneuve-Rosemont, and the Institut de Recherche en Rhumatologie de Montréal, Université de Montréal, Montreal, Quebec, Canada; RAND Corp., Santa Monica, California, USA.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, departments of Medicine and Community Health Sciences, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, Research Scientist, Arthritis Research Canada; D.P. Mosher, MD, FRCPC, Professor, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, Associate Professor, Université de Montréal; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health, and Arthritis Research Canada; D. Choquette, MD, FRCPC, Institut de Recherche en Rhumatologie de Montréal, Scientific Director, Rhumadata, Université de Montréal; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, Senior Scientist, Arthritis Research Canada; C. Bombardier, MD, FRCPC, Professor, Division of Rheumatology, University of Toronto; A. Lyddiatt, member, CIHR National Steering Committee, OMERACT patient research partner, AAC Inflammatory Arthritis Models of Care Executive Member; V. Chandran, MBBS, MD, DM, PhD, Assistant Professor, Department of Medicine and Laboratory Medicine and Pathobiology, Institute of Medical Science, Krembil Research Institute; D. Khodyakov, PhD, MA, BA, Senior Behavioral/Social Scientist, RAND Corp.; E. Dao, BS, RAND Corp.; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary
| | - Vandana Ahluwalia
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences of the Cumming School of Medicine, and the McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Division of Rheumatology, and the Department of Medicine and Laboratory Medicine and Pathobiology, and the Institute of Medical Science, and the Krembil Research Institute, University of Toronto, Toronto; Arthritis Alliance of Canada (AAC) Inflammatory Arthritis Models of Care, Toronto; William Osler Health System, Brampton; Canadian Institute of Health Research (CIHR) National Steering Committee, Ottawa; Outcome Measures in Rheumatology (OMERACT), Ottawa, Ontario; Hôpital Maisonneuve-Rosemont, and the Institut de Recherche en Rhumatologie de Montréal, Université de Montréal, Montreal, Quebec, Canada; RAND Corp., Santa Monica, California, USA.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, departments of Medicine and Community Health Sciences, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, Research Scientist, Arthritis Research Canada; D.P. Mosher, MD, FRCPC, Professor, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, Associate Professor, Université de Montréal; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health, and Arthritis Research Canada; D. Choquette, MD, FRCPC, Institut de Recherche en Rhumatologie de Montréal, Scientific Director, Rhumadata, Université de Montréal; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, Senior Scientist, Arthritis Research Canada; C. Bombardier, MD, FRCPC, Professor, Division of Rheumatology, University of Toronto; A. Lyddiatt, member, CIHR National Steering Committee, OMERACT patient research partner, AAC Inflammatory Arthritis Models of Care Executive Member; V. Chandran, MBBS, MD, DM, PhD, Assistant Professor, Department of Medicine and Laboratory Medicine and Pathobiology, Institute of Medical Science, Krembil Research Institute; D. Khodyakov, PhD, MA, BA, Senior Behavioral/Social Scientist, RAND Corp.; E. Dao, BS, RAND Corp.; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary
| | - Michel Zummer
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences of the Cumming School of Medicine, and the McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Division of Rheumatology, and the Department of Medicine and Laboratory Medicine and Pathobiology, and the Institute of Medical Science, and the Krembil Research Institute, University of Toronto, Toronto; Arthritis Alliance of Canada (AAC) Inflammatory Arthritis Models of Care, Toronto; William Osler Health System, Brampton; Canadian Institute of Health Research (CIHR) National Steering Committee, Ottawa; Outcome Measures in Rheumatology (OMERACT), Ottawa, Ontario; Hôpital Maisonneuve-Rosemont, and the Institut de Recherche en Rhumatologie de Montréal, Université de Montréal, Montreal, Quebec, Canada; RAND Corp., Santa Monica, California, USA.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, departments of Medicine and Community Health Sciences, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, Research Scientist, Arthritis Research Canada; D.P. Mosher, MD, FRCPC, Professor, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, Associate Professor, Université de Montréal; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health, and Arthritis Research Canada; D. Choquette, MD, FRCPC, Institut de Recherche en Rhumatologie de Montréal, Scientific Director, Rhumadata, Université de Montréal; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, Senior Scientist, Arthritis Research Canada; C. Bombardier, MD, FRCPC, Professor, Division of Rheumatology, University of Toronto; A. Lyddiatt, member, CIHR National Steering Committee, OMERACT patient research partner, AAC Inflammatory Arthritis Models of Care Executive Member; V. Chandran, MBBS, MD, DM, PhD, Assistant Professor, Department of Medicine and Laboratory Medicine and Pathobiology, Institute of Medical Science, Krembil Research Institute; D. Khodyakov, PhD, MA, BA, Senior Behavioral/Social Scientist, RAND Corp.; E. Dao, BS, RAND Corp.; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary
| | - Deborah A Marshall
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences of the Cumming School of Medicine, and the McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Division of Rheumatology, and the Department of Medicine and Laboratory Medicine and Pathobiology, and the Institute of Medical Science, and the Krembil Research Institute, University of Toronto, Toronto; Arthritis Alliance of Canada (AAC) Inflammatory Arthritis Models of Care, Toronto; William Osler Health System, Brampton; Canadian Institute of Health Research (CIHR) National Steering Committee, Ottawa; Outcome Measures in Rheumatology (OMERACT), Ottawa, Ontario; Hôpital Maisonneuve-Rosemont, and the Institut de Recherche en Rhumatologie de Montréal, Université de Montréal, Montreal, Quebec, Canada; RAND Corp., Santa Monica, California, USA.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, departments of Medicine and Community Health Sciences, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, Research Scientist, Arthritis Research Canada; D.P. Mosher, MD, FRCPC, Professor, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, Associate Professor, Université de Montréal; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health, and Arthritis Research Canada; D. Choquette, MD, FRCPC, Institut de Recherche en Rhumatologie de Montréal, Scientific Director, Rhumadata, Université de Montréal; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, Senior Scientist, Arthritis Research Canada; C. Bombardier, MD, FRCPC, Professor, Division of Rheumatology, University of Toronto; A. Lyddiatt, member, CIHR National Steering Committee, OMERACT patient research partner, AAC Inflammatory Arthritis Models of Care Executive Member; V. Chandran, MBBS, MD, DM, PhD, Assistant Professor, Department of Medicine and Laboratory Medicine and Pathobiology, Institute of Medical Science, Krembil Research Institute; D. Khodyakov, PhD, MA, BA, Senior Behavioral/Social Scientist, RAND Corp.; E. Dao, BS, RAND Corp.; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary
| | - Denis Choquette
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences of the Cumming School of Medicine, and the McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Division of Rheumatology, and the Department of Medicine and Laboratory Medicine and Pathobiology, and the Institute of Medical Science, and the Krembil Research Institute, University of Toronto, Toronto; Arthritis Alliance of Canada (AAC) Inflammatory Arthritis Models of Care, Toronto; William Osler Health System, Brampton; Canadian Institute of Health Research (CIHR) National Steering Committee, Ottawa; Outcome Measures in Rheumatology (OMERACT), Ottawa, Ontario; Hôpital Maisonneuve-Rosemont, and the Institut de Recherche en Rhumatologie de Montréal, Université de Montréal, Montreal, Quebec, Canada; RAND Corp., Santa Monica, California, USA.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, departments of Medicine and Community Health Sciences, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, Research Scientist, Arthritis Research Canada; D.P. Mosher, MD, FRCPC, Professor, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, Associate Professor, Université de Montréal; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health, and Arthritis Research Canada; D. Choquette, MD, FRCPC, Institut de Recherche en Rhumatologie de Montréal, Scientific Director, Rhumadata, Université de Montréal; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, Senior Scientist, Arthritis Research Canada; C. Bombardier, MD, FRCPC, Professor, Division of Rheumatology, University of Toronto; A. Lyddiatt, member, CIHR National Steering Committee, OMERACT patient research partner, AAC Inflammatory Arthritis Models of Care Executive Member; V. Chandran, MBBS, MD, DM, PhD, Assistant Professor, Department of Medicine and Laboratory Medicine and Pathobiology, Institute of Medical Science, Krembil Research Institute; D. Khodyakov, PhD, MA, BA, Senior Behavioral/Social Scientist, RAND Corp.; E. Dao, BS, RAND Corp.; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary
| | - Diane Lacaille
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences of the Cumming School of Medicine, and the McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Division of Rheumatology, and the Department of Medicine and Laboratory Medicine and Pathobiology, and the Institute of Medical Science, and the Krembil Research Institute, University of Toronto, Toronto; Arthritis Alliance of Canada (AAC) Inflammatory Arthritis Models of Care, Toronto; William Osler Health System, Brampton; Canadian Institute of Health Research (CIHR) National Steering Committee, Ottawa; Outcome Measures in Rheumatology (OMERACT), Ottawa, Ontario; Hôpital Maisonneuve-Rosemont, and the Institut de Recherche en Rhumatologie de Montréal, Université de Montréal, Montreal, Quebec, Canada; RAND Corp., Santa Monica, California, USA.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, departments of Medicine and Community Health Sciences, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, Research Scientist, Arthritis Research Canada; D.P. Mosher, MD, FRCPC, Professor, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, Associate Professor, Université de Montréal; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health, and Arthritis Research Canada; D. Choquette, MD, FRCPC, Institut de Recherche en Rhumatologie de Montréal, Scientific Director, Rhumadata, Université de Montréal; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, Senior Scientist, Arthritis Research Canada; C. Bombardier, MD, FRCPC, Professor, Division of Rheumatology, University of Toronto; A. Lyddiatt, member, CIHR National Steering Committee, OMERACT patient research partner, AAC Inflammatory Arthritis Models of Care Executive Member; V. Chandran, MBBS, MD, DM, PhD, Assistant Professor, Department of Medicine and Laboratory Medicine and Pathobiology, Institute of Medical Science, Krembil Research Institute; D. Khodyakov, PhD, MA, BA, Senior Behavioral/Social Scientist, RAND Corp.; E. Dao, BS, RAND Corp.; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary
| | - Claire Bombardier
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences of the Cumming School of Medicine, and the McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Division of Rheumatology, and the Department of Medicine and Laboratory Medicine and Pathobiology, and the Institute of Medical Science, and the Krembil Research Institute, University of Toronto, Toronto; Arthritis Alliance of Canada (AAC) Inflammatory Arthritis Models of Care, Toronto; William Osler Health System, Brampton; Canadian Institute of Health Research (CIHR) National Steering Committee, Ottawa; Outcome Measures in Rheumatology (OMERACT), Ottawa, Ontario; Hôpital Maisonneuve-Rosemont, and the Institut de Recherche en Rhumatologie de Montréal, Université de Montréal, Montreal, Quebec, Canada; RAND Corp., Santa Monica, California, USA.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, departments of Medicine and Community Health Sciences, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, Research Scientist, Arthritis Research Canada; D.P. Mosher, MD, FRCPC, Professor, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, Associate Professor, Université de Montréal; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health, and Arthritis Research Canada; D. Choquette, MD, FRCPC, Institut de Recherche en Rhumatologie de Montréal, Scientific Director, Rhumadata, Université de Montréal; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, Senior Scientist, Arthritis Research Canada; C. Bombardier, MD, FRCPC, Professor, Division of Rheumatology, University of Toronto; A. Lyddiatt, member, CIHR National Steering Committee, OMERACT patient research partner, AAC Inflammatory Arthritis Models of Care Executive Member; V. Chandran, MBBS, MD, DM, PhD, Assistant Professor, Department of Medicine and Laboratory Medicine and Pathobiology, Institute of Medical Science, Krembil Research Institute; D. Khodyakov, PhD, MA, BA, Senior Behavioral/Social Scientist, RAND Corp.; E. Dao, BS, RAND Corp.; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary
| | - Anne Lyddiatt
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences of the Cumming School of Medicine, and the McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Division of Rheumatology, and the Department of Medicine and Laboratory Medicine and Pathobiology, and the Institute of Medical Science, and the Krembil Research Institute, University of Toronto, Toronto; Arthritis Alliance of Canada (AAC) Inflammatory Arthritis Models of Care, Toronto; William Osler Health System, Brampton; Canadian Institute of Health Research (CIHR) National Steering Committee, Ottawa; Outcome Measures in Rheumatology (OMERACT), Ottawa, Ontario; Hôpital Maisonneuve-Rosemont, and the Institut de Recherche en Rhumatologie de Montréal, Université de Montréal, Montreal, Quebec, Canada; RAND Corp., Santa Monica, California, USA.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, departments of Medicine and Community Health Sciences, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, Research Scientist, Arthritis Research Canada; D.P. Mosher, MD, FRCPC, Professor, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, Associate Professor, Université de Montréal; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health, and Arthritis Research Canada; D. Choquette, MD, FRCPC, Institut de Recherche en Rhumatologie de Montréal, Scientific Director, Rhumadata, Université de Montréal; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, Senior Scientist, Arthritis Research Canada; C. Bombardier, MD, FRCPC, Professor, Division of Rheumatology, University of Toronto; A. Lyddiatt, member, CIHR National Steering Committee, OMERACT patient research partner, AAC Inflammatory Arthritis Models of Care Executive Member; V. Chandran, MBBS, MD, DM, PhD, Assistant Professor, Department of Medicine and Laboratory Medicine and Pathobiology, Institute of Medical Science, Krembil Research Institute; D. Khodyakov, PhD, MA, BA, Senior Behavioral/Social Scientist, RAND Corp.; E. Dao, BS, RAND Corp.; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary
| | - Vinod Chandran
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences of the Cumming School of Medicine, and the McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Division of Rheumatology, and the Department of Medicine and Laboratory Medicine and Pathobiology, and the Institute of Medical Science, and the Krembil Research Institute, University of Toronto, Toronto; Arthritis Alliance of Canada (AAC) Inflammatory Arthritis Models of Care, Toronto; William Osler Health System, Brampton; Canadian Institute of Health Research (CIHR) National Steering Committee, Ottawa; Outcome Measures in Rheumatology (OMERACT), Ottawa, Ontario; Hôpital Maisonneuve-Rosemont, and the Institut de Recherche en Rhumatologie de Montréal, Université de Montréal, Montreal, Quebec, Canada; RAND Corp., Santa Monica, California, USA.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, departments of Medicine and Community Health Sciences, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, Research Scientist, Arthritis Research Canada; D.P. Mosher, MD, FRCPC, Professor, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, Associate Professor, Université de Montréal; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health, and Arthritis Research Canada; D. Choquette, MD, FRCPC, Institut de Recherche en Rhumatologie de Montréal, Scientific Director, Rhumadata, Université de Montréal; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, Senior Scientist, Arthritis Research Canada; C. Bombardier, MD, FRCPC, Professor, Division of Rheumatology, University of Toronto; A. Lyddiatt, member, CIHR National Steering Committee, OMERACT patient research partner, AAC Inflammatory Arthritis Models of Care Executive Member; V. Chandran, MBBS, MD, DM, PhD, Assistant Professor, Department of Medicine and Laboratory Medicine and Pathobiology, Institute of Medical Science, Krembil Research Institute; D. Khodyakov, PhD, MA, BA, Senior Behavioral/Social Scientist, RAND Corp.; E. Dao, BS, RAND Corp.; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary
| | - Dmitry Khodyakov
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences of the Cumming School of Medicine, and the McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Division of Rheumatology, and the Department of Medicine and Laboratory Medicine and Pathobiology, and the Institute of Medical Science, and the Krembil Research Institute, University of Toronto, Toronto; Arthritis Alliance of Canada (AAC) Inflammatory Arthritis Models of Care, Toronto; William Osler Health System, Brampton; Canadian Institute of Health Research (CIHR) National Steering Committee, Ottawa; Outcome Measures in Rheumatology (OMERACT), Ottawa, Ontario; Hôpital Maisonneuve-Rosemont, and the Institut de Recherche en Rhumatologie de Montréal, Université de Montréal, Montreal, Quebec, Canada; RAND Corp., Santa Monica, California, USA.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, departments of Medicine and Community Health Sciences, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, Research Scientist, Arthritis Research Canada; D.P. Mosher, MD, FRCPC, Professor, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, Associate Professor, Université de Montréal; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health, and Arthritis Research Canada; D. Choquette, MD, FRCPC, Institut de Recherche en Rhumatologie de Montréal, Scientific Director, Rhumadata, Université de Montréal; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, Senior Scientist, Arthritis Research Canada; C. Bombardier, MD, FRCPC, Professor, Division of Rheumatology, University of Toronto; A. Lyddiatt, member, CIHR National Steering Committee, OMERACT patient research partner, AAC Inflammatory Arthritis Models of Care Executive Member; V. Chandran, MBBS, MD, DM, PhD, Assistant Professor, Department of Medicine and Laboratory Medicine and Pathobiology, Institute of Medical Science, Krembil Research Institute; D. Khodyakov, PhD, MA, BA, Senior Behavioral/Social Scientist, RAND Corp.; E. Dao, BS, RAND Corp.; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary
| | - Emily Dao
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences of the Cumming School of Medicine, and the McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta; Arthritis Research Canada, Richmond; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Division of Rheumatology, and the Department of Medicine and Laboratory Medicine and Pathobiology, and the Institute of Medical Science, and the Krembil Research Institute, University of Toronto, Toronto; Arthritis Alliance of Canada (AAC) Inflammatory Arthritis Models of Care, Toronto; William Osler Health System, Brampton; Canadian Institute of Health Research (CIHR) National Steering Committee, Ottawa; Outcome Measures in Rheumatology (OMERACT), Ottawa, Ontario; Hôpital Maisonneuve-Rosemont, and the Institut de Recherche en Rhumatologie de Montréal, Université de Montréal, Montreal, Quebec, Canada; RAND Corp., Santa Monica, California, USA.,C.E. Barber, MD, FRCPC, PhD, Assistant Professor, Division of Rheumatology, departments of Medicine and Community Health Sciences, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, Research Scientist, Arthritis Research Canada; D.P. Mosher, MD, FRCPC, Professor, Chief, Division of Rheumatology, Department of Medicine, University of Calgary; V. Ahluwalia, MD, FRCPC, Consultant Rheumatologist, William Osler Health System; M. Zummer, MD, FRCPC, Chief, Rheumatology, Hôpital Maisonneuve-Rosemont, Associate Professor, Université de Montréal; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, Canada Research Chair (Health Services and Systems Research), Arthur J.E. Child Chair in Rheumatology Research, Department of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health, and Arthritis Research Canada; D. Choquette, MD, FRCPC, Institut de Recherche en Rhumatologie de Montréal, Scientific Director, Rhumadata, Université de Montréal; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, Senior Scientist, Arthritis Research Canada; C. Bombardier, MD, FRCPC, Professor, Division of Rheumatology, University of Toronto; A. Lyddiatt, member, CIHR National Steering Committee, OMERACT patient research partner, AAC Inflammatory Arthritis Models of Care Executive Member; V. Chandran, MBBS, MD, DM, PhD, Assistant Professor, Department of Medicine and Laboratory Medicine and Pathobiology, Institute of Medical Science, Krembil Research Institute; D. Khodyakov, PhD, MA, BA, Senior Behavioral/Social Scientist, RAND Corp.; E. Dao, BS, RAND Corp.; C. Barnabe, MD, MSc, FRCPC, Associate Professor, departments of Medicine and Community Health Sciences, University of Calgary
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Widdifield J, Ivers NM, Bernatsky S, Jaakkimainen L, Bombardier C, Thorne JC, Ahluwalia V, Paterson JM, Young J, Wing L, Tu K. Primary Care Screening and Comorbidity Management in Rheumatoid Arthritis in Ontario, Canada. Arthritis Care Res (Hoboken) 2017; 69:1495-1503. [DOI: 10.1002/acr.23178] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Revised: 12/07/2016] [Accepted: 12/13/2016] [Indexed: 12/12/2022]
Affiliation(s)
- Jessica Widdifield
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada, and Research Institute of the McGill University Health Centre and McGill University; Montreal Quebec Canada
| | - Noah M. Ivers
- Institute for Clinical Evaluative Sciences, University of Toronto, and Women's College Hospital; Toronto Ontario Canada
| | - Sasha Bernatsky
- Research Institute of the McGill University Health Centre and McGill University; Montreal Quebec Canada
| | - Liisa Jaakkimainen
- Institute for Clinical Evaluative Sciences and University of Toronto; Toronto Ontario Canada
| | - Claire Bombardier
- University of Toronto and University Health Network; Toronto Ontario Canada
| | - J. Carter Thorne
- University of Toronto, Toronto, Ontario, Canada, and Southlake Regional Health Centre; Newmarket Ontario Canada
| | | | - J. Michael Paterson
- Institute for Clinical Evaluative Sciences and University of Toronto, Toronto, Ontario, Canada, and McMaster University; Hamilton Ontario Canada
| | - Jacqueline Young
- Institute for Clinical Evaluative Sciences; Toronto Ontario Canada
| | - Laura Wing
- Institute for Clinical Evaluative Sciences; Toronto Ontario Canada
| | - Karen Tu
- Institute for Clinical Evaluative Sciences, University of Toronto, Sunnybrook Health Sciences Centre, and University Health Network; Toronto Ontario Canada
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Khodyakov D, Grant S, Meeker D, Booth M, Pacheco-Santivanez N, Kim KK. Comparative analysis of stakeholder experiences with an online approach to prioritizing patient-centered research topics. J Am Med Inform Assoc 2017; 24:537-543. [PMID: 28011596 PMCID: PMC7651951 DOI: 10.1093/jamia/ocw157] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Little evidence exists about effective and scalable methods for meaningful stakeholder engagement in research. We explored patient/caregiver experiences with a high-tech online engagement approach for patient-centered research prioritization, compared their experiences with those of professional stakeholders, and identified factors associated with favorable participant experiences. METHODS We conducted 8 online modified-Delphi (OMD) panels. Panelists participated in 2 rating rounds with a statistical feedback/online discussion round in between. Panels focused on weight management/obesity, heart failure, and Kawasaki disease. We recruited a convenience sample of adults with any of the 3 conditions (or parents/guardians of Kawasaki disease patients), clinicians, and researchers. Measures included self-reported willingness to use OMD again, the panelists' study participation and online discussion experiences, the system's perceived ease of use, and active engagement metrics. RESULTS Out of 349 panelists, 292 (84%) completed the study. Of those, 46% were patients, 36% were clinicians, and 19% were researchers. In multivariate models, patients were not significantly more actively engaged (Odds ratio (OR) = 1.69, 95% confidence interval (CI), 0.94-3.05) but had more favorable study participation (β = 0.49; P ≤ .05) and online discussion (β = 0.18; P ≤ .05) experiences and were more willing to use OMD again (β = 0.36; P ≤ .05), compared to professional stakeholders. Positive perceptions of the OMD system's ease of use (β = 0.16; P ≤ .05) and favorable study participation (β = 0.26; P ≤ .05) and online discussion (β = 0.57; P ≤ .05) experiences were also associated with increased willingness to use OMD in the future. Active engagement was not associated with online experience indices or willingness to use OMD again. CONCLUSION Online approaches to engaging large numbers of stakeholders are a promising and efficient adjunct to in-person meetings.
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Affiliation(s)
- Dmitry Khodyakov
- RAND Corporation, Santa Monica, CA, USA,Corresponding Author: Dmitry Khodyakov, RAND Corporation, 1776 Main St, PO Box 2138, Santa Monica, CA 90407-2138, USA. E-mail: ; Tel: 310-393-0411, ext. 6159
| | | | - Daniella Meeker
- RAND Corporation, Santa Monica, CA, USA,University of Southern California, Los Angeles, CA, USA
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Khodyakov D, Kinnett K, Grant S, Lucas A, Martin A, Denger B, Peay H, Coulter I, Fink A. Engaging Patients and Caregivers Managing Rare Diseases to Improve the Methods of Clinical Guideline Development: A Research Protocol. JMIR Res Protoc 2017; 6:e57. [PMID: 28455279 PMCID: PMC5429434 DOI: 10.2196/resprot.6902] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 02/16/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Clinical guidelines provide systematically developed recommendations for deciding on appropriate health care options for specific conditions and clinical circumstances. Up until recently, patients and caregivers have rarely been included in the process of developing care guidelines. OBJECTIVE This project will develop and test a new online method for including patients and their caregivers in this process using Duchenne muscular dystrophy (DMD) care guidelines as an example. The new method will mirror and complement the RAND/UCLA Appropriateness Method (RAM)-the gold standard approach for conducting clinical expert panels that uses a modified Delphi format. RAM is often used in clinical guideline development to determine care appropriateness and necessity in situations where existing clinical evidence is uncertain, weak, or unavailable. METHODS To develop the new method for engaging patients and their caregivers in guideline development, we will first conduct interviews with experts on RAM, guideline development, patient engagement, and patient-centeredness and engage with Duchenne patients and caregivers to identify how RAM should be modified for the purposes of patient engagement and what rating criteria should patients and caregivers use to provide their input during the process of guideline development. Once the new method is piloted, we will test it by conducting two concurrently run patient/caregiver panels that will rate patient-centeredness of a subset of DMD care management recommendations already deemed clinically appropriate and necessary. The ExpertLens™ system-a previously evaluated online modified Delphi system that combines two rounds of rating with a round of feedback and moderated online discussions-will be used to conduct these panels. In addition to developing and testing the new engagement method, we will work with the members of our project's Advisory Board to generate a list of best practices for enhancing the level of patient and caregiver involvement in the guideline development process. We will solicit input on these best practice from Duchenne patients, caregivers, and clinicians by conducting a series of round-table discussions and making a presentation at an annual conference on Duchenne. RESULTS The study protocol was reviewed by RAND's Human Subjects Protection Committee, which determined it to be exempt from review. Interviews with RAM experts have been completed. The projected study completion date is May 2020. CONCLUSIONS We expect that the new method will make it easier to engage large numbers of patients and caregivers in the process of guideline development in a rigorous and culturally appropriate manner that is consistent with the way clinicians participate in guideline development. Moreover, this project will develop best practices that could help involve patients and caregivers in the clinical guideline development process in other clinical areas, thereby facilitating the work of guideline developers.
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Affiliation(s)
| | - Kathi Kinnett
- Parent Project Muscular Dystrophy, Hackensack, NJ, United States
| | - Sean Grant
- RAND Health, Santa Monica, CA, United States
| | - Ann Lucas
- Parent Project Muscular Dystrophy, Hackensack, NJ, United States
| | - Ann Martin
- Parent Project Muscular Dystrophy, Hackensack, NJ, United States
| | - Brian Denger
- Parent Project Muscular Dystrophy, Hackensack, NJ, United States
| | - Holly Peay
- RTI International, Research Triangle Park, NC, United States
| | | | - Arlene Fink
- University of California Los Angeles, Los Angeles, CA, United States
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Khodyakov D, Grant S, Barber CEH, Marshall DA, Esdaile JM, Lacaille D. Acceptability of an online modified Delphi panel approach for developing health services performance measures: results from 3 panels on arthritis research. J Eval Clin Pract 2017; 23:354-360. [PMID: 27619536 DOI: 10.1111/jep.12623] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 07/11/2016] [Accepted: 07/12/2016] [Indexed: 01/23/2023]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Online modified Delphi (OMD) panel approaches can be used to engage large and diverse groups of clinical experts and stakeholders in developing health services performance measures. Such approaches are increasing in popularity among health researchers. However, information about their acceptability to participating experts and stakeholders is lacking but important to determine before recommending widespread use of online approaches. Therefore, the objective of this paper is to explore acceptability of the OMD panel approach from the participants' perspective. METHOD We use data from participants in three OMD panels designed to develop performance measures for use in arthritis research and quality improvement efforts. At the end of each online panel, we surveyed clinical experts and stakeholders who shared their experiences with the OMD process by answering 13 close-ended questions using 7-point Likert-type scales. A mean of 5 or higher on a given question was treated as an indication of acceptability. RESULTS Ninety-eight clinical experts and stakeholders (92% participation rate) answered survey questions about the online process. They considered the OMD panel approach to be acceptable, particularly the ease of using the online system (mean = 5.3, standard deviation = 1.3) and the understanding gained from online discussions (mean = 5.2, standard deviation = 1.0). Participants also felt that participation in the Delphi study was interesting (mean = 5.6, standard deviation =1.1). CONCLUSION These findings illustrate likely acceptability and a potential for a more widespread use of OMD panel approaches by stakeholders in developing health services performance measures.
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Affiliation(s)
| | | | - Claire E H Barber
- University of Calgary; Arthritis Research Centre Canada, Calgary, Canada
| | - Deborah A Marshall
- University of Calgary; Arthritis Research Centre Canada, Calgary, Canada
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Khodyakov D, Ochoa A, Olivieri-Mui BL, Bouwmeester C, Zarowitz BJ, Patel M, Ching D, Briesacher B. Screening Tool of Older Person's Prescriptions/Screening Tools to Alert Doctors to Right Treatment Medication Criteria Modified for U.S. Nursing Home Setting. J Am Geriatr Soc 2016; 65:586-591. [PMID: 28008599 DOI: 10.1111/jgs.14689] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To develop a set of prescribing indicators measurable with available data from electronic nursing home (NH) databases by adapting the European-based 2014 Screening Tool of Older Person's Prescriptions (STOPP) and Screening Tools to Alert Doctors to Right Treatment (START) criteria of potentially inappropriate and underused medications for the U.S. SETTING DESIGN A two-stage expert panel process. In the first stage, the investigator team reviewed 114 criteria for compatibility and measurability. In the second stage, an online modified e-Delphi (OMD) panel was convened to rate the validity of criteria, and two webinars were held to identify criteria with highest relevance to U.S. NHs. PARTICIPANTS Seventeen experts with recognized reputations in NH care participated in the e-Delphi panel and 12 in the webinar. MEASUREMENTS Compatibility and measurability were assessed by comparing criteria with U.S. terminology and setting standards and data elements in NH databases. Validity was rated using a 9-point Likert-type scale (1 = not valid at all, 9 = highly valid). Mean, median, interpercentile ranges, and agreement were determined for each criterion score. Relevance was determined by ranking the mean panel ratings on criteria that reached agreement; the webinar participants reviewed and approved half of the criteria with the highest mean values. RESULTS Fifty-three STOPP/START criteria were deemed to be compatible with the U.S. NH setting and measurable using data from electronic NH databases. E-Delphi panelists rated 48 criteria as valid for U.S. NHs. Twenty-four criteria were deemed to be most relevant, consisting of 22 measures of potentially inappropriate medications and two measures of underused medications. CONCLUSION This study created the first explicit criteria for assessing the quality of prescribing in U.S. NHs.
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Affiliation(s)
- Dmitry Khodyakov
- RAND Corporation and RAND Pardee Graduate School, Santa Monica, California
| | - Aileen Ochoa
- School of Pharmacy, Northeastern University, Boston, Massachusetts
| | | | | | | | - Meenakshi Patel
- Boonshoft School of Medicine, Wright State University, Dayton, Ohio
| | - Diana Ching
- School of Pharmacy, Northeastern University, Boston, Massachusetts
| | - Becky Briesacher
- School of Pharmacy, Northeastern University, Boston, Massachusetts
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Jafri K, Bartels CM, Shin D, Gelfand JM, Ogdie A. Incidence and Management of Cardiovascular Risk Factors in Psoriatic Arthritis and Rheumatoid Arthritis: A Population-Based Study. Arthritis Care Res (Hoboken) 2016; 69:51-57. [PMID: 27696731 DOI: 10.1002/acr.23094] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 08/08/2016] [Accepted: 09/13/2016] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To examine the prevalence and incidence of cardiovascular (CV) risk factors, including hypertension, hyperlipidemia, diabetes mellitus (DM), and obesity among patients with psoriatic arthritis (PsA) and rheumatoid arthritis (RA) compared to the general population, and to examine the treatment of incident CV risk factors in PsA and RA compared to controls. METHODS A cohort study was conducted within The Health Improvement Network, a medical record database in the UK, using data from 1994 to 2014. Patients ages 18-89 years with PsA or RA were matched to controls on practice and start date. The prevalence and incidence of CV risk factors identified by diagnostic codes were calculated. Cox proportional hazards models were used to examine the relative incidence of these CV risk factors. Finally, pharmacologic therapies for incident CV risk factors were examined. RESULTS Study subjects included patients with PsA (n = 12,548), RA (n = 53,215), and controls (n = 389,269). The prevalence of all CV risk factors was significantly elevated in PsA. Only the prevalence of DM and obesity was increased in RA. Incidence of hypertension, hyperlipidemia, and DM was elevated in PsA and RA. Receipt of therapy within 1 year following incident diagnosis of CV risk factors was not substantially different between the groups; approximately 85%, 65%, and 45% of patients received prescriptions for hypertension, hyperlipidemia, and DM, respectively. CONCLUSION Patients with PsA have an increased prevalence of CV risk factors, and both patients with PsA and patients with RA have increased incidence of a new diagnosis of CV risk factors. Pharmacologic treatment of CV risk factors in patients with PsA and RA was similar to controls in the UK.
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Affiliation(s)
| | | | - Daniel Shin
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Joel M Gelfand
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Alexis Ogdie
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Barber CEH, Esdaile JM, Martin LO, Faris P, Barnabe C, Guo S, Lopatina E, Marshall DA. Gaps in Addressing Cardiovascular Risk in Rheumatoid Arthritis: Assessing Performance Using Cardiovascular Quality Indicators. J Rheumatol 2016; 43:1965-1973. [PMID: 27481908 DOI: 10.3899/jrheum.160241] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2016] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Cardiovascular disease (CVD) is a major comorbidity for patients with rheumatoid arthritis (RA). This study sought to determine the performance of 11 recently developed CVD quality indicators (QI) for RA in clinical practice. METHODS Medical charts for patients with RA (early disease or biologic-treated) followed at 1 center were retrospectively reviewed. A systematic assessment of adherence to 11 QI over a 2-year period was completed. Performance on the QI was reported as a percentage pass rate. RESULTS There were 170 charts reviewed (107 early disease and 63 biologic-treated). The most frequent CVD risk factors present at diagnosis (early disease) and biologic start (biologic-treated) included hypertension (26%), obesity (25%), smoking (21%), and dyslipidemia (15%). Performance on the CVD QI was highly variable. Areas of low performance (< 10% pass rates) included documentation of a formal CVD risk assessment, communication to the primary care physician (PCP) that patients with RA were at increased risk of CVD, body mass index documentation and counseling if overweight, communication to a PCP about an elevated blood pressure, and discussion of risks and benefits of antiinflammatories in patients at CVD risk. Rates of diabetes screening and lipid screening were 67% and 69%, respectively. The area of highest performance was observed for documentation of intent to taper corticosteroids (98%-100% for yrs 1 and 2, respectively). CONCLUSION Gaps in CVD risk management were found and highlight the need for quality improvements. Key targets for improvement include coordination of CVD care between rheumatology and primary care, and communication of increased CVD risk in RA.
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Affiliation(s)
- Claire E H Barber
- From the Division of Rheumatology, Department of Medicine, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary; Alberta Health Services, Alberta; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; University of Toronto, Toronto, Ontario, Canada; University of Queensland, Brisbane, Australia. .,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; J.M. Esdaile, MD, MPH, FRCPC, FCAHS, Professor of Medicine, Division of Rheumatology, Department of Medicine, University of British Columbia, and Adjunct Professor of Medicine, University of Calgary, and Visiting Professor of Medicine, University of Queensland, and Scientific Director, Arthritis Research Canada; L.O. Martin, MB, MRCPI, FRCPC, Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; P. Faris, PhD, Adjunct Associate Professor, Department of Community Health Sciences, University of Calgary, and Biostatistician, Research Support, Alberta Health Services; C. Barnabe, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; S. Guo, BSc, Medical Student, University of Toronto; E. Lopatina, MD, MSc, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary; D.A. Marshall, MHSA, PhD, Professor, Department of Community Health Sciences, and Arthur JE Child Chair in Rheumatology Research, Cumming School of Medicine, University of Calgary.
| | - John M Esdaile
- From the Division of Rheumatology, Department of Medicine, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary; Alberta Health Services, Alberta; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; University of Toronto, Toronto, Ontario, Canada; University of Queensland, Brisbane, Australia.,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; J.M. Esdaile, MD, MPH, FRCPC, FCAHS, Professor of Medicine, Division of Rheumatology, Department of Medicine, University of British Columbia, and Adjunct Professor of Medicine, University of Calgary, and Visiting Professor of Medicine, University of Queensland, and Scientific Director, Arthritis Research Canada; L.O. Martin, MB, MRCPI, FRCPC, Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; P. Faris, PhD, Adjunct Associate Professor, Department of Community Health Sciences, University of Calgary, and Biostatistician, Research Support, Alberta Health Services; C. Barnabe, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; S. Guo, BSc, Medical Student, University of Toronto; E. Lopatina, MD, MSc, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary; D.A. Marshall, MHSA, PhD, Professor, Department of Community Health Sciences, and Arthur JE Child Chair in Rheumatology Research, Cumming School of Medicine, University of Calgary
| | - Liam O Martin
- From the Division of Rheumatology, Department of Medicine, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary; Alberta Health Services, Alberta; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; University of Toronto, Toronto, Ontario, Canada; University of Queensland, Brisbane, Australia.,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; J.M. Esdaile, MD, MPH, FRCPC, FCAHS, Professor of Medicine, Division of Rheumatology, Department of Medicine, University of British Columbia, and Adjunct Professor of Medicine, University of Calgary, and Visiting Professor of Medicine, University of Queensland, and Scientific Director, Arthritis Research Canada; L.O. Martin, MB, MRCPI, FRCPC, Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; P. Faris, PhD, Adjunct Associate Professor, Department of Community Health Sciences, University of Calgary, and Biostatistician, Research Support, Alberta Health Services; C. Barnabe, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; S. Guo, BSc, Medical Student, University of Toronto; E. Lopatina, MD, MSc, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary; D.A. Marshall, MHSA, PhD, Professor, Department of Community Health Sciences, and Arthur JE Child Chair in Rheumatology Research, Cumming School of Medicine, University of Calgary
| | - Peter Faris
- From the Division of Rheumatology, Department of Medicine, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary; Alberta Health Services, Alberta; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; University of Toronto, Toronto, Ontario, Canada; University of Queensland, Brisbane, Australia.,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; J.M. Esdaile, MD, MPH, FRCPC, FCAHS, Professor of Medicine, Division of Rheumatology, Department of Medicine, University of British Columbia, and Adjunct Professor of Medicine, University of Calgary, and Visiting Professor of Medicine, University of Queensland, and Scientific Director, Arthritis Research Canada; L.O. Martin, MB, MRCPI, FRCPC, Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; P. Faris, PhD, Adjunct Associate Professor, Department of Community Health Sciences, University of Calgary, and Biostatistician, Research Support, Alberta Health Services; C. Barnabe, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; S. Guo, BSc, Medical Student, University of Toronto; E. Lopatina, MD, MSc, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary; D.A. Marshall, MHSA, PhD, Professor, Department of Community Health Sciences, and Arthur JE Child Chair in Rheumatology Research, Cumming School of Medicine, University of Calgary
| | - Cheryl Barnabe
- From the Division of Rheumatology, Department of Medicine, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary; Alberta Health Services, Alberta; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; University of Toronto, Toronto, Ontario, Canada; University of Queensland, Brisbane, Australia.,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; J.M. Esdaile, MD, MPH, FRCPC, FCAHS, Professor of Medicine, Division of Rheumatology, Department of Medicine, University of British Columbia, and Adjunct Professor of Medicine, University of Calgary, and Visiting Professor of Medicine, University of Queensland, and Scientific Director, Arthritis Research Canada; L.O. Martin, MB, MRCPI, FRCPC, Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; P. Faris, PhD, Adjunct Associate Professor, Department of Community Health Sciences, University of Calgary, and Biostatistician, Research Support, Alberta Health Services; C. Barnabe, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; S. Guo, BSc, Medical Student, University of Toronto; E. Lopatina, MD, MSc, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary; D.A. Marshall, MHSA, PhD, Professor, Department of Community Health Sciences, and Arthur JE Child Chair in Rheumatology Research, Cumming School of Medicine, University of Calgary
| | - Selynne Guo
- From the Division of Rheumatology, Department of Medicine, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary; Alberta Health Services, Alberta; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; University of Toronto, Toronto, Ontario, Canada; University of Queensland, Brisbane, Australia.,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; J.M. Esdaile, MD, MPH, FRCPC, FCAHS, Professor of Medicine, Division of Rheumatology, Department of Medicine, University of British Columbia, and Adjunct Professor of Medicine, University of Calgary, and Visiting Professor of Medicine, University of Queensland, and Scientific Director, Arthritis Research Canada; L.O. Martin, MB, MRCPI, FRCPC, Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; P. Faris, PhD, Adjunct Associate Professor, Department of Community Health Sciences, University of Calgary, and Biostatistician, Research Support, Alberta Health Services; C. Barnabe, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; S. Guo, BSc, Medical Student, University of Toronto; E. Lopatina, MD, MSc, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary; D.A. Marshall, MHSA, PhD, Professor, Department of Community Health Sciences, and Arthur JE Child Chair in Rheumatology Research, Cumming School of Medicine, University of Calgary
| | - Elena Lopatina
- From the Division of Rheumatology, Department of Medicine, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary; Alberta Health Services, Alberta; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; University of Toronto, Toronto, Ontario, Canada; University of Queensland, Brisbane, Australia.,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; J.M. Esdaile, MD, MPH, FRCPC, FCAHS, Professor of Medicine, Division of Rheumatology, Department of Medicine, University of British Columbia, and Adjunct Professor of Medicine, University of Calgary, and Visiting Professor of Medicine, University of Queensland, and Scientific Director, Arthritis Research Canada; L.O. Martin, MB, MRCPI, FRCPC, Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; P. Faris, PhD, Adjunct Associate Professor, Department of Community Health Sciences, University of Calgary, and Biostatistician, Research Support, Alberta Health Services; C. Barnabe, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; S. Guo, BSc, Medical Student, University of Toronto; E. Lopatina, MD, MSc, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary; D.A. Marshall, MHSA, PhD, Professor, Department of Community Health Sciences, and Arthur JE Child Chair in Rheumatology Research, Cumming School of Medicine, University of Calgary
| | - Deborah A Marshall
- From the Division of Rheumatology, Department of Medicine, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary; Alberta Health Services, Alberta; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; University of Toronto, Toronto, Ontario, Canada; University of Queensland, Brisbane, Australia.,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; J.M. Esdaile, MD, MPH, FRCPC, FCAHS, Professor of Medicine, Division of Rheumatology, Department of Medicine, University of British Columbia, and Adjunct Professor of Medicine, University of Calgary, and Visiting Professor of Medicine, University of Queensland, and Scientific Director, Arthritis Research Canada; L.O. Martin, MB, MRCPI, FRCPC, Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; P. Faris, PhD, Adjunct Associate Professor, Department of Community Health Sciences, University of Calgary, and Biostatistician, Research Support, Alberta Health Services; C. Barnabe, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; S. Guo, BSc, Medical Student, University of Toronto; E. Lopatina, MD, MSc, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary; D.A. Marshall, MHSA, PhD, Professor, Department of Community Health Sciences, and Arthur JE Child Chair in Rheumatology Research, Cumming School of Medicine, University of Calgary
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Khodyakov D, Mikesell L, Schraiber R, Booth M, Bromley E. On using ethical principles of community-engaged research in translational science. Transl Res 2016; 171:52-62.e1. [PMID: 26773561 PMCID: PMC4833614 DOI: 10.1016/j.trsl.2015.12.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 11/20/2015] [Accepted: 12/16/2015] [Indexed: 11/20/2022]
Abstract
The transfer of new discoveries into both clinical practice and the wider community calls for reliance on interdisciplinary translational teams that include researchers with different areas of expertise, representatives of health care systems and community organizations, and patients. Engaging new stakeholders in research, however, calls for a reconsideration or expansion of the meaning of ethics in translational research. We explored expert opinion on the applicability of ethical principles commonly practiced in community-engaged research (CEnR) to translational research. To do so, we conducted 2 online, modified-Delphi panels with 63 expert stakeholders who iteratively rated and discussed 9 ethical principles commonly used in CEnR in terms of their importance and feasibility for use in translational research. The RAND/UCLA appropriateness method was used to analyze the data and determine agreement and disagreement among participating experts. Both panels agreed that ethical translational research should be "grounded in trust." Although the academic panel endorsed "culturally appropriate" and "forthcoming with community about study risks and benefits," the mixed academic-community panel endorsed "scientifically valid" and "ready to involve community in interpretation and dissemination" as important and feasible principles of ethical translational research. These findings suggest that in addition to protecting human subjects, contemporary translational science models need to account for the interests of, and owe ethical obligations to, members of the investigative team and the community at large.
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Affiliation(s)
- Dmitry Khodyakov
- Behavioral/Social Scientist, The RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA 90407-2138, Phone: +1-310-393-0411x 6159
| | - Lisa Mikesell
- Assistant Professor, Communication Department, School of Communication and Information, Institute for Health, Health Care Policy and Aging Research, Rutgers University, 4 Huntington Street, New Brunswick, NJ 08901-1071
| | - Ron Schraiber
- Executive Director, The Well-Being Programs, Inc., 644 Knoll Drive, P.O. Box 1104, Crestline, CA 92324
| | - Marika Booth
- Statistical Project Associate, The RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA 90407-2138, Phone: +1-310-393-0411x 6338
| | - Elizabeth Bromley
- Assistant Professor in Residence, Semel Institute Center for Health Services and Society, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Research Psychiatrist, Desert Pacific MIRECC, West Los Angeles VA Healthcare Center, 10920 Wilshire Blvd, Los Angeles, CA 90024
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Khodyakov D, Stockdale SE, Smith N, Booth M, Altman L, Rubenstein LV. Patient engagement in the process of planning and designing outpatient care improvements at the Veterans Administration Health-care System: findings from an online expert panel. Health Expect 2016; 20:130-145. [PMID: 26914249 PMCID: PMC5217877 DOI: 10.1111/hex.12444] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2016] [Indexed: 11/28/2022] Open
Abstract
CONTEXT There is a strong interest in the Veterans Administration (VA) Health-care System in promoting patient engagement to improve patient care. METHODS We solicited expert opinion using an online expert panel system with a modified Delphi structure called ExpertLens™ . Experts reviewed, rated and discussed eight scenarios, representing four patient engagement roles in designing and improving VA outpatient care (consultant, implementation advisor, equal stakeholder and lead stakeholder) and two VA levels (local and regional). Rating criteria included desirability, feasibility, patient ability, physician/staff acceptance and impact on patient-centredness and care quality. Data were analysed using the RAND/UCLA Appropriateness Method for determining consensus. FINDINGS Experts rated consulting with patients at the local level as the most desirable and feasible patient engagement approach. Engagement at the local level was considered more desirable than engagement at the regional level. Being an equal stakeholder at the local level received the highest ratings on the patient-centredness and health-care quality criteria. CONCLUSIONS Our findings illustrate expert opinion about different approaches to patient engagement and highlight the benefits and challenges posed by each. Although experts rated local consultations with patients on an as-needed basis as most desirable and feasible, they rated being an equal stakeholder at the local level as having the highest potential impact on patient-centredness and care quality. This result highlights a perceived discrepancy between what is most desirable and what is potentially most effective, but suggests that routine local engagement of patients as equal stakeholders may be a desirable first step for promoting high-quality, patient-centred care.
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Affiliation(s)
| | - Susan E Stockdale
- VISN 22 Veterans Assessment and Improvement PACT Demonstration Laboratory, Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System (152), Los Angeles, CA, USA.,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Nina Smith
- Center for Implementation Practice and Research Support (CIPRS), VA Greater Los Angeles Healthcare System (152), Los Angeles, CA, USA
| | | | - Lisa Altman
- VA Greater Los Angeles Healthcare System (GLA), Office of Healthcare Transformation and Innovation, Los Angeles, CA, USA.,The David Geffen School of Medicine at University of California, Los Angeles, USA
| | - Lisa V Rubenstein
- RAND Corporation, Santa Monica, CA, USA.,VISN 22 Veterans Assessment and Improvement PACT Demonstration Laboratory, Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System (152), Los Angeles, CA, USA.,Center for Implementation Practice and Research Support (CIPRS), VA Greater Los Angeles Healthcare System (152), Los Angeles, CA, USA
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Barber CE, Marshall DA, Mosher DP, Akhavan P, Tucker L, Houghton K, Batthish M, Levy DM, Schmeling H, Ellsworth J, Tibollo H, Grant S, Khodyakov D, Lacaille D. Development of System-level Performance Measures for Evaluation of Models of Care for Inflammatory Arthritis in Canada. J Rheumatol 2016; 43:530-40. [DOI: 10.3899/jrheum.150839] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2015] [Indexed: 12/21/2022]
Abstract
Objective.To develop system-level performance measures for evaluating the care of patients with inflammatory arthritis (IA), including rheumatoid arthritis (RA), psoriatic arthritis, ankylosing spondylitis, and juvenile idiopathic arthritis.Methods.This study involved several methodological phases. Over multiple rounds, various participants were asked to help define a set of candidate measurement themes. A systematic search was conducted of existing guidelines and measures. A set of 6 performance measures was defined and presented to 50 people, including patients with IA, rheumatologists, allied health professionals, and researchers using a 3-round, online, modified Delphi process. Participants rated the validity, feasibility, relevance, and likelihood of use of the measures. Measures with median ratings ≥ 7 for validity and relevance were included in the final set.Results.Six performance measures were developed evaluating the following aspects of care, with each measure being applied separately for each type of IA except where specified: waiting times for rheumatology consultation for patients with new onset IA, percentage of patients with IA seen by a rheumatologist, percentage of patients with IA seen in yearly followup by a rheumatologist, percentage of patients with RA treated with a disease-modifying antirheumatic drug (DMARD), time to DMARD therapy in RA, and number of rheumatologists per capita.Conclusion.The first set of system-level performance measures for IA care in Canada has been developed with broad input. The measures focus on timely access to care and initiation of appropriate treatment for patients with IA, and are likely to be of interest to other arthritis care systems internationally.
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Ogdie A, Eder L. Improving cardiovascular health and metabolic comorbidities in patients with psoriatic arthritis. ACTA ACUST UNITED AC 2015; 10:451-459. [PMID: 27134682 DOI: 10.2217/ijr.15.45] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Numerous studies have suggested a link between psoriatic arthritis (PsA) and comorbidities, in particular cardiovascular disease and metabolic comorbidities such as diabetes. The co-existence of these comorbidities is likely the result of systemic inflammation. In order to improve the health of patients with PsA and provide optimal care, these comorbidities must be addressed. However, little is known about how to improve metabolic and cardiovascular health in patients with PsA. In this perspective, we describe the research needs in the area of improving cardiovascular disease and metabolic comorbidities among patients with PsA.
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Affiliation(s)
- Alexis Ogdie
- Perelman School of Medicine, University of Pennsylvania, White Building, Room 5024, 3400 Spruce St, Philadelphia, PA 19104, USA
| | - Lihi Eder
- Centre for Prognosis Studies in the Rheumatic Diseases, University of Toronto, Toronto Western Hospital, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada
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Davis JM. Toward Quality of Cardiovascular Preventive Care for Patients with Rheumatic Diseases. J Rheumatol 2015; 42:1539-41. [PMID: 26330123 DOI: 10.3899/jrheum.150697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- John M Davis
- Consultant, Division of Rheumatology; Associate Professor of Medicine, College of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
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