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Skoufalos A, Thomas R, Patel R, Mei C, Clarke JL. Continuous Glucose Monitoring: An Opportunity for Population-Based Diabetes Management. Popul Health Manag 2022; 25:583-591. [PMID: 36154298 DOI: 10.1089/pop.2022.0196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The increasing prevalence of prediabetes and diabetes in the United States poses a serious threat to the health of the population. Closely associated with obesity, hypertension, dyslipidemia, and cardiovascular disease, a diagnosis of diabetes or prediabetes carries with it life-altering demands. Critically important among these is the requirement for frequent glucose level checks-typically performed with blood obtained from a fingerstick. Innovative real-time continuous glucose monitoring (rtCGM) technology makes it possible for patients and their clinicians to receive continuous glucose level measurements around the clock without finger sticks. Accruing evidence shows that rtCGM is an effective tool for patients and their clinicians in managing diabetes (ie, maintaining glucose levels within the recommended target range) and in understanding how lifestyle behaviors directly influence glucose levels. In recent years, a number of large payer organizations (eg, private health insurers, employers) have incorporated rtCGM in their diabetes management programs as a means of addressing the dual challenge of achieving/maintaining control of glucose levels and preventing or delaying the onset of complications. Programmatic integrated approaches have been used successfully and cost-effectively for managing other chronic conditions. Incorporating rtCGM in similar integrated approaches in diabetes management may be of value in improving quality outcomes and reducing costs on a population level. The evidence supports broader adoption and continued study to evaluate models that incorporate the use of rtCGM.
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Affiliation(s)
- Alexis Skoufalos
- Jefferson College of Population Health, Philadelphia, Pennsylvania, USA
| | - Roy Thomas
- Medical Science and Communications, Managed Markets, Dexcom, San Diego, California, USA
| | - Ravi Patel
- Health Economics and Outcomes Research Fellowship, Jefferson College of Population Health, Philadelphia, Pennsylvania, USA
| | - Chuchu Mei
- Health Economics and Outcomes Research Fellowship, Jefferson College of Population Health, Philadelphia, Pennsylvania, USA
| | - Janice L Clarke
- Jefferson College of Population Health, Philadelphia, Pennsylvania, USA
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Waters AM, Skoufalos A, Frelick E, Dorn G, Nash DB. The Hearst Health Prize: The First Five Years. Popul Health Manag 2021; 25:551-560. [PMID: 34516239 PMCID: PMC9419972 DOI: 10.1089/pop.2021.0174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The Hearst Health Prize is the first national annual award for excellence in population health. The prize was established “to discover, support, and showcase the work of an individual, group, organization, or institution that has successfully implemented a population health program or intervention that has made a measurable difference” in health outcomes. Now, 5 years since the award's inception, this article reflects on how submissions for the prize collectively mirror – and may even predict – changes within the field of population health. It examines how the most successful programs demonstrated genuine, measurable improvements in health outcomes and/or health behaviors. In exploring the work of these outstanding programs, the aim of this article is to help disseminate best practices, advance the mission of the prize, and inspire improvements in population health practices.
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Affiliation(s)
- Alexa M Waters
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alexis Skoufalos
- College of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Emily Frelick
- College of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - David B Nash
- College of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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3
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Affiliation(s)
| | - Alexis Skoufalos
- Jefferson College of Population Health, Philadelphia, Pennsylvania, USA
| | - David B Nash
- Jefferson College of Population Health, Philadelphia, Pennsylvania, USA
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Boullata JI, Clarke JL, Stone A, Skoufalos A, Nash DB. Optimizing Clinical and Cost Outcomes for Patients on Enteral Nutrition Support for Treatment of Exocrine Pancreatic Insufficiency: Proceedings from an Expert Advisory Board Meeting. Popul Health Manag 2020; 22:S1-S10. [PMID: 31066618 PMCID: PMC6537119 DOI: 10.1089/pop.2019.0042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Joseph I Boullata
- 1 Department of Nutrition Sciences, Drexel University, Philadelphia, Pennsylvania.,2 Clinical Nutrition Support Services, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Janice L Clarke
- 3 Jefferson College of Population Health, Philadelphia, Pennsylvania
| | - Archie Stone
- 4 Alcresta Therapeutics, Inc., Newton, Massachusetts
| | - Alexis Skoufalos
- 3 Jefferson College of Population Health, Philadelphia, Pennsylvania
| | - David B Nash
- 3 Jefferson College of Population Health, Philadelphia, Pennsylvania
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Nash DB, Fabius RJ, Skoufalos A. Preventing Colorectal Cancer: Pathway to Achieving an 80% Screening Goal in the United States: Overview and Proceedings of a Population Health Advisory Board. Popul Health Manag 2020; 24:286-295. [PMID: 32384005 PMCID: PMC8060720 DOI: 10.1089/pop.2020.0076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- David B Nash
- Jefferson College of Population Health, Philadelphia, Pennsylvania, USA
| | | | - Alexis Skoufalos
- Jefferson College of Population Health, Philadelphia, Pennsylvania, USA
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Affiliation(s)
- Mitchell Kaminski
- Jefferson College of Population Health, Philadelphia, Pennsylvania, USA
| | - Alexis Skoufalos
- Jefferson College of Population Health, Philadelphia, Pennsylvania, USA
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Abstract
Rural Aging in America: Proceedings of the 2017 Connectivity Summit Alexis Skoufalos, EdD, Janice L. Clarke, RN, BBA, Dana Rose Ellis, BA, Vicki L. Shepard, MSW, MPA, and Elizabeth Y. Rula, PhD Editorial: Creating a Movement to Transform Rural Aging David B. Nash, MD, MBA, with Donato J. Tramuto, and Joseph F. Coughlin, PhD S-3 Introduction S-4 Summit Proceedings S-5 Roundtable 1: The Power of Community - Enabling Social Connections and Access to Health Resources Through Community-Based Programs S-5 Roundtable 2: Technology and Rural Health: Innovative Solutions to Bridge the Distance, Improve Care, and Deliver Programs S-7 Roundtable 3: An Integrated Experience: The Exponential Potential of a Collaborative Approach to Rural Aging S-8 General Discussion and Recommendations S-8 Post-Summit Debriefing S-9 Strategy and objectives S-9 6-12 month action plan S-9 Conclusion S-9.
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Affiliation(s)
- Alexis Skoufalos
- Jefferson College of Population Health, Philadelphia, Pennsylvania
| | - Janice L. Clarke
- Jefferson College of Population Health, Philadelphia, Pennsylvania
| | - Dana Rose Ellis
- AgeLab, Massachusetts Institute of Technology, Cambridge, Massachusetts
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Nash DB, Skoufalos A, Harris D. Achieving a Patient-Centered, Value-Based System of Diabetes Care in the United States: Report on a National Stakeholder Summit. Popul Health Manag 2017; 21:20-23. [PMID: 28795910 PMCID: PMC5790059 DOI: 10.1089/pop.2017.0131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Chronic instability in the health care environment has raised concerns among providers and patients, especially those who treat and cope with chronic conditions. Changes to existing health care laws are unlikely to alter what have become the primary goals of the US health care system: cost-effectiveness and patient-centricity. To that end, it is vital that patient and physician voices be incorporated in policy decisions and, importantly, that access to care and patient-reported outcomes are considered when calculating “value.” Following a discussion of perceived pressures on patient access to information and appropriate treatment for diabetes, a panel of engaged stakeholders in the diabetes community outlined and committed to a collaborative effort aimed at effecting necessary policy changes and ensuring that a patient-centered, value-based system of diabetes care is achieved. The overarching themes that emerged included: (1) patients and physicians must have a stronger voice and a place at the table; (2) a collaborative of multiple organizations is necessary to seize improvement opportunities; and (3) the diabetes community must advocate for population health initiatives around diabetes.
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Affiliation(s)
- David B Nash
- 1 Jefferson College of Population Health , Philadelphia, Pennsylvania
| | - Alexis Skoufalos
- 1 Jefferson College of Population Health , Philadelphia, Pennsylvania
| | - Dennis Harris
- 2 The Endocrine Society , Washington, District of Columbia
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Clarke JL, Skoufalos A, Scranton R. The American Opioid Epidemic: Population Health Implications and Potential Solutions. Report from the National Stakeholder Panel. Popul Health Manag 2016; 19 Suppl 1:S1-10. [PMID: 26908092 DOI: 10.1089/pop.2015.0144] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Janice L Clarke
- 1 Jefferson College of Population Health, Thomas Jefferson University , Philadelphia, Pennsylvania
| | - Alexis Skoufalos
- 1 Jefferson College of Population Health, Thomas Jefferson University , Philadelphia, Pennsylvania
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Clarke JL, Skoufalos A, Medalia A, Fendrick AM. Improving Health Outcomes for Patients with Depression: A Population Health Imperative. Report on an Expert Panel Meeting. Popul Health Manag 2016; 19 Suppl 2:S1-S12. [PMID: 27636743 PMCID: PMC5076486 DOI: 10.1089/pop.2016.0114] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Improving Health Outcomes for Patients with Depression: A Population Health Imperative. Report on an Expert Panel Meeting Janice L. Clarke, RN, Alexis Skoufalos, EdD, Alice Medalia, PhD, and A. Mark Fendrick, MD Editorial: A Call to Action : David B. Nash, MD, MBA S-2 OVERVIEW: Depression and the Population Health Imperative S-3 Promoting Awareness of the Issues and Opportunities for Improvement S-5 Cognitive Dysfunction in Affective Disorders S-5 Critical Role of Employers in Improving Health Outcomes for Employees with Depression S-6 Closing the Behavioral Health Professional and Process Gaps S-6 Achieving the Triple Aim for Patients with Depressive Disorders S-6 Improving the Experience of Care for Patients with Depression S-6 Improving Quality of Care and Health Outcomes for Patients with Depression S-7 Changing the Cost of Care Discussion from How Much to How Well S-8 Panel Insights and Recommendations S-9 Conclusion S-10.
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Affiliation(s)
| | | | | | - A Mark Fendrick
- 3 University of Michigan , Center for Value-Based Design, Ann Arbor, MI
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Clarke JL, Bourn S, Skoufalos A, Beck EH, Castillo DJ. An Innovative Approach to Health Care Delivery for Patients with Chronic Conditions. Popul Health Manag 2016; 20:23-30. [PMID: 27563751 PMCID: PMC5278805 DOI: 10.1089/pop.2016.0076] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Although the health care reform movement has brought about positive changes, lingering inefficiencies and communication gaps continue to hamper system-wide progress toward achieving the overarching goal—higher quality health care and improved population health outcomes at a lower cost. The multiple interrelated barriers to improvement are most evident in care for the population of patients with multiple chronic conditions. During transitions of care, the lack of integration among various silos and inadequate communication among providers cause delays in delivering appropriate health care services to these vulnerable patients and their caregivers, diminishing positive health outcomes and driving costs ever higher. Long-entrenched acute care-focused treatment and reimbursement paradigms hamper more effective deployment of existing resources to improve the ongoing care of these patients. New models for care coordination during transitions, longitudinal high-risk care management, and unplanned acute episodic care have been conceived and piloted with promising results. Utilizing existing resources, Mobile Integrated Healthcare is an emerging model focused on closing these care gaps by means of a round-the-clock, technologically sophisticated, physician-led interprofessional team to manage care transitions and chronic care services on-site in patients' homes or workplaces.
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Affiliation(s)
- Janice L Clarke
- 1 Jefferson College of Population Health , Philadelphia, Pennsylvania
| | | | - Alexis Skoufalos
- 1 Jefferson College of Population Health , Philadelphia, Pennsylvania
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Kosloff TM, Elton D, Shulman SA, Clarke JL, Skoufalos A, Solis A. Conservative spine care: opportunities to improve the quality and value of care. Popul Health Manag 2013; 16:390-6. [PMID: 23965043 PMCID: PMC3870576 DOI: 10.1089/pop.2012.0096] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Low back pain (LBP) has received considerable attention from researchers and health care systems because of its substantial personal, social, work-related, and economic consequences. A narrative review was conducted summarizing data about the epidemiology, care seeking, and utilization patterns for LBP in the adult US population. Recommendations from a consensus of clinical practice guidelines were compared to findings about the current state of clinical practice for LBP. The impact of the first provider consulted on the quality and value of care was analyzed longitudinally across the continuum of episodes of care. The review concludes with a description of recently published evidence that has demonstrated that favorable health and economic outcomes can be achieved by incorporating evidence-informed decision criteria and guidance about entry into conservative low back care pathways.
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Affiliation(s)
| | - David Elton
- Clinical Programs at UnitedHealth Group, Optum Health, Golden Valley, Minnesota
| | - Stephanie A. Shulman
- Innovative Health and Technology Solutions, Optum Health Care Solutions, Golden Valley, Minnesota
| | - Janice L. Clarke
- Jefferson School of Population Health, Philadelphia, Pennsylvania
| | - Alexis Skoufalos
- Jefferson School of Population Health, Philadelphia, Pennsylvania
| | - Amanda Solis
- Jefferson School of Population Health, Philadelphia, Pennsylvania
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Cheatle M, Comer D, Wunsch M, Skoufalos A, Reddy Y. Treating pain in addicted patients: recommendations from an expert panel. Popul Health Manag 2013; 17:79-89. [PMID: 24138341 DOI: 10.1089/pop.2013.0041] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Clinicians may face pragmatic, ethical, and legal issues when treating addicted patients. Equal pressures exist for clinicians to always address the health care needs of these patients in addition to their addiction. Although controversial, mainly because of the lack of evidence regarding their long-term efficacy, the use of opioids for the treatment of chronic pain management is widespread. Their use for pain management in the addicted population can present even more challenges, especially when evaluating the likelihood of drug-seeking behavior. As the misuse and abuse of opioids continues to burgeon, clinicians must be particularly vigilant when prescribing chronic opioid therapy. The purpose of this article is to summarize recommendations from a recent meeting of experts convened to recommend how primary care physicians should approach treatment of chronic pain for addicted patients when an addiction specialist is not available for a referral. As there is a significant gap in guidelines and recommendations in this specific area of care, this article serves to create a foundation for expanding chronic pain guidelines in the area of treating the addicted population. This summary is designed to be a practical how-to guide for primary care physicians, discussing risk assessment, patient stratification, and recommended therapeutic approaches.
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Affiliation(s)
- Martin Cheatle
- 1 University of Pennsylvania Center for Studies of Addiction , Philadelphia, PA
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14
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Skoufalos A, Cecil K. The journey to creating safety net accountable care in New Jersey. Popul Health Manag 2013; 16 Suppl 1:S12-6. [PMID: 24070243 DOI: 10.1089/pop.2013.1681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
New Jersey's 3-year Medicaid Accountable Care Organization (ACO) Demonstration Project was the result of a bipartisan effort to address the quality and cost issues regarding the State's safety net population. The legislation sets forth a framework that allows communities to customize ACOs to meet the unique needs of their population. Camden, Trenton, and Newark are currently experimenting with implementation at various levels. This article documents the context, journey, challenges, and future direction of the legislation through the accounts of 7 stakeholders whose roles were integral in the process of its creation, marketing, and eventual implementation. Their individual perspectives serve not only as an historical record of events but also as a guide for states seeking reference for implementing their own ACO framework.
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Affiliation(s)
- Alexis Skoufalos
- Jefferson School of Population Health, Philadelphia, Pennsylvania
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15
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Behnke LM, Solis A, Shulman SA, Skoufalos A. A targeted approach to reducing overutilization: use of percutaneous coronary intervention in stable coronary artery disease. Popul Health Manag 2012; 16:164-8. [PMID: 23113635 DOI: 10.1089/pop.2012.0019] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Overutilization, defined as use of unnecessary care when alternatives may produce similar outcomes, results in higher cost without increased value. Overutilization can be understood by focusing on settings where overuse is obvious. One example is percutaneous coronary intervention (PCI) in chronic stable angina. PCI is a potentially lifesaving procedure in an acute setting, but current practice guidelines indicate low-risk patients with chronic stable angina should be treated initially with optimal medical therapy (OMT) and lifestyle modification. A decision to move from this approach to PCI should be based on severity of symptoms and degree of risk. Over the last 30 years, advances in equipment, adjunctive medical treatments, and safety have made PCI more common. Recent evidence questions the benefit of PCI in stable coronary artery disease demonstrating no reduction in overall mortality or major cardiac events compared to OMT. Despite these findings, some continue to favor aggressive PCI interventions over conservative management in low-risk situations. Patients who undergo PCI without understanding the evidence may be inappropriately reassured that PCI will reduce the need for OMT and the risk of heart attack and death. Research shows shared decision-making can result in more conservative care, particularly when patients are assessed for health literacy and counseled on clinical evidence. Overutilization of PCI can be addressed by promoting active participation in an evidence-based decision-making process, allowing the opportunity to understand the expected value of invasive procedures over OMT alone through processes that encourage physicians to incorporate shared decision making prior to PCI in non-acute situations.
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Affiliation(s)
- Lisa M Behnke
- OptumHealth Care Solutions, Fort Myers, FL 33967, USA.
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Clarke JL, Skoufalos A, Nash DB, Toppy E. Opportunity, resources, and affordability: multistakeholder perspectives. Biotechnol Healthc 2009; 6:27-34. [PMID: 22478751 PMCID: PMC2702810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
On two occasions last year, the Jefferson School of Population Health convened a National Advisory Board of scientists and opinion leaders from key stakeholder groups at a high-level forum to explore different perspectives and to discuss improving access for patients who require treatment with biologic drugs. The following is the first of two articles documenting these discussions. The second article will appear in a subsequent issue of Biotechnology Healthcare.
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Affiliation(s)
- Janice L Clarke
- Janice L. Clarke, RN, BBA, Alexis Skoufalos, EdD, and David B. Nash, MD, MBA, are affiliated with the Jefferson School of Population Health, in Philadelphia. Eric Toppy is affiliated with Centocor OrthoBiotech Inc. Corresponding author: Janice L. Clarke « »
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