1
|
Varlamos CJ, Sinco B, Van Weiren I, Regenbogen S, Gamboa AC, Silviera M, Abdel-Misih SRZ, Hawkins AT, Balch G, Hendren S. Close distal margin is associated with locoregional rectal cancer recurrence: A multicenter study. J Surg Oncol 2023; 128:1106-1113. [PMID: 37458131 DOI: 10.1002/jso.27401] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 07/09/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND AND OBJECTIVES The importance of the radial margin for rectal cancer resection is well understood. However, surgeons have deemphasized the distal margin, accepting very close distal margins to perform sphincter-preserving surgery. We hypothesized that distal margins < 1 cm would be an independent risk factor for locoregional recurrence. The objective was to determine whether close distal margins are associated with increased locoregional recurrence risk. METHODS This was a multi-institutional retrospective cohort study conducted at six academic medical centers including patients who received low anterior resection surgery for primary rectal cancer between 2007 and 2018. RESULTS Of 556 low anterior resection patients, the rate of close distal margin was 12.8% (n = 71), and the locoregional recurrence rate was 5.0% (n = 28). The locoregional recurrence rate for close distal margin cases was 9.9% (n = 7) compared to 4.3% (n = 21) for distal margins ≥1.0 cm. In multivariable analysis, the only factor significantly associated with locoregional recurrence was close distal margin (adjusted odds ratio: 2.80, confidence interval: 1.08-7.25, p = 0.035). CONCLUSIONS Rectal cancer patients with close distal margins (<1 cm) following low anterior resection had a significantly higher risk for locoregional recurrence. Therefore, the decision to perform low anterior resection with margins < 1 cm should be taken with caution.
Collapse
Affiliation(s)
| | - Brandy Sinco
- Department of Surgery, University of Michigan Medicine, Ann Arbor, Michigan, USA
| | - Inga Van Weiren
- Department of Surgery, University of Michigan Medicine, Ann Arbor, Michigan, USA
| | - Scott Regenbogen
- Department of Surgery, University of Michigan Medicine, Ann Arbor, Michigan, USA
| | - Adriana C Gamboa
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Matthew Silviera
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Sherif R Z Abdel-Misih
- Department of Surgery (Surgical Oncology), Stony Brook University Hospital, Stony Brook, New York, USA
| | - Alexander T Hawkins
- Division of General Surgery, Section of Colon and Rectal Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Glen Balch
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Samantha Hendren
- Department of Surgery, University of Michigan Medicine, Ann Arbor, Michigan, USA
| |
Collapse
|
2
|
Irani S, Haraczy A, Juratli L, Landschulz A, Chinnusamy S, Byrnes M, Sinco B, Edwards S, Duby A, Kwakye G. Elucidating academic surgical staff perspectives of medical student learning in the operating room: An embedded mixed methods study. Am J Surg 2023; 226:148-154. [PMID: 36966016 DOI: 10.1016/j.amjsurg.2023.03.014] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/04/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023]
Abstract
BACKGROUND The operating room (OR) is a complex environment for medical students. Little is known about the OR staff's perception of medical students. METHODS We utilized an embedded mixed methods design to characterize surgical staff perceptions of students at an academic institution. We surveyed 408 OR nursing/technician staff with 16 follow-up interviews. RESULTS 139 respondents. 91.3% reported having daily-to-weekly interactions with medical students. Yet, only 37.9% agreed that "patient care is better when medical students are part of the team." 25.2% felt confident that they knew what a student's education entails outside the OR. 93.5% agreed that interprofessional training between physicians and OR staff should be included in educational programs. 54% agreed that their responsibilities include medical student training in the OR setting. CONCLUSIONS Despite an overall desire for teamwork, this study highlights a lack of knowledge of each others' roles. To improve OR culture and team dynamics, concerted efforts need to be made around interprofessional training.
Collapse
Affiliation(s)
- Sanaya Irani
- University of Michigan Medical School, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.
| | - Alexandra Haraczy
- University of Michigan Medical School, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Lena Juratli
- University of Michigan Medical School, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Alexander Landschulz
- University of Michigan Medical School, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Sadhana Chinnusamy
- University of Michigan Medical School, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Mary Byrnes
- Department of Surgery, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA; Center for Healthcare Outcomes and Policy (CHOP), North Campus Research Complex, 2800 Plymouth Road, Building 16, Ann Arbor, MI, 48109, USA
| | - Brandy Sinco
- Center for Healthcare Outcomes and Policy (CHOP), North Campus Research Complex, 2800 Plymouth Road, Building 16, Ann Arbor, MI, 48109, USA
| | - Sydney Edwards
- Department of Surgery, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Ashley Duby
- Department of Surgery, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Gifty Kwakye
- Department of Surgery, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| |
Collapse
|
3
|
Broman KK, Hughes TM, Bredbeck BC, Sun J, Kirichenko D, Carr MJ, Sharma A, Bartlett EK, Nijhuis AAG, Thompson JF, Hieken TJ, Kottschade L, Downs J, Gyorki DE, Stahlie E, van Akkooi A, Ollila DW, O'shea K, Song Y, Karakousis G, Moncrieff M, Nobes J, Vetto J, Han D, Hotz M, Farma JM, Deneve JL, Fleming MD, Perez M, Baecher K, Lowe M, Bagge RO, Mattsson J, Lee AY, Berman RS, Chai H, Kroon HM, Teras J, Teras RM, Farrow NE, Beasley GM, Hui JYC, Been L, Kruijff S, Sinco B, Sarnaik AA, Sondak VK, Zager JS, Dossett LA. International Center-Level Variation in Utilization of Completion Lymph Node Dissection and Adjuvant Systemic Therapy for Sentinel Lymph Node-Positive Melanoma at Major Referral Centers. Ann Surg 2023; 277:e1106-e1115. [PMID: 35129464 PMCID: PMC10097464 DOI: 10.1097/sla.0000000000005370] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to determine overall trends and center-level variation in utilization of completion lymph node dissection (CLND) and adjuvant systemic therapy for sentinel lymph node (SLN)-positive melanoma. SUMMARY BACKGROUND DATA Based on recent clinical trials, management options for SLN-positive melanoma now include effective adjuvant systemic therapy and nodal observation instead of CLND. It is unknown how these findings have shaped practice or how these contemporaneous developments have influenced their respective utilization. METHODS We performed an international cohort study at 21 melanoma referral centers in Australia, Europe, and the United States that treated adults with SLN-positive melanoma and negative distant staging from July 2017 to June 2019. We used generalized linear and multinomial logistic regression models with random intercepts for each center to assess center-level variation in CLND and adjuvant systemic treatment, adjusting for patient and disease-specific characteristics. RESULTS Among 1109 patients, performance of CLND decreased from 28% to 8% and adjuvant systemic therapy use increased from 29 to 60%. For both CLND and adjuvant systemic treatment, the most influential factors were nodal tumor size, stage, and location of treating center. There was notable variation among treating centers in management of stage IIIA patients and use of CLND with adjuvant systemic therapy versus nodal observation alone for similar risk patients. CONCLUSIONS There has been an overall decline in CLND and simultaneous adoption of adjuvant systemic therapy for patients with SLN-positive melanoma though wide variation in practice remains. Accounting for differences in patient mix, location of care contributed significantly to the observed variation.
Collapse
Affiliation(s)
- Kristy K Broman
- Moffitt Cancer Center, Tampa, FL
- University of South Florida Morsani College of Medicine, Tampa, FL
- University of Alabama at Birmingham, Birmingham, AL
| | | | | | | | | | | | | | | | - Amanda A G Nijhuis
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
| | | | | | | | | | - Emma Stahlie
- Netherlands Cancer institute, Amsterdam, The Netherlands
| | | | | | | | - Yun Song
- University of Gothenburg, Gothenburg, Sweden
| | | | - Marc Moncrieff
- Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Jenny Nobes
- Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - John Vetto
- Oregon Health & Science University, Portland, OR
| | - Dale Han
- Oregon Health & Science University, Portland, OR
| | | | | | | | | | | | | | | | | | - Jan Mattsson
- University Medical Center, Groningen, Netherlands
| | | | | | - Harvey Chai
- Royal Adelaide Hospital, University of Adelaide, Adelaide, Australia
| | - Hidde M Kroon
- Royal Adelaide Hospital, University of Adelaide, Adelaide, Australia
| | - Juri Teras
- North Estonia Medical Centre Foundation, Tallinn, Estonia
| | - Roland M Teras
- North Estonia Medical Centre Foundation, Tallinn, Estonia
| | | | | | | | | | | | | | - Amod A Sarnaik
- Moffitt Cancer Center, Tampa, FL
- University of South Florida Morsani College of Medicine, Tampa, FL
| | - Vernon K Sondak
- Moffitt Cancer Center, Tampa, FL
- University of South Florida Morsani College of Medicine, Tampa, FL
| | - Jonathan S Zager
- Moffitt Cancer Center, Tampa, FL
- University of South Florida Morsani College of Medicine, Tampa, FL
| | | |
Collapse
|
4
|
Ellsworth BL, Sinco B, Matusko N, Pitt SC, Hughes DT, Gauger PG, Englesbe M, Underwood HJ. Examining National Guideline Changes Association With Hemithyroidectomy Rates by Surgeon Volume. J Surg Res 2023; 283:858-866. [PMID: 36915013 DOI: 10.1016/j.jss.2022.11.037] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 10/26/2022] [Accepted: 11/11/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The 2015 American Thyroid Association (ATA) guidelines established that hemithyroidectomy (HT) is an appropriate treatment for patients with low-risk thyroid cancer. HT rates increased since the ATA guidelines were released; however, the relationship between surgeon volume and the initial extent of surgery has not been established. METHODS A statewide database was used to identify patients with thyroid cancer who underwent initial thyroidectomy from 2013 to 2020. High-volume thyroid surgeons were defined as those who performed >25 thyroid procedures per year. A mixed-effect logistic model was used to compare low- and high-volume surgeons' initial extent of surgery pre-2015 and post-2015 ATA guidelines. Descriptive statistics were used to describe other surgical outcomes. RESULTS The analysis included 3199 patients with thyroid cancer who underwent initial thyroidectomy. Twenty-four surgeons (6%) were considered high-volume; they performed 48% (n = 1349) of the operations. After the 2015 ATA guidelines were released, the rate of HT increased significantly for low- (23% to 28%, P = 0.042) but not high-volume (19% to 23%, P = 0.149) surgeons. Low-volume surgeons had significantly higher rates of readmission (P = 0.008), re-operation (P = 0.030), complications (P < 0.001), and emergency room visits (P = 0.002) throughout the entire study period. CONCLUSIONS The publication of the 2015 ATA guidelines was associated with a significant increase in HT rates, primarily in low-volume thyroid surgeons. While low-volume surgeons began performing more HTs, they continued to have higher rates of readmission, reoperations, complications, and emergency room visits than high-volume surgeons.
Collapse
Affiliation(s)
| | - Brandy Sinco
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan; Center for Healthcare Outcomes and Policy, Michigan Medicine, Ann Arbor, Michigan
| | - Niki Matusko
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan; Center for Healthcare Outcomes and Policy, Michigan Medicine, Ann Arbor, Michigan
| | - Susan C Pitt
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan; Center for Healthcare Outcomes and Policy, Michigan Medicine, Ann Arbor, Michigan
| | - David T Hughes
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
| | - Paul G Gauger
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
| | - Michael Englesbe
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan; Center for Healthcare Outcomes and Policy, Michigan Medicine, Ann Arbor, Michigan
| | - Hunter J Underwood
- University of Michigan School of Medicine, Ann Arbor, Michigan; Department of Surgery, Michigan Medicine, Ann Arbor, Michigan.
| |
Collapse
|
5
|
Felsman P, Seifert CM, Sinco B, Himle JA. Reducing Social Anxiety and Intolerance of Uncertainty in Adolescents with Improvisational Theater. The Arts in Psychotherapy 2022. [DOI: 10.1016/j.aip.2022.101985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
6
|
Hawkins J, Kieffer EC, Sinco B, Piatt G, Jones L, Mitchell J, Espitia N, LeBron A, Kloss KA, Kurnick K, Palmsiano G, Spencer MS. Using Path Analysis and Linear Regression to Test for Gender and Participation: Effects in a Culturally Tailored Diabetes Intervention for Latino Adults. Int J Environ Res Public Health 2022; 19:11982. [PMID: 36231282 PMCID: PMC9565909 DOI: 10.3390/ijerph191911982] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/17/2022] [Accepted: 09/17/2022] [Indexed: 06/16/2023]
Abstract
While the incidence and prevalence of type 2 diabetes is higher among Latino/as, Latino men are disproportionately affected and have poorer outcomes. We aimed to determine whether gender impacted any outcomes in a culturally tailored type 2 diabetes (T2D) intervention and to evaluate the effects of gender and intervention participation intensity on outcomes at 6-month follow-up. Nested path and regression models were compared with the likelihood ratio test and information criteria in a sample of Latino/a adults with T2D (n = 222) participating in a T2D community health worker (CHW)-led intervention. Path analysis showed that the effect of the intervention did not vary by gender. The intervention was associated with significant improvements in knowledge of T2D management 0.24 (0.10); p = 0.014, diabetes distress, -0.26 (0.12); p = 0.023, and self-efficacy, 0.61 (0.21); p = 0.005. At 6-month follow-up, improved self-management was associated with greater self-efficacy and Hemoglobin A1c (HbA1c) was lower by -0.18 (0.08); p = 0.021 for each unit of self-management behavior. Linear regressions showed that class attendance and home visits contributed to positive intervention results, while gender was non-significant. Pathways of change in a CHW-led culturally tailored T2D intervention can have a significant effect on participant behaviors and health status outcomes, regardless of gender.
Collapse
Affiliation(s)
- Jaclynn Hawkins
- School of Social Work, University of Michigan, 1080 South University Avenue, Ann Arbor, MI 48109, USA
| | - Edith C. Kieffer
- School of Social Work, University of Michigan, 1080 South University Avenue, Ann Arbor, MI 48109, USA
| | - Brandy Sinco
- Center for Healthcare Outcomes & Policy, University of Michigan, 2800 Plymouth Road, North Campus Research Complex, Bldg. 16, Ann Arbor, MI 48109, USA
| | - Gretchen Piatt
- Department of Learning Health Sciences, School of Medicine, University of Michigan, 1111 E. Catherine Street, Ann Arbor, MI 48109, USA
| | - Lenette Jones
- School of Nursing, University of Michigan, 400 North Ingalls Building, Ann Arbor, MI 48109, USA
| | - Jamie Mitchell
- School of Social Work, University of Michigan, 1080 South University Avenue, Ann Arbor, MI 48109, USA
| | - Nicolaus Espitia
- Department of Sociology, Anthropology, Social Work and Criminal Justice Oakland University, 614 Pioneer Dr, Rochester, MI 48309, USA
| | - Alana LeBron
- School of Public Health, University of California, Irvine, 3151 Social Science Plaza, SST 369 (Chicano/Latino Studies) OR 653 E Peltason Drive, AIRB 2026 (Public Health), Irvine, CA 92697, USA
| | - Katherine A. Kloss
- School of Social Work, University of Michigan, 1080 South University Avenue, Ann Arbor, MI 48109, USA
| | - Katie Kurnick
- School of Social Work, University of Michigan, 1080 South University Avenue, Ann Arbor, MI 48109, USA
| | - Gloria Palmsiano
- Community Health and Social Services Center, 5635 West Fort Street, Detroit, MI 48209, USA
| | - Michael S. Spencer
- School of Social Work, University of Washington, 4101 15th Avenue NE, Seattle, WA 98105, USA
| |
Collapse
|
7
|
Hughes TM, Ellsworth B, Berlin NL, Sinco B, Bredbeck B, Baskin A, Wang T, Nathan H, Dossett LA. Statewide Episode Spending Variation of Mastectomy for Breast Cancer. J Am Coll Surg 2022; 234:14-23. [PMID: 35213456 DOI: 10.1097/xcs.0000000000000005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Centralizing complex cancer operations, such as pancreatectomy and esophagectomy, has been shown to increase value, largely due to reduction in complications. For high-volume operations with low complication rates, it is unknown to what degree value varies between facilities, or by what mechanism value may be improved. To identify possible opportunities for value enhancement for such operations, we sought to describe variations in episode spending for mastectomy with a secondary aim of identifying patient- and facility-level determinants of variation. STUDY DESIGN Using the Michigan Value Collaborative risk-adjusted, price-standardized claims data, we evaluated mean spending for patients undergoing mastectomy at 74 facilities (n = 7,342 patients) across the state of Michigan. Primary outcomes were 30- and 90-day episode spending. Using linear mixed models, facility- and patient-level factors were explored for association with spending variability. RESULTS Among 7,342 women treated across 74 facilities, mean 30-day spending by facility ranged from $11,129 to $20,830 (median $14,935). Ninety-day spending ranged from $17,303 to $31,060 (median $23,744). Patient-level factors associated with greater spending included simultaneous breast reconstruction, bilateral surgery, length of stay, and readmission. Among women not undergoing reconstruction, variation persisted, and length of stay, bilateral surgery, and readmission were all associated with increased spending. CONCLUSION Michigan hospitals have significant variation in spending for mastectomy. Reducing length of stay through wider adoption of same-day discharge for mastectomy and reducing the frequency of bilateral surgery may represent opportunities to increase value, without compromising patient safety or oncologic outcomes.
Collapse
Affiliation(s)
- Tasha M Hughes
- From the Department of Surgery (Hughes, Berlin, Bredbeck, Wang, Nathan, Dossett), Michigan Medicine, Ann Arbor, MI
- the Center for Healthcare Outcomes and Policy (Hughes, Berlin, Sinco, Bredbeck, Wang, Nathan, Dossett), Michigan Medicine, Ann Arbor, MI
| | - Brandon Ellsworth
- the University of Michigan School of Medicine, Ann Arbor, MI (Ellsworth, Baskin)
| | - Nicholas L Berlin
- From the Department of Surgery (Hughes, Berlin, Bredbeck, Wang, Nathan, Dossett), Michigan Medicine, Ann Arbor, MI
- the Center for Healthcare Outcomes and Policy (Hughes, Berlin, Sinco, Bredbeck, Wang, Nathan, Dossett), Michigan Medicine, Ann Arbor, MI
| | - Brandy Sinco
- the Center for Healthcare Outcomes and Policy (Hughes, Berlin, Sinco, Bredbeck, Wang, Nathan, Dossett), Michigan Medicine, Ann Arbor, MI
| | - Brooke Bredbeck
- From the Department of Surgery (Hughes, Berlin, Bredbeck, Wang, Nathan, Dossett), Michigan Medicine, Ann Arbor, MI
- the Center for Healthcare Outcomes and Policy (Hughes, Berlin, Sinco, Bredbeck, Wang, Nathan, Dossett), Michigan Medicine, Ann Arbor, MI
| | - Alison Baskin
- the University of Michigan School of Medicine, Ann Arbor, MI (Ellsworth, Baskin)
| | - Ton Wang
- From the Department of Surgery (Hughes, Berlin, Bredbeck, Wang, Nathan, Dossett), Michigan Medicine, Ann Arbor, MI
- the Center for Healthcare Outcomes and Policy (Hughes, Berlin, Sinco, Bredbeck, Wang, Nathan, Dossett), Michigan Medicine, Ann Arbor, MI
| | - Hari Nathan
- From the Department of Surgery (Hughes, Berlin, Bredbeck, Wang, Nathan, Dossett), Michigan Medicine, Ann Arbor, MI
- the Center for Healthcare Outcomes and Policy (Hughes, Berlin, Sinco, Bredbeck, Wang, Nathan, Dossett), Michigan Medicine, Ann Arbor, MI
| | - Lesly A Dossett
- From the Department of Surgery (Hughes, Berlin, Bredbeck, Wang, Nathan, Dossett), Michigan Medicine, Ann Arbor, MI
- the Center for Healthcare Outcomes and Policy (Hughes, Berlin, Sinco, Bredbeck, Wang, Nathan, Dossett), Michigan Medicine, Ann Arbor, MI
| |
Collapse
|
8
|
Neiman PU, Taylor KK, Sinco B, Anderson GA, Sangji NF, Hemmila MR, Scott JW. Insult to injury: National analysis of return to work and financial outcomes of trauma patients. J Trauma Acute Care Surg 2021; 91:121-129. [PMID: 34144560 DOI: 10.1097/ta.0000000000003135] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 11/26/2022]
Abstract
BACKGROUND While much of trauma care is rightly focused on improving inpatient survival, the ultimate goal of recovery is to help patients return to their daily lives after injury. Although the overwhelming majority of trauma patients in the United States survive to hospital discharge, little is known nationally regarding the postdischarge economic burden of injuries among trauma survivors. METHODS We used the National Health Interview Survey from 2008 to 2017 to identify working-age trauma patients, aged 18 to 64 years, who sustained injuries requiring hospitalization. We used propensity score matching to identify noninjured respondents. Our primary outcome measure was postinjury return to work among trauma patients. Our secondary outcomes included measures of food insecurity, medical debt, accessibility and affordability of health care, and disability. RESULTS A nationally weighted sample of 319,580 working-age trauma patients were identified. Of these patients, 51.7% were employed at the time of injury, and 58.9% of them had returned to work at the time of interview, at a median of 47 days postdischarge. Higher rates of returning to work were associated with shorter length of hospital stay, higher education level, and private health insurance. Injury was associated with food insecurity at an adjusted odds ratio (aOR) of 1.8 (95% confidence interval, 1.40-2.37), with difficulty affording health care at aOR of 1.6 (1.00-2.47), with medical debt at aOR of 2.6 (2.11-3.20), and with foregoing care due to cost at aOR of 2.0 (1.52-2.63). Working-age trauma patients had disability at an aOR of 17.6 (12.93-24.05). CONCLUSION The postdischarge burden of injury among working-age US trauma survivors is profound-patients report significant limitations in employment, financial security, disability, and functional independence. A better understanding of the long-term impact of injury is necessary to design the interventions needed to optimize postinjury recovery so that trauma survivors can lead productive and fulfilling lives after injury. LEVEL OF EVIDENCE Economic & Value-Based Evaluations, level II; Prognostic, level II.
Collapse
Affiliation(s)
- Pooja U Neiman
- From the National Clinician Scholars Program (P.U.N., K.K.T.), Institute for Healthcare Policy and Innovation and Center for Healthcare Outcomes and Policy (P.U.N., K.K.T., B.S., N.F.S., M.R.H., J.W.S.), University of Michigan, Ann Arbor, Michigan; Department of Surgery (P.U.N., G.A.A.), Brigham and Women's Hospital, Boston, Massachusetts; Department of Surgery (K.K.T.), Stanford University, Stanford, California; Center for Surgery and Public Health (G.A.A.), Brigham and Women's Hospital, Boston, Massachusetts; and Department of Surgery (N.F.S., M.R.H., J.W.S.), University of Michigan, Ann Arbor, Michigan
| | | | | | | | | | | | | |
Collapse
|
9
|
Ye W, Kuo S, Kieffer EC, Piatt G, Sinco B, Palmisano G, Spencer MS, Herman WH. Cost-Effectiveness of a Diabetes Self-Management Education and Support Intervention Led by Community Health Workers and Peer Leaders: Projections From the Racial and Ethnic Approaches to Community Health Detroit Trial. Diabetes Care 2021; 44:1108-1115. [PMID: 33958424 PMCID: PMC8132331 DOI: 10.2337/dc20-0307] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 02/22/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To simulate the long-term cost-effectiveness of a peer leader (PL)-led diabetes self-management support (DSMS) program following a structured community health worker (CHW)-led diabetes self-management education (DSME) program in reducing risks of complications in people with type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS The trial randomized 222 Latino adults with T2D to 1) enhanced usual care (EUC); 2) a CHW-led, 6-month DSME program and 6 months of CHW-delivered monthly telephone outreach (CHW only); or 3) a CHW-led, 6-month DSME program and 12 months of PL-delivered weekly group sessions with telephone outreach to those unable to attend (CHW + PL). Empirical data from the trial and the validated Michigan Model for Diabetes were used to estimate cost and health outcomes over a 20-year time horizon from a health care sector perspective, discounting both costs and benefits at 3% annually. The primary outcome measure was the incremental cost-effectiveness ratio (ICER). RESULTS Over 20 years, the CHW + PL intervention had an ICER of $28,800 and $5,900 per quality-adjusted life-year (QALY) gained compared with the EUC and CHW-only interventions, respectively. The CHW-only intervention had an ICER of $430,600 per QALY gained compared with the EUC intervention. In sensitivity analyses, the results comparing the CHW + PL with EUC and CHW-only interventions were robust to changes in intervention effects and costs. CONCLUSIONS The CHW + PL-led DSME/DSMS intervention improved health and provided good value compared with the EUC intervention. The 6-month CHW-led DSME intervention without further postintervention CHW support was not cost effective in Latino adults with T2D.
Collapse
Affiliation(s)
- Wen Ye
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI
| | - Shihchen Kuo
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
| | | | - Gretchen Piatt
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI
| | - Brandy Sinco
- University of Michigan School of Social Work, Ann Arbor, MI
| | | | | | - William H Herman
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
| |
Collapse
|
10
|
Wang T, Bredbeck BC, Sinco B, Shubeck S, Baskin AS, Skolarus T, Dossett LA. Variations in Persistent Use of Low-Value Breast Cancer Surgery. JAMA Surg 2021; 156:353-362. [PMID: 33533894 DOI: 10.1001/jamasurg.2020.6942] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Importance Through the Choosing Wisely campaign, surgical specialties identified 4 low-value breast cancer operations. Preliminary data suggest varying rates of deimplementation and have identified patient-level and clinician-level determinants of continued overuse. However, little information exists about facility-level variation or determinants of differential deimplementation. Objective To identify variation and determinants of persistent use of low-value breast cancer surgical care. Design, Setting, and Participants Retrospective cohort study in which reliability-adjusted facility rates of each procedure were calculated using random-intercept hierarchical logistic regression before and after evidence demonstrated that each procedure was unnecessary. The National Cancer Database is a prospective cancer registry of patients encompassing approximately 70% of all new cancer diagnoses from more than 1500 facilities in the United States. Data were analyzed from November 2019 to August 2020. The registry included women 18 years and older diagnosed as having breast cancer between 2004 and 2016 and meeting inclusion criteria for each Choosing Wisely recommendation. Main Outcomes and Measures Rate of each low-value breast cancer procedure based on facility type and breast cancer volume categories before and after the release of data supporting each procedure's omission. Results The total cohort included 920 256 women with a median age of 63 years. Overall, 86% self-identified as White, 10% as Black, 3% as Asian, and 4.5% as Hispanic. Most women in this cohort were insured (51% private and 47% public), were living in a metropolitan or urban area (88% and 11%, respectively), and originated from the top half of income-earning households (65.5%). While there was significant deimplementation of axillary lymph node dissection and lumpectomy reoperation in response to guidelines supporting omission of these procedures, rates of contralateral prophylactic mastectomy and sentinel lymph node biopsy in older women increased during the study period. Academic research programs and high-volume facilities overall demonstrated the greatest reduction in use of these low-value procedures. There was significant interfacility variation for each low-value procedure. Facility-level axillary lymph node dissection rates ranged from 7% to 47%, lumpectomy reoperation rates ranged from 3% to 62%, contralateral prophylactic mastectomy rates ranged from 9% to 67%, and sentinel lymph node biopsy rates ranged from 25% to 97%. Pearson correlation coefficient for each combination of 2 of the 4 procedures was less than 0.11, suggesting that hospitals were not consistent in their deimplementation performance across all 4 procedures. Many were high outliers in one procedure but low outliers in another. Conclusions and Relevance Interfacility variation demonstrates a performance gap and an opportunity for formal deimplementation efforts targeting each procedure. Several facility-level characteristics were associated with differential deimplementation and performance.
Collapse
Affiliation(s)
- Ton Wang
- Department of Surgery, Michigan Medicine, Ann Arbor.,Center for Health Outcomes and Policy, Michigan Medicine, Ann Arbor
| | - Brooke C Bredbeck
- Department of Surgery, Michigan Medicine, Ann Arbor.,Center for Health Outcomes and Policy, Michigan Medicine, Ann Arbor
| | - Brandy Sinco
- Center for Health Outcomes and Policy, Michigan Medicine, Ann Arbor
| | - Sarah Shubeck
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alison S Baskin
- Center for Health Outcomes and Policy, Michigan Medicine, Ann Arbor.,University of Michigan School of Medicine, Ann Arbor
| | - Ted Skolarus
- Department of Urology, Michigan Medicine, Ann Arbor.,Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Lesly A Dossett
- Department of Surgery, Michigan Medicine, Ann Arbor.,Center for Health Outcomes and Policy, Michigan Medicine, Ann Arbor
| |
Collapse
|
11
|
Smith MJ, Mitchell JA, Blajeski S, Parham B, Harrington MM, Ross B, Sinco B, Brydon DM, Johnson JE, Cuddeback GS, Smith JD, Jordan N, Bell MD, McGeorge R, Kaminski K, Suganuma A, Kubiak SP. Enhancing vocational training in corrections: A type 1 hybrid randomized controlled trial protocol for evaluating virtual reality job interview training among returning citizens preparing for community re-entry. Contemp Clin Trials Commun 2020; 19:100604. [PMID: 32671283 PMCID: PMC7339026 DOI: 10.1016/j.conctc.2020.100604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 06/17/2020] [Accepted: 06/28/2020] [Indexed: 11/18/2022] Open
Abstract
The Michigan Department of Corrections operates the Vocational Villages, which are skilled trades training programs set within prisons that include an immersive educational community using virtual reality, robotics, and other technologies to develop employable trades. An enhancement to the Vocational Villages could be an evidence-based job interview training component. Recently, we conducted a series of randomized controlled trials funded by the National Institute of Mental Health to evaluate the efficacy of virtual reality job interview training (VR-JIT). The results suggested that the use of VR-JIT was associated with improved job interview skills and a greater likelihood of receiving job offers within 6 months. The primary goal of this study is to report on the protocol we developed to evaluate the effectiveness of VR-JIT at improving interview skills, increasing job offers, and reducing recidivism when delivered within two Vocational Villages via a randomized controlled trial and process evaluation. Our aims are to: (1) evaluate whether services-as-usual in combination with VR-JIT, compared to services-as-usual alone, enhances employment outcomes and reduces recidivism among returning citizens enrolled in the Vocational Villages; (2) evaluate mechanisms of employment outcomes and explore mechanisms of recidivism; and (3) conduct a multilevel, mixed-method process evaluation of VR-JIT implementation to assess the adoptability, acceptability, scalability, feasibility, and implementation costs of VR-JIT.
Collapse
Affiliation(s)
- Matthew J. Smith
- University of Michigan School of Social Work, Ann Arbor, MI, USA
- Corresponding author. School of Social Work, University of Michigan, 1080 South University Avenue, Room 3796, Ann Arbor, MI, 48109-1106.
| | | | - Shannon Blajeski
- University of Michigan School of Social Work, Ann Arbor, MI, USA
| | - Brittani Parham
- University of Michigan School of Social Work, Ann Arbor, MI, USA
- University of Michigan Department of Psychology, Ann Arbor, MI, USA
| | | | - Brittany Ross
- University of Michigan School of Social Work, Ann Arbor, MI, USA
| | - Brandy Sinco
- University of Michigan School of Social Work, Ann Arbor, MI, USA
| | - Daphne M. Brydon
- University of Michigan School of Social Work, Ann Arbor, MI, USA
- University of Denver Graduate School of Social Work, Denver, CO, USA
| | | | - Gary S. Cuddeback
- University of North Carolina at Chapel Hill School of Social Work, Chapel Hill, NC, USA
| | - Justin D. Smith
- Northwestern University Feinberg School of Medicine Department of Psychiatry and Behavioral Sciences, Chicago, IL, USA
| | - Neil Jordan
- Northwestern University Feinberg School of Medicine Department of Psychiatry and Behavioral Sciences, Chicago, IL, USA
- Hines VA Center of Innovation for Complex Chronic Healthcare, USA
| | - Morris D. Bell
- Yale School of Medicine, Department of Psychiatry, West Haven, CT, USA
| | | | - Kyle Kaminski
- Michigan Department of Corrections, Lansing, MI, USA
| | | | | |
Collapse
|
12
|
Spencer MS, Kieffer EC, Sinco B, Piatt G, Palmisano G, Hawkins J, Lebron A, Espitia N, Tang T, Funnell M, Heisler M. Outcomes at 18 Months From a Community Health Worker and Peer Leader Diabetes Self-Management Program for Latino Adults. Diabetes Care 2018; 41:1414-1422. [PMID: 29703724 PMCID: PMC6014532 DOI: 10.2337/dc17-0978] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 04/07/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study evaluated the effectiveness of a community health worker (CHW) diabetes self-management education (DSME) program, followed by two different approaches to maintain improvements in HbA1c and other clinical and patient-centered outcomes over 18 months. RESEARCH DESIGN AND METHODS The study randomized 222 Latino adults with type 2 diabetes and poor glycemic control from a federally qualified health center to 1) a CHW-led, 6-month DSME program or 2) enhanced usual care (EUC). After the 6-month program, participants randomized to the CHW-led DSME were further randomized to 1) 12 months of CHW-delivered monthly telephone outreach (CHW-only) or 2) 12 months of weekly group sessions delivered by peer leaders (PLs) with telephone outreach to those unable to attend (CHW+PL). The primary outcome was HbA1c. Secondary outcomes were blood pressure, lipid levels, diabetes distress, depressive symptoms, understanding of diabetes self-management, and diabetes social support. Assessments were conducted at baseline and at 6, 12, and 18 months. RESULTS Participants in the CHW intervention at the 6-month follow-up had greater decreases in HbA1c (-0.45% [95% CI -0.87, -0.03]; P < 0.05) and in diabetes distress (-0.3 points [95% CI -0.6, -0.03]; P < 0.05) compared with EUC. CHW+PL participants maintained HbA1c improvements at 12 and 18 months, and CHW-only participants maintained improvements in diabetes distress at 12 and 18 months. CHW+PL participants also had significantly fewer depressive symptoms at 18 months compared with EUC (-2.2 points [95% CI -4.1, -0.3]; P < 0.05). Participants in CHW-led DSME had significant improvements in diabetes social support and in understanding of diabetes self-management at 6 months relative to EUC, but these intervention effects were not sustained at 18 months. CONCLUSIONS This study demonstrates the effectiveness of a 6-month CHW intervention on key diabetes outcomes and of a volunteer PL program in sustaining key achieved gains. These are scalable models for health care centers in low-resource settings for achieving and maintaining improvements in key diabetes outcomes.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Tricia Tang
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | |
Collapse
|
13
|
LeBron AMW, Valerio MA, Kieffer E, Sinco B, Rosland AM, Hawkins J, Espitia N, Palmisano G, Spencer M. Everyday discrimination, diabetes-related distress, and depressive symptoms among African Americans and Latinos with diabetes. J Immigr Minor Health 2016; 16:1208-16. [PMID: 23689972 DOI: 10.1007/s10903-013-9843-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
It is not known how discrimination might affect diabetes-related distress (DRD), an important correlate of diabetes outcomes. We examined correlates of discrimination and the influence of discrimination on DRD and depressive symptoms (DS) for African Americans and Latinos with type 2 diabetes. We analyzed survey data (n = 157) collected at enrollment into a diabetes management intervention. Using multiple linear regression, we examined correlates of discrimination and the association between discrimination and DRD and DS. Discrimination was significantly associated with higher DRD for Latinos (b 1.58, 95% CI 1.08, 2.31, p < 0.05), but not significant for African Americans (b 0.96, 95% CI 0.59, 1.57). Discrimination was marginally significantly associated with more DS for Latinos (b 1.43, 95% CI 0.97, 2.12, p < 0.10), but not significant for African Americans (b 1.21, 95% CI 0.87, 1.70). These findings suggest the need to address stressors unique to racial/ethnic minorities to improve diabetes-related outcomes.
Collapse
Affiliation(s)
- Alana M W LeBron
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA,
| | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Rosland AM, Kieffer E, Spencer M, Sinco B, Palmisano G, Valerio M, Nicklett E, Heisler M. Do pre-existing diabetes social support or depressive symptoms influence the effectiveness of a diabetes management intervention? Patient Educ Couns 2015; 98:1402-1409. [PMID: 26234800 PMCID: PMC4609239 DOI: 10.1016/j.pec.2015.05.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 03/27/2015] [Accepted: 05/28/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Examine influences of diabetes-specific social support (D-SS) and depressive symptoms on glycemic control over time, among adults randomized to a diabetes self-management education and support (DSME/S) intervention or usual care. METHODS Data were from 108 African-American and Latino participants in a 6-month intervention trial. Multivariable linear regression models assessed associations between baseline D-SS from family and friends and depressive symptoms with changes in HbA1c. We then examined whether baseline D-SS or depression moderated intervention-associated effects on HbA1c. RESULTS Higher baseline D-SS was associated with larger improvements in HbA1c (adjusted ΔHbA1c -0.39% for each +1-point D-SS, p=0.02), independent of intervention-associated HbA1c decreases. Baseline depressive symptoms had no significant association with subsequent HbA1c change. Neither D-SS nor depression moderated intervention-associated effects on HbA1c. CONCLUSIONS AND PRACTICE IMPLICATIONS Diabetes self-management education and support programs have potential to improve glycemic control for participants starting with varying levels of social support and depressive symptoms. Participants starting with more support for diabetes management from family and friends improved HbA1c significantly more over 6 months than those with less support, independent of additional significant DSME/S intervention-associated HbA1c improvements. Social support from family and friends may improve glycemic control in ways additive to DSME/S.
Collapse
Affiliation(s)
- Ann-Marie Rosland
- University of Michigan Medical School, Department of Internal Medicine, USA; VA Ann Arbor Center for Clinical Management Research, USA.
| | | | | | - Brandy Sinco
- University of Michigan School of Social Work, USA
| | | | - Melissa Valerio
- University of Michigan School of Public Health, Department of Health Behavior and Health Education, USA
| | | | - Michele Heisler
- University of Michigan Medical School, Department of Internal Medicine, USA; VA Ann Arbor Center for Clinical Management Research, USA; University of Michigan School of Public Health, Department of Health Behavior and Health Education, USA
| |
Collapse
|
15
|
Tang TS, Funnell MM, Sinco B, Spencer MS, Heisler M. Peer-Led, Empowerment-Based Approach to Self-Management Efforts in Diabetes (PLEASED): A Randomized Controlled Trial in an African American Community. Ann Fam Med 2015; 13 Suppl 1:S27-35. [PMID: 26304969 PMCID: PMC4648139 DOI: 10.1370/afm.1819] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
PURPOSE We compared a 3-month diabetes self-management education (DSME) program followed by a 12-month peer support intervention with a 3-month DSME program alone in terms of initial and sustained improvements in glycated hemoglobin (HbA1c). Secondary outcomes were risk factors for cardiovascular disease (CVD), diabetes distress, and social support. METHODS We randomized 106 community-dwelling African American adults with type 2 diabetes to a 3-month DSME program followed by 12 months of weekly group sessions and supplementary telephone support delivered by peer leaders or to a 3-month DSME program with no follow-up peer support. Assessments were conducted at baseline, 3, 9, and 15 months. RESULTS No changes in HbA1c were observed at 3 months or at 15 months for either group. The peer support group either sustained improvement in key CVD risk factors or stayed the same while the control group worsened at 15 months. At 15 months, the peer-support group had significantly lower low-density lipoprotein cholesterol levels (-15 mg/dL, P = .03), systolic blood pressure (-10 mm Hg, P = .01), diastolic blood pressure (-8.3 mm Hg, P = .001), and body mass index (-0.8 kg/m(2), P = .032) than the DSME-alone group. CONCLUSIONS In this population of African American adults, an initial DSME program, whether or not followed by 12 months of peer support, had no effect on glycemic control. Participants in the peer-support arm of the trial did, however, experience significant improvements in some CVD risk factors or stay approximately the same while the control group declined.
Collapse
Affiliation(s)
- Tricia S Tang
- University of British Columbia Department of Medicine, Vancouver, British Columbia
| | - Martha M Funnell
- University of Michigan Department of Learning Health Sciences. Ann Arbor Michigan
| | - Brandy Sinco
- University of Michigan School of Social Work, Ann Arbor, Michigan
| | | | - Michele Heisler
- University of Michigan Department of Internal Medicine, Ann Arbor, Michigan Ann Arbor VA Center for Clinical Management Research (CCMR), Ann Arbor, Michigan
| |
Collapse
|
16
|
Tang TS, Funnell M, Sinco B, Piatt G, Palmisano G, Spencer MS, Kieffer EC, Heisler M. Comparative effectiveness of peer leaders and community health workers in diabetes self-management support: results of a randomized controlled trial. Diabetes Care 2014; 37:1525-34. [PMID: 24722495 PMCID: PMC4030090 DOI: 10.2337/dc13-2161] [Citation(s) in RCA: 123] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To compare a peer leader (PL) versus a community health worker (CHW) telephone outreach intervention in sustaining improvements in HbA1c over 12 months after a 6-month diabetes self-management education (DSME) program. RESEARCH DESIGN AND METHODS One hundred and sixteen Latino adults with type 2 diabetes were recruited from a federally qualified health center and randomized to (1) a 6-month DSME program followed by 12 months of weekly group sessions delivered by PLs with telephone outreach to those unable to attend or (2) a 6-month DSME program followed by 12 months of monthly telephone outreach delivered by CHWs. The primary outcome was HbA1c. Secondary outcomes were cardiovascular disease risk factors, diabetes distress, and diabetes social support. Assessments were conducted at baseline, 6, 12, and 18 months. RESULTS After DSME, the PL group achieved a reduction in mean HbA1c (8.2-7.5% or 66-58 mmol/mol, P < 0.0001) that was maintained at 18 months (-0.6% or -6.6 mmol/mol from baseline [P = 0.009]). The CHW group also showed a reduction in HbA1c (7.8 vs. 7.3% or 62 vs. 56 mmol/mol, P = 0.0004) post-6 month DSME; however, it was attenuated at 18 months (-0.3% or -3.3 mmol/mol from baseline, within-group P = 0.234). Only the PL group maintained improvements achieved in blood pressure at 18 months. At the 18-month follow-up, both groups maintained improvements in waist circumference, diabetes support, and diabetes distress, with no significant differences between groups. CONCLUSIONS Both low-cost maintenance programs led by either a PL or a CHW maintained improvements in key patient-reported diabetes outcomes, but the PL intervention may have additional benefit in sustaining clinical improvements beyond 12 months.
Collapse
Affiliation(s)
- Tricia S Tang
- University of British Columbia Department of Medicine, Vancouver, British Columbia, Canada
| | - Martha Funnell
- University of Michigan Department of Medical Education, Ann Arbor, MI
| | - Brandy Sinco
- University of Michigan School of Social Work, Ann Arbor, MI
| | - Gretchen Piatt
- University of Michigan Department of Medical Education, Ann Arbor, MI
| | | | | | | | - Michele Heisler
- University of Michigan Department of Internal Medicine, Ann Arbor, MIAnn Arbor VA Center for Clinical Management Research, Ann Arbor, MI
| |
Collapse
|
17
|
Hawkins J, Kieffer EC, Sinco B, Spencer M, Anderson M, Rosland AM. Does gender influence participation? Predictors of participation in a community health worker diabetes management intervention with African American and Latino adults. Diabetes Educ 2013; 39:647-54. [PMID: 23859885 DOI: 10.1177/0145721713492569] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of the study was to determine the effects of gender on participation in a community-based, culturally tailored diabetes lifestyle intervention, led by trained community health workers (CHW) and conducted with African Americans and Latinos with type 2 diabetes. METHODS This study utilized data collected from 180 participants. Multivariable binary and cumulative logistic regression models were used to analyze associations between gender and race/ethnicity with study completion and participation in 3 aspects of the intervention: group classes, CHW home visits, and CHW-accompanied doctor visits. RESULTS Among Latinos, men were less likely than women to complete the study, attend group classes, and complete CHW home visits. There were no gender differences in participation seen among African Americans. CONCLUSIONS Diabetes management interventions may need to adapt their designs to optimize retention and participation of Latino men. Among African American men, the CHW model may be promising. Reasons for low participation among Latino men should receive more study. Future studies should assess whether similar findings apply in other communities and populations.
Collapse
Affiliation(s)
- Jaclynn Hawkins
- University of Michigan School of Social Work, Ann Arbor, Michigan (Ms Hawkins, Dr Kieffer, Ms Sinco, Dr Spencer),REACH Detroit Partnership, Detroit, Michigan (Ms Hawkins, Dr Kieffer, Dr Rosland, Ms Sinco, Mr Anderson, Dr Spencer)
| | - Edith C Kieffer
- University of Michigan School of Social Work, Ann Arbor, Michigan (Ms Hawkins, Dr Kieffer, Ms Sinco, Dr Spencer),REACH Detroit Partnership, Detroit, Michigan (Ms Hawkins, Dr Kieffer, Dr Rosland, Ms Sinco, Mr Anderson, Dr Spencer)
| | - Brandy Sinco
- University of Michigan School of Social Work, Ann Arbor, Michigan (Ms Hawkins, Dr Kieffer, Ms Sinco, Dr Spencer),REACH Detroit Partnership, Detroit, Michigan (Ms Hawkins, Dr Kieffer, Dr Rosland, Ms Sinco, Mr Anderson, Dr Spencer)
| | - Michael Spencer
- University of Michigan School of Social Work, Ann Arbor, Michigan (Ms Hawkins, Dr Kieffer, Ms Sinco, Dr Spencer),REACH Detroit Partnership, Detroit, Michigan (Ms Hawkins, Dr Kieffer, Dr Rosland, Ms Sinco, Mr Anderson, Dr Spencer)
| | - Michael Anderson
- REACH Detroit Partnership, Detroit, Michigan (Ms Hawkins, Dr Kieffer, Dr Rosland, Ms Sinco, Mr Anderson, Dr Spencer),Community Health and Social Services Center, Detroit, Michigan (Mr Anderson)
| | - Ann-Marie Rosland
- REACH Detroit Partnership, Detroit, Michigan (Ms Hawkins, Dr Kieffer, Dr Rosland, Ms Sinco, Mr Anderson, Dr Spencer),University of Michigan Medical School Department of Internal Medicine, Ann Arbor, Michigan (Dr Rosland),VA Ann Arbor Center for Clinical Management Research, Ann Arbor Center for Clinical Management Research, Ann Arbor, Michigan (Dr Rosland)
| |
Collapse
|
18
|
Spencer MS, Hawkins J, Espitia NR, Sinco B, Jennings T, Lewis C, Palmisano G, Kieffer E. Influence of a Community Health Worker Intervention on Mental Health Outcomes among Low-Income Latino and African American Adults with Type 2 Diabetes. Race Soc Probl 2013; 5:137-146. [PMID: 26448789 PMCID: PMC4593061 DOI: 10.1007/s12552-013-9098-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This study investigated the influence of a community health worker (CHW) diabetes lifestyle intervention on mental health outcomes. Our study was guided by the principles of community-based participatory research. Data were collected from 164 African American (N = 94) and Hispanic adults (N = 70) participating in a randomized, 6-month delayed intervention group design for improving glycemic control. The intervention time periods were baseline to 6 months for the treatment group and 6-12 months for the delayed group. Linear mixed models were used to conduct longitudinal analyses of the Problem Areas in Diabetes (PAID) and Patient Health Questionnaire (PHQ) scales. In the model adjusted for demographics, the PAID dropped significantly from pre-intervention to post-intervention within both the treatment and delayed groups (p < 0.05) with an average intervention effect of -6.4 (p < 0.01). The PAID dropped even further within the immediate group from 6 to 12 months. Although the PHQ did not change significantly, the PHQ-2 had an average intervention effect of -0.3 (p < 0.05) in the model adjusted for demographics. This study contributes to an understanding of how a CHW-led diabetes intervention can result in positive mental health outcomes for Latinos and African Americans with Type 2 diabetes. It also highlights the importance of further exploring what factors may contribute to racial/ethnic variation in mental health outcomes for African Americans and Latinos with diabetes and the role CHWs can play.
Collapse
Affiliation(s)
- Michael S. Spencer
- School of Social Work, University of Michigan, 1080 South University Avenue, Ann Arbor, MI 48109-1106, USA. REACH Detroit Partnership, Detroit, MI, USA
| | - Jaclynn Hawkins
- School of Social Work, University of Michigan, 1080 South University Avenue, Ann Arbor, MI 48109-1106, USA. REACH Detroit Partnership, Detroit, MI, USA
| | - Nicolas R. Espitia
- School of Social Work, University of Michigan, 1080 South University Avenue, Ann Arbor, MI 48109-1106, USA. REACH Detroit Partnership, Detroit, MI, USA. Community Health and Social Services Center, Detroit, MI, USA
| | - Brandy Sinco
- School of Social Work, University of Michigan, 1080 South University Avenue, Ann Arbor, MI 48109-1106, USA. REACH Detroit Partnership, Detroit, MI, USA
| | - Tezra Jennings
- School of Social Work, University of Michigan, 1080 South University Avenue, Ann Arbor, MI 48109-1106, USA. REACH Detroit Partnership, Detroit, MI, USA
| | - Carissa Lewis
- School of Social Work, University of Michigan, 1080 South University Avenue, Ann Arbor, MI 48109-1106, USA. REACH Detroit Partnership, Detroit, MI, USA. Community Health and Social Services Center, Detroit, MI, USA
| | - Gloria Palmisano
- REACH Detroit Partnership, Detroit, MI, USA. Community Health and Social Services Center, Detroit, MI, USA
| | - Edith Kieffer
- School of Social Work, University of Michigan, 1080 South University Avenue, Ann Arbor, MI 48109-1106, USA. REACH Detroit Partnership, Detroit, MI, USA
| |
Collapse
|
19
|
Kim C, Sinco B, Kieffer EA. Racial and ethnic variation in access to health care, provision of health care services, and ratings of health among women with histories of gestational diabetes mellitus. Diabetes Care 2007; 30:1459-65. [PMID: 17363750 DOI: 10.2337/dc06-2523] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The purpose of this study was to assess racial/ethnic variation in access to health care, use of particular health care services, presence of cardiovascular risk factors, and perceptions of health and impairment among women at risk for type 2 diabetes because of their histories of gestational diabetes mellitus (hGDM). RESEARCH DESIGN AND METHODS We performed a cross-sectional study using the 2001-2003 Behavioral Risk Factor Surveillance System, a national population-based, random sample telephone survey. We assessed access to health care, use of family planning, measurement and elevation of cholesterol, elevation of blood pressure, and respondents' perceptions of health and impairment among women aged 18-44 years with hGDM (n = 4,718). Multivariate models adjusted for sociodemographic characteristics, BMI, presence of children in the household, and current smoking. RESULTS Outcome measures were suboptimal across racial/ethnic groups. Approximately one-fifth of the overall population reported no health insurance, cost barriers to physician visits, and no primary care provider. One-quarter had no examination within the past year, and almost one-fifth reported no family planning and elevated cholesterol levels. Latinas were the most disadvantaged, with 40% reporting no health insurance and no primary care provider and one-fourth reporting suboptimal perceptions of health. Asian/Pacific Islanders were the most advantaged in terms of health care access, cholesterol and blood pressure elevation, and impaired physical health. Racial/ethnic differences in health care use and presence of risk factors were not entirely explained by health care access or other covariates. CONCLUSIONS Significant racial/ethnic variation exists among women with hGDM for access to and use of health care, presence of risk factors, and perceptions of health.
Collapse
Affiliation(s)
- Catherine Kim
- Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA.
| | | | | |
Collapse
|
20
|
Abstract
OBJECTIVE To estimate the prevalence of several health-related behaviors among women of reproductive age with and without a history of gestational diabetes mellitus (hGDM). RESEARCH DESIGN AND METHODS We performed a cross-sectional study using the 2001-2003 Behavioral Risk Factor Surveillance System, a national population-based random sample telephone survey. Participants were 177,420 women aged 18-44 years with and without self-reported hGDM. Outcome measures included meeting physical activity and fruit and vegetable guidelines, sedentary activity level, and current smoking. RESULTS Approximately 3% (n = 4,718) of women aged 18-44 years reported physician-diagnosed hGDM. Women with hGDM had higher BMIs, were significantly older, were less often educated or employed, and were more often Hispanic or African American, married, and living with children. Women with hGDM reported worse self-rated health than women without hGDM. In unadjusted and multivariate adjusted comparisons, there were no significant differences in levels of physical activity, fruit and vegetable consumption, or smoking among women with and without hGDM. However, women with hGDM who lived with children were significantly less likely to meet fruit and vegetable consumption guidelines (odds ratio 0.78 [95% CI 0.63-0.97]; P < 0.05) and more likely to smoke (1.21 [1.01-1.47]; P < 0.05) than their counterparts without hGDM. CONCLUSIONS Despite their elevated risk for future diabetes, women with hGDM who lived with children were less likely to meet fruit and vegetable consumption guidelines and more likely to smoke than women with children who did not have hGDM.
Collapse
Affiliation(s)
- Edith C Kieffer
- School of Social Work, University of Michigan, Ann Arbor, USA.
| | | | | |
Collapse
|
21
|
Two Feathers J, Kieffer EC, Palmisano G, Anderson M, Sinco B, Janz N, Heisler M, Spencer M, Guzman R, Thompson J, Wisdom K, James SA. Racial and Ethnic Approaches to Community Health (REACH) Detroit partnership: improving diabetes-related outcomes among African American and Latino adults. Am J Public Health 2005; 95:1552-60. [PMID: 16051927 PMCID: PMC1449397 DOI: 10.2105/ajph.2005.066134] [Citation(s) in RCA: 166] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2005] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We sought to determine the effects of a community-based, culturally tailored diabetes lifestyle intervention on risk factors for diabetes complications among African Americans and Latinos with type 2 diabetes. METHODS One hundred fifty-one African American and Latino adults with diabetes were recruited from 3 health care systems in Detroit, Michigan, to participate in the Racial and Ethnic Approaches to Community Health (REACH) Detroit Partnership diabetes lifestyle intervention. The curriculum, delivered by trained community residents, was aimed at improving dietary, physical activity, and diabetes self-care behaviors. Baseline and postintervention levels of diabetes-specific quality-of-life, diet, physical activity, self-care knowledge and behaviors, and hemoglobin A1C were assessed. RESULTS There were statistically significant improvements in postintervention dietary knowledge and behaviors and physical activity knowledge. A statistically significant improvement in A1C level was achieved among REACH Detroit program participants (P<.0001) compared with a group of patients with diabetes in the same health care system in which no significant changes were observed (P=.160). CONCLUSIONS A culturally tailored diabetes lifestyle intervention delivered by trained community residents produced significant improvement in dietary and diabetes self-care related knowledge and behaviors as well as important metabolic improvements.
Collapse
Affiliation(s)
- Jacqueline Two Feathers
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|