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Spiegel BMR, Liran O, Clark A, Samaan JS, Khalil C, Chernoff R, Reddy K, Mehra M. Author Correction: Feasibility of combining spatial computing and AI for mental health support in anxiety and depression. NPJ Digit Med 2024; 7:60. [PMID: 38448651 PMCID: PMC10918056 DOI: 10.1038/s41746-024-01060-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024] Open
Affiliation(s)
- Brennan M R Spiegel
- Department of Medicine, Division of Health Services Research Virtual Medicine Program, Cedars-Sinai, Los Angeles, CA, 90048, USA.
- Department of Medicine, Division of Gastroenterology, Cedars-Sinai, Los Angeles, CA, 90048, USA.
| | - Omer Liran
- Department of Medicine, Division of Health Services Research Virtual Medicine Program, Cedars-Sinai, Los Angeles, CA, 90048, USA
- Department of Psychiatry and Behavioral Sciences, Cedars-Sinai, Los Angeles, CA, 90048, USA
| | - Allistair Clark
- Department of Medicine, Division of Health Services Research Virtual Medicine Program, Cedars-Sinai, Los Angeles, CA, 90048, USA
| | - Jamil S Samaan
- Department of Medicine, Division of Gastroenterology, Cedars-Sinai, Los Angeles, CA, 90048, USA
| | - Carine Khalil
- Department of Medicine, Division of Health Services Research Virtual Medicine Program, Cedars-Sinai, Los Angeles, CA, 90048, USA
| | - Robert Chernoff
- Department of Psychiatry and Behavioral Sciences, Cedars-Sinai, Los Angeles, CA, 90048, USA
| | - Kavya Reddy
- Department of Medicine, Division of Gastroenterology, Cedars-Sinai, Los Angeles, CA, 90048, USA
| | - Muskaan Mehra
- Department of Medicine, Division of Health Services Research Virtual Medicine Program, Cedars-Sinai, Los Angeles, CA, 90048, USA
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Khalil C, Almario CV, Dupuy T, Arnold C, Chen YJ, Spiegel BMR. Perspectives, experiences, and concerns with cyclical vomiting syndrome: Insights from online targeted-disease forums. Neurogastroenterol Motil 2024; 36:e14712. [PMID: 38191754 DOI: 10.1111/nmo.14712] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 10/10/2023] [Accepted: 11/07/2023] [Indexed: 01/10/2024]
Abstract
INTRODUCTION There is limited research examining the biopsychosocial impact of cyclic vomiting syndrome (CVS) on patients. This study aims to assess individuals' experiences, fears, and concerns associated with CVS and the impact of CVS on their daily lives. METHODS We employed social netnography to analyze publicly available posts related to CVS that were identified from six US online forums and Twitter. A randomly selected sub-cohort of posts per pre-defined criteria was first qualitatively analyzed using an inductive thematic approach. Then, machine learning topic modeling was applied to explore themes in an unsupervised manner for the entire corpus of posts. Afterward, findings from the qualitative and quantitative approaches were integrated to generate a thematic network. RESULTS Based on the 39,179 collected posts, seven domain themes were identified. Overall, 41.4% of the posts were related to "biopsychosocial burden" of CVS, including physical impact, psychological impact, and social impact. In 22.3% of posts, individuals shared their experience of "interactions with the healthcare system", and 14.2% of posts were related to "perceived CVS triggers." Individuals also shared "solutions to alleviate their symptoms" and "mental health needs" in 10.2% and 8.8% of posts, respectively. Finally, 6.1% of the posts were about "seeking/sharing support" with others. DISCUSSION This is the first social netnography study to describe the in-depth experiences of individuals living with CVS and the marked impact on their physical, mental, and social health. The study also highlights the unmet need for effective therapies, both pharmacological and non-pharmacological, to alleviate the biopsychosocial impact of CVS.
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Affiliation(s)
- Carine Khalil
- Division of Health Services Research, Cedars-Sinai Medical Center, Center for Outcomes Research and Education (CS-CORE), Los Angeles, California, USA
| | - Christopher V Almario
- Division of Health Services Research, Cedars-Sinai Medical Center, Center for Outcomes Research and Education (CS-CORE), Los Angeles, California, USA
| | - Taylor Dupuy
- Division of Health Services Research, Cedars-Sinai Medical Center, Center for Outcomes Research and Education (CS-CORE), Los Angeles, California, USA
| | - Corey Arnold
- Department of Radiology, Medical Imaging Informatics, UCLA, Los Angeles, California, USA
| | - Yaozhu J Chen
- Takeda Development Center Americas, Cambridge, Massachusetts, USA
| | - Brennan M R Spiegel
- Division of Health Services Research, Cedars-Sinai Medical Center, Center for Outcomes Research and Education (CS-CORE), Los Angeles, California, USA
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Spiegel BMR, Liran O, Clark A, Samaan JS, Khalil C, Chernoff R, Reddy K, Mehra M. Feasibility of combining spatial computing and AI for mental health support in anxiety and depression. NPJ Digit Med 2024; 7:22. [PMID: 38279034 PMCID: PMC10817913 DOI: 10.1038/s41746-024-01011-0] [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] [Received: 08/15/2023] [Accepted: 01/11/2024] [Indexed: 01/28/2024] Open
Abstract
The increasing need for mental health support and a shortage of therapists have led to the development of the eXtended-reality Artificial Intelligence Assistant (XAIA). This platform combines spatial computing, virtual reality (VR), and artificial intelligence (AI) to provide immersive mental health support. Utilizing GPT-4 for AI-driven therapy, XAIA engaged participants with mild-to-moderate anxiety or depression in biophilic VR environments. Speaking with an AI therapy avatar in VR was considered acceptable, helpful, and safe, with participants observed to engage genuinely with the program. However, some still favored human interaction and identified shortcomings with using a digital VR therapist. The study provides initial evidence of the acceptability and safety of AI psychotherapy via spatial computing, warranting further research on technical enhancements and clinical impact.
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Affiliation(s)
- Brennan M R Spiegel
- Department of Medicine, Division of Health Services Research Virtual Medicine Program, Cedars-Sinai, Los Angeles, CA, 90048, USA.
- Department of Medicine, Division of Gastroenterology, Cedars-Sinai, Los Angeles, CA, 90048, USA.
| | - Omer Liran
- Department of Medicine, Division of Health Services Research Virtual Medicine Program, Cedars-Sinai, Los Angeles, CA, 90048, USA
- Department of Psychiatry and Behavioral Sciences, Cedars-Sinai, Los Angeles, CA, 90048, USA
| | - Allistair Clark
- Department of Medicine, Division of Health Services Research Virtual Medicine Program, Cedars-Sinai, Los Angeles, CA, 90048, USA
| | - Jamil S Samaan
- Department of Medicine, Division of Gastroenterology, Cedars-Sinai, Los Angeles, CA, 90048, USA
| | - Carine Khalil
- Department of Medicine, Division of Health Services Research Virtual Medicine Program, Cedars-Sinai, Los Angeles, CA, 90048, USA
| | - Robert Chernoff
- Department of Psychiatry and Behavioral Sciences, Cedars-Sinai, Los Angeles, CA, 90048, USA
| | - Kavya Reddy
- Department of Medicine, Division of Gastroenterology, Cedars-Sinai, Los Angeles, CA, 90048, USA
| | - Muskaan Mehra
- Department of Medicine, Division of Health Services Research Virtual Medicine Program, Cedars-Sinai, Los Angeles, CA, 90048, USA
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Liu X, Makaroff KE, Almario CV, Khalil C, Choi SY, Curtis JR, Spiegel BMR. Determining patient preferences for the medical management of osteoporosis using conjoint analysis. Osteoporos Int 2024; 35:153-164. [PMID: 37721558 PMCID: PMC10787002 DOI: 10.1007/s00198-023-06882-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 07/31/2023] [Indexed: 09/19/2023]
Abstract
We used conjoint analysis-a method that assesses complex decision making-to quantify patients' choices when selecting an osteoporosis therapy. While 60% of people prioritized medication efficacy when deciding among treatments, the remaining 40% highly valued factors other than efficacy, suggesting the need for personalized shared decision-making tools. INTRODUCTION In this study, we aimed to examine patient decision-making surrounding osteoporosis medications using conjoint analysis. METHODS We enrolled osteoporosis patients at an academic medical center to complete an online conjoint exercise which calculated each patient's relative importance score of 6 osteoporosis medication attributes (higher = greater relative importance in decision-making). We used latent class analysis to identify distinct segments of patients with similar choice patterns and then used logistic regression to determine if demographics and osteoporosis disease features were associated with latent class assignment. RESULTS Overall, 304 participants completed the survey. The rank order of medication attributes by importance score was the following: efficacy at preventing hip fractures (accounted for 31.0% of decision making), mode of administration (17.5%); risk of serious side effects (16.6%); dose frequency (13.9%); efficacy at preventing spine fractures (12.5%); risk of non-serious side effects (8.4%). We found that 60.9% of the cohort prioritized medication efficacy as their top factor when selecting among the therapies. Being a college graduate, having stronger beliefs on the necessity of using medications for osteoporosis, and never having used osteoporosis medicines were the only factors associated with prioritizing medication efficacy for fracture prevention over the other factors in the decision-making process. CONCLUSIONS While about 60% of patients prioritized efficacy when selecting an osteoporosis therapy, the remaining 40% valued other factors more highly. Furthermore, individual patient characteristics and clinical factors did not reliably predict patient decision making, suggesting that development and implementation of shared decision-making tools is warranted.
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Affiliation(s)
- Xiaoyu Liu
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Katherine E Makaroff
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Christopher V Almario
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Carine Khalil
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA
| | - So Yung Choi
- Biostatistics and Bioinformatics Research Center, Cedars-Sinai Cancer, Los Angeles, CA, USA
| | - Jeffrey R Curtis
- Division of Clinical Immunology and Rheumatology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brennan M R Spiegel
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA.
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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Cangemi DJ, Montenegro M, Spiegel BMR, Lacy ABE. Virtual Reality Improves Symptoms of Functional Dyspepsia: Results of a Randomized, Double-Blind, Sham-Controlled, Pilot Study. Am J Gastroenterol 2024; 119:210-213. [PMID: 37655713 DOI: 10.14309/ajg.0000000000002492] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/29/2023] [Indexed: 09/02/2023]
Abstract
INTRODUCTION We investigated the efficacy and safety of virtual reality (VR) for functional dyspepsia. METHODS Patients were randomized 2:1 between active vs sham VR. Symptoms were assessed using the Patient Assessment of Gastrointestinal Disorders-Symptom Severity Index (PAGI-SYM) over 2-week. RESULTS Patients in the active VR group had greater numerical improvement in PAGI-SYM scores (mean difference -0.7; P < 0.001) compared with sham VR (mean difference -0.4; P = 0.032). Active VR led to significant improvements for all PAGI-SYM subscales, except lower abdominal pain, whereas sham only improved heartburn/regurgitation and nausea/vomiting. Half of the total patients reported nonserious adverse effects, although only 1 patient withdrew from the study because of adverse effects. DISCUSSION VR is safe and results in significant symptom improvement in functional dyspepsia. Larger trials are warranted.
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Affiliation(s)
- David J Cangemi
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Marilia Montenegro
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Brennan M R Spiegel
- Division of Health Sciences Research, Department of Medicine, Cedars-Sinai Health System, Los Angeles, California, USA
| | - And Brian E Lacy
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
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Almario CV, Sharabi E, Chey WD, Lauzon M, Higgins CS, Spiegel BMR. Prevalence and Burden of Illness of Rome IV Irritable Bowel Syndrome in the United States: Results From a Nationwide Cross-Sectional Study. Gastroenterology 2023; 165:1475-1487. [PMID: 37595647 DOI: 10.1053/j.gastro.2023.08.010] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 07/06/2023] [Accepted: 08/06/2023] [Indexed: 08/20/2023]
Abstract
BACKGROUND & AIMS The estimated prevalence of irritable bowel syndrome (IBS) using Rome IV criteria in the United States (US) ranges from 4.7% to 5.3%, although these estimates arise from studies with relatively small sample sizes. This study assessed the prevalence of IBS and its associated burden of illness using a nationally representative data set with nearly 89,000 people in the US. METHODS From May 3 to June 24, 2020, we performed an online survey described to participating adults aged ≥18 years old as a "national health survey." We recruited a representative sample of people in the US to complete the survey, which included the Rome IV IBS questionnaire, National Institutes of Health Patient-Reported Outcome Measurement Information System (PROMIS) gastrointestinal scales, and questions on health care-seeking behavior. RESULTS Overall, 88,607 people completed the survey, of whom 5414 (6.1%) met Rome IV IBS criteria: mixed IBS (n = 1838 [33.9%]), constipation-predominant IBS (n = 1819 [33.6%]), diarrhea-predominant IBS (n = 1521 [28.1%]), and unsubtyped IBS (n = 236 [4.4%]). Women had higher odds for IBS compared with men, whereas racial/ethnic minorities had lower odds for IBS vs non-Hispanic Whites. Across the 3 main subtypes, 68.2% to 73.2% of people reported ever seeking care for their IBS symptoms, whereas 53.8% to 58.9% did so in the past 12 months. CONCLUSIONS In this nationwide US survey, we found that Rome IV IBS is slightly more prevalent (6.1%) vs prior estimates (4.7%-5.3%). Additional research is needed to determine whether this higher prevalence is in part due to the coronavirus disease 2019 pandemic during which this study was conducted.
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Affiliation(s)
- Christopher V Almario
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California; Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California; Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, California
| | - Eden Sharabi
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - William D Chey
- Division of Gastroenterology, Michigan Medicine, Ann Arbor, Michigan
| | - Marie Lauzon
- Biostatistics and Bioinformatics Research Center, Cedars-Sinai Cancer, Los Angeles, California
| | | | - Brennan M R Spiegel
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California; Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California; Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, California.
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Liang J, Almario CV, Chey WD, Higgins CS, Spiegel BMR. Prevalence and Burden of Illness of Rome IV Chronic Idiopathic Constipation, Opioid-Induced Constipation, and Opioid-Exacerbated Constipation in the United States. Am J Gastroenterol 2023; 118:2033-2040. [PMID: 37335135 DOI: 10.14309/ajg.0000000000002376] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/13/2023] [Indexed: 06/21/2023]
Abstract
INTRODUCTION Chronic idiopathic constipation (CIC) and opioid-induced constipation (OIC) are disorders that negatively affect quality of life. We sought to assess the prevalence, symptom severity, and medication use among people with Rome IV CIC, OIC, and opioid-exacerbated constipation (OEC) using a nationally representative data set with nearly 89,000 people in the United States. METHODS From May 3, 2020, to June 24, 2020, we recruited a representative sample of people in the United States ≥ 18 years to complete an online national health survey. The survey guided participants through the Rome IV CIC and OIC questionnaires, Patient-Reported Outcome Measurement Information System gastrointestinal scales (percentile 0-100; higher = more severe), and medication questions. Individuals with OEC were identified by asking those with OIC whether they experienced constipation before starting an opioid and whether their symptoms worsened afterward. RESULTS Among the 88,607 participants, 5,334 (6.0%) had Rome IV CIC, and 1,548 (1.7%) and 335 (0.4%) had Rome IV OIC and OEC, respectively. When compared with people with CIC (Patient-Reported Outcome Measurement Information System score, 53.9 ± 26.5; reference), those with OIC (62.7 ± 28.0; adjusted P < 0.001) and OEC (61.1 ± 25.8, adjusted P = 0.048) had more severe constipation symptoms. People with OIC (odds ratio 2.72, 95% confidence interval 2.04-3.62) and OEC (odds ratio 3.52, 95% confidence interval 2.22-5.59) were also more likely to be taking a prescription medication for their constipation vs those with CIC. DISCUSSION In this nationwide US survey, we found that Rome IV CIC is common (6.0%) while Rome IV OIC (1.7%) and OEC (0.4%) are less prevalent. Individuals with OIC and OEC have a higher burden of illness with respect to symptom severity and prescription constipation medication use.
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Affiliation(s)
- Jeff Liang
- Department of Medicine, Cedars-Sinai, Los Angeles, California, USA
| | - Christopher V Almario
- Department of Medicine, Cedars-Sinai, Los Angeles, California, USA
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai, Los Angeles, California, USA
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, California, USA
| | - William D Chey
- Division of Gastroenterology, Michigan Medicine, Ann Arbor, Michigan, USA
| | | | - Brennan M R Spiegel
- Department of Medicine, Cedars-Sinai, Los Angeles, California, USA
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai, Los Angeles, California, USA
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, California, USA
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Khalil C, van Deen WK, Dupuy T, Syal G, Arnold C, Cazzetta SE, Nazarey PP, Almario CV, Spiegel BMR. Patients' Perspectives, Experiences, and Concerns With Perianal Fistulae: Insights From Online Targeted-Disease Forums. Crohns Colitis 360 2023; 5:otad073. [PMID: 38046445 PMCID: PMC10693318 DOI: 10.1093/crocol/otad073] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Indexed: 12/05/2023] Open
Abstract
Background Perianal fistulae can undermine physical, emotional, and social well-being in patients with Crohn's disease and are challenging to manage. Social media offers a rich opportunity to gain an in-depth understanding of the impact of perianal fistulae on patients' daily lives outside of controlled environments. In this study, we conducted social media analytics to examine patients' experiences with perianal fistulae and assessed the impact of perianal fistulae on patients' behavior and overall well-being. Methods We used a mixed-method approach to examine 119 986 publicly available posts collected from 10 Crohn's disease forums in the United States between January 01, 2010 and January 01, 2020. Discussions related to Crohn's perianal fistulae were retrieved. We randomly selected 700 posts and qualitatively analyzed them using an inductive thematic approach. We then applied a latent Dirichlet allocation probabilistic topic model to explore themes in an unsupervised manner on the collection of 119 986 posts. Results In the qualitative analysis, 5 major themes were identified: (1) burden of perianal fistula; (2) challenges associated with treatment; (3) online information seeking and sharing; (4) patient experiences with treatments; and (5) patients' apprehension about treatments. In the quantitative analysis, the percentages of posts related to the major themes were (1) 20%, (2) 29%, (3) 66%, and (4) 28%, while the topic model did not identify theme 5. Conclusions Social media reveals a dynamic range of themes governing patients' perspectives and experiences with Crohn's perianal fistulae. In addition to the biopsychosocial burden, patients frequently express dissatisfaction with current treatments and often struggle to navigate among available management options.
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Affiliation(s)
- Carine Khalil
- Division of Health Services Research, Cedars-Sinai Medical Center, Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA
| | - Welmoed K van Deen
- Division of Health Services Research, Cedars-Sinai Medical Center, Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA
- Erasmus School of Health Policy & Management, Rotterdam, The Netherlands
| | - Taylor Dupuy
- Division of Health Services Research, Cedars-Sinai Medical Center, Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA
| | - Gaurav Syal
- Cedars-Sinai Medical Center, Department of Medicine, Los Angeles, CA, USA
| | - Corey Arnold
- Medical Imaging Informatics, Department of Radiology, UCLA, Los Angeles, CA, USA
| | | | | | - Christopher V Almario
- Division of Health Services Research, Cedars-Sinai Medical Center, Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA
| | - Brennan M R Spiegel
- Division of Health Services Research, Cedars-Sinai Medical Center, Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA
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Spiegel BMR, Fuller G, Liu X, Dupuy T, Norris T, Bolus R, Gale R, Danovitch I, Eberlein S, Jusufagic A, Nuckols T, Cowan P. Cluster-Randomized Comparative Effectiveness Trial of Physician-Directed Clinical Decision Support Versus Patient-Directed Education to Promote Appropriate Use of Opioids for Chronic Pain. J Pain 2023; 24:1745-1758. [PMID: 37330159 DOI: 10.1016/j.jpain.2023.06.001] [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] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 04/26/2023] [Accepted: 06/01/2023] [Indexed: 06/19/2023]
Abstract
We compared the effectiveness of physician-directed clinical decision support (CDS) administered via electronic health record versus patient-directed education to promote the appropriate use of opioids by conducting a cluster-randomized trial involving 82 primary care physicians and 951 of their patients with chronic pain. Primary outcomes were satisfaction with patient-physician communication consumer assessment of health care providers and system clinician and group survey (CG-CAHPS) and pain interference patient-reported outcomes measurement information system. Secondary outcomes included physical function (patient-reported outcomes measurement information system), depression (PHQ-9), high-risk opioid prescribing (>90 morphine milligram equivalents per day [≥90 mg morphine equivalent/day]), and co-prescription of opioids and benzodiazepines. We used multi-level regression to compare longitudinal difference-in-difference scores between arms. The odds of achieving the maximum CG-CAHPS score were 2.65 times higher in the patient education versus the CDS arm (P = .044; 95% confidence interval [CI] 1.03-6.80). However, baseline CG-CAHPS scores were dissimilar between arms, making these results challenging to interpret definitively. No difference in pain interference was found between groups (Coef = -0.64, 95% CI -2.66 to 1.38). The patient education arm experienced higher odds of Rx ≥ 90 milligrams morphine equivalent/day (odds ratio = 1.63; P = .010; 95% CI 1.13, 2.36). There were no differences between groups in physical function, depression, or co-prescription of opioids and benzodiazepines. These results suggest that patient-directed education may have the potential to improve satisfaction with patient-physician communication, whereas physician-directed CDS via electronic health records may have greater potential to reduce high-risk opioid dosing. More evidence is needed to ascertain the relative cost-effectiveness between strategies. PERSPECTIVE: This article presents the results of a comparative-effectiveness study of 2 broadly used communication strategies to catalyze dialog between patients and primary care physicians around chronic pain. The results add to the decision-making literature and offer insights about the relative benefits of physician-directed versus patient-directed interventions to promote the appropriate use of opioids.
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Affiliation(s)
- Brennan M R Spiegel
- Department of Medicine, Division of Health Services Research, Cedars-Sinai, Los Angeles, California.
| | - Garth Fuller
- Department of Medicine, Division of Health Services Research, Cedars-Sinai, Los Angeles, California
| | - Xiaoyu Liu
- Department of Medicine, Division of Health Services Research, Cedars-Sinai, Los Angeles, California
| | - Taylor Dupuy
- Department of Medicine, Division of Health Services Research, Cedars-Sinai, Los Angeles, California
| | - Tom Norris
- American Chronic Pain Association, Rocklin, California
| | - Roger Bolus
- Research Solutions Group, Encinitas, California
| | - Rebecca Gale
- Department of Medicine, Division of Health Services Research, Cedars-Sinai, Los Angeles, California
| | - Itai Danovitch
- Department of Psychiatry and Behavioral Health, Cedars-Sinai, Los Angeles, California
| | - Sam Eberlein
- Department of Medicine, Division of Health Services Research, Cedars-Sinai, Los Angeles, California
| | - Alma Jusufagic
- Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Teryl Nuckols
- Department of Medicine, Division of General Internal Medicine, Cedars-Sinai, Los Angeles, California
| | - Penney Cowan
- American Chronic Pain Association, Rocklin, California
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Long MD, van Deen WK, Weisbein L, Khalil C, Appel KL, Zhang X, Chen W, Zubrod L, Maris R, Ghafari A, Dupuy T, Ha CY, Spiegel BMR, Almario CV, Melmed GY. Web-Based Video Education to Improve Uptake of Influenza Vaccination and Other Preventive Health Recommendations in Adults With Inflammatory Bowel Disease: Randomized Controlled Trial of Project PREVENT. J Med Internet Res 2023; 25:e42921. [PMID: 37610821 PMCID: PMC10483303 DOI: 10.2196/42921] [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: 10/07/2022] [Revised: 02/09/2023] [Accepted: 03/23/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Patients with inflammatory bowel disease (IBD) are at increased risk of infections, bone fractures, and skin cancers. OBJECTIVE We developed preventive health videos using a patient-centered approach and tested their impact on preventive health uptake. METHODS Five animated videos explaining preventive health recommendations in IBD were iteratively developed with patient-centered focus groups and interviews. A randomized controlled trial was then conducted in a web-based IBD cohort to test the impact of video- versus text-based educational interventions. The primary outcome was receipt of the influenza vaccine. Secondary outcomes included intention to receive other preventive health services. RESULTS Five animated videos were developed with patient input. A total of 1056 patients with IBD were then randomized to receive the video (n=511) or text-only (n=545) interventions; 55% (281/511) of the video group and 57% (311/545) of the text-only group had received their influenza vaccine in the prior year. Immediately after the intervention, 73% (502/683) of patients reported their intention to receive the vaccine, with no difference by the type of intervention (75%, 231/307, for the video group and 72%, 271/376, for the text-only group). The proportion of patients who actually received the influenza vaccine after the intervention also did not differ by messaging type (P=.07). The strongest predictor of both intention to receive and actual receipt of the influenza vaccine was prior influenza vaccination. Older age was also associated with a higher likelihood of the intention to receive (age 36-75 years relative to 18-35 years; P=.006) and actual receipt (age >75 years relative to 18-35 years; P=.05) of the influenza vaccine. CONCLUSIONS The proportion of patients receiving the influenza vaccine was high in both groups, but there was no difference in receipt of or in the intention to receive preventive health recommendations by type of messaging. Notably, a portion of patients in both groups had intended to be vaccinated but did not ultimately receive the vaccine. Further evaluation of patient-education strategies is warranted to improve preventive health uptake among patients with IBD. TRIAL REGISTRATION ClinicalTrials.gov NCT05997537; https://clinicaltrials.gov/ct2/show/NCT05997537.
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Affiliation(s)
- Millie D Long
- Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, University of Chapel Hill, Chapel Hill, NC, United States
| | - Welmoed K van Deen
- Erasmus School of Health Policy and Management, Health Technology Assessment Section, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Laura Weisbein
- Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, University of Chapel Hill, Chapel Hill, NC, United States
| | - Carine Khalil
- Division of Health Services Research, Cedars-Sinai, Los Angeles, CA, United States
| | - Keren L Appel
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Karsh Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Xian Zhang
- Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, University of Chapel Hill, Chapel Hill, NC, United States
| | - Wenli Chen
- Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, University of Chapel Hill, Chapel Hill, NC, United States
| | - Lori Zubrod
- IBD Partners Patient Powered Research Network, Washington, DC, United States
| | - Robbie Maris
- IBD Partners Patient Powered Research Network, Washington, DC, United States
| | - Afsoon Ghafari
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Karsh Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Taylor Dupuy
- Division of Health Services Research, Cedars-Sinai, Los Angeles, CA, United States
| | - Christina Y Ha
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Karsh Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Brennan M R Spiegel
- Division of Health Services Research, Cedars-Sinai, Los Angeles, CA, United States
| | | | - Gil Y Melmed
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Karsh Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, United States
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11
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Syal G, Melmed GY, Almario CV, Spiegel BMR. Azathioprine Withdrawal Is Cost-Effective in Patients with Crohn's Disease in Remission on Infliximab and Azathioprine. Dig Dis Sci 2023; 68:404-413. [PMID: 36512266 DOI: 10.1007/s10620-022-07789-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 12/05/2022] [Indexed: 02/09/2023]
Abstract
BACKGROUND In Crohn's disease, combination therapy with infliximab and azathioprine is more effective than either drug alone but is associated with a higher risk of therapy-related complications. Though therapy de-escalation can reduce risks and save costs, it is associated with a risk of Crohn's disease relapse. AIMS We aimed to study the cost-effectiveness of de-escalation strategies in Crohn's disease patients in remission on infliximab and azathioprine. METHODS We constructed a decision tree with Markov models for continuation of infliximab and azathioprine, discontinuation of azathioprine followed by its re-introduction in case of relapse, discontinuation of azathioprine followed by infliximab dose intensification without azathioprine reintroduction in case of relapse and discontinuation of infliximab. Third-party payers' perspective with a willingness-to-pay threshold of $100,000/quality-adjusted life years was used. Markov cycle length was 3 months, and the study period was 5 years. A 35-year-old patient with Crohn's disease in clinical remission on azathioprine 150 mg daily and infliximab 5 mg/kg every 8 weeks was used for base-case analysis. RESULTS Azathioprine withdrawal followed by its reintroduction upon relapse was the dominant strategy as it was the most effective and least expensive approach on base-case analysis. It was also cost-effective in 99.3% of Monte Carlo trial simulations. AZA withdrawal without IFX dose intensification upon relapse was the least effective and the most expensive strategy. CONCLUSION Azathioprine withdrawal is the most effective and least costly de-escalation strategy in CD patients in remission on combination therapy if AZA re-introduction is performed upon CD relapse.
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Affiliation(s)
- Gaurav Syal
- Division of Gastroenterology, University of California at San Diego, 9452 S Medical Ctr Dr, La Jolla, San Diego, CA, 92037, USA.
| | - Gil Y Melmed
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, 8730 Alden Drive, Second Floor East, Los Angeles, CA, 90048, USA
| | - Christopher V Almario
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Pacific Theaters Building, Suite 800, 116 N. Robertson Blvd., Los Angeles, CA, 90048, USA
| | - Brennan M R Spiegel
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Pacific Theaters Building, Suite 800, 116 N. Robertson Blvd., Los Angeles, CA, 90048, USA
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12
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Makaroff KE, Shergill J, Lauzon M, Khalil C, Ahluwalia SC, Spiegel BMR, Almario CV. Patient Preferences for Colorectal Cancer Screening Tests in Light of Lowering the Screening Age to 45 Years. Clin Gastroenterol Hepatol 2023; 21:520-531.e10. [PMID: 35870766 PMCID: PMC9852355 DOI: 10.1016/j.cgh.2022.07.012] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 06/11/2022] [Accepted: 07/12/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND & AIMS In 2021, the US Preventive Services Task Force lowered the colorectal cancer (CRC) screening age to 45 years. We used conjoint analysis, a method that assesses complex decision making, to update our understanding on people's CRC screening test preferences in the context of new guidelines. METHODS We conducted a conjoint analysis survey among unscreened individuals ≥40 years at average risk for CRC to determine the relative importance of screening test attributes in their decision making (eg, modality, effectiveness at reducing CRC risk, bowel prep). We also performed simulations to estimate the proportion of people who would prefer each US Multi-Society Task Force (MSTF) on CRC-recommended test. The analyses were stratified among those aged 40-49 years (newly or soon-to-be eligible for screening) and ≥50 years (have been eligible). RESULTS Overall, 1000 participants completed the conjoint analysis (40-49 years, n = 456; ≥50 years, n = 544). When considering all 5 US MSTF-recommended tests, there were differences in test preferences between age groups (P = .019), and the most preferred test was a fecal immunochemical test (FIT)-fecal DNA every 3 years: 40-49 years, 34.6%; ≥50 years, 37.3%. When considering only the US MSTF tier 1 tests, most 40- to 49- (68.9%) and ≥50-year-olds (77.4%; P = .004) preferred an annual FIT over a colonoscopy every 10 years. CONCLUSIONS Our findings suggest that more than one-third of people may want to do a FIT-fecal DNA every 3 years for their CRC screening. When only considering US MSTF tier 1 tests, three-fourths of people may prefer an annual FIT over colonoscopy. Further research examining CRC screening test preferences among broader populations is warranted to inform and enhance screening programs.
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Affiliation(s)
- Katherine E Makaroff
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, California; David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jaspreet Shergill
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Marie Lauzon
- Biostatistics and Bioinformatics Research Center, Cedars-Sinai Cancer, Los Angeles, California
| | - Carine Khalil
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, California
| | - Sangeeta C Ahluwalia
- Department of Behavioral and Policy Sciences, RAND Corporation, Santa Monica, California; Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California
| | - Brennan M R Spiegel
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, California; David Geffen School of Medicine at UCLA, Los Angeles, California; Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California; Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California; Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California; Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, California; Division of Informatics, Cedars-Sinai Medical Center, Los Angeles, California; Cancer Prevention & Control Program, Cedars-Sinai Cancer, Los Angeles, California
| | - Christopher V Almario
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, California; Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California; Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California; Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, California; Division of Informatics, Cedars-Sinai Medical Center, Los Angeles, California; Cancer Prevention & Control Program, Cedars-Sinai Cancer, Los Angeles, California.
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13
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Wong MS, Gregory KD, Spiegel BMR, Khalil C. Patient perceptions of virtual reality for pain relief in labor: A qualitative study. Front Pain Res (Lausanne) 2022; 3:1063751. [PMID: 36582195 PMCID: PMC9792960 DOI: 10.3389/fpain.2022.1063751] [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] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 11/21/2022] [Indexed: 12/14/2022]
Abstract
Introduction Labor represents the most common reason for hospitalization, and most patients will use some form of pain management during their labor. While some studies have suggested that virtual reality (VR) may be an effective option for managing pain, more study is necessary to understand the patient experience of VR. The aim of this study is to characterize the effect of VR on patient perceptions of coping in labor and their descriptions of the VR experience. Methodology A nested prospective, descriptive study within a randomized controlled trial of VR in laboring patients. We included nulliparous, term patients, having contractions at least every 5 min, a pain score on the Wong-Baker pain scale of 4-7, and who had been randomized to receive the 30 min virtual reality intervention in the trial. Subjects completed a childbirth self-efficacy inventory prior to the intervention. After the intervention, they completed a modified childbirth self-efficacy inventory related to VR and underwent a structured interview. Self-efficacy scores were compared using t-tests and qualitative, thematic analysis was performed using Dedoose. Results Twenty-one subjects received the VR intervention. Twenty subjects completed the post-intervention survey and structured interview; one declined due to discomfort. Subjects noted a significant increase in perceived degree to which VR could improve their self-efficacy in managing pain during labor. Thematic analysis revealed that subjects described the VR experience as allowing them to connect with their breathing, feeling more relaxed, and being distracted from pain. In total, 70% believed VR reduced their pain, 60% felt it reduced their anxiety, and 100% would recommend VR availability for laboring patients. Conclusion VR can improve patient self-efficacy for managing pain in labor. Future studies should focus on the content of the visualizations, optimized user experience and design, and effectiveness with ongoing exposure to VR content in labor.
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Affiliation(s)
- Melissa S. Wong
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, United States,Division of Informatics, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Kimberly D. Gregory
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, United States,Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States,Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, United States
| | - Brennan M. R. Spiegel
- Division of Informatics, Cedars-Sinai Medical Center, Los Angeles, CA, United States,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, United States,Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, United States,Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Carine Khalil
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, United States,Le Laboratoire Interdisciplinaire de Recherche Appliquée en Economie de la Santé (LIRAES) Lab, Paris Descartes University, Paris, France
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14
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van Deen WK, Khalil C, Bonthala NN, Gale R, Patel DB, Warui E, Melmed GY, Spiegel BMR. Inflammatory Bowel Disease Patients' Preferences for Subcutaneous Versus Intravenous Therapies: A Mixed Methods Study. Dig Dis 2022; 41:412-421. [PMID: 36476714 DOI: 10.1159/000528586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/07/2022] [Indexed: 02/02/2023]
Abstract
Background Multiple biologics are available to treat inflammatory bowel disease (IBD), which can either be administered subcutaneously (SC) or intravenously (IV). The factors that determine patients' preferences for SC/IV administration in IBD are largely unknown. This study aims to elucidate how IBD patients trade-off between medications' route of administration and other medication characteristics, and to understand what drives patients' preferences. Methods We employed a mixed methods design using data from a prior quantitative conjoint analysis survey and a series of 22 qualitative interviews. We quantitatively assessed individual patients' preferences for SC or IV medications based on the part-worth utilities derived from the conjoint analysis and identified predictors for these preferences. We used a qualitative analysis to identify key themes surrounding patients' preferences in the interview data. Results Of 1,077 survey participants, 49% preferred an SC medication every 2 weeks, whereas 51% preferred an IV medication every 8 weeks. More people preferred SC at reduced administration frequencies, whereas less people preferred SC at the expense of lower efficacy or higher side-effects rates. Prior experience with SC/IV was the strongest predictor for patients' preferences. Qualitatively, we obtained in-depth insights in the perceived advantages and disadvantages of SC and IV medications and in patients' preconceived ideas. Conclusion While prior SC/IV exposure was a strong predictor for SC/IV preferences, patients' preferences largely are determined by a variety of other personal factors. The themes we identified could help guide clinicians when discussing therapeutic options with their patients and support shared decision making.
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15
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Yeo YH, He X, Ting PS, Zu J, Almario CV, Spiegel BMR, Ji F. Evaluation of Trends in Alcohol Use Disorder-Related Mortality in the US Before and During the COVID-19 Pandemic. JAMA Netw Open 2022; 5:e2210259. [PMID: 35507347 PMCID: PMC9069253 DOI: 10.1001/jamanetworkopen.2022.10259] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
This cross-sectional study uses US vital statistics data to evaluate alcohol use disorder–related mortality rates from 2012 to 2021, with a focus on trends during the COVID-19 pandemic.
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Affiliation(s)
- Yee Hui Yeo
- Division of General Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Xinyuan He
- Department of Infectious Diseases, Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Peng-Sheng Ting
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jian Zu
- School of Mathematics and Statistics, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Christopher V. Almario
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Brennan M. R. Spiegel
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Fanpu Ji
- Department of Infectious Diseases, Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
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16
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van Deen WK, Khalil C, Dupuy TP, Bonthala NN, Spiegel BMR, Almario CV. Assessment of inflammatory bowel disease educational videos for increasing patient engagement and family and friends' levels of understanding. Patient Educ Couns 2022; 105:660-669. [PMID: 34154860 PMCID: PMC9910446 DOI: 10.1016/j.pec.2021.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 11/30/2020] [Revised: 05/11/2021] [Accepted: 06/05/2021] [Indexed: 05/04/2023]
Abstract
OBJECTIVE We developed five educational videos through a user-centered approach for patients with inflammatory bowel diseases (IBD) and their families and friends. Here, we assessed if IBD patient activation and family and friends' abilities to understand IBD patients' thoughts, feelings, and behaviors (i.e., perspective taking) changed after watching the videos. METHODS Through a pre-post survey, we assessed patient activation and perspective taking levels in people with a self-reported IBD diagnosis and their family and friends, respectively, before and after watching one of the videos. RESULTS Among 767 participants with IBD, patient activation scores increased significantly after watching each video. In regression analyses, patient activation levels were less likely to increase in biologic-naïve participants after viewing the coping video. Among 232 people who knew someone with IBD, perspective taking scores increased significantly in 8/9 domains, which was more likely to occur among women. CONCLUSIONS Educational videos developed through a user-centered approach were associated with higher self-reported IBD patient activation scores and perspective taking levels among family and friends. PRACTICE IMPLICATIONS These videos, which are now widely disseminated on social media, serve as a model for how to create educational materials for improving patient activation and empathy in the social media era.
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Affiliation(s)
- Welmoed K van Deen
- Division of Health Services Research, Cedars-Sinai, Los Angeles, CA, United States; Department of Medicine, Cedars-Sinai, Los Angeles, CA, United States; Erasmus School of Health Policy and Management, Health Technology Assessment Section, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Carine Khalil
- Division of Health Services Research, Cedars-Sinai, Los Angeles, CA, United States; LIRAES, Paris Descartes University, Paris, France
| | - Taylor P Dupuy
- Division of Health Services Research, Cedars-Sinai, Los Angeles, CA, United States
| | - Nirupama N Bonthala
- Department of Medicine, Cedars-Sinai, Los Angeles, CA, United States; Inflammatory Bowel Disease Center, Cedars-Sinai, Los Angeles, CA, United States; Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai, Los Angeles, CA, United States
| | - Brennan M R Spiegel
- Division of Health Services Research, Cedars-Sinai, Los Angeles, CA, United States; Department of Medicine, Cedars-Sinai, Los Angeles, CA, United States; Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai, Los Angeles, CA, United States
| | - Christopher V Almario
- Division of Health Services Research, Cedars-Sinai, Los Angeles, CA, United States; Department of Medicine, Cedars-Sinai, Los Angeles, CA, United States; Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai, Los Angeles, CA, United States.
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17
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Cohen ER, Lopez M, Spiegel BMR, Almario CV. Non-invasive digestion monitoring with an FDA-cleared wearable biosensor: further validation for use in tracking food ingestion. Gastroenterol Rep (Oxf) 2021; 9:475-477. [PMID: 34733534 PMCID: PMC8560032 DOI: 10.1093/gastro/goaa097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 08/31/2020] [Accepted: 10/15/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Erica R Cohen
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA
| | - Mayra Lopez
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA
| | - Brennan M R Spiegel
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA.,Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Christopher V Almario
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA.,Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Division of Informatics, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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18
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Patel DB, van Deen WK, Almario CV, Khalil C, Warui E, Bonthala N, Melmed GY, Spiegel BMR. Assessing Patient Decision-Making on Biologic and Small-Molecule Therapies in Inflammatory Bowel Diseases: Insights From a Conjoint Analysis in the United States, Canada, and the United Kingdom. Inflamm Bowel Dis 2021; 27:1593-1601. [PMID: 33300555 DOI: 10.1093/ibd/izaa311] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Received: 08/25/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Recent drug approvals have increased the number of therapies available for inflammatory bowel disease (IBD), making it difficult for patients to navigate available treatment options. We examined patient decision-making surrounding biologic and small-molecule therapies in an international cohort of patients from the United States, Canada, and the United Kingdom using conjoint analysis (CA), a form of tradeoff analysis examining how respondents make complex decisions. METHODS We performed a CA survey that quantified the relative importance of therapy attributes (eg, efficacy, adverse effects) in decision-making. Patients with IBD were recruited from the general population and through specialty IBD clinics. We used a hierarchical Bayes analysis to model individual patients' preferences and compared the relative importance of medication attributes between countries and practice settings. Using a series of multivariable linear regression models, we assessed whether demographic and clinical characteristics (eg, IBD subtype, severity) predicted how patients made decisions. RESULTS Overall, 1077 patients in 3 countries completed the survey. No differences in the relative importance of medication attributes were observed between the 3 countries' general IBD populations. However, efficacy was more important for patients in the US-based IBD specialty care cohort than for the general IBD population (29% and 23% importance, respectively; P < 0.0001). A few demographic and clinical characteristics were associated with small changes in individual preferences. CONCLUSIONS In this large international CA study, patients prioritized efficacy as the most important therapeutic attribute. Decision-making seemed to be highly personalized in that therapeutic preferences were hard to predict based on patient characteristics.
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Affiliation(s)
- Devin B Patel
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Welmoed K van Deen
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Cedars-Sinai Center for Outcomes Research and Education, Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Christopher V Almario
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Cedars-Sinai Center for Outcomes Research and Education, Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Division of Informatics, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Carine Khalil
- Cedars-Sinai Center for Outcomes Research and Education, Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Paris Descartes University, LIRAES, Paris, France
| | - Esther Warui
- Cedars-Sinai Center for Outcomes Research and Education, Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Nirupama Bonthala
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Gil Y Melmed
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, California, USA.,F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Brennan M R Spiegel
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Cedars-Sinai Center for Outcomes Research and Education, Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Division of Informatics, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
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19
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Gale R, Eberlein S, Fuller G, Khalil C, Almario CV, Spiegel BMR. Public Perspectives on Decisions About Emergency Care Seeking for Care Unrelated to COVID-19 During the COVID-19 Pandemic. JAMA Netw Open 2021; 4:e2120940. [PMID: 34410398 PMCID: PMC8377572 DOI: 10.1001/jamanetworkopen.2021.20940] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
IMPORTANCE Delaying critical care for treatable conditions owing to fear of contracting COVID-19 in the emergency department (ED) is associated with avoidable morbidity and mortality. OBJECTIVE To assess and quantify how people decided whether to present to the ED during the COVID-19 pandemic for care unrelated to COVID-19 using conjoint analysis, a form of trade-off analysis that examines how individuals make complex decisions. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional survey study was conducted using a nationwide sample from June 1, 2020, during the initial peak of the COVID-19 pandemic. Included participants were adults aged 18 years or older in the US who self-reported that they had not tested positive for COVID-19. Data were analyzed from July 2020 through May 2021. EXPOSURES Participants completed a self-administered online survey. MAIN OUTCOMES AND MEASURES Using a choice-based conjoint analysis survey, the relative importance was assessed for the following attributes for individuals in deciding whether to seek ED care for symptoms consistent with myocardial infarction or appendicitis: reduction in chance of dying because of ED treatment, crowdedness of ED with other patients, and chance of contracting COVID-19 in the ED. We also performed latent class analyses using conjoint data to identify distinct segments of the respondent population with similar choice patterns. Logistic regression was then used to explore whether patient sociodemographics and political affiliations were factors associated with decision-making. RESULTS Among 1981 individuals invited to participate, 933 respondents (47.1%) completed the survey; participants' mean (SD) age was 40.1 (13.0) years, and 491 (52.6%) were women. In latent class analyses, 158 individuals (16.9%) with symptoms of myocardial infarction and 238 individuals (25.5%) with symptoms of appendicitis prioritized avoidance of COVID-19 exposure in the ED (ie, chance of contracting COVID-19 in the ED or crowdedness of ED with other patients) over seeking appropriate care for symptoms. Having a usual source of care was a factor associated with lower odds of prioritizing avoidance of COVID-19 exposure (myocardial infarction scenario: adjusted odds ratio, 0.49 [95% CI, 0.32-0.76]; P = .001; appendicitis scenario: adjusted odds ratio, 0.57 [95% CI, 0.40-0.82]; P = .003), but most sociodemographic factors and political affiliations were not factors associated with decision-making. CONCLUSIONS AND RELEVANCE This study found that up to one-quarter of individuals were willing to forgo potentially life-saving ED care to avoid exposure to COVID-19. These findings suggest that health care systems and public health organizations should develop effective communications for patients and the community at large that reassure and encourage timely health care for critical needs during the ongoing COVID-19 pandemic and other scenarios.
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Affiliation(s)
- Rebecca Gale
- Cedars-Sinai Center for Outcomes Research and Education, Los Angeles, California
| | - Samuel Eberlein
- Cedars-Sinai Center for Outcomes Research and Education, Los Angeles, California
| | - Garth Fuller
- Cedars-Sinai Center for Outcomes Research and Education, Los Angeles, California
| | - Carine Khalil
- Cedars-Sinai Center for Outcomes Research and Education, Los Angeles, California
| | - Christopher V Almario
- Cedars-Sinai Center for Outcomes Research and Education, Los Angeles, California
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California
- Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, California
- Division of Informatics, Cedars-Sinai Medical Center, Los Angeles, California
| | - Brennan M R Spiegel
- Cedars-Sinai Center for Outcomes Research and Education, Los Angeles, California
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California
- Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, California
- Division of Informatics, Cedars-Sinai Medical Center, Los Angeles, California
- Department of Health Policy and Management, University of California, Los Angeles Fielding School of Public Health
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20
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Abstract
OBJECTIVE Virtual reality (VR) represents a potential method for easing labor pain and in nonpregnant patients has been shown to achieve similar or greater analgesia than hydromorphone. Few studies of VR have been performed in pregnant women. The aim of this randomized controlled trial (RCT) is to evaluate whether VR is effective in reducing pain in laboring women. STUDY DESIGN An open-label, RCT of nulliparous, term women in labor in a tertiary care hospital. We included women with a pain score level of 4 to 7 having regular contractions at least every 5 minutes. We excluded women who had received any pharmacologic pain relief including neuraxial analgesia and those with contraindications to VR. Participants were randomized to up to 30 minutes of either VR or the control arm (no additional intervention). Our primary outcome was the difference in differences from pre- to postintervention pain score. Prespecified secondary outcomes included postintervention pain scores, duration of intervention use, pharmacologic analgesia use, maternal vitals, and obstetric outcomes. RESULTS From March 2018 to February 2019, 40 subjects were enrolled, randomized, and completed the study; 19 were randomized to control and 21 to the VR arm. Most baseline characteristics were similar between groups. For the primary outcome, those assigned to the control arm had a statistically significant increase in pain of +0.58, while the VR arm had a significant reduction in pain of -0.52 (p = 0.03). There was also a difference in the proportion who had a minimum clinically important difference in pain (0% control and 23.8% VR; p = 0.049). Postintervention maternal heart rate was higher in the control arm (86.8 vs. 76.3, p = 0.01). Most other secondary outcomes did not differ. CONCLUSION In our study, we found that VR was effective for reducing pain in women in labor as compared with those receiving no intervention. KEY POINTS · Virtual reality (VR) represents a nonpharmacologic option for pain relief.. · VR has been little studied in pregnant or laboring women.. · VR was associated with a reduction in pain in nulliparous women in labor..
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Affiliation(s)
- Melissa S Wong
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California.,Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California.,Division of Informatics, Cedars-Sinai Medical Center, Los Angeles, California
| | - Brennan M R Spiegel
- Division of Informatics, Cedars-Sinai Medical Center, Los Angeles, California.,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, California.,Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, California.,Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, California
| | - Kimberly D Gregory
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California.,Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California.,Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, California
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21
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Hall NJ, Berry SK, Aguilar J, Brier E, Shah P, Cheng D, Herman J, Stein T, Spiegel BMR, Almario CV. Impact of an Online Gastrointestinal Symptom History Taker on Physician Documentation and Charting Time: Pragmatic Controlled Trial. JMIR Form Res 2021; 5:e23599. [PMID: 33944789 PMCID: PMC8132977 DOI: 10.2196/23599] [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] [Received: 08/17/2020] [Revised: 01/18/2021] [Accepted: 04/11/2021] [Indexed: 11/28/2022] Open
Abstract
Background A potential benefit of electronic health records (EHRs) is that they could potentially save clinician time and improve documentation by auto-generating the history of present illness (HPI) in partnership with patients prior to the clinic visit. We developed an online patient portal called AEGIS (Automated Evaluation of Gastrointestinal [GI] Symptoms) that systematically collects patient GI symptom information and then transforms the data into a narrative HPI that is available for physicians to review in the EHR prior to seeing the patient. Objective This study aimed to compare whether use of an online GI symptom history taker called AEGIS improves physician-centric outcomes vs usual care. Methods We conducted a pragmatic controlled trial among adults aged ≥18 years scheduled for a new patient visit at 4 GI clinics at an academic medical center. Patients who completed AEGIS were matched with controls in the intervention period who did not complete AEGIS as well as controls who underwent usual care in the pre-intervention period. Of note, the pre-intervention control group was formed as it was not subject to contamination bias, unlike for post-intervention controls. We then compared the following outcomes among groups: (1) documentation of alarm symptoms, (2) documentation of family history of GI malignancy, (3) number of follow-up visits in a 6-month period, (4) number of tests ordered in a 6-month period, and (5) charting time (difference between appointment time and time the encounter was closed). Multivariable regression models were used to adjust for potential confounding. Results Of the 774 patients who were invited to complete AEGIS, 116 (15.0%) finished it prior to their visit. The 116 AEGIS patients were then matched with 343 and 102 controls in the pre- and post-intervention periods, respectively. There were no statistically significant differences among the groups for documentation of alarm symptoms and GI cancer family history, number of follow-up visits and ordered tests, or charting time (all P>.05). Conclusions Use of a validated online HPI-generation portal did not improve physician documentation or reduce workload. Given universal adoption of EHRs, further research examining how to optimally leverage patient portals for improving outcomes are needed.
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Affiliation(s)
- Natalie J Hall
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Sameer K Berry
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Jack Aguilar
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Elizabeth Brier
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Parth Shah
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Derek Cheng
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Jeremy Herman
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Theodore Stein
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Brennan M R Spiegel
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States.,Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA, United States.,Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA, United States.,Division of Informatics, Cedars-Sinai Medical Center, Los Angeles, CA, United States.,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, United States
| | - Christopher V Almario
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States.,Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA, United States.,Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA, United States.,Division of Informatics, Cedars-Sinai Medical Center, Los Angeles, CA, United States.,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, United States
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22
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Burton CS, Gonzalez G, Vaculik K, Khalil C, Zektser Y, Arnold C, Almario CV, Spiegel BMR, Anger JT. Female Lower Urinary Tract Symptom Prevention and Treatment Strategies on Social Media: Mixed Correlation With Evidence. Urology 2021; 150:139-145. [PMID: 32673678 PMCID: PMC9354551 DOI: 10.1016/j.urology.2020.06.056] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Received: 03/01/2020] [Revised: 05/21/2020] [Accepted: 06/28/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the level of evidence behind recommendations on social media for disease prevention in five lower urinary tract symptoms. MATERIALS AND METHODS We conducted a digital analysis of anonymous online posts on social media sites collected by a social media data mining service. One thousand posts about pelvic organ prolapse, stress urinary incontinence, overactive bladder, urinary tract infection, and interstitial cystitis/bladder pain syndrome were randomly selected. We analyzed these posts for recommendations regarding the prevention and treatment of these diseases, which were then compared to recommendations in available clinical guidelines and assessed for level of evidence. RESULTS A total of 158 of 1000 posts contained 239 prevention strategies. For pelvic organ prolapse, there were 41 strategies identified, 25 (61%) of which had no evidence. For urinary tract infection 14 of 58 (29%) had no evidence, including recommendations for dietary modifications and urinary alkalization. For overactive bladder 8 of 28 (29%) had level 4 or no evidence. For stress urinary incontinence, 12 of 34 (36%) of prevention strategies had no evidence, such as laser rejuvenation and bladder training. Interstitial cystitis had the highest number of prevention strategies, and most were low or nonevidence based (70/79, 89%). CONCLUSION Prevention and treatment strategies are common in online discussions of pelvic floor disorders, but at least one third of these recommendations have no evidential support. There is a role for further online education and social media engagement by health care specialists to promote evidence-based practices.
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Affiliation(s)
- Claire S Burton
- Department of Urology, David Geffen School of Medicine, UCLA, Los Angeles, CA
| | - Gabriela Gonzalez
- David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Kristina Vaculik
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA
| | - Carine Khalil
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA
| | - Yuliya Zektser
- David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Corey Arnold
- Medical Imaging Informatics, Department of Radiology, UCLA, Los Angeles, CA
| | | | - Brennan M R Spiegel
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA
| | - Jennifer T Anger
- Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA.
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23
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Gonzalez G, Vaculik K, Khalil C, Zektser Y, Arnold CW, Almario CV, Spiegel BMR, Anger JT. Social media analytics of overactive bladder posts: what do patients know and want to know? Int Urogynecol J 2021; 32:2729-2736. [PMID: 33710426 DOI: 10.1007/s00192-021-04686-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/10/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess women's knowledge, patient experience, and treatment decision making regarding overactive bladder (OAB) using digital ethnography. METHODS Online posts were identified using a data mining service. Two hundred randomized posts were reviewed and coded using grounded theory. We then applied a latent Dirichlet allocation (LDA) probabilistic topic modeling process to review the entire collection of identified posts. RESULTS A total of 2618 posts by 1867 unique users from 203 different websites were identified. Our analysis yielded six themes: the impact of OAB on quality of life, patient-physician interactions, online engagement, symptom management, patient knowledge acquisition, and alternative therapies. CONCLUSION Overall, online communities are a source of support for women to self-manage the OAB symptom complex and help overcome treatment pathway challenges. Digital ethnography provides insight into patient knowledge and barriers to patient-centered care, which are important to improve patient outreach. Additionally, we identify similar findings to prior work, indicating the reliability of studying social media.
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Affiliation(s)
- Gabriela Gonzalez
- Department of Urology, Davis School of Medicine, University of California, Sacramento, CA, USA
| | - Kristina Vaculik
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA
| | - Carine Khalil
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA
| | - Yuliya Zektser
- David Geffen School of Medicine at University of California, Los Angeles, CA, USA
| | - Corey W Arnold
- Computational Diagnostics, Departments of Radiology and Pathology, UCLA, Los Angeles, CA, USA
| | - Christopher V Almario
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA
| | - Brennan M R Spiegel
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA
| | - Jennifer T Anger
- Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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24
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Joo W, Almario CV, Ishimori M, Park Y, Jusufagic A, Noah B, Gensler LS, Venuturupalli RS, Kay J, Weisman MH, Spiegel BMR. Examining Treatment Decision-Making Among Patients With Axial Spondyloarthritis: Insights From a Conjoint Analysis Survey. ACR Open Rheumatol 2020; 2:391-400. [PMID: 32519467 PMCID: PMC7368141 DOI: 10.1002/acr2.11151] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/27/2020] [Indexed: 12/13/2022] Open
Abstract
Objective The number of therapies for axial spondyloarthritis (axSpA) is increasing. Thus, it has become more challenging for patients and physicians to navigate the risk‐benefit profiles of the various treatment options. In this study, we used conjoint analysis—a form of trade‐off analysis that elucidates how people make complex decisions by balancing competing factors—to examine patient decision‐making surrounding medication options for axSpA. Methods We conducted an adaptive choice‐based conjoint analysis survey for patients with axSpA to assess the relative importance of medication attributes (eg, chance of symptom improvement, risk of side effects, route of administration, etc) in their decision‐making. We also performed logistic regression to explore whether patient demographics and disease characteristics predicted decision‐making. Results Overall, 397 patients with axSpA completed the conjoint analysis survey. Patients prioritized medication efficacy (importance score 26.8%), cost (26.3%), and route of administration (13.9%) as most important in their decision‐making. These were followed by risk of lymphoma (9.5%), dosing frequency (7.2%), risk of serious infection (6.0%), tolerability of side effects (5.3%), and clinic visit and laboratory test frequency (4.8%). In regression analyses, there were few significant associations between patients’ treatment preferences and sociodemographic and axSpA characteristics. Conclusions Treatment decision‐making in axSpA is highly individualized, and demographics and baseline disease characteristics are poor predictors of individual preferences. This calls for the development of online shared decision‐making tools for patients and providers, with the goal of selecting a treatment that is consistent with patients’ preferences.
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Affiliation(s)
- Woojin Joo
- Cedars-Sinai Medical Center, Los Angeles, California
| | - Christopher V Almario
- Cedars-Sinai Medical Center and David Geffen School of Medicine, University of California, Los Angeles
| | - Mariko Ishimori
- Cedars-Sinai Medical Center and David Geffen School of Medicine, University of California, Los Angeles
| | - Yujin Park
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | | | - Benjamin Noah
- Cedars-Sinai Medical Center, Los Angeles, California
| | | | - R Swamy Venuturupalli
- Cedars-Sinai Medical Center and David Geffen School of Medicine, University of California, Los Angeles
| | - Jonathan Kay
- University of Massachusetts Memorial Medical Center and University of Massachusetts Medical School, Worcester
| | - Michael H Weisman
- Cedars-Sinai Medical Center and David Geffen School of Medicine, University of California, Los Angeles
| | - Brennan M R Spiegel
- Cedars-Sinai Medical Center and David Geffen School of Medicine, University of California, Los Angeles
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25
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Oh SJ, Fuller G, Patel D, Khalil C, Spalding W, Nag A, Spiegel BMR, Almario CV. Chronic Constipation in the United States: Results From a Population-Based Survey Assessing Healthcare Seeking and Use of Pharmacotherapy. Am J Gastroenterol 2020; 115:895-905. [PMID: 32324606 PMCID: PMC7269025 DOI: 10.14309/ajg.0000000000000614] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 03/10/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Chronic idiopathic constipation (CIC) is characterized by unsatisfactory defecation and difficult or infrequent stools. CIC affects 9%-20% of adults in the United States, and although prevalent, gaps in knowledge remain regarding CIC healthcare seeking and medication use in the community. We recruited a population-based sample to determine the prevalence and predictors of (i) individuals having discussed their constipation symptoms with a healthcare provider and (ii) the use of constipation therapies. METHODS We recruited a representative sample of Americans aged 18 years or older who had experienced constipation. Those who met the Rome IV criteria for irritable bowel syndrome and opioid-induced constipation were excluded. The survey included questions on constipation severity, healthcare seeking, and the use of constipation medications. We used multivariable regression methods to adjust for confounders. RESULTS Overall, 4,702 participants had experienced constipation (24.0% met the Rome IV CIC criteria). Among all respondents with previous constipation, 37.6% discussed their symptoms with a clinician (primary care provider 87.6%, gastroenterologist 26.0%, and urgent care/emergency room physician 7.7%). Age, sex, race/ethnicity, marital status, employment status, having a source of usual care, insurance status, comorbidities, locus of control, and constipation severity were associated with seeking care (P < 0.05). Overall, 47.8% of respondents were taking medication to manage their constipation: over-the-counter medication(s) only, 93.5%; prescription medication(s) only, 1.3%; and both over-the-counter medication(s) and prescription medication(s), 5.2%. DISCUSSION We found that 3 of 5 Americans with constipation have never discussed their symptoms with a healthcare provider. Furthermore, the use of prescription medications for managing constipation symptoms is low because individuals mainly rely on over-the-counter therapies.
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Affiliation(s)
- Sun Jung Oh
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA;
| | - Garth Fuller
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, California, USA;
| | - Devin Patel
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA;
| | - Carine Khalil
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, California, USA;
| | | | - Arpita Nag
- Shire, a Takeda Company, Lexington, Massachusetts, USA;
| | - Brennan M. R. Spiegel
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA;
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, California, USA;
- Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, California, USA;
- Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, California, USA;
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA.
| | - Christopher V. Almario
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA;
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, California, USA;
- Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, California, USA;
- Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, California, USA;
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26
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Keller MS, Jusufagic A, Spiegel BMR. Patient and provider differences in the treatment of opioid-induced constipation: a qualitative study. BMC Gastroenterol 2019; 19:182. [PMID: 31718543 PMCID: PMC6852732 DOI: 10.1186/s12876-019-1097-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 10/23/2019] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Patients using opioids to treat chronic non-cancer pain often experience side effects that may affect health-related quality of life (HRQOL). These side effects include opioid-induced constipation (OIC), sedation, dizziness, and nausea. OIC can significantly affect HRQOL for patients on a daily basis. However, it is not well understood whether patients and clinicians view OIC management similarly. AIMS In this study, we sought to elucidate the decision-making process around managing OIC by assessing patient and provider treatment preferences, experiences, and communication regarding this condition. METHODS We conducted semi-structured interviews with 33 clinicians, and held three focus groups with patients who were currently using or had used opioids for chronic non-cancer pain. We then analyzed transcribed interviews using descriptive qualitative methods based on grounded theory methodology. RESULTS Clinicians recognized OIC as a concern but prioritized pain management over constipation. They focused on medication-based treatments for OIC, but also recommended lifestyle changes (e.g., diet) and reducing opioids to relieve symptoms. Patients reported using over-the-counter treatments, but the majority focused on diet-related constipation management. Patients reported not receiving adequate information from clinicians about OIC and relevant treatments. Cost of treatment was a major concern for both patients and clinicians. CONCLUSIONS Assessing experiences with and preferences for OIC treatment, including cost, ease of access, and side effects, could improve patient-provider communication and HRQOL. Quality improvement efforts can target uncovered misalignments between patients and clinicians to improve communication about opioid medication adverse effects and relevant treatment options, which may help improve quality of life for patients with chronic pain.
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Affiliation(s)
- Michelle S Keller
- Division of General Internal Medicine, Department of Medicine, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA. .,Department of Health Policy and Management, UCLA Fielding School of Public Health, 650 Charles Young Dr. S., 31-269 CHS, Box 951772, Los Angeles, CA, 90095, USA.
| | - Alma Jusufagic
- Penn State University College of Medicine, Hershey, PA, USA
| | - Brennan M R Spiegel
- Division of General Internal Medicine, Department of Medicine, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA.,Department of Health Policy and Management, UCLA Fielding School of Public Health, 650 Charles Young Dr. S., 31-269 CHS, Box 951772, Los Angeles, CA, 90095, USA.,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), 116 N Robertson Blvd, Suite 800, Los Angeles, CA, 90048, USA
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27
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Dzubur E, Khalil C, Almario CV, Noah B, Minhas D, Ishimori M, Arnold C, Park Y, Kay J, Weisman MH, Spiegel BMR. Patient Concerns and Perceptions Regarding Biologic Therapies in Ankylosing Spondylitis: Insights From a Large-Scale Survey of Social Media Platforms. Arthritis Care Res (Hoboken) 2019; 71:323-330. [PMID: 29781587 DOI: 10.1002/acr.23600] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 05/15/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Few studies have examined ankylosing spondylitis (AS) patients' concerns about and perceptions of biologic therapies, apart from traditional surveys. In this study, we used social media data to examine the knowledge, attitudes, and beliefs of AS patients regarding biologic therapies. METHODS We collected posts published on 601 social media sites between January 1, 2016 and April 26, 2017. In each post, both an AS keyword and a biologic were mentioned. To explore themes within the collection of posts in an unsupervised manner, a latent Dirichlet allocation topic model was fit to the data set. Each discovered topic was represented as a discrete distribution over the words in the collection, similar to a word cloud. The topics were manually reviewed to identify themes, which were confirmed using thematic data analysis. RESULTS We examined 27,416 social media posts and identified 112 themes. The majority of themes (n = 67 [60%]) focused on discussions related to AS treatment. Other themes, including the psychological impact of AS, reporting of medical literature, and AS disease consequences, accounted for the remaining 40% (n = 45). In discussions regarding AS treatment, most topics involved biologics, and most subthemes involved side effects (e.g., fatigue, allergic reactions), biologic treatment attributes (e.g., dosing, frequency), and concerns about use of biologics (e.g., increased cancer risk). Additional implicit patient needs (e.g., support) were identified using qualitative analyses. CONCLUSION Social media revealed a dynamic range of themes governing AS patients' experience with and choice of biologic agents. The complexity of selecting biologics from among many such agents and navigating their risk/benefit profiles suggests the merit of creating online tools tailored to support patients' decision-making with regard to biologic therapies for AS.
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Affiliation(s)
- Eldin Dzubur
- Cedars-Sinai Medical Center, Los Angeles, California
| | - Carine Khalil
- Cedars-Sinai Medical Center and Cedars-Sinai Center for Outcomes Research and Education, Los Angeles, California
| | - Christopher V Almario
- Cedars-Sinai Medical Center and Cedars-Sinai Center for Outcomes Research and Education, Los Angeles, California
| | - Benjamin Noah
- Cedars-Sinai Medical Center and Cedars-Sinai Center for Outcomes Research and Education, Los Angeles, California
| | - Deeba Minhas
- Cedars-Sinai Medical Center, Los Angeles, California
| | | | - Corey Arnold
- Medical Imaging Informatics, University of California, Los Angeles
| | - Yujin Park
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | - Jonathan Kay
- University of Massachusetts Memorial Medical Center and University of Massachusetts Medical School, Worcester
| | | | - Brennan M R Spiegel
- Cedars-Sinai Medical Center and Cedars-Sinai Center for Outcomes Research and Education, Los Angeles, California
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Sarma KV, Spiegel BMR, Reid MW, Chen S, Merchant RM, Seltzer E, Arnold CW. Estimating the Health-Related Quality of Life of Twitter Users Using Semantic Processing. Stud Health Technol Inform 2019; 264:1065-1069. [PMID: 31438088 PMCID: PMC8081585 DOI: 10.3233/shti190388] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Social media presents a rich opportunity to gather health information with limited intervention through the analysis of completely unstructured and unlabeled microposts. We sought to estimate the health-related quality of life (HRQOL) of Twitter users using automated semantic processing methods. We collected tweets from 878 Twitter users recruited through online solicitation and in-person contact with patients. All participants completed the four-item Centers for Disease Control Healthy Days Questionnaire at the time of enrollment and 30 days later to measure “ground truth” HRQOL. We used a combination of document frequency analysis, sentiment analysis, topic analysis, and concept mapping to extract features from tweets, which we then used to estimate dichotomized HRQOL (“high” vs. “low”) using logistic regression. Binary HRQOL status was estimated with moderate performance (AUC=0.64). This result indicates that free-range social media data only offers a window into HRQOL, but does not afford direct access to current health status.
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Affiliation(s)
- Karthik V Sarma
- Department of Radiological Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Brennan M R Spiegel
- Center for Outcomes Research and Education, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Mark W Reid
- Center for Outcomes Research and Education, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Shawn Chen
- Department of Radiological Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Raina M Merchant
- Penn Medicine Center for Digital Health, University of Pennsylvania, Philadelphia, PA, USA
| | - Emily Seltzer
- Penn Medicine Center for Digital Health, University of Pennsylvania, Philadelphia, PA, USA
| | - Corey W Arnold
- Department of Radiological Sciences, University of California, Los Angeles, Los Angeles, CA, USA
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Almario CV, Chen MS, Spiegel BMR. Reply to Johnson et al. Regarding Optimizing Selection of Biologics in Inflammatory Bowel Disease: Development of an Online Patient Decision Aid Using Conjoint Analysis. Am J Gastroenterol 2018; 113:1721. [PMID: 30214014 DOI: 10.1038/s41395-018-0279-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 08/22/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Christopher V Almario
- Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA. Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Division of Informatics, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA.,Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA. Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Division of Informatics, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA.,Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA. Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Division of Informatics, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA.,Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA. Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Division of Informatics, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Michelle S Chen
- Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA. Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Division of Informatics, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA.,Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA. Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Division of Informatics, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA.,Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA. Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Division of Informatics, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Brennan M R Spiegel
- Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA. Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Division of Informatics, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA.,Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA. Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Division of Informatics, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA.,Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA. Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Division of Informatics, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA.,Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA. Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Division of Informatics, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA.,Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA. Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Division of Informatics, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
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Almario CV, Noah BD, Jusufagic A, Lew D, Spiegel BMR. Cost Effectiveness of Biomarker Tests for Irritable Bowel Syndrome With Diarrhea: A Framework for Payers. Clin Gastroenterol Hepatol 2018; 16:1434-1441.e21. [PMID: 29596984 PMCID: PMC6098734 DOI: 10.1016/j.cgh.2018.03.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 03/02/2018] [Accepted: 03/19/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Diagnosis of diarrhea-predominant irritable bowel syndrome (IBS-D) relies on the Rome IV symptom-based criteria, which are imperfect for separating functional vs organic disease. Biomarker tests for IBS-D might be added to symptom data to allow clinicians to make more accurate and precise diagnoses in a cost-effective manner. We tested the economic consequences of using a range of hypothetical IBS-D biomarkers, and explored at what cost and level of accuracy a biomarker becomes cost effective. We produced a framework for payers to evaluate the return on an investment of implementing IBS-D biomarkers of varying accuracy and cost. METHODS We used decision analysis software to evaluate a hypothetical cohort of patients who met Rome IV criteria for IBS-D. We conducted cost-utility and budget impact analyses of 2 competing approaches: usual care or an IBS biomarker-based diagnostic approach. Patients in the usual care group received empiric IBS treatment; non-responders received additional diagnostic tests for organic disease. In the group evaluated with a biomarker test, those with a positive result received IBS treatment before additional diagnostic analyses, whereas patients with a negative result underwent upfront diagnostic testing. Outcomes were incremental cost per quality-adjusted life year gained (third-party payer perspective) and incremental per-member per-month cost. RESULTS In the base-case analysis, using a willingness-to-pay threshold of $100,000/quality-adjusted life year, we found that biomarkers are not cost effective when the biomarker test costs more than $846, even if the test is 100% accurate in detecting IBS-D. In probabilistic analysis using 1,000 simulations, most trials (75% or more) show that the biomarker-based diagnostic approach is cost effective above the following accuracy thresholds: a $100 biomarker test with 51% accuracy, a $200 test with 57% accuracy, a $300 test with 63% accuracy, a $400 test with 69% accuracy, a $500 test with 76% accuracy, a $600 test with 82% accuracy, a $700 test with 89% accuracy, and a $800 test with 94% accuracy. CONCLUSIONS In decision analysis of a hypothetical cohort of patients who met Rome IV criteria for IBS-D, we identified cost and accuracy thresholds that can guide investigators and payers as they develop, validate, price, and/or reimburse IBS-D biomarker tests for use in everyday clinical practice.
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Affiliation(s)
- Christopher V Almario
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California; Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, California; Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, California; Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, California
| | - Benjamin D Noah
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California; Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, California
| | - Alma Jusufagic
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California; Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, California; Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California
| | - Daniel Lew
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Brennan M R Spiegel
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California; Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, California; Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, California; Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, California; Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California.
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Delshad SD, Almario CV, Fuller G, Luong D, Spiegel BMR. Economic analysis of implementing virtual reality therapy for pain among hospitalized patients. NPJ Digit Med 2018; 1:22. [PMID: 31304304 PMCID: PMC6550142 DOI: 10.1038/s41746-018-0026-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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] [Received: 11/14/2017] [Revised: 02/08/2018] [Accepted: 03/09/2018] [Indexed: 01/08/2023] Open
Abstract
Virtual reality (VR) has emerged as a novel and effective non-pharmacologic therapy for pain, and there is growing interest to use VR in the acute hospital setting. We sought to explore the cost and effectiveness thresholds VR therapy must meet to be cost-saving as an inpatient pain management program. The result is a framework for hospital administrators to evaluate the return on investment of implementing inpatient VR programs of varying effectiveness and cost. Utilizing decision analysis software, we compared adjuvant VR therapy for pain management vs. usual care among hospitalized patients. In the VR strategy, we analyzed potential cost-savings from reductions in opioid utilization and hospital length of stay (LOS), as well as increased reimbursements from higher patient satisfaction as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. The average overall hospitalization cost-savings per patient for the VR program vs. usual care was $5.39 (95% confidence interval –$11.00 to $156.17). In a probabilistic sensitivity analysis across 1000 hypothetical hospitals of varying size and staffing, VR remained cost-saving in 89.2% of trials. The VR program was cost-saving so long as it reduced LOS by ≥14.6%; the model was not sensitive to differences in opioid use or HCAHPS. We conclude that inpatient VR therapy may be cost-saving for a hospital system primarily if it reduces LOS. In isolation, cost-savings from reductions in opioid utilization and increased HCAHPS-related reimbursements are not sufficient to overcome the costs of VR. Implementing virtual reality (VR) programs for inpatient pain management can potentially save hospitals money. Recent studies have highlighted VR as an effective alternative to traditional opioid treatments for the management of pain. Brennan Spiegel, at Cedars-Sinai Medical Center in Los Angeles, and colleagues carried out an economic analysis to determine the cost implications of implementing inpatient VR therapy programs for acute pain management in different US hospital settings. They found that such programs are cost-saving when they reduce patients’ length of stay in the hospital. However, the projected costs for inpatient VR programs are higher than the savings that can be made from decreases in opioid use or additional income from Hospital Consumer Assessment of Healthcare Providers and Systems-related reimbursements through increased patient satisfaction alone.
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Affiliation(s)
- Sean D Delshad
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA USA.,2Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | - Christopher V Almario
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA USA.,3Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA USA.,4Division of Informatics, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Garth Fuller
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA USA
| | - Duong Luong
- 5Department of Pharmacy, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Brennan M R Spiegel
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA USA.,3Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA USA.,4Division of Informatics, Cedars-Sinai Medical Center, Los Angeles, CA USA.,6Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA USA
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Shah ED, Almario CV, Spiegel BMR, Chey WD. Lower and Upper Gastrointestinal Symptoms Differ Between Individuals With Irritable Bowel Syndrome With Constipation or Chronic Idiopathic Constipation. J Neurogastroenterol Motil 2018; 24:299-306. [PMID: 29605985 PMCID: PMC5885729 DOI: 10.5056/jnm17112] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 12/09/2017] [Accepted: 01/21/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND/AIMS We evaluated the distribution of lower and upper gastrointestinal (GI) symptoms among individuals with irritable bowel syndrome with constipation (IBS-C) and chronic idiopathic constipation (CIC) in a nationwide survey. METHODS Individuals (≥ 18 years of age) were identified from a nationwide sample of > 70 000 United States adults. Participants completed the National Institutes of Health GI Patient Reported Outcomes Measurement Information System (NIH GI-PROMIS) questionnaire. Symptom frequency and intensity in the prior 7 days were assessed using validated PROMIS scores. Odds ratios (OR) with 95% confidence intervals (CI) were calculated to compare symptom prevalence in IBS-C vs CIC, and one-way ANOVA was used to assess differences in PROMIS scores. Regression analysis was performed to adjust for demographic variables. RESULTS Nine hundred and seventy adults met eligibility criteria (275 with IBS-C, 734 with CIC). Demographics were similar among groups except for education, marital and employment status, and income. Adjusting for demographic differences, GI-PROMIS scores of global GI symptoms were higher in IBS-C (251.1; 95% CI, 230.0-273.1) compared to CIC (177.8; 95% CI 167.2-188.4) (P < 0.001). Abdominal pain was more prevalent (OR, 4.3; 95% CI, 2.9-6.6) and more severe (P = 0.007) in IBS-C. Constipation was more severe in IBS-C (P = 0.011). Incontinence was more common (OR, 2.9; 95% CI, 1.3-6.3) but just as severe (P = 0.389) in IBS-C versus CIC. Regarding upper GI symptoms, the prevalence of dysphagia, heartburn, and nausea were similar. However, IBS-C individuals had more severe heartburn (P = 0.001). CONCLUSION GI symptoms are generally more severe in IBS-C compared to CIC, however abdominal pain, bloating, and upper GI symptoms still commonly occur in CIC.
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Affiliation(s)
- Eric D Shah
- Division of Gastroenterology, Michigan Medicine, Ann Arbor, Michigan,
USA
| | - Christopher V Almario
- Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, California,
USA
| | - Brennan M R Spiegel
- Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, California,
USA
| | - William D Chey
- Division of Gastroenterology, Michigan Medicine, Ann Arbor, Michigan,
USA
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Nangit A, Lin C, Ishimori ML, Spiegel BMR, Weisman MH. Causes and Predictors of Early Hospital Readmission in Systemic Lupus Erythematosus. J Rheumatol 2018; 45:929-933. [PMID: 29657150 DOI: 10.3899/jrheum.170176] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We investigated characteristics of adult patients with systemic lupus erythematosus (SLE) readmitted to the hospital within 30 days of discharge, in an attempt to identify the causes of early readmission. METHODS We performed a retrospective case-control study examining all inpatient electronic health records of patients with SLE at Cedars-Sinai Medical Center over a 2.5-year period (2012-2014). Patients were included if they had an International Classification of Diseases, 9th ed diagnosis of SLE and were readmitted within 30 days of their initial hospitalization. Patients with SLE not readmitted during this time period were used as a control group. Demographic and clinical variables for each patient were collected, and we used the Charlson Comorbidity Index to characterize comorbidities. The Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) was used to assess the chronic damage of SLE. Stepwise multivariable logistic regression analysis was used to predict factors associated with readmission. RESULTS In total, 570 hospitalizations representing 455 unique patients met our inclusion and exclusion criteria. Of these, 154 patients (34%) underwent readmission within 30 days of their initial hospitalization. Patients in the early readmission group were more likely to have government-sponsored Medicaid insurance and were significantly associated with an increased SDI (OR 1.27, 95% CI 1.1-1.48), lower serum hemoglobin (OR 0.82, 95% CI 0.72-0.93), and lower serum albumin (OR 0.66, 95% CI 0.47-0.91). CONCLUSION One-third of hospitalized patients with SLE were readmitted within 30 days at our institution. We identified characteristics of this at-risk population at time of discharge with high specificity, in hopes of reducing this costly outcome.
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Affiliation(s)
- Angelica Nangit
- From the Departments of Rheumatology, Internal Medicine, and Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, California, USA.,A. Nangit, MD, Rheumatology, Cedars-Sinai Medical Center; C. Lin, MD, Internal Medicine, Cedars-Sinai Medical Center; M.L. Ishimori, MD, Rheumatology, Cedars-Sinai Medical Center; B.M. Spiegel, MD, Gastroenterology, Cedars-Sinai Medical Center; M.H. Weisman, MD, Rheumatology, Cedars-Sinai Medical Center
| | - Connie Lin
- From the Departments of Rheumatology, Internal Medicine, and Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, California, USA.,A. Nangit, MD, Rheumatology, Cedars-Sinai Medical Center; C. Lin, MD, Internal Medicine, Cedars-Sinai Medical Center; M.L. Ishimori, MD, Rheumatology, Cedars-Sinai Medical Center; B.M. Spiegel, MD, Gastroenterology, Cedars-Sinai Medical Center; M.H. Weisman, MD, Rheumatology, Cedars-Sinai Medical Center
| | - Mariko L Ishimori
- From the Departments of Rheumatology, Internal Medicine, and Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, California, USA.,A. Nangit, MD, Rheumatology, Cedars-Sinai Medical Center; C. Lin, MD, Internal Medicine, Cedars-Sinai Medical Center; M.L. Ishimori, MD, Rheumatology, Cedars-Sinai Medical Center; B.M. Spiegel, MD, Gastroenterology, Cedars-Sinai Medical Center; M.H. Weisman, MD, Rheumatology, Cedars-Sinai Medical Center
| | - Brennan M R Spiegel
- From the Departments of Rheumatology, Internal Medicine, and Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, California, USA.,A. Nangit, MD, Rheumatology, Cedars-Sinai Medical Center; C. Lin, MD, Internal Medicine, Cedars-Sinai Medical Center; M.L. Ishimori, MD, Rheumatology, Cedars-Sinai Medical Center; B.M. Spiegel, MD, Gastroenterology, Cedars-Sinai Medical Center; M.H. Weisman, MD, Rheumatology, Cedars-Sinai Medical Center
| | - Michael H Weisman
- From the Departments of Rheumatology, Internal Medicine, and Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, California, USA. .,A. Nangit, MD, Rheumatology, Cedars-Sinai Medical Center; C. Lin, MD, Internal Medicine, Cedars-Sinai Medical Center; M.L. Ishimori, MD, Rheumatology, Cedars-Sinai Medical Center; B.M. Spiegel, MD, Gastroenterology, Cedars-Sinai Medical Center; M.H. Weisman, MD, Rheumatology, Cedars-Sinai Medical Center.
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Affiliation(s)
- Christopher V Almario
- Cedars-Sinai Center for Outcomes Research and Education, Los Angeles, California; Division of Digestive and Liver Diseases, Division of Health Services Research, Division of Informatics, Cedars-Sinai Medical Center, Los Angeles, California
| | - Brennan M R Spiegel
- Cedars-Sinai Center for Outcomes Research and Education, Los Angeles, California; Division of Digestive and Liver Diseases, Division of Health Services Research, Division of Informatics, Cedars-Sinai Medical Center, Los Angeles, California.
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Ahmed S, Almario CV, Chey WD, Robbins LA, Chang B, Ahn J, Ko J, Gu P, Siu A, Spiegel BMR. Electronic patient agenda forms: comparing agreement between the reason for specialty consultation reported by referring providers and patients. Inform Health Soc Care 2018; 44:105-113. [PMID: 29509054 DOI: 10.1080/17538157.2018.1437041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 10/17/2022]
Abstract
OBJECTIVE Little is known about the agreement between referring providers' reason for specialty evaluation and patients' understanding of why they are referred for consultation. Here, we compared the reason for consult (RFC) documented by referring providers during usual care vs. the perceived RFC independently reported by patients through an e-portal just prior to the specialist visit. METHODS We performed an observational study among patients referred for gastrointestinal (GI) evaluation. Patients referred to the specialty clinic submitted their self-reported RFC using an online patient agenda form prior to their visit. Therefore, each participant had a referring provider- and patient-documented RFC. Blinded physicians reviewed the RFCs in random order using a priori coding criteria. We then compared whether the provider and patient RFC pairs were concordant (i.e., ≥1 clinical topic[s] in the RFCs matched). RESULTS Sixty patients completed the e-portal prior to their visit, leading to 60 provider-patient RFC pairs. The RFC pairs were concordant in only 52% of cases. CONCLUSIONS There is poor agreement between referring providers' reason for GI referral and patients' understanding of why they are visiting the clinic. Future research examining whether electronic patient agenda forms impact diagnostic and management precision, patient satisfaction, and healthcare utilization is warranted.
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Affiliation(s)
- Shahzad Ahmed
- a Department of Medicine , Cedars-Sinai Medical Center , Los Angeles , CA , USA
| | - Christopher V Almario
- a Department of Medicine , Cedars-Sinai Medical Center , Los Angeles , CA , USA.,b Division of Digestive and Liver Diseases , Cedars-Sinai Medical Center , Los Angeles , CA , USA.,c Division of Health Services Research , Cedars-Sinai Medical Center , Los Angeles , CA , USA.,d Division of Informatics , Cedars-Sinai Medical Center , Los Angeles , CA , USA.,e Cedars-Sinai Center for Outcomes Research and Education (CS-CORE) , Los Angeles , CA , USA
| | - William D Chey
- f Division of Gastroenterology , University of Michigan , Ann Arbor , MI , USA
| | - Lori A Robbins
- a Department of Medicine , Cedars-Sinai Medical Center , Los Angeles , CA , USA.,b Division of Digestive and Liver Diseases , Cedars-Sinai Medical Center , Los Angeles , CA , USA
| | - Bianca Chang
- a Department of Medicine , Cedars-Sinai Medical Center , Los Angeles , CA , USA
| | - Joseph Ahn
- a Department of Medicine , Cedars-Sinai Medical Center , Los Angeles , CA , USA
| | - Jeffrey Ko
- a Department of Medicine , Cedars-Sinai Medical Center , Los Angeles , CA , USA
| | - Phillip Gu
- a Department of Medicine , Cedars-Sinai Medical Center , Los Angeles , CA , USA
| | - Alvin Siu
- a Department of Medicine , Cedars-Sinai Medical Center , Los Angeles , CA , USA
| | - Brennan M R Spiegel
- a Department of Medicine , Cedars-Sinai Medical Center , Los Angeles , CA , USA.,b Division of Digestive and Liver Diseases , Cedars-Sinai Medical Center , Los Angeles , CA , USA.,c Division of Health Services Research , Cedars-Sinai Medical Center , Los Angeles , CA , USA.,d Division of Informatics , Cedars-Sinai Medical Center , Los Angeles , CA , USA.,e Cedars-Sinai Center for Outcomes Research and Education (CS-CORE) , Los Angeles , CA , USA
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Siegel CA, Whitman CB, Spiegel BMR, Feagan B, Sands B, Loftus EV, Panaccione R, D'Haens G, Bernstein CN, Gearry R, Ng SC, Mantzaris GJ, Sartor B, Silverberg MS, Riddell R, Koutroubakis IE, O'Morain C, Lakatos PL, McGovern DPB, Halfvarson J, Reinisch W, Rogler G, Kruis W, Tysk C, Schreiber S, Danese S, Sandborn W, Griffiths A, Moum B, Gasche C, Pallone F, Travis S, Panes J, Colombel JF, Hanauer S, Peyrin-Biroulet L. Development of an index to define overall disease severity in IBD. Gut 2018; 67:244-254. [PMID: 27780886 DOI: 10.1136/gutjnl-2016-312648] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [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] [Received: 07/18/2016] [Revised: 09/08/2016] [Accepted: 10/03/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIM Disease activity for Crohn's disease (CD) and UC is typically defined based on symptoms at a moment in time, and ignores the long-term burden of disease. The aims of this study were to select the attributes determining overall disease severity, to rank the importance of and to score these individual attributes for both CD and UC. METHODS Using a modified Delphi panel, 14 members of the International Organization for the Study of Inflammatory Bowel Diseases (IOIBD) selected the most important attributes related to IBD. Eighteen IOIBD members then completed a statistical exercise (conjoint analysis) to create a relative ranking of these attributes. Adjusted utilities were developed by creating proportions for each level within an attribute. RESULTS For CD, 15.8% of overall disease severity was attributed to the presence of mucosal lesions, 10.9% to history of a fistula, 9.7% to history of abscess and 7.4% to history of intestinal resection. For UC, 18.1% of overall disease severity was attributed to mucosal lesions, followed by 14.0% for impact on daily activities, 11.2% C reactive protein and 10.1% for prior experience with biologics. Overall disease severity indices were created on a 100-point scale by applying each attribute's average importance to the adjusted utilities. CONCLUSIONS Based on specialist opinion, overall CD severity was associated more with intestinal damage, in contrast to overall UC disease severity, which was more dependent on symptoms and impact on daily life. Once validated, disease severity indices may provide a useful tool for consistent assessment of overall disease severity in patients with IBD.
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Affiliation(s)
- Corey A Siegel
- Dartmouth-Hitchcock Inflammatory Bowel Disease Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Cynthia B Whitman
- Department of Health Services, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Brennan M R Spiegel
- Department of Health Services, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Brian Feagan
- Robarts Clinical Trials, London, Ontario, Canada
| | - Bruce Sands
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | | | - Siew C Ng
- Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | | | - Balfour Sartor
- University of North Carolina, Chapel Hill, North Carolina, USA
| | | | | | | | - Colm O'Morain
- Faculty of Health Sciences Trinity College Dublin, Dublin, Ireland
| | | | - Dermot P B McGovern
- Widjaja Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jonas Halfvarson
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | | | | | | | - Curt Tysk
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | | | | | | | | | - Bjorn Moum
- Oslo University Hospital and University Oslo, Oslo, Norway
| | | | | | | | - Julian Panes
- Hospital Clinic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
| | | | - Stephen Hanauer
- Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
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Noah B, Keller MS, Mosadeghi S, Stein L, Johl S, Delshad S, Tashjian VC, Lew D, Kwan JT, Jusufagic A, Spiegel BMR. Impact of remote patient monitoring on clinical outcomes: an updated meta-analysis of randomized controlled trials. NPJ Digit Med 2018; 1:20172. [PMID: 31304346 PMCID: PMC6550143 DOI: 10.1038/s41746-017-0002-4] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [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] [Received: 05/11/2017] [Revised: 08/28/2017] [Accepted: 08/31/2017] [Indexed: 12/31/2022] Open
Abstract
Despite growing interest in remote patient monitoring, limited evidence exists to substantiate claims of its ability to improve outcomes. Our aim was to evaluate randomized controlled trials (RCTs) that assess the effects of using wearable biosensors (e.g. activity trackers) for remote patient monitoring on clinical outcomes. We expanded upon prior reviews by assessing effectiveness across indications and presenting quantitative summary data. We searched for articles from January 2000 to October 2016 in PubMed, reviewed 4,348 titles, selected 777 for abstract review, and 64 for full text review. A total of 27 RCTs from 13 different countries focused on a range of clinical outcomes and were retained for final analysis; of these, we identified 16 high-quality studies. We estimated a difference-in-differences random effects meta-analysis on select outcomes. We weighted the studies by sample size and used 95% confidence intervals (CI) around point estimates. Difference-in-difference point estimation revealed no statistically significant impact of remote patient monitoring on any of six reported clinical outcomes, including body mass index (-0.73; 95% CI: -1.84, 0.38), weight (-1.29; -3.06, 0.48), waist circumference (-2.41; -5.16, 0.34), body fat percentage (0.11; -1.56, 1.34), systolic blood pressure (-2.62; -5.31, 0.06), and diastolic blood pressure (-0.99; -2.73, 0.74). Studies were highly heterogeneous in their design, device type, and outcomes. Interventions based on health behavior models and personalized coaching were most successful. We found substantial gaps in the evidence base that should be considered before implementation of remote patient monitoring in the clinical setting.
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Affiliation(s)
- Benjamin Noah
- 1Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA USA.,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA USA
| | - Michelle S Keller
- 1Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA USA.,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA USA.,3Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA USA
| | - Sasan Mosadeghi
- 4Department of Medicine, University of Arizona, College of Medicine Tucson, Tucson, AZ USA
| | - Libby Stein
- 1Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA USA.,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA USA
| | - Sunny Johl
- 1Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA USA.,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA USA
| | - Sean Delshad
- 1Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA USA.,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA USA
| | - Vartan C Tashjian
- 1Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA USA.,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA USA.,5Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Daniel Lew
- 1Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA USA.,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA USA.,5Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - James T Kwan
- 1Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA USA.,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA USA
| | - Alma Jusufagic
- 1Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA USA.,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA USA.,3Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA USA
| | - Brennan M R Spiegel
- 1Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA USA.,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA USA.,3Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA USA.,5Cedars-Sinai Medical Center, Los Angeles, CA USA.,American Journal of Gastroenterology, Bethesda, USA
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Almario CV, Almario AA, Cunningham ME, Fouladian J, Spiegel BMR. Old Farts - Fact or Fiction? Results From a Population-Based Survey of 16,000 Americans Examining the Association Between Age and Flatus. Clin Gastroenterol Hepatol 2017; 15:1308-1310. [PMID: 28344066 DOI: 10.1016/j.cgh.2017.03.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 03/10/2017] [Accepted: 03/18/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Christopher V Almario
- Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, California; Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, California; Cedars-Sinai Center for Outcomes Research and Education, Los Angeles, California
| | - Alison A Almario
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | | | - Joshua Fouladian
- Cedars-Sinai Center for Outcomes Research and Education, Los Angeles, California
| | - Brennan M R Spiegel
- Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, California; Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, California; Cedars-Sinai Center for Outcomes Research and Education, Los Angeles, California.
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Martinez B, Dailey F, Almario CV, Keller MS, Desai M, Dupuy T, Mosadeghi S, Whitman C, Lasch K, Ursos L, Spiegel BMR. Patient Understanding of the Risks and Benefits of Biologic Therapies in Inflammatory Bowel Disease: Insights from a Large-scale Analysis of Social Media Platforms. Inflamm Bowel Dis 2017; 23:1057-1064. [PMID: 28410343 DOI: 10.1097/mib.0000000000001110] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [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] [Indexed: 12/14/2022]
Abstract
BACKGROUND Few studies have examined inflammatory bowel disease (IBD) patients' knowledge and understanding of biologic therapies outside traditional surveys. Here, we used social media data to examine IBD patients' understanding of the risks and benefits associated with biologic therapies and how this affects decision-making. METHODS We collected posts from Twitter and e-forum discussions from >3000 social media sites posted between June 27, 2012 and June 27, 2015. Guided by natural language processing, we identified posts with specific IBD keywords that discussed the risks and/or benefits of biologics. We then manually coded the resulting posts and performed qualitative analysis using ATLAS.ti software. A hierarchical coding structure was developed based on the keyword list and relevant themes were identified through manual coding. RESULTS We examined 1598 IBD-related posts, of which 452 (28.3%) centered on the risks and/or benefits of biologics. There were 5 main themes: negative experiences and concerns with biologics (n = 247; 54.6%), decision-making surrounding biologic use (n = 169; 37.4%), positive experiences with biologics (n = 168; 37.2%), information seeking from peers (n = 125; 27.7%), and cost (n = 38; 8.4%). Posts describing negative experiences primarily commented on side effects from biologics, concerns about potential side effects and increased cancer risk, and pregnancy safety concerns. Posts on decision-making focused on nonbiologic treatment options, hesitation to initiate biologics, and concerns about changing or discontinuing regimens. CONCLUSIONS Social media reveals a wide range of themes governing patients' experience and choice with IBD biologics. The complexity of navigating their risk-benefit profiles suggests merit in creating online tailored decision tools to support IBD patients' decision-making with biologic therapies.
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Affiliation(s)
- Bibiana Martinez
- *Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, California; †Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California; ‡Department of Medicine, Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, California; §Department of Medicine, Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, California; and ‖Takeda Pharmaceuticals U.S.A., Inc., Deerfield, Illinois
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Almario CV, Spiegel BMR. Does endoscopist fatigue impact adenoma detection rate? A review of the evidence to date. Gastrointest Endosc 2017; 85:611-613. [PMID: 28215770 DOI: 10.1016/j.gie.2016.11.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 11/21/2016] [Indexed: 12/11/2022]
Affiliation(s)
- Christopher V Almario
- Cedars-Sinai Center for Outcomes Research and Education, Division of Digestive and Liver Diseases, Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Brennan M R Spiegel
- Cedars-Sinai Center for Outcomes Research and Education, Division of Digestive and Liver Diseases, Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, California, USA
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May FP, Glenn BA, Crespi CM, Ponce N, Spiegel BMR, Bastani R. Decreasing Black-White Disparities in Colorectal Cancer Incidence and Stage at Presentation in the United States. Cancer Epidemiol Biomarkers Prev 2016; 26:762-768. [PMID: 28035021 DOI: 10.1158/1055-9965.epi-16-0834] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 12/14/2016] [Accepted: 12/15/2016] [Indexed: 12/18/2022] Open
Abstract
Background: There are long-standing black-white disparities in colorectal cancer incidence and outcomes in the United States. Incidence and stage at diagnosis reflect the impact of national efforts directed at colorectal cancer prevention and control. We aimed to evaluate trends in black-white disparities in both indicators over four decades to inform the future direction of prevention and control efforts.Methods: We used Surveillance, Epidemiology, & End Results (SEER) data to identify whites and blacks with histologically confirmed colorectal cancer from January 1, 1975 through December 31, 2012. We calculated the age-adjusted incidence and the proportion of cases presenting in late stage by race and year. We then calculated the annual percentage change (APC) and average APC for each indicator by race, examined changes in indicators over time, and calculated the incidence disparity for each year.Results: There were 440,144 colorectal cancer cases from 1975 to 2012. The overall incidence decreased by 1.35% and 0.46% per year for whites and blacks, respectively. Although the disparity in incidence declined from 2004 to 2012 (APC = -3.88%; P = 0.01), incidence remained higher in blacks in 2012. Late-stage disease declined by 0.27% and 0.45% per year in whites and blacks, respectively. The proportion of late-stage cases became statistically similar in whites and blacks in 2010 (56.60% vs. 56.96%; P = 0.17).Conclusions: Black-white disparities in colorectal cancer incidence and stage at presentation have decreased over time.Impact: Our findings reflect the positive impact of efforts to improve colorectal cancer disparities and emphasize the need for interventions to further reduce the incidence gap. Cancer Epidemiol Biomarkers Prev; 26(5); 762-8. ©2016 AACR.
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Affiliation(s)
- Folasade P May
- Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California. .,UCLA Kaiser Permanente Center for Health Equity, Los Angeles, California.,Jonsson Comprehensive Cancer Center, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Beth A Glenn
- UCLA Kaiser Permanente Center for Health Equity, Los Angeles, California.,Jonsson Comprehensive Cancer Center, David Geffen School of Medicine at UCLA, Los Angeles, California.,Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California
| | - Catherine M Crespi
- Jonsson Comprehensive Cancer Center, David Geffen School of Medicine at UCLA, Los Angeles, California.,Department of Biostatistics at UCLA Fielding School of Public Health, Los Angeles, California
| | - Ninez Ponce
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California
| | - Brennan M R Spiegel
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California.,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, California
| | - Roshan Bastani
- UCLA Kaiser Permanente Center for Health Equity, Los Angeles, California.,Jonsson Comprehensive Cancer Center, David Geffen School of Medicine at UCLA, Los Angeles, California.,Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California
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Pevnick JM, Fuller G, Duncan R, Spiegel BMR. A Large-Scale Initiative Inviting Patients to Share Personal Fitness Tracker Data with Their Providers: Initial Results. PLoS One 2016; 11:e0165908. [PMID: 27846287 PMCID: PMC5112984 DOI: 10.1371/journal.pone.0165908] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 10/19/2016] [Indexed: 11/28/2022] Open
Abstract
Background Personal fitness trackers (PFT) have substantial potential to improve healthcare. Objective To quantify and characterize early adopters who shared their PFT data with providers. Methods We used bivariate statistics and logistic regression to compare patients who shared any PFT data vs. patients who did not. Results A patient portal was used to invite 79,953 registered portal users to share their data. Of 66,105 users included in our analysis, 499 (0.8%) uploaded data during an initial 37-day study period. Bivariate and regression analysis showed that early adopters were more likely than non-adopters to be younger, male, white, health system employees, and to have higher BMIs. Neither comorbidities nor utilization predicted adoption. Conclusion Our results demonstrate that patients had little intrinsic desire to share PFT data with their providers, and suggest that patients most at risk for poor health outcomes are least likely to share PFT data. Marketing, incentives, and/or cultural change may be needed to induce such data-sharing.
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Affiliation(s)
- Joshua M Pevnick
- Division of General Internal Medicine, Department of Medicine, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, California, United States of America.,Division of Informatics, Department of Biomedical Sciences, 8700 Beverly Blvd, Los Angeles, California, United States of America
| | - Garth Fuller
- Center for Outcomes Research and Education, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, California, United States of America
| | - Ray Duncan
- Division of Informatics, Department of Biomedical Sciences, 8700 Beverly Blvd, Los Angeles, California, United States of America
| | - Brennan M R Spiegel
- Center for Outcomes Research and Education, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, California, United States of America
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May FP, Whitman CB, Varlyguina K, Bromley EG, Spiegel BMR. Addressing Low Colorectal Cancer Screening in African Americans: Using Focus Groups to Inform the Development of Effective Interventions. J Cancer Educ 2016; 31:567-74. [PMID: 25963898 PMCID: PMC4644112 DOI: 10.1007/s13187-015-0842-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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] [Indexed: 05/24/2023]
Abstract
African Americans have the highest burden of colorectal cancer (CRC) in the United States of America (USA) yet lower CRC screening rates than whites. Although poor screening has prompted efforts to increase screening uptake, there is a persistent need to develop public health interventions in partnership with the African American community. The aim of this study was to conduct focus groups with African Americans to determine preferences for the content and mode of dissemination of culturally tailored CRC screening interventions. In June 2013, 45-75-year-old African Americans were recruited through online advertisements and from an urban Veterans Affairs system to create four focus groups. A semi-structured interview script employing open-ended elicitation was used, and transcripts were analyzed using ATLAS.ti software to code and group data into a concept network. A total of 38 participants (mean age = 54) were enrolled, and 59 ATLAS.ti codes were generated. Commonly reported barriers to screening included perceived invasiveness of colonoscopy, fear of pain, and financial concerns. Facilitators included poor diet/health and desire to prevent CRC. Common sources of health information included media and medical providers. CRC screening information was commonly obtained from medical personnel or media. Participants suggested dissemination of CRC screening education through commercials, billboards, influential African American public figures, Internet, and radio. Participants suggested future interventions include culturally specific information, including details about increased risk, accessing care, and dispelling of myths. Public health interventions to improve CRC screening among African Americans should employ media outlets, emphasize increased risk among African Americans, and address race-specific barriers. Specific recommendations are presented for developing future interventions.
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Affiliation(s)
- Folasade P May
- Division of Gastroenterology, Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
- Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA.
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Cynthia B Whitman
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ksenia Varlyguina
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Erica G Bromley
- Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Brennan M R Spiegel
- Division of Gastroenterology, Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Almario CV, May FP, Maxwell AE, Ren W, Ponce NA, Spiegel BMR. Persistent racial and ethnic disparities in flu vaccination coverage: Results from a population-based study. Am J Infect Control 2016; 44:1004-9. [PMID: 27372226 DOI: 10.1016/j.ajic.2016.03.064] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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: 01/14/2016] [Revised: 03/02/2016] [Accepted: 03/02/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND The Advisory Committee on Immunization Practices recommends annual flu vaccination for all adults. We aimed to identify predictors of receiving a flu vaccination, with an emphasis on the impact of race and ethnicity. METHODS We used data from the 2011-2012 California Health Interview Survey and included all individuals aged ≥18 years. We performed a survey-weighted logistic regression on receipt of flu vaccination within the last year, adjusted by demographic and socioeconomic variables, and calculated odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS Our study included a population-weighted sample of 27,796,484 individuals. Overall, 35.8% received a flu vaccination within the last year. Blacks were 33% less likely (95% CI, 21%-43%) to have been vaccinated than whites. Conversely, Koreans (OR, 1.77; 95% CI, 1.35-2.33) and Vietnamese (OR, 1.57; 95% CI, 1.19-2.07) were more likely than whites to have been vaccinated. No differences were seen between whites and the remaining racial and ethnic groups (Latino, Japanese, Chinese, Filipino, South Asian, Asian other, and other). CONCLUSIONS Racial and ethnic disparities in flu vaccination uptake exist in California. Namely, blacks have lower vaccination rates than whites, and there are disparate vaccination rates among the Asian-American subgroups. Efforts to increase vaccination rates among these groups are needed.
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Affiliation(s)
- Christopher V Almario
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA; Division of Gastroenterology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Folasade P May
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA; Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA; Division of Digestive Diseases, Department of Medicine, UCLA, Los Angeles, CA
| | - Allison E Maxwell
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA
| | - Wanmeng Ren
- UCLA Luskin School of Public Affairs, Los Angeles, CA
| | - Ninez A Ponce
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA; UCLA Center for Health Policy Research, UCLA Fielding School of Public Health, Los Angeles, CA
| | - Brennan M R Spiegel
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA; Division of Gastroenterology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA; Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA.
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Reid MW, Cohen S, Wang H, Kaung A, Patel A, Tashjian V, Williams DL, Martinez B, Spiegel BMR. Preventing patient absenteeism: validation of a predictive overbooking model. Am J Manag Care 2015; 21:902-910. [PMID: 26671702] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To develop a model that identifies patients at high risk for missing scheduled appointments ("no-shows" and cancellations) and to project the impact of predictive overbooking in a gastrointestinal endoscopy clinic-an exemplar resource-intensive environment with a high no-show rate. STUDY DESIGN We retrospectively developed an algorithm that uses electronic health record (EHR) data to identify patients who do not show up to their appointments. Next, we prospectively validated the algorithm at a Veterans Administration healthcare network clinic. METHODS We constructed a multivariable logistic regression model that assigned a no-show risk score optimized by receiver operating characteristic curve analysis. Based on these scores, we created a calendar of projected open slots to offer to patients and compared the daily performance of predictive overbooking with fixed overbooking and typical "1 patient, 1 slot" scheduling. RESULTS Data from 1392 patients identified several predictors of no-show, including previous absenteeism, comorbid disease burden, and current diagnoses of mood and substance use disorders. The model correctly classified most patients during the development (area under the curve [AUC] = 0.80) and validation phases (AUC = 0.75). Prospective testing in 1197 patients found that predictive overbooking averaged 0.51 unused appointments per day versus 6.18 for typical booking (difference = -5.67; 95% CI, -6.48 to -4.87; P < .0001). Predictive overbooking could have increased service utilization from 62% to 97% of capacity, with only rare clinic overflows. CONCLUSIONS Information from EHRs can accurately predict whether patients will no-show. This method can be used to overbook appointments, thereby maximizing service utilization while staying within clinic capacity.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Brennan M R Spiegel
- West Los Angeles VA Medical Center, 11301 Wilshire Blvd, Bldg 115, Rm 215, Los Angeles, CA 90073. E-mail:
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Whitman CB, Reid MW, Arnold C, Patel H, Ursos L, Sa'adon R, Pourmorady J, Spiegel BMR. Balancing opioid-induced gastrointestinal side effects with pain management: Insights from the online community. J Opioid Manag 2015; 11:383-391. [PMID: 26535966 DOI: 10.5055/jom.2015.0288] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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: 06/05/2023]
Abstract
Opioids cause gastrointestinal (GI) symptoms such as nausea, vomiting, pain, and (in 40 percent) constipation that diminish patients' quality of life. Outside traditional surveys, little is known about the opioid-induced constipation (OIC) patient experience and its impact on pain management. The purpose of this study was to use data from social media platforms to qualitatively examine patient beliefs about OIC and other prominent GI side effects, their impact on effective pain management and doctor-patient interaction. The authors collected Tweets from March 25 to July 31, 2014, and e-forum posts from health-related social networking sites regardless of timestamp. The authors identified specific keywords related to opioids and GI side effects to locate relevant content in the dataset, which was then manually coded using ATLAS.ti software. The authors examined 2,519,868 Tweets and more than 1.8 billion e-forum posts, of which, 88,586 Tweets and 9,767 posts satisfied the search criteria. Three thousand three individuals experienced opioidinduced GI side effects, mostly related to phenanthrenes (n = 1,589), and 1,274 (42.4 percent) individuals described constipation. Over-the-counter medications and nonevidence-based natural approaches were most commonly used to alleviate constipation. Many individuals questioned, rotated, reduced, or stopped their opioid treatments as a result of their GI side effects. Investigation of social media reveals a struggle to balance pain management with opioid-induced GI side effects, especially constipation. Individuals are often unprepared to treat OIC, to modify opioid regiments without medical advice, and to resort to using natural remedies and treatments lacking scientific evidence of effectiveness. These results identify opportunities to improve physician-patient communication and explore effective treatment alternatives.
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Affiliation(s)
- Cynthia B Whitman
- Clinical Research Coordinator, Cedars-Sinai Health System, Principal Research Coordinator, Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Mark W Reid
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California; VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Corey Arnold
- Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | | | - Lyann Ursos
- Scientific Associate Director, Takeda Pharmaceuticals International, Inc., Deerfield, Illinois
| | - Roee Sa'adon
- Vice President, Technology, Treato Ltd., Or Yehuda, Israel
| | - Jonathan Pourmorady
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Brennan M R Spiegel
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California; VA Greater Los Angeles Healthcare System, Los Angeles, California; Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California
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Moayyedi P, Quigley EMM, Lacy BE, Lembo AJ, Saito YA, Schiller LR, Soffer EE, Spiegel BMR, Ford AC. The Effect of Dietary Intervention on Irritable Bowel Syndrome: A Systematic Review. Clin Transl Gastroenterol 2015; 6:e107. [PMID: 26291435 PMCID: PMC4816279 DOI: 10.1038/ctg.2015.21] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [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] [Received: 11/01/2014] [Accepted: 03/20/2015] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Elimination diets have been used for many years to treat irritable bowel syndrome (IBS). These approaches had fallen out of favor until a recent resurgence, which was based on new randomized controlled trial (RCT) data that suggested it might be effective. The evidence for the efficacy of dietary therapies has not been evaluated systematically. We have therefore conducted a systematic review to examine this issue. METHODS MEDLINE, EMBASE, and the Cochrane Controlled Trials Register were searched up to December 2013. Trials recruiting adults with IBS, which compared any form of dietary restriction or addition of an offending food group in patients already on a restricted diet vs. placebo, control therapy, or "usual management", were eligible. Dichotomous symptom data were pooled to obtain a relative risk of remaining symptomatic after therapy as well as the number needed to treat with a 95% confidence interval. RESULTS We identified 17 RCTs involving 1,568 IBS patients that assessed elimination diets. Only three RCTs involving 230 patients met our eligibility criteria, all of which evaluated different approaches, and thus a meta-analysis could not be conducted. CONCLUSIONS More evidence is needed before generally recommending elimination diets for IBS patients.
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Affiliation(s)
- Paul Moayyedi
- Farncombe Family Digestive Health Research Institute, McMaster University, Health Sciences Centre, Hamilton, Ontario, Canada
| | - Eamonn M M Quigley
- Division of Gastroenterology and Hepatology, Department of Medicine, Houston Methodist Hospital, Houston, Texas, USA
| | - Brian E Lacy
- Dartmouth-Hitchcock Medical Centre, Division of Gastroenterology and Hepatology, One Medical Centre Drive, Lebanon, New Hampshire, USA
| | - Anthony J Lembo
- The Beth Israel Deaconess Medical Centre, Boston, Massachusetts, USA
| | - Yuri A Saito
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Lawrence R Schiller
- Digestive Health Associates of Texas, Baylor University Medical Centre, Dallas, Texas, USA
| | - Edy E Soffer
- Division of Gastroenterology at Cedars-Sinai, University of Southern California, Los Angeles, California, USA
| | - Brennan M R Spiegel
- Department of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Alexander C Ford
- Leeds Gastroenterology Institute, St James's University Hospital, Leeds, UK
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
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Almario CV, Chey WD, Iriana S, Dailey F, Robbins K, Patel AV, Reid M, Whitman C, Fuller G, Bolus R, Dennis B, Encarnacion R, Martinez B, Soares J, Modi R, Agarwal N, Lee A, Kubomoto S, Sharma G, Bolus S, Chang L, Spiegel BMR. Computer versus physician identification of gastrointestinal alarm features. Int J Med Inform 2015; 84:1111-7. [PMID: 26254875 DOI: 10.1016/j.ijmedinf.2015.07.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 07/14/2015] [Accepted: 07/14/2015] [Indexed: 12/27/2022]
Abstract
OBJECTIVE It is important for clinicians to inquire about "alarm features" as it may identify those at risk for organic disease and who require additional diagnostic workup. We developed a computer algorithm called Automated Evaluation of Gastrointestinal Symptoms (AEGIS) that systematically collects patient gastrointestinal (GI) symptoms and alarm features, and then "translates" the information into a history of present illness (HPI). Our study's objective was to compare the number of alarms documented by physicians during usual care vs. that collected by AEGIS. METHODS We performed a cross-sectional study with a paired sample design among patients visiting adult GI clinics. Participants first received usual care by their physicians and then completed AEGIS. Each individual thus contributed both a physician-documented and computer-generated HPI. Blinded physician reviewers enumerated the positive alarm features (hematochezia, melena, hematemesis, unintentional weight loss, decreased appetite, and fevers) mentioned in each HPI. We compared the number of documented alarms within patient using the Wilcoxon signed-rank test. RESULTS Seventy-five patients had both physician and AEGIS HPIs. AEGIS identified more patients with positive alarm features compared to physicians (53% vs. 27%; p<.001). AEGIS also documented more positive alarms (median 1, interquartile range [IQR] 0-2) vs. physicians (median 0, IQR 0-1; p<.001). Moreover, clinicians documented only 30% of the positive alarms self-reported by patients through AEGIS. CONCLUSIONS Physicians documented less than one-third of red flags reported by patients through a computer algorithm. These data indicate that physicians may under report alarm features and that computerized "checklists" could complement standard HPIs to bolster clinical care.
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Affiliation(s)
- Christopher V Almario
- Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Division of Digestive Diseases, UCLA, Los Angeles, CA, USA; Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA
| | - William D Chey
- Division of Gastroenterology, University of Michigan, Ann Arbor, MI, USA
| | - Sentia Iriana
- Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Francis Dailey
- Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Karen Robbins
- Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Anish V Patel
- Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Mark Reid
- Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA
| | - Cynthia Whitman
- Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA
| | - Garth Fuller
- Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA
| | - Roger Bolus
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA
| | - Buddy Dennis
- UCLA Computing Technology Research Laboratory (CTRL), Los Angeles, CA, USA
| | - Rey Encarnacion
- UCLA Computing Technology Research Laboratory (CTRL), Los Angeles, CA, USA
| | - Bibiana Martinez
- Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA
| | - Jennifer Soares
- Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA
| | - Rushaba Modi
- Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Division of Digestive Diseases, UCLA, Los Angeles, CA, USA
| | - Nikhil Agarwal
- Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Division of Digestive Diseases, UCLA, Los Angeles, CA, USA
| | - Aaron Lee
- Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Scott Kubomoto
- Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Gobind Sharma
- Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Sally Bolus
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA
| | - Lin Chang
- Division of Digestive Diseases, UCLA, Los Angeles, CA, USA
| | - Brennan M R Spiegel
- Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA.
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Spiegel BMR, Hays RD, Bolus R, Melmed GY, Chang L, Whitman C, Khanna PP, Paz SH, Hays T, Reise S, Khanna D. Corrigendum: development of the NIH Patient-Reported Outcomes Measurement Information System (PROMIS) gastrointestinal symptom scales. Am J Gastroenterol 2015; 110:608. [PMID: 25853211 DOI: 10.1038/ajg.2015.62] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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50
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Bromley EG, May FP, Federer L, Spiegel BMR, van Oijen MGH. Explaining persistent under-use of colonoscopic cancer screening in African Americans: a systematic review. Prev Med 2015; 71:40-8. [PMID: 25481094 PMCID: PMC4329030 DOI: 10.1016/j.ypmed.2014.11.022] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [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] [Received: 05/15/2014] [Revised: 10/01/2014] [Accepted: 11/26/2014] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Although African Americans have the highest incidence and mortality from colorectal cancer (CRC), they are less likely than other racial groups to undergo CRC screening. Previous research has identified barriers to CRC screening among African Americans. However we lack a systematic review that synthesizes contributing factors and informs interventions to address persistent disparities. METHODS We conducted a systematic review to evaluate barriers to colonoscopic CRC screening in African Americans. We developed a conceptual model to summarize the patient-, provider-, and system-level barriers and suggest strategies to address these barriers. RESULTS Nineteen studies met inclusion criteria. Patient barriers to colonoscopy included fear, poor knowledge of CRC risk, and low perceived benefit of colonoscopy. Provider-level factors included failure to recommend screening and knowledge deficits about guidelines and barriers to screening. System barriers included financial obstacles, lack of insurance and access to care, and intermittent primary care visits. CONCLUSIONS There are modifiable barriers to colonoscopic CRC screening among African Americans. Future interventions should confront patient fear, patient and physician knowledge about barriers, and access to healthcare services. As the Affordable Care Act aims to improve uptake of preventive services, focused interventions to increase CRC screening in African Americans are essential and timely.
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Affiliation(s)
- Erica G Bromley
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; UCLA/VA Center for Outcomes Research and Education (CORE), Los Angeles, CA, USA
| | - Folasade P May
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Medicine, Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; UCLA/VA Center for Outcomes Research and Education (CORE), Los Angeles, CA, USA.
| | - Lisa Federer
- University of California Los Angeles, Los Angeles, CA, USA
| | - Brennan M R Spiegel
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Medicine, Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; UCLA/VA Center for Outcomes Research and Education (CORE), Los Angeles, CA, USA
| | - Martijn G H van Oijen
- Department of Medicine, Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; University of Utrecht, The Netherlands
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