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Goetz ME, Ford CB, Greiner MA, Clark A, Johnson KG, Kaufman BG, Mantri S, Xian Y, O'Brien RJ, O'Brien EC, Lusk JB. Racial Disparities in Low-Value Care in the Last Year of Life for Medicare Beneficiaries With Neurodegenerative Disease. Neurol Clin Pract 2024; 14:e200273. [PMID: 38524836 PMCID: PMC10955333 DOI: 10.1212/cpj.0000000000200273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/09/2024] [Indexed: 03/26/2024]
Abstract
Background and Objectives There are racial disparities in health care services received by patients with neurodegenerative diseases, but little is known about disparities in the last year of life, specifically in high-value and low-value care utilization. This study evaluated racial disparities in the utilization of high-value and low-value care in the last year of life among Medicare beneficiaries with dementia or Parkinson disease. Methods This was a retrospective, population-based cohort analysis using data from North and South Carolina fee-for-service Medicare claims between 2013 and 2017. We created a decedent cohort of beneficiaries aged 50 years or older at diagnosis with dementia or Parkinson disease. Specific low-value utilization outcomes were selected from the Choosing Wisely initiative, including cancer screening, peripheral artery stenting, and feeding tube placement in the last year of life. Low-value outcomes included hospitalization, emergency department visits, neuroimaging services, and number of days receiving skilled nursing. High-value outcomes included receipt of occupational and physical therapy, hospice care, and medications indicated for dementia and/or Parkinson disease. Results Among 70,650 decedents, 13,753 were Black, 55,765 were White, 93.1% had dementia, and 7.7% had Parkinson disease. Adjusting for age, sex, Medicaid dual enrollment status, rural vs urban location, state (NC and SC), and comorbidities, Black decedents were more likely to receive low-value care including colorectal cancer screening (adjusted hazard ratio [aHR] 1.46 [1.32-1.61]), peripheral artery stenting (aHR 1.72 [1.43-2.08]), and feeding tube placement (aHR 2.96 [2.70-3.24]) and less likely to receive physical therapy (aHR 0.73 [0.64-0.85)], dementia medications (aHR 0.90 [0.86-0.95]), or Parkinson disease medications (aHR 0.88 [0.75-1.02]) within the last year of life. Black decedents were more likely to be hospitalized (aHR 1.28 [1.25-1.32]), more likely to be admitted to skilled nursing (aHR 1.09 [1.05-1.13]), and less likely to be admitted to hospice (aHR 0.82 [0.79-0.85]) than White decedents. Discussion We found racial disparities in care utilization among patients with neurodegenerative disease in the last year of life, such that Black decedents were more likely to receive specific low-value care services and less likely to receive high-value supportive care than White decedents, even after adjusting for health status and socioeconomic factors.
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Affiliation(s)
- Margarethe E Goetz
- Departments of Neurology (MEG, KGJ, SM, RJOB, ECOB, JBL), Population Health Sciences (CBF, AC, BGK, ECOB, MAG), and Psychiatry and Behavioral Sciences (KGJ), Duke University, Durham, NC; Departments of Population and Data Sciences (YX), and Neurology (YX), University of Texas-Southwestern, Dallas; Duke University School of Medicine (JBL); and Duke University Fuqua School of Business (JBL), Durham, NC
| | - Cassie B Ford
- Departments of Neurology (MEG, KGJ, SM, RJOB, ECOB, JBL), Population Health Sciences (CBF, AC, BGK, ECOB, MAG), and Psychiatry and Behavioral Sciences (KGJ), Duke University, Durham, NC; Departments of Population and Data Sciences (YX), and Neurology (YX), University of Texas-Southwestern, Dallas; Duke University School of Medicine (JBL); and Duke University Fuqua School of Business (JBL), Durham, NC
| | - Melissa A Greiner
- Departments of Neurology (MEG, KGJ, SM, RJOB, ECOB, JBL), Population Health Sciences (CBF, AC, BGK, ECOB, MAG), and Psychiatry and Behavioral Sciences (KGJ), Duke University, Durham, NC; Departments of Population and Data Sciences (YX), and Neurology (YX), University of Texas-Southwestern, Dallas; Duke University School of Medicine (JBL); and Duke University Fuqua School of Business (JBL), Durham, NC
| | - Amy Clark
- Departments of Neurology (MEG, KGJ, SM, RJOB, ECOB, JBL), Population Health Sciences (CBF, AC, BGK, ECOB, MAG), and Psychiatry and Behavioral Sciences (KGJ), Duke University, Durham, NC; Departments of Population and Data Sciences (YX), and Neurology (YX), University of Texas-Southwestern, Dallas; Duke University School of Medicine (JBL); and Duke University Fuqua School of Business (JBL), Durham, NC
| | - Kim G Johnson
- Departments of Neurology (MEG, KGJ, SM, RJOB, ECOB, JBL), Population Health Sciences (CBF, AC, BGK, ECOB, MAG), and Psychiatry and Behavioral Sciences (KGJ), Duke University, Durham, NC; Departments of Population and Data Sciences (YX), and Neurology (YX), University of Texas-Southwestern, Dallas; Duke University School of Medicine (JBL); and Duke University Fuqua School of Business (JBL), Durham, NC
| | - Brystana G Kaufman
- Departments of Neurology (MEG, KGJ, SM, RJOB, ECOB, JBL), Population Health Sciences (CBF, AC, BGK, ECOB, MAG), and Psychiatry and Behavioral Sciences (KGJ), Duke University, Durham, NC; Departments of Population and Data Sciences (YX), and Neurology (YX), University of Texas-Southwestern, Dallas; Duke University School of Medicine (JBL); and Duke University Fuqua School of Business (JBL), Durham, NC
| | - Sneha Mantri
- Departments of Neurology (MEG, KGJ, SM, RJOB, ECOB, JBL), Population Health Sciences (CBF, AC, BGK, ECOB, MAG), and Psychiatry and Behavioral Sciences (KGJ), Duke University, Durham, NC; Departments of Population and Data Sciences (YX), and Neurology (YX), University of Texas-Southwestern, Dallas; Duke University School of Medicine (JBL); and Duke University Fuqua School of Business (JBL), Durham, NC
| | - Ying Xian
- Departments of Neurology (MEG, KGJ, SM, RJOB, ECOB, JBL), Population Health Sciences (CBF, AC, BGK, ECOB, MAG), and Psychiatry and Behavioral Sciences (KGJ), Duke University, Durham, NC; Departments of Population and Data Sciences (YX), and Neurology (YX), University of Texas-Southwestern, Dallas; Duke University School of Medicine (JBL); and Duke University Fuqua School of Business (JBL), Durham, NC
| | - Richard J O'Brien
- Departments of Neurology (MEG, KGJ, SM, RJOB, ECOB, JBL), Population Health Sciences (CBF, AC, BGK, ECOB, MAG), and Psychiatry and Behavioral Sciences (KGJ), Duke University, Durham, NC; Departments of Population and Data Sciences (YX), and Neurology (YX), University of Texas-Southwestern, Dallas; Duke University School of Medicine (JBL); and Duke University Fuqua School of Business (JBL), Durham, NC
| | - Emily C O'Brien
- Departments of Neurology (MEG, KGJ, SM, RJOB, ECOB, JBL), Population Health Sciences (CBF, AC, BGK, ECOB, MAG), and Psychiatry and Behavioral Sciences (KGJ), Duke University, Durham, NC; Departments of Population and Data Sciences (YX), and Neurology (YX), University of Texas-Southwestern, Dallas; Duke University School of Medicine (JBL); and Duke University Fuqua School of Business (JBL), Durham, NC
| | - Jay B Lusk
- Departments of Neurology (MEG, KGJ, SM, RJOB, ECOB, JBL), Population Health Sciences (CBF, AC, BGK, ECOB, MAG), and Psychiatry and Behavioral Sciences (KGJ), Duke University, Durham, NC; Departments of Population and Data Sciences (YX), and Neurology (YX), University of Texas-Southwestern, Dallas; Duke University School of Medicine (JBL); and Duke University Fuqua School of Business (JBL), Durham, NC
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2
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Jutkowitz E, Shewmaker P, Ford CB, Smith VA, O'Brien E, Shepherd-Banigan M, Belanger E, Plassman BL, Burke JR, Van Houtven CH, Wetle T. Association between results of an amyloid PET scan and healthcare utilization in individuals with cognitive impairment. J Am Geriatr Soc 2024; 72:707-717. [PMID: 38069618 DOI: 10.1111/jgs.18696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/15/2023] [Accepted: 11/05/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND The Imaging Dementia Evidence for Amyloid Scanning (IDEAS) study reports that amyloid PET scans help providers diagnose and manage Alzheimer's disease and related dementias (ADRD). Using CARE-IDEAS, an IDEAS supplemental study, we examined the association between amyloid PET scan result (elevated or non-elevated amyloid), patient characteristics, and participant healthcare utilization. METHODS We linked respondents in CARE-IDEAS study to their Medicare fee-for-service records (n = 1333). We examined participants' cognitive impairment-related, outpatient, emergency department (ED), and inpatient encounters in the year before compared with the 2 years after the amyloid PET scan. RESULTS Individuals with a non-elevated amyloid scan had more healthcare encounters throughout the overall study period than those with an elevated amyloid scan. Regardless of the amyloid scan result, cognitive impairment-related and outpatient encounters overall decreased, but ED and inpatient encounters increased in the 2 years after the scan compared with the year prior. There was minimal evidence of differences in healthcare utilization between participants with an elevated and non-elevated amyloid scan. CONCLUSIONS There is no difference in change in healthcare utilization between people with scans showing elevated and non-elevated beta-amyloid.
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Affiliation(s)
- Eric Jutkowitz
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA
- Center of Innovation in Long Term Services and Supports, Providence VA Medical Center, Providence, Rhode Island, USA
- Evidence Synthesis Program Center Providence VA Medical Center, Providence, Rhode Island, USA
| | - Peter Shewmaker
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Cassie B Ford
- Department of Population Health Sciences, Duke University, Durham, North Carolina, USA
| | - Valerie A Smith
- Department of Population Health Sciences, Duke University, Durham, North Carolina, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
- Division of General Internal Medicine, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Emily O'Brien
- Department of Population Health Sciences, Duke University, Durham, North Carolina, USA
| | - Megan Shepherd-Banigan
- Department of Population Health Sciences, Duke University, Durham, North Carolina, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
- Duke Margolis Health Policy Center, Duke University, Durham, North Carolina, USA
| | - Emmanuelle Belanger
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Brenda L Plassman
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - James R Burke
- Department of Neurology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Courtney H Van Houtven
- Department of Population Health Sciences, Duke University, Durham, North Carolina, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
- Duke Margolis Health Policy Center, Duke University, Durham, North Carolina, USA
| | - Terrie Wetle
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA
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Plassman BL, Ford CB, Smith VA, DePasquale N, Burke JR, Korthauer L, Ott BR, Belanger E, Shepherd-Banigan ME, Couch E, Jutkowitz E, O’Brien EC, Sorenson C, Wetle TT, Van Houtven CH. Elevated Amyloid-β PET Scan and Cognitive and Functional Decline in Mild Cognitive Impairment and Dementia of Uncertain Etiology. J Alzheimers Dis 2024; 97:1161-1171. [PMID: 38306055 PMCID: PMC11034799 DOI: 10.3233/jad-230950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
BACKGROUND Elevated amyloid-β (Aβ) on positron emission tomography (PET) scan is used to aid diagnosis of Alzheimer's disease (AD), but many prior studies have focused on patients with a typical AD phenotype such as amnestic mild cognitive impairment (MCI). Little is known about whether elevated Aβ on PET scan predicts rate of cognitive and functional decline among those with MCI or dementia that is clinically less typical of early AD, thus leading to etiologic uncertainty. OBJECTIVE We aimed to investigate whether elevated Aβ on PET scan predicts cognitive and functional decline over an 18-month period in those with MCI or dementia of uncertain etiology. METHODS In 1,028 individuals with MCI or dementia of uncertain etiology, we evaluated the association between elevated Aβ on PET scan and change on a telephone cognitive status measure administered to the participant and change in everyday function as reported by their care partner. RESULTS Individuals with either MCI or dementia and elevated Aβ (66.6% of the sample) showed greater cognitive decline compared to those without elevated Aβ on PET scan, whose cognition was relatively stable over 18 months. Those with either MCI or dementia and elevated Aβ were also reported to have greater functional decline compared to those without elevated Aβ, even though the latter group showed significant care partner-reported functional decline over time. CONCLUSIONS Elevated Aβ on PET scan can be helpful in predicting rates of both cognitive and functional decline, even among cognitively impaired individuals with atypical presentations of AD.
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Affiliation(s)
- Brenda L. Plassman
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, NC, USA
- Department of Neurology, School of Medicine, Duke University, NC, USA
| | - Cassie B. Ford
- Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Valerie A. Smith
- Department of Population Health Sciences, Duke University, Durham, NC, USA
- Department of Medicine, Division of General Internal Medicine, Duke University, Durham, NC, USA
- Durham ADAPT, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Nicole DePasquale
- Department of Medicine, Division of General Internal Medicine, Duke University, Durham, NC, USA
| | - James R. Burke
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, NC, USA
- Department of Neurology, School of Medicine, Duke University, NC, USA
| | - Laura Korthauer
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Brian R. Ott
- Department of Neurology, Alpert Medical School of Brown University, Providence, RI, USA
| | - Emmanuelle Belanger
- Department of Health Services Policy and Practice, School of Public Health, Brown University, Providence, RI, USA
| | - Megan E. Shepherd-Banigan
- Department of Population Health Sciences, Duke University, Durham, NC, USA
- Durham ADAPT, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Duke-Margolis Center for Health Policy, Durham, NC, USA
| | - Elyse Couch
- Department of Health Services Policy and Practice, School of Public Health, Brown University, Providence, RI, USA
| | - Eric Jutkowitz
- Department of Health Services Policy and Practice, School of Public Health, Brown University, Providence, RI, USA
| | - Emily C. O’Brien
- Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Corinna Sorenson
- Department of Population Health Sciences, Duke University, Durham, NC, USA
- Duke-Margolis Center for Health Policy, Durham, NC, USA
- Sanford School of Public Policy, Duke University, Durham, NC, USA
| | - Terrie T. Wetle
- Department of Health Services Policy and Practice, School of Public Health, Brown University, Providence, RI, USA
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA
| | - Courtney H. Van Houtven
- Department of Population Health Sciences, Duke University, Durham, NC, USA
- Durham ADAPT, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Duke-Margolis Center for Health Policy, Durham, NC, USA
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Lusk JB, Choi S, Clark AG, Johnson K, Ford CB, Greiner MA, Goetz M, Kaufman BG, O'Brien R, O'Brien EC. Dementia and Parkinson's disease diagnoses in electronic health records vs. Medicare claims data: a study of 101,980 linked patients. BMC Neurol 2023; 23:325. [PMID: 37700254 PMCID: PMC10496225 DOI: 10.1186/s12883-023-03361-w] [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: 03/01/2023] [Accepted: 08/07/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Medicare claims and electronic health record data are both commonly used for research and clinical practice improvement; however, it is not known how concordant diagnoses of neurodegenerative diseases (NDD, comprising dementia and Parkinson's disease) are in these data types. Therefore, our objective was to determine the sensitivity and specificity of neurodegenerative disease (NDD) diagnoses contained in structured electronic health record (EHR) data compared to Medicare claims data. METHODS This was a retrospective cohort study of 101,980 unique patients seen at a large North Carolina health system between 2013-2017, which were linked to 100% North and South Carolina Medicare claims data, to evaluate the accuracy of diagnoses of neurodegenerative diseases in EHRs compared to Medicare claims data. Patients age > 50 who were enrolled in fee-for-service Medicare were included in the study. Patients were classified as having or not having NDD based on the presence of validated ICD-CM-9 or ICD-CM-10 codes associated with NDD or claims for prescription drugs used to treat NDD. EHR diagnoses were compared to Medicare claims diagnoses. RESULTS The specificity of any EHR diagnosis of NDD was 99.0%; sensitivity was 61.3%. Positive predictive value and negative predictive value were 90.8% and 94.1% respectively. Specificity of an EHR diagnosis of dementia was 99.0%, and sensitivity was 56.1%. Specificity of an EHR diagnosis of PD was 99.7%, while sensitivity was 76.1%. CONCLUSIONS More research is needed to investigate under-documentation of NDD in electronic health records relative to Medicare claims data, which has major implications for clinical practice (particularly patient safety) and research using real-world data.
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Affiliation(s)
- Jay B Lusk
- Duke University School of Medicine, DUMC 3710, Durham, NC, 27710, USA.
- Duke University Fuqua School of Business, Durham, NC, USA.
- Department of Population Health Sciences, Duke University, Durham, NC, USA.
- Department of Neurology, Duke University, Durham, NC, USA.
| | - Sujung Choi
- Janssen Scientific Affairs, Inc, Titusville, NJ, USA
| | - Amy G Clark
- Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Kim Johnson
- Department of Neurology, Duke University, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Cassie B Ford
- Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Melissa A Greiner
- Department of Population Health Sciences, Duke University, Durham, NC, USA
| | | | - Brystana G Kaufman
- Department of Population Health Sciences, Duke University, Durham, NC, USA
| | | | - Emily C O'Brien
- Department of Population Health Sciences, Duke University, Durham, NC, USA
- Department of Neurology, Duke University, Durham, NC, USA
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Raman SR, Ford CB, Hammill BG, Clark AG, Clifton DC, Jackson GL. Non-overdose acute care hospitalizations for opioid use disorder among commercially-insured adults: a retrospective cohort study. Addict Sci Clin Pract 2023; 18:42. [PMID: 37434260 PMCID: PMC10337199 DOI: 10.1186/s13722-023-00396-9] [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] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 06/26/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Acute care inpatient admissions outside of psychiatric facilities have been increasingly identified as a critical touchpoint for opioid use disorder (OUD) treatment. We sought to describe non-opioid overdose hospitalizations with documented OUD and examine receipt of post-discharge outpatient buprenorphine. METHODS We examined acute care hospitalizations with an OUD diagnosis in any position within US commercially-insured adults age 18-64 years (IBM MarketScan claims, 2013-2017), excluding opioid overdose diagnoses. We included individuals with ≥ 6 months of continuous enrollment prior to the index hospitalization and ≥ 10 days following discharge. We described demographic and hospitalization characteristics, including outpatient buprenorphine receipt within 10 days of discharge. RESULTS Most (87%) hospitalizations with documented OUD did not include opioid overdose. Of 56,717 hospitalizations (49,959 individuals), 56.8% had a primary diagnosis other than OUD, 37.0% had documentation of an alcohol-related diagnosis code, and 5.8% end in a self-directed discharge. Where opioid use disorder was not the primary diagnosis, 36.5% were due to other substance use disorders, and 23.1% were due to psychiatric disorders. Of all non-overdose hospitalizations who had prescription medication insurance coverage and who were discharged to an outpatient setting (n = 49, 237), 8.8% filled an outpatient buprenorphine prescription within 10 days of discharge. CONCLUSIONS Non-overdose OUD hospitalizations often occur with substance use disorders and psychiatric disorders, and very few are followed by timely outpatient buprenorphine. Addressing the OUD treatment gap during hospitalization may include implementing medication for OUD for inpatients with a broad range of diagnoses.
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Affiliation(s)
- Sudha R Raman
- Department of Population Health Sciences, Duke University School of Medicine, 215 Morris Street, Suite 210, Durham, NC, 27701, USA.
| | - Cassie B Ford
- Department of Population Health Sciences, Duke University School of Medicine, 215 Morris Street, Suite 210, Durham, NC, 27701, USA
| | - Bradley G Hammill
- Department of Population Health Sciences, Duke University School of Medicine, 215 Morris Street, Suite 210, Durham, NC, 27701, USA
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, 2301 Erwin Road, Durham, NC, 27710, USA
| | - Amy G Clark
- Department of Population Health Sciences, Duke University School of Medicine, 215 Morris Street, Suite 210, Durham, NC, 27701, USA
| | - Dana C Clifton
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, 2301 Erwin Road, Durham, NC, 27710, USA
- Department of Pediatrics, Duke University School of Medicine, 2301 Erwin Road, Durham, NC, 27710, USA
| | - George L Jackson
- Department of Population Health Sciences, Duke University School of Medicine, 215 Morris Street, Suite 210, Durham, NC, 27701, USA
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, 2301 Erwin Road, Durham, NC, 27710, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham Veterans Affairs (VA) Health Care System, 508 Fulton Street, Durham, NC, 27705, USA
- Department of Family Medicine and Community Health, Duke University School of Medicine, 2100 Erwin Road, Durham, NC, 27705, USA
- Peter O'Donnell Jr. School of Public Health, University of Texas Southweatern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
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Shepherd-Banigan ME, Ford CB, Smith VA, Belanger E, Wetle TT, Plassman BL, Burke JR, DePasquale N, O’Brien EC, Sorenson C, Van Houtven CH. Amyloid-β PET Scan Results Disclosure and Care-Partner Emotional Well-Being Over Time. J Alzheimers Dis 2022; 90:775-782. [DOI: 10.3233/jad-220611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Diagnostic tests, such as amyloid-β positron emission tomography (PET) scans, can increase appropriate therapeutic management for the underlying causes of cognitive decline. To evaluate the full utility of this diagnostic tool, information is needed on whether results from amyloid-β PET scans influence care-partner outcomes. Objective: This study examines the extent to which previous disclosure of elevated amyloid (suggestive of Alzheimer’s disease (AD) etiology) versus not-elevated amyloid (not suggestive of AD etiology) is associated with changes in care-partner wellbeing. Methods: The study used data derived from a national longitudinal survey of Medicare beneficiaries (n = 921) with mild cognitive impairment (MCI) or dementia and their care-partners. Care-partner wellbeing outcomes included depressive symptoms (PHQ-8), subjective burden (4-item Zarit burden score), and a 3-item measure of loneliness. Change was measured between 4 (Time 1) and 18 (Time 2) months after receiving the scan results. Adjusted linear regression models regressed change (Time 2-Time 1) in each outcome on scan result. Results: Care-partners were primarily white, non-Hispanic, college-educated, and married to the care recipient. Elevated amyloid was not associated with statistically significant Time 1 differences in outcomes or with statistically significant changes in depressive symptoms 0.22 (–0.18, 0.61), subjective burden 0.36 (–0.01, 0.73), or loneliness 0.15 (–0.01, 0.32) for care-partners from one time point to another. Conclusion: Given advances in AD biomarker testing, future research in more diverse samples is needed to understand the influence of scan results on care-partner wellbeing across populations.
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Affiliation(s)
- Megan E. Shepherd-Banigan
- Duke University, Department of Population Health Sciences, Durham, NC, USA
- Duke-Margolis Centerfor Health Policy, Durham, NC, USA
- Durham VA Health Care System, Durham, NC, USA
| | - Cassie B. Ford
- Duke University, Department of Population Health Sciences, Durham, NC, USA
| | - Valerie A. Smith
- Duke University, Department of Population Health Sciences, Durham, NC, USA
- Durham VA Health Care System, Durham, NC, USA
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Emmanuelle Belanger
- Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, RI, USA
- Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, RI, USA
| | - Terrie T. Wetle
- Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, RI, USA
- Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, RI, USA
| | - Brenda L. Plassman
- Department of Neurology and Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, NC, USA
| | - James R. Burke
- Department of Neurology and Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, NC, USA
| | - Nicole DePasquale
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Emily C. O’Brien
- Duke University, Department of Population Health Sciences, Durham, NC, USA
| | - Corinna Sorenson
- Duke University, Department of Population Health Sciences, Durham, NC, USA
- Duke-Margolis Centerfor Health Policy, Durham, NC, USA
- Duke University, Sanford School of Public Policy, Durham, NC, USA
| | - Courtney H. Van Houtven
- Duke University, Department of Population Health Sciences, Durham, NC, USA
- Duke-Margolis Centerfor Health Policy, Durham, NC, USA
- Durham VA Health Care System, Durham, NC, USA
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Mihalik JP, Teel EF, Ford CB, Amalfe SA, Barczak-Scarboro NE, Lynall RC, Riegler KE, Wasserman EB, Putukian M. The Effect of Sex, Sport, and Preexisting Histories on Baseline Concussion Test Performance in College Lacrosse and Soccer Athletes. Clin J Sport Med 2022; 32:e461-e468. [PMID: 36083332 DOI: 10.1097/jsm.0000000000001018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 02/24/2021] [Accepted: 11/19/2021] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To study sex and sport differences in baseline clinical concussion assessments. A secondary purpose was to determine if these same assessments are affected by self-reported histories of (1) concussion; (2) learning disability; (3) anxiety and/or depression; and (4) migraine. DESIGN Prospective cohort. SETTING National Collegiate Athletic Association D1 Universities. PARTICIPANTS Male and female soccer and lacrosse athletes (n = 237; age = 19.8 ± 1.3 years). ASSESSMENT OF RISK FACTORS Sport, sex, history of (1) concussion; (2) learning disability; (3) anxiety and/or depression; and (4) migraine. MAIN OUTCOME MEASURES Sport Concussion Assessment Tool 22-item symptom checklist, Standardized Assessment of Concussion, Balance Error Scoring System (BESS), Generalized Anxiety Disorder 7-item scale, and Patient Health Questionnaire. RESULTS Female athletes had significantly higher total symptoms endorsed (P = 0.02), total symptom severity (P < 0.001), and BESS total errors (P = 0.01) than male athletes. No other sex, sport, or sex-by-sport interactions were observed (P > 0.05). Previous concussion and migraine history were related to greater total symptoms endorsed (concussion: P = 0.03; migraine: P = 0.01) and total symptom severity (concussion: P = 0.04; migraine: P = 0.02). Athletes with a migraine history also self-reported higher anxiety (P = 0.004) and depression (P = 0.01) scores. No other associations between preexisting histories and clinical concussion outcomes were observed (P > 0.05). CONCLUSIONS Our findings reinforce the need to individualize concussion assessment and management. This is highlighted by the findings involving sex differences and preexisting concussion and migraine histories. CLINICAL RELEVANCE Clinicians should fully inventory athletes' personal and medical histories to better understand variability in measures, which may be used to inform return-to-participation decisions following injury.
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Affiliation(s)
- Jason P Mihalik
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, The University of North Carolina, Chapel Hill, North Carolina
- Human Movement Science Curriculum, Department of Allied Health Sciences, School of Medicine, The University of North Carolina, Chapel Hill, North Carolina
| | - Elizabeth F Teel
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Cassie B Ford
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Stephanie A Amalfe
- Department of Athletic Medicine, University Health Services, Princeton University, Princeton, New Jersey
- School of Psychology, Fairleigh Dickinson University, Teaneck, New Jersey
| | - Nikki E Barczak-Scarboro
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, The University of North Carolina, Chapel Hill, North Carolina
- Human Movement Science Curriculum, Department of Allied Health Sciences, School of Medicine, The University of North Carolina, Chapel Hill, North Carolina
| | - Robert C Lynall
- Department of Kinesiology, University of Georgia, Athens, Georgia
| | - Kaitlin E Riegler
- Department of Athletic Medicine, University Health Services, Princeton University, Princeton, New Jersey
- Department of Psychology, Pennsylvania State University, State College, Pennsylvania
| | - Erin B Wasserman
- Injury Surveillance and Analytics, IQVIA, Durham, North Carolina; and
| | - Margot Putukian
- Department of Athletic Medicine, University Health Services, Princeton University, Princeton, New Jersey
- Department of Family Medicine and Community Health, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
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Pohlman FW, Ford CB, Weissler EH, Smerek MM, Hardy NC, Narcisse DI, Lippmann SJ, Greiner MA, Long C, Rymer JA, Gutierez JA, Patel MR, Jones WS. Impact of risk factor control on peripheral artery disease outcomes and health disparities. Vasc Med 2022; 27:323-332. [PMID: 35387516 PMCID: PMC10908093 DOI: 10.1177/1358863x221084360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Peripheral artery disease (PAD) is associated with modifiable atherosclerotic risk factors like hypertension, diabetes, hyperlipidemia, and smoking. However, the effect of risk factor control on outcomes and disparities in achieving control is less well understood. METHODS All patients in an integrated, regional health system with PAD-related encounters, fee-for-service Medicare, and clinical risk factor control data were identified. Component risk factors were dichotomized into controlled and uncontrolled categories (control defined as low-density lipoprotein < 100 mg/dL, hemoglobin A1c < 7.0%, SBP < 140 mmHg, and current nonsmoker) and composite categories (none, 1, ⩾ 2 uncontrolled RFs) created. The primary outcome was major adverse vascular events (MAVE, a composite of all-cause mortality, myocardial infarction, stroke, and lower-extremity revascularization and amputation). RESULTS The cohort included 781 patients with PAD, average age 72.5 ± 9.8 years, of whom 30.1% were Black, and 19.1% were Medicaid dual-enrolled. In this cohort, 260 (33.3%) had no uncontrolled risk factors and 200 (25.6%) had two or more uncontrolled risk factors. Patients with the poorest risk factor control were more likely to be Black (p < 0.001), Medicaid dual-enrolled (p < 0.001), and have chronic limb-threatening ischemia (p = 0.009). Significant differences in MAVE by degree of risk factor control were observed at 30 days (none uncontrolled: 5.8%, 1 uncontrolled: 11.5%, ⩾ 2 uncontrolled: 13.6%; p = 0.01) but not at 1 year (p = 0.08). risk factor control was not associated with outcomes at 1 year after adjustment for patient and PAD-specific characteristics. CONCLUSIONS risk factor control is poor among patients with PAD. Significant disparities in achieving optimal risk factor control represent a potential target for reducing inequities in outcomes.
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Affiliation(s)
| | - Cassie B. Ford
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - E. Hope Weissler
- Division of Vascular and Endovascular Surgery, Duke University School of Medicine, Durham, NC
| | - Michelle M. Smerek
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - N. Chantelle Hardy
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | | | - Steven J. Lippmann
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - Melissa A. Greiner
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - Chandler Long
- Division of Vascular and Endovascular Surgery, Duke University School of Medicine, Durham, NC
| | - Jennifer A. Rymer
- Division of Cardiology, Duke University School of Medicine, Durham, NC
| | | | - Manesh R. Patel
- Division of Cardiology, Duke University School of Medicine, Durham, NC
- Duke Clinical Research Institute, Durham, NC
| | - W. Schuyler Jones
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
- Division of Cardiology, Duke University School of Medicine, Durham, NC
- Duke Clinical Research Institute, Durham, NC
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Weissler EH, Ford CB, Narcisse DI, Lippmann SJ, Smerek MM, Greiner MA, Hardy NC, O'Brien B, Sullivan RC, Brock AJ, Long C, Curtis LH, Patel MR, Jones WS. Clinician Specialty, Access to Care, and Outcomes Among Patients with Peripheral Artery Disease. Am J Med 2022; 135:219-227. [PMID: 34627781 PMCID: PMC8840959 DOI: 10.1016/j.amjmed.2021.08.025] [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: 07/21/2021] [Revised: 08/18/2021] [Accepted: 08/23/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Understanding the relationship between patterns of peripheral artery disease and outcomes is an essential step toward improving care and outcomes. We hypothesized that clinician specialty would be associated with occurrence of major adverse vascular events (MAVE). METHODS Patients with at least 1 peripheral artery disease-related encounter in our health system and fee-for-service Medicare were divided into groups based on the specialty of the clinician (ie, cardiologist, surgeon, podiatrist, primary care, or other) providing a plurality of peripheral artery disease-coded care in the year prior to index encounter. The primary outcome was MAVE (a composite of all-cause mortality, myocardial infarction, stroke, lower extremity revascularization, and lower extremity amputation). RESULTS The cohort included 1768 patients, of whom 30.0% were Black, 23.9% were Medicaid dual-enrollment eligible, and 31.1% lived in rural areas. Patients receiving a plurality of their care from podiatrists had the highest 1-year rates of MAVE (34.4%, P <.001), hospitalization (65.9%, P <.001), and amputations (22.6%, P <.001). Clinician specialty was not associated with outcomes after adjustment. Patients who were Medicaid dual-eligible had higher adjusted risks of mortality (adjusted hazard ratio [HRadj] 1.54, 95% confidence interval [CI] 1.11-2.14) and all-cause hospitalization (HRadj 1.20, 95% CI 1.03-1.40) and patients who were Black had a higher adjusted risk of amputation (HRadj 1.49, 95% CI 1.03-2.15). CONCLUSIONS Clinician specialty was not associated with worse outcomes after adjustment, but certain socioeconomic factors were. The effects of clinician specialty and socioeconomic status were likely attenuated by the fact that all patients in this study had health insurance; these analyses require confirmation in a more representative cohort.
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Affiliation(s)
- E Hope Weissler
- Division of Vascular and Endovascular Surgery, Duke University School of Medicine, Durham, NC.
| | - Cassie B Ford
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - Dennis I Narcisse
- Division of Cardiology, Duke University School of Medicine, Durham, NC
| | - Steven J Lippmann
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - Michelle M Smerek
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - Melissa A Greiner
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - N Chantelle Hardy
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - Benjamin O'Brien
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - R Casey Sullivan
- Division of Cardiology, Washington University School of Medicine, St. Louis, Mo
| | - Adam J Brock
- Division of Cardiology, Duke University School of Medicine, Durham, NC
| | - Chandler Long
- Division of Vascular and Endovascular Surgery, Duke University School of Medicine, Durham, NC
| | - Lesley H Curtis
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC; Clinical Research Institute, Durham, NC
| | - Manesh R Patel
- Division of Cardiology, Duke University School of Medicine, Durham, NC; Clinical Research Institute, Durham, NC
| | - W Schuyler Jones
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC; Division of Cardiology, Duke University School of Medicine, Durham, NC; Clinical Research Institute, Durham, NC
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Shepherd-Banigan M, Ford CB, DePasquale N, Smith VA, Belanger E, Lippmann SJ, O'Brien EC, Van Houtven CH. Making the Informal Formal: Discussing and Completing Advance Care Plans in Care Dyads with Cognitive Impairment. J Palliat Care 2021; 37:289-297. [PMID: 34898305 DOI: 10.1177/08258597211063047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Discussing advance care planning (ACP) with care partners may be a steppingstone to the completion of advance directives (ADs) for persons with cognitive impairment (PwCIs). OBJECTIVES To examine whether PwCI-reported occurrence of and PwCI-care partner agreement about ACP discussions are associated with completion of ADs. DESIGN AND SUBJECTS We conducted a secondary, cross-sectional analysis of data from 1672 PwCI-care partner dyads in the BLINDED study. PwCIs were Medicare beneficiaries in the US, aged >65 years, and diagnosed with mild cognitive impairment or dementia. Care partners were identified by PwCIs as being most involved in their health care. MEASUREMENTS PwCIs' completion of ADs was determined by 1 or more affirmative responses to dichotomous indicators for formalizing a living will, medical directive, or durable power of attorney for health care. Discussion occurrence was based on PwCI reports and agreement between PwCI and care partner reports of prior conversations about PwCIs' ACP preferences between PwCIs and care partners. RESULTS In logistic regression models adjusted for PwCI and care partner characteristics, PwCIs who had (vs. had not) discussed ACP were 10% more likely to complete ADs. PwCIs from dyads agreeing (vs. disagreeing) a discussion occurred were 7% more likely to complete ADs. PwCIs from care dyads in agreement (vs. disagreement) about non-discussion were 11% less likely to formalize ADs. CONCLUSIONS Discussing ACP with care partners plays a direct, positive role in completing ADs among PwCIs. Health care providers who approach ACP as a dyadic, communicative decision-making process from the outset may facilitate PwCIs' uptake of ADs.
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Affiliation(s)
- Megan Shepherd-Banigan
- Durham VA Health Care System, NC, USA.,Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.,Duke-Margolis Center for Health Policy, Durham, NC, USA
| | - Cassie B Ford
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Nicole DePasquale
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Valerie A Smith
- Durham VA Health Care System, NC, USA.,Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.,Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Emmanuelle Belanger
- Department of Health Services, Policy and Practice, Brown University, Providence, RI, USA.,Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA
| | - Steven J Lippmann
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Emily C O'Brien
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Courtney H Van Houtven
- Durham VA Health Care System, NC, USA.,Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.,Duke-Margolis Center for Health Policy, Durham, NC, USA
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11
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Weissler EH, Ford CB, Patel MR, Goodney P, Clark A, Long C, Jones WS. Younger patients with chronic limb threatening ischemia face more frequent amputations. Am Heart J 2021; 242:6-14. [PMID: 34371002 DOI: 10.1016/j.ahj.2021.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/02/2021] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Amputations among younger patients with chronic limb threatening ischemia (CLTI) may carry higher personal and societal costs, but younger patients are often not included in CLTI research because of dataset limitations. We aimed to characterize and compare outcomes between younger (<65 years old) and older patients with CLTI. METHODS This retrospective cohort study identified patients with CLTI between July 1, 2014 and December 31, 2017 in the MarketScan commercial claims database, a proprietary set of claims for over 50 million patients with private insurance in the United States. The primary outcome was major adverse limb events (MALE); secondary outcomes included amputations, major adverse cardiovascular events, and statin prescription fills. RESULTS The study cohort included 64,663 people with CLTI, of whom 25,595 (39.6%) were <65 years old. Younger patients were more likely to have diabetes mellitus (54.1% versus 49.9%, P<.001) but less likely to have other comorbidities. A higher proportion of younger patients suffered MALE (31.7% versus 30.2%, P=.002), specifically amputation (11.5% versus 9.3%, P<.001). After adjustment, age <65 years old was associated with a 24% increased risk of amputation (HRadj 1.24, 95%CI 1.18-1.32, P<.001) and a 10% increased risk of MALE (HRadj 1.10, 95%CI 1.07-1.14, P<.001). CONCLUSIONS A significant proportion of commercially insured patients with CLTI are under the age of 65, and younger patients have worse limb-related outcomes. These findings highlight the importance of aggressively treating risk factors for atherosclerosis and intentionally including younger patients with CLTI in future analyses to better understand their disease patterns and outcomes.
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Affiliation(s)
- E Hope Weissler
- Division of Vascular and Endovascular Surgery, Duke University School of Medicine, Durham, NC.
| | - Cassie B Ford
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - Manesh R Patel
- Division of Cardiology, Duke University School of Medicine, Durham, NC
| | - Phil Goodney
- Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Amy Clark
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - Chandler Long
- Division of Vascular and Endovascular Surgery, Duke University School of Medicine, Durham, NC
| | - W Schuyler Jones
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC; Division of Cardiology, Duke University School of Medicine, Durham, NC
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Mihalik JP, Ford CB, DeLellis SM, Healy ML, Kane SF, Means GE, Lynch JH. Stroboscopic Effect On Functional Balance Performance In Special Operations Forces Combat Soldiers. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000675480.94596.a0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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13
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Roby PR, Chandran A, Barczak-Scarboro NE, DeLellis SM, Ford CB, Healy ML, Means GE, Kane SF, Lynch JH, Mihalik JP. Cerebrovascular Reactivity in Special Operations Forces Combat Soldiers. Ann Biomed Eng 2020; 48:1651-1660. [DOI: 10.1007/s10439-020-02514-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 04/11/2020] [Indexed: 01/19/2023]
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14
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Combs PR, Chandran AS, Barczak NE, DeLellis SM, Ford CB, Healy ML, Kane SF, Lynch JH, Means GE, Mihalik JP. Concussion History Impairs Cerebrovascular Reactivity in Special Operations Forces Personnel. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000562759.42610.7c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Vander Vegt CB, Ford CB, Register-Mihalik JK, DeLellis SM, Healy ML, Kane SF, Lynch JH, Means GE, Mihalik JP. Concussion and the Pupillary Light Reflex: Implications for Special Operations Forces Personnel. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000562761.27363.ec] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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16
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Ford CB, Vander Vegt CB, Barczak N, Combs PR, DeCicco J, Vandermark L, Yang K, Wikstrom EA, Mihalik JP. Concussion History Does Not Predict Pupillary Light Reflex or Visual Sensory Performance in Young Adults. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000560801.23086.0a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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17
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Ford JM, Campbell KR, Ford CB, Boyd KE, Padua DA, Mihalik JP. Can Functional Movement Assessment Predict Football Head Impact Biomechanics? Med Sci Sports Exerc 2019; 50:1233-1240. [PMID: 29293120 DOI: 10.1249/mss.0000000000001538] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE The purposes of this study was to determine functional movement assessments' ability to predict head impact biomechanics in college football players and to determine whether head impact biomechanics could explain preseason to postseason changes in functional movement performance. METHODS Participants (N = 44; mass, 109.0 ± 20.8 kg; age, 20.0 ± 1.3 yr) underwent two preseason and postseason functional movement assessment screenings: 1) Fusionetics Movement Efficiency Test and 2) Landing Error Scoring System (LESS). Fusionetics is scored 0 to 100, and participants were categorized into the following movement quality groups as previously published: good (≥75), moderate (50-75), and poor (<50). The LESS is scored 0 to 17, and participants were categorized into the following previously published movement quality groups: good (≤5 errors), moderate (6-7 errors), and poor (>7 errors). The Head Impact Telemetry (HIT) System measured head impact frequency and magnitude (linear acceleration and rotational acceleration). An encoder with six single-axis accelerometers was inserted between the padding of a commercially available Riddell football helmet. We used random intercepts general linear-mixed models to analyze our data. RESULTS There were no effects of preseason movement assessment group on the two Head Impact Telemetry System impact outcomes: linear acceleration and rotational acceleration. Head impact frequency did not significantly predict preseason to postseason score changes obtained from the Fusionetics (F1,36 = 0.22, P = 0.643, R = 0.006) or the LESS (F1,36 < 0.01, P = 0.988, R < 0.001) assessments. CONCLUSIONS Previous research has demonstrated an association between concussion and musculoskeletal injury, as well as functional movement assessment performance and musculoskeletal injury. The functional movement assessments chosen may not be sensitive enough to detect neurological and neuromuscular differences within the sample and subtle changes after sustaining head impacts.
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Affiliation(s)
- Julia M Ford
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Kody R Campbell
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC.,Curriculum in Human Movement Science, Department of Allied Health Sciences, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Cassie B Ford
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Darin A Padua
- Sports Medicine Research Laboratory, Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jason P Mihalik
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC.,Curriculum in Human Movement Science, Department of Allied Health Sciences, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC
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Abstract
Background: Baseline concussion assessments are advocated to provide an objective preinjury point of comparison for determining the extent of postconcussion neurological deficits and to assist with return-to-activity decision making. Many factors, including testing environment, proctor availability, and testing group size, can influence test accuracy and validity; however, it is unknown how self-reported fatigue affects test scores. Purpose: To investigate the influence of self-reported fatigue and patient sex on baseline concussion assessment scores. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Participants included 494 healthy Division I college student-athletes (221 women, 273 men; mean ± SD age, 20.0 ± 1.3 years). During preseason baseline testing, participants were asked to rate their fatigue on a scale from 0 to 100 based on how they normally feel and function each day (0, completely exhausted; 100, completely awake and alert). Each participant then completed a multimodal baseline concussion assessment, including a graded symptom checklist (number of symptoms endorsed and total symptom severity score), Standardized Assessment of Concussion (SAC), Balance Error Scoring System (BESS), and CNS Vital Signs computerized neurocognitive testing. Multiple linear regressions tested whether self-reported fatigue and sex predicted baseline concussion examination scores. Results: Athletes with higher self-reported fatigue levels (ß = –0.014, P < .01) and female athletes (ß = –0.216, P < .01) reported more total symptoms. Being male (ß = 0.856, P < .01) increased the likelihood of endorsing zero symptoms versus any symptoms by a factor of 2.40. Women also had significantly higher SAC scores (ß = 0.569, P < .001), BESS scores (ß = –2.747, P < .001), and CNS Vital Signs summary scores (ß = 4.506, P < .001). SAC, BESS, and CNS Vital Signs scores were not predicted by fatigue level (P > .05). Conclusion: Female athletes and fatigued athletes endorsed more symptoms and higher symptom severity at baseline. Using total symptom endorsement and total symptom severity scores as part of the postinjury management is a common practice. The current data suggest that levels of reported exhaustion can influence concussion assessment scores meant to represent a healthy baseline and likely would interfere with postinjury assessment scores.
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Affiliation(s)
- Patricia R Combs
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Curriculum in Human Movement Science, Department of Allied Health Sciences, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Cassie B Ford
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kody R Campbell
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Curriculum in Human Movement Science, Department of Allied Health Sciences, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kevin A Carneiro
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Neurosurgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jason P Mihalik
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Curriculum in Human Movement Science, Department of Allied Health Sciences, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Neurosurgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Vander Vegt CB, Register-Mihalik JK, Ford CB, Rodrigo CJ, Guskiewicz KM, Mihalik JP. Baseline Concussion Clinical Measures Are Related to Sensory Organization and Balance. Med Sci Sports Exerc 2018; 51:264-270. [PMID: 30239494 DOI: 10.1249/mss.0000000000001789] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE This study aimed to examine relationships among baseline demographics, symptom severity, computerized neurocognitive outcomes, and balance performance in collegiate athletes. METHODS Collegiate varsity athletes (N = 207, age = 19.3 ± 1.0 yr) participating in an ongoing clinical research program who completed concussion baseline assessments including a demographic questionnaire, a graded symptom checklist, a neurocognitive assessment, and the Sensory Organization Test (SOT) were included in this study. The SOT composite equilibrium score (COMP) and three sensory ratio scores-vestibular (VEST), visual (VIS), and somatosensory (SOM)-were used to describe athletes' overall sensory organization and ability to use input from each sensory system to maintain balance. Separate stepwise multiple linear regression models were performed for each SOT outcome. Total symptom severity level and CNS Vital Signs domain scores served as predictor variables. RESULTS Stepwise regression models for COMP (R = 0.18, F4,201 = 11.29, P < 0.001), VEST (R = 0.14, F4,201 = 8.16, P < 0.001), and VIS (R = 0.10, F4,201 = 5.52, P < 0.001) were all significant. Faster reaction times and higher executive function scores were associated with higher COMP and VEST scores in separate models. Those with faster reaction times also had significantly higher VIS scores. CONCLUSION Reaction time and executive function demonstrated significant relationships with SOT balance performance. These cognitive processes may influence athletes' ability to organize and process higher-order information and generate appropriate responses to changes in their environment, with respect to balance and injury risk. Future investigations should consider these relationships after injury, and clinicians should be mindful of this relationship when considering concussion management strategies.
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Affiliation(s)
- Christina B Vander Vegt
- Department of Exercise and Sport Science, Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC.,Curriculum in Human Movement Science, Department of Allied Health Sciences, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Johna K Register-Mihalik
- Department of Exercise and Sport Science, Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC.,Curriculum in Human Movement Science, Department of Allied Health Sciences, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC.,Injury Prevention Research Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Cassie B Ford
- Department of Exercise and Sport Science, Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Corey J Rodrigo
- Department of Exercise and Sport Science, Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Kevin M Guskiewicz
- Department of Exercise and Sport Science, Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC.,Curriculum in Human Movement Science, Department of Allied Health Sciences, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jason P Mihalik
- Department of Exercise and Sport Science, Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC.,Curriculum in Human Movement Science, Department of Allied Health Sciences, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC
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Ford CB, Cools MJ, DeLellis SM, Kane SF, Lutz RH, Lynch JH, Mihalik JP. Concussion History Moderates Relationships Between Neural and Clinical Outcomes in Special Operations Forces Personnel. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000538717.21606.6c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Mihalik JP, Ford CB, Cools MJ, DeLellis SM, Kane SF, Lutz RH, Lynch JH. Concussion History Predicts Reduced Cortical Thickness in Special Operations Forces Personnel. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000538718.21606.88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Kay MC, Register-Mihalik JK, Ford CB, Williams RM, Valovich McLeod TC. Parents' and Child's Concussion History as Predictors of Parental Attitudes and Knowledge of Concussion Recognition and Response. Orthop J Sports Med 2017; 5:2325967117742370. [PMID: 29242807 PMCID: PMC5724649 DOI: 10.1177/2325967117742370] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Parents’ knowledge of and attitudes toward concussions are often vital factors that affect care for injured adolescent athletes. It is important to understand the role that parents’ personal experiences with concussions play with regard to current concussion knowledge and attitudes so that clinicians may tailor their educational approaches. Purpose/Hypothesis: The purpose of this study was to determine an association between parents’ personal experiences and their child’s experiences with concussions as well as parental concussion knowledge and attitudes. We hypothesized that parents who have personally experienced symptoms or have a child who has experienced symptoms would have better knowledge and more favorable attitudes toward concussions. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Parents of youth sport athletes (N = 234 [82 male, 144 female, 8 unreported]; mean age, 44.0 ± 6.3 years) completed a prevalidated survey for concussion knowledge (maximum score possible, 29) and attitudes (maximum score possible, 49). Higher scores indicated better knowledge and more favorable attitudes toward concussive injuries. Parents reported the frequency of concussion diagnoses and/or experiences of concussion-related symptoms and whether their child had suffered a diagnosed concussion or experienced concussion symptoms (yes/no). Spearman rank correlation and multivariable regression were used to examine the association between experience of symptom clusters (self or child) and concussion knowledge and attitudes. Results: Knowledge was moderate (mean, 23.3 ± 2.5 of 29), while attitudes prioritized disclosure (mean, 46.3 ± 3.7 of 49). Parents’ experience of the sleep-arousal symptom cluster was positively associated with concussion attitudes (r = 0.22, P = .002; β = –3.301, P = .011). Parents with children who experienced sleep-arousal and vestibular-somatic symptom clusters were weakly associated with parental concussion knowledge (sleep-arousal: r = 0.15, P = .041; vestibular-somatic: r = 0.17, P = .020; β = 0.540, P = .012). Conclusion: Our findings suggest that parents’ personal experiences with concussion-related symptoms have little effect on parental knowledge and attitudes as a whole. However, clinicians should consider particular symptom clusters that may provide insight into targets for future concussion education. According to these findings, parents of youth sport participants would benefit from increased concussion education focusing on the types of symptoms as well as the consequences of suffering a concussion.
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Affiliation(s)
- Melissa C Kay
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Cassie B Ford
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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